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Reoperation for Misplaced Pedicle Screws: A Multicenter Retrospective Study.

Seiichi Odate1, Shunsuke Fujibayashi2, Bungo Otsuki2

  • 1Department of Orthopedic Surgery, Gakkentoshi Hospital, Kyoto, Japan.

Spine
|July 7, 2022
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Summary

Reoperation for misplaced pedicle screws (MPSs) after posterior spinal fusion (PSF) can resolve neurological complications in 70.1% of patients. Factors like medial-caudal breaches and sensory/motor deficits predict incomplete recovery.

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Area of Science:

  • Spine surgery outcomes
  • Neurosurgical complications
  • Spinal fusion techniques

Background:

  • Management strategies for misplaced pedicle screws (MPSs) after posterior spinal fusion (PSF) are not well-defined.
  • Clinical outcomes following reoperation for MPSs require further investigation.

Purpose of the Study:

  • To investigate reoperation for misplaced pedicle screws (MPSs) following posterior spinal fusion (PSF).
  • To identify neurological complications associated with MPSs and their reoperation outcomes.

Main Methods:

  • A multicenter retrospective analysis of 10,754 patients (73,777 pedicle screws) undergoing PSF over 15 years.
  • Data on reoperations for MPSs and patient clinical information were collected from medical records.
  • Statistical analysis was performed to identify factors influencing neurological symptom resolution.

Main Results:

  • The reoperation rate for screw misplacement was 0.17%.
  • Neurological symptoms were the primary reason for reoperation in 58 of 69 patients.
  • Medial-caudal breaches and sensory/motor disturbances were significant factors for incomplete neurological symptom resolution (P<0.05).

Conclusions:

  • Reoperation for MPSs led to complete resolution of neurological symptoms in 70.1% of patients.
  • Factors associated with residual neurological symptoms include sensory and motor disturbances, medial-caudal breaches, and pedicle breaches larger than 5 mm.
  • This study highlights the importance of precise screw placement and identifies predictors for suboptimal outcomes after reoperation.