Complications of thoracic pedicle screws in scoliosis treatment

Mario Di Silvestre, Patrizio Parisini, Francesco Lolli, Georgios Bakaloudis

Research output: Contribution to journalArticle

Abstract

STUDY DESIGN. A retrospective study. OBJECTIVE. To analyze complications with thoracic pedicle screws in scoliosis treatment at our Department over a 3-year period (1999-2001). SUMMARY OF BACKGROUND DATA. The use of pedicle screws remains controversial for thoracic scoliosis for fear of complications. METHODS. A total of 115 consecutive patients who underwent posterior fusion using 1035 transpedicular thoracic screws were reviewed. All patients presented a main thoracic scoliosis with a mean Cobb angle of 75.4° (range, 60°-105°). For thoracic screw placement, a mini-laminotomy technique was used, inserting a spatula inside the vertebral canal to palpate the borders of the pedicle. Postoperative CT scan was used in 25 patients (21.7%) to study a total of 311 screws, when the screw position was questionable. RESULTS. An independent spine surgeon retrospectively reviewed medical records and radiographs of the patients, at a mean follow-up of 4 years. There were 18 screws misplaced (1.7%) in a total of 13 patients (11.3%). Screw malposition was symptomatic only in 1 patient (pleural effusion and fever) and asymptomatic in the other 12 cases (10.4%). Other complications included intraoperative pedicle fractures in 15 patients (13%), dural tears (without neurologic complications) in 14 cases (12.1%), and superficial wound infections in 2 (1.7%). Another operation for screw removal was performed in 5 patients (4.3%), due to pleural effusion (in 1 case), asymptomatic late lateral loosening of a malpositioned screw (in 1), and the possible future risks related the intrathoracic screw position despite the lack of any symptoms (in 3). Two cases (1.7%) were retreated due to wound infection, without removing instrumentation. There was no loss of correction at follow-up. CONCLUSIONS. The thoracic pedicle screw placement in scoliosis patients requires utmost caution. The mini-laminotomy technique was beneficial in increasing safety of the procedure with an acceptable incidence of complications.

Original languageEnglish
Pages (from-to)1655-1661
Number of pages7
JournalSpine
Volume32
Issue number15
DOIs
Publication statusPublished - Jul 2007

Fingerprint

Scoliosis
Thorax
Laminectomy
Therapeutics
Wound Infection
Pleural Effusion
Pedicle Screws
Intraoperative Complications
Tears
Nervous System
Fear
Medical Records
Spine
Fever
Retrospective Studies
Safety
Incidence

Keywords

  • Complications
  • Scoliosis
  • Surgical treatment
  • Thoracic pedicle screws

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Di Silvestre, M., Parisini, P., Lolli, F., & Bakaloudis, G. (2007). Complications of thoracic pedicle screws in scoliosis treatment. Spine, 32(15), 1655-1661. https://doi.org/10.1097/BRS.0b013e318074d604

Complications of thoracic pedicle screws in scoliosis treatment. / Di Silvestre, Mario; Parisini, Patrizio; Lolli, Francesco; Bakaloudis, Georgios.

In: Spine, Vol. 32, No. 15, 07.2007, p. 1655-1661.

