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Pedicle screw loosening in dynamic stabilization: incidence, risk, and outcome in 126 patients

OBJECT: The long-term outcome of lumbar dynamic stabilization is uncertain. This study aimed to investigate the incidence, risk factors, and outcomes associated with screw loosening in a dynamic stabilization system. METHODS: The authors conducted a retrospective review of medical records, radiological studies, and clinical evaluations obtained in consecutive patients who underwent 1- or 2-level lumbar dynamic stabilization and were followed up for more than 24 months. Loosening of screws was determined on radiography and CT scanning. Radiographic and standardized clinical outcomes, including the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, were analyzed with a focus on cases in which screw loosening occurred. RESULTS: The authors analyzed 658 screws in 126 patients, including 54 women (42.9%) and 72 men (57.1%) (mean age 60.4 +/- 11.8 years). During the mean clinical follow-up period of 37.0 +/- 7.1 months, 31 screws (4.7%) in 25 patients (19.8%) were shown to have loosened. The mean age of patients with screw loosening was significantly higher than those without loosening (64.8 +/- 8.8 vs 59.3 +/- 12.2, respectively; p = 0.036). Patients with diabetes mellitus had a significantly higher rate of screw loosening compared with those without diabetes (36.0% vs 15.8%, respectively; p = 0.024). Diabetic patients with well-controlled serum glucose (HbA1c 0.05). All 25 patients with screw loosening were asymptomatic, and in 6 (24%) osseous integration was demonstrated on later follow-up. Also, there were 3 broken screws (2.38% in 126 patients or 0.46% in 658 screws). To date, none of these loosened or broken screws have required revision surgery. CONCLUSIONS: Screw loosening in dynamic stabilization systems is not uncommon (4.7% screws in 19.8% patients). Patients of older age or those with diabetes have higher rates of screw loosening. Screw loosening can be asymptomatic and presents opportunity for osseous integration on later follow-up. Although adverse effects on clinical outcomes are rare, longer-term follow-up is required in cases in which screws become loose

Keywords : adverse effects,Aged,Back,Back Pain,Bone Screws,Decompression,Surgical,Diabetes Mellitus,diagnostic imaging,epidemiology,Equipment Failure,Female,Follow-Up Studies,Glucose,Humans,Incidence,instrumentation,Leg,Lumbar Vertebrae,Male,Medical Records,methods,Middle Aged,Neurosurgery,Pain,Patients,Postoperative Complications,Prospective Studies,Radiography,Retrospective Studies,Risk,Risk Factors,Spinal Fusion,surgery,Taiwan,Time,Treatment Outcome,Veterans,, Screw,Loosening,Dynamic,Stabilization, ilioinguinal nerve pain

Date of Publication : 2011 Oct

Authors : Wu JC;Huang WC;Tsai HW;Ko CC;Wu CL;Tu TH;Cheng H;

Organisation : Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan

Journal of Publication : Neurosurg Focus

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/21961872

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