RT Journal Article
SR Electronic
T1 Strategy for salvage pedicle screw placement: A technical note
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP e67
OP e71
DO 10.1016/j.ijsp.2013.03.002
VO 7
A1 Fujibayashi, Shunsuke
A1 Takemoto, Mitsuru
A1 Neo, Masashi
A1 Matsuda, Shuichi
YR 2013
UL https://www.ijssurgery.com/content/7/e67.abstract
AB Background Salvage surgery for failed lumbar spine fusion with a loosened pedicle screw is challenging. In general, the strategy includes replacement with larger and longer pedicle screws, augmentation with polymethylmethacrylate cement or hydroxyapatite granules, and extension of fused segments. The purpose of this study is to introduce a new technique for pedicle screw replacement after failed lumbar spine fusion.Methods Five salvage operations were performed using a different trajectory (DT) pedicle screw replacement technique based on 3-dimensional radiological information. Position of the alternative pedicle screws was planned carefully on the computer screen of a computed tomography-based navigation system before the operation. To obtain sufficient initial stability, 1 of 2 techniques was chosen, depending on the patient. One technique created a completely new route, which did not interfere with the existing screw hole, and the other involved penetration of the existing screw hole.Results DT pedicle screws were replaced successfully according to the preoperative plan. In all patients, bony union were achieved at the final follow-up period without any instrument failure. Extension of the fused segments could be avoided by using the DT pedicle screw replacement technique combined with transforaminal lumbar interbody fusion.Conclusions The DT pedicle screw replacement technique is a treatment option for salvage lumbar spine surgery.Clinical relevance The current technique is a treatment option for salvage operations that can both avoid extension of a fused segment and achieve successful bony union.