Abstract
These data indicate that pedicle screws can loosen significantly in patients with recurrent back pain and warrant further research into methods to reduce the incidence of screw loosening and to understand the risks and potential benefits of instrumentation removal. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2673-2681, 2017.
Highlights
States, and interbody fusion is common in patients non-responsive to non-surgical options.[1]
Paired insertion and removal torque measurements (N = 139 pairs) revealed a significant 58.1% lower removal torque compared to insertion of those same screws (p < 0.0001), with only 9% of screws loosening by less than 15% (Figure 2A)
Insertion torque correlated with screw loosening (p < 0.01), but with little predictive power (R2 = 6%; Figure 4A)
Summary
Interbody fusion is common in patients non-responsive to non-surgical options.[1]. Reoperation secondary to recurrent back pain has been reported in approximately 1427% of patients,[8] with complications including improper instrumentation placement, loss of fixation, fatigue and bending failure, dural tears, nerve root injury, infection, and pedicle screw loosening.[9,10]. While successful fusion is correlated with desirable clinical outcomes,[11] recurrent pain can occur even in patients with solid arthrodesis, which may be associated with instrumentation loosening, requiring revision or removal. When unexplainable recurrent pain is severe, screw removal has been recommended,[21,22,23,24] and may reduce risks of metal toxicity and hypersensitivity.[25]
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