Outcome after Wiltse pedicle screw removal

Area of Science:

• Orthopedic Surgery
• Spinal Fusion
• Biomedical Engineering

Background:

• Posterior lumbar spinal fusion using Wiltse pedicle screw fixation is a common procedure.
• Hardware removal is often performed after spinal fusion.
• Assessing the success of spinal fusion can be challenging.

Purpose of the Study:

• To evaluate the outcomes of hardware removal after Wiltse pedicle screw posterior lumbar spinal fusion.
• To determine the impact of pseudarthrosis on patient outcomes after revision surgery.
• To assess the reliability of preoperative methods for determining fusion status.

Main Methods:

• Retrospective review of 35 patients who underwent hardware removal after Wiltse pedicle screw posterior lumbar spinal fusion.
• Intraoperative confirmation of pseudarthrosis in 10 patients.
• Clinical review of 30 patients at an average of 17.5 months post-surgery.

Main Results:

• All 30 reviewed patients experienced persistent back pain and limited lumbar motion.
• Patients with confirmed pseudarthrosis reported less pain, reduced narcotic use, and improved quality of life after reoperation compared to those with solid fusions.
• Postsurgical assessment of fusion is difficult, with instrumentation potentially obscuring the true state of arthrodesis.

Conclusions:

• Accurate preoperative assessment of the fusion mass is crucial for surgical decision-making in patients with persistent symptoms after Wiltse pedicle screw lumbar fusion.
• Reoperation may yield better outcomes for patients with pseudarthrosis than for those with solid fusions.
• Intraoperative exploration remains the most reliable method for determining the state of lumbar spinal arthrodesis.