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Feasibility of pedicle screw fixation in lumbar fusion surgery
EANS Academy. IIZUKA T. 09/26/19; 275987; EP02081
Dr. Takahiro IIZUKA
Dr. Takahiro IIZUKA

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Abstract
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Introduction: Pedicle Screw (PS) is a mainstay to maintain spinal stability after spinal reconstruction surgery. However, there are few reports discussing the range of fixed segments from the point of biomechanical view though the spinal mobility varies according to the number of fused segments.
Aims: To clarify PS fixation can maintain the ideal reconstructed spine
Patients and Methods: This study includes consecutive 225 patients (F:125, M: 100, 71.0 y.o) which were divided into 5 groups concerning the range of fused segments. G1:35patients, G2:64, G3: 68, G4: 35, G5:more than 5 segments: 23. And S-group including L5/s :110 and L-group excluding L5/s:115. Radiological evaluation was performed at 1,2,3 months until bony fusion was observed. The radiological PS loosening and clinical problems were compared between groups. P< 0.05 is significant.
Results: PS loosening was found in 30 patients (13.3% ; upper PS :18 , lower PS:3 ,both PS:9patients ). PS loosening was found in female 25/125 and in male 5/100 ([OR] 4.7500, 95% CI 1.7467-12.9172, p< 0.005). PS loosening was found in G1:0(0%),G2 :2(2/64: 3.1%) ,G3:9(9/68: 13.2%),G4:4(4/35: 11.4%) and G5: 15 (15/23: 65.2%). PS loosening was found in L -group: 7/115 (6.1%) and in S- group: 23/110 (20.9%). PS loosening was found in S-group in 3.4 times of L-group ([OR] 3.4351, 95%CI1.4170-8.3275, p< 0.01).
However not all of PS loosening was resulted in PS removal. Only PS which was cut-out at the lowest fused segment in G3 or G4 was removed (5 patients) because of nerve root irritation.
Conclusion: Ideal PS fixation was achieved in 86.7% of the patients. The high rate of PS loosening was found in G5 (65.2%). PS loosening will be cautious when PS is used in lower end of L4 or L5 in long fusion(G4 and G5) which may entrap nerve roots if it is cut-out of pedicles.
Introduction: Pedicle Screw (PS) is a mainstay to maintain spinal stability after spinal reconstruction surgery. However, there are few reports discussing the range of fixed segments from the point of biomechanical view though the spinal mobility varies according to the number of fused segments.
Aims: To clarify PS fixation can maintain the ideal reconstructed spine
Patients and Methods: This study includes consecutive 225 patients (F:125, M: 100, 71.0 y.o) which were divided into 5 groups concerning the range of fused segments. G1:35patients, G2:64, G3: 68, G4: 35, G5:more than 5 segments: 23. And S-group including L5/s :110 and L-group excluding L5/s:115. Radiological evaluation was performed at 1,2,3 months until bony fusion was observed. The radiological PS loosening and clinical problems were compared between groups. P< 0.05 is significant.
Results: PS loosening was found in 30 patients (13.3% ; upper PS :18 , lower PS:3 ,both PS:9patients ). PS loosening was found in female 25/125 and in male 5/100 ([OR] 4.7500, 95% CI 1.7467-12.9172, p< 0.005). PS loosening was found in G1:0(0%),G2 :2(2/64: 3.1%) ,G3:9(9/68: 13.2%),G4:4(4/35: 11.4%) and G5: 15 (15/23: 65.2%). PS loosening was found in L -group: 7/115 (6.1%) and in S- group: 23/110 (20.9%). PS loosening was found in S-group in 3.4 times of L-group ([OR] 3.4351, 95%CI1.4170-8.3275, p< 0.01).
However not all of PS loosening was resulted in PS removal. Only PS which was cut-out at the lowest fused segment in G3 or G4 was removed (5 patients) because of nerve root irritation.
Conclusion: Ideal PS fixation was achieved in 86.7% of the patients. The high rate of PS loosening was found in G5 (65.2%). PS loosening will be cautious when PS is used in lower end of L4 or L5 in long fusion(G4 and G5) which may entrap nerve roots if it is cut-out of pedicles.
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