Research output: Contribution to journalArticle

Di Silvestre, M, Parisini, P, Lolli, F & Bakaloudis, G 2007, 'Complications of thoracic pedicle screws in scoliosis treatment', Spine, vol. 32, no. 15, pp. 1655-1661. https://doi.org/10.1097/BRS.0b013e318074d604
Di Silvestre M, Parisini P, Lolli F, Bakaloudis G. Complications of thoracic pedicle screws in scoliosis treatment. Spine. 2007 Jul;32(15):1655-1661. https://doi.org/10.1097/BRS.0b013e318074d604
Di Silvestre, Mario ; Parisini, Patrizio ; Lolli, Francesco ; Bakaloudis, Georgios. / Complications of thoracic pedicle screws in scoliosis treatment. In: Spine. 2007 ; Vol. 32, No. 15. pp. 1655-1661.
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abstract = "STUDY DESIGN. A retrospective study. OBJECTIVE. To analyze complications with thoracic pedicle screws in scoliosis treatment at our Department over a 3-year period (1999-2001). SUMMARY OF BACKGROUND DATA. The use of pedicle screws remains controversial for thoracic scoliosis for fear of complications. METHODS. A total of 115 consecutive patients who underwent posterior fusion using 1035 transpedicular thoracic screws were reviewed. All patients presented a main thoracic scoliosis with a mean Cobb angle of 75.4° (range, 60°-105°). For thoracic screw placement, a mini-laminotomy technique was used, inserting a spatula inside the vertebral canal to palpate the borders of the pedicle. Postoperative CT scan was used in 25 patients (21.7{\%}) to study a total of 311 screws, when the screw position was questionable. RESULTS. An independent spine surgeon retrospectively reviewed medical records and radiographs of the patients, at a mean follow-up of 4 years. There were 18 screws misplaced (1.7{\%}) in a total of 13 patients (11.3{\%}). Screw malposition was symptomatic only in 1 patient (pleural effusion and fever) and asymptomatic in the other 12 cases (10.4{\%}). Other complications included intraoperative pedicle fractures in 15 patients (13{\%}), dural tears (without neurologic complications) in 14 cases (12.1{\%}), and superficial wound infections in 2 (1.7{\%}). Another operation for screw removal was performed in 5 patients (4.3{\%}), due to pleural effusion (in 1 case), asymptomatic late lateral loosening of a malpositioned screw (in 1), and the possible future risks related the intrathoracic screw position despite the lack of any symptoms (in 3). Two cases (1.7{\%}) were retreated due to wound infection, without removing instrumentation. There was no loss of correction at follow-up. CONCLUSIONS. The thoracic pedicle screw placement in scoliosis patients requires utmost caution. The mini-laminotomy technique was beneficial in increasing safety of the procedure with an acceptable incidence of complications.",
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N2 - STUDY DESIGN. A retrospective study. OBJECTIVE. To analyze complications with thoracic pedicle screws in scoliosis treatment at our Department over a 3-year period (1999-2001). SUMMARY OF BACKGROUND DATA. The use of pedicle screws remains controversial for thoracic scoliosis for fear of complications. METHODS. A total of 115 consecutive patients who underwent posterior fusion using 1035 transpedicular thoracic screws were reviewed. All patients presented a main thoracic scoliosis with a mean Cobb angle of 75.4° (range, 60°-105°). For thoracic screw placement, a mini-laminotomy technique was used, inserting a spatula inside the vertebral canal to palpate the borders of the pedicle. Postoperative CT scan was used in 25 patients (21.7%) to study a total of 311 screws, when the screw position was questionable. RESULTS. An independent spine surgeon retrospectively reviewed medical records and radiographs of the patients, at a mean follow-up of 4 years. There were 18 screws misplaced (1.7%) in a total of 13 patients (11.3%). Screw malposition was symptomatic only in 1 patient (pleural effusion and fever) and asymptomatic in the other 12 cases (10.4%). Other complications included intraoperative pedicle fractures in 15 patients (13%), dural tears (without neurologic complications) in 14 cases (12.1%), and superficial wound infections in 2 (1.7%). Another operation for screw removal was performed in 5 patients (4.3%), due to pleural effusion (in 1 case), asymptomatic late lateral loosening of a malpositioned screw (in 1), and the possible future risks related the intrathoracic screw position despite the lack of any symptoms (in 3). Two cases (1.7%) were retreated due to wound infection, without removing instrumentation. There was no loss of correction at follow-up. CONCLUSIONS. The thoracic pedicle screw placement in scoliosis patients requires utmost caution. The mini-laminotomy technique was beneficial in increasing safety of the procedure with an acceptable incidence of complications.

AB - STUDY DESIGN. A retrospective study. OBJECTIVE. To analyze complications with thoracic pedicle screws in scoliosis treatment at our Department over a 3-year period (1999-2001). SUMMARY OF BACKGROUND DATA. The use of pedicle screws remains controversial for thoracic scoliosis for fear of complications. METHODS. A total of 115 consecutive patients who underwent posterior fusion using 1035 transpedicular thoracic screws were reviewed. All patients presented a main thoracic scoliosis with a mean Cobb angle of 75.4° (range, 60°-105°). For thoracic screw placement, a mini-laminotomy technique was used, inserting a spatula inside the vertebral canal to palpate the borders of the pedicle. Postoperative CT scan was used in 25 patients (21.7%) to study a total of 311 screws, when the screw position was questionable. RESULTS. An independent spine surgeon retrospectively reviewed medical records and radiographs of the patients, at a mean follow-up of 4 years. There were 18 screws misplaced (1.7%) in a total of 13 patients (11.3%). Screw malposition was symptomatic only in 1 patient (pleural effusion and fever) and asymptomatic in the other 12 cases (10.4%). Other complications included intraoperative pedicle fractures in 15 patients (13%), dural tears (without neurologic complications) in 14 cases (12.1%), and superficial wound infections in 2 (1.7%). Another operation for screw removal was performed in 5 patients (4.3%), due to pleural effusion (in 1 case), asymptomatic late lateral loosening of a malpositioned screw (in 1), and the possible future risks related the intrathoracic screw position despite the lack of any symptoms (in 3). Two cases (1.7%) were retreated due to wound infection, without removing instrumentation. There was no loss of correction at follow-up. CONCLUSIONS. The thoracic pedicle screw placement in scoliosis patients requires utmost caution. The mini-laminotomy technique was beneficial in increasing safety of the procedure with an acceptable incidence of complications.

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