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Complications associated with pedicle screws.

J E Lonstein1, F Denis, J H Perra

  • 1Twin Cities Spine Center, Minneapolis, Minnesota 55404, USA.

The Journal of Bone and Joint Surgery. American Volume
|November 24, 1999
PubMed
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Pedicle-screw instrumentation for spinal stabilization is safe and effective when performed by experienced surgeons. Complication rates are low, though late-onset pain may occur, with its exact cause often difficult to determine.

Area of Science:

  • Orthopedic Surgery
  • Spinal Instrumentation
  • Biomedical Engineering

Background:

  • Pedicle-screw instrumentation is widely used for spinal stabilization.
  • Concerns exist regarding the safety and effectiveness of pedicle-screw techniques.
  • This review addresses insertion techniques and screw-related complications.

Purpose of the Study:

  • To evaluate the safety and effectiveness of pedicle-screw instrumentation.
  • To analyze insertion techniques and identify the causes of complications.
  • To assess the accuracy of screw placement and associated outcomes.

Main Methods:

  • Retrospective review of 915 procedures involving 4790 pedicle screws (1984-1993).
  • Follow-up averaged three years.

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  • Screw placement accuracy assessed via radiographs; complication prevalence evaluated.

    • Main Results:

    • 94.9% of screws were accurately placed within the pedicle and vertebral body.
    • 2.8% of screws perforated the anterior cortex; 2.4% were associated with complications.
    • Late-onset pain (23.0%) was the most common issue; nerve root irritation (1.0%) and screw breakage (0.5%) were less frequent.

    Conclusions:

    • Pedicle-screw insertion has a low complication rate when performed by experienced surgeons using proper technique.
    • Postoperative complications are infrequent.
    • The etiology of late-onset pain is multifactorial, potentially related to implants or construct stiffness.