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Pedicle screw loosening: a clinically relevant complication?

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Abstract

Purpose

Literature studies showed a very wide range of pedicle screw loosening rates after thoracolumbar stabilization, ranging from less than 1 to 15 % in non-osteoporotic patients treated with rigid systems and even higher in osteoporotic subjects or patients treated with dynamic systems. Firstly, this paper aims to investigate how much this complication is affecting the success rate of pedicle screw fixation, in both non-osteoporotic and osteoporotic patients, and to discuss the biomechanical reasons which may be related to the variability of the rates found in the literature. The secondary aim was to summarize and discuss the published definitions and conventions about screw loosening from a clinical and radiological point of view.

Methods

Narrative literature review.

Results

Screw loosening appears to be a minor problem for fixation and fusion of healthy, non-osteoporotic bone. Pedicle screw fixation in osteoporotic bone is believed to be at risk of loosening, but clinical data are actually scarce. Both expandable and augmented screws may be a viable option to reduce the risk of loosening, but clinical evidence is missing. Posterior motion-preserving implants seems to have a significant risk of screw loosening. Standardization appears to be lacking regarding the radiological assessment. Marked differences in the loosening rates found based either on planar radiography or on CT scanning were observed.

Conclusions

Reported loosening rates primarily depended on the protocol used for the clinical examination during follow-up and on the conventions used for the radiological assessment. Aiming to a better comparability of published data, we recommend the authors of clinical studies to describe which criteria were used to assess a loosened screw, as well as the protocol of the clinical follow-up examination. Low-dose CT should be used for the assessment of screw loosening whenever possible.

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Acknowledgments

Funding by the German Federal Ministry for Economic Affairs and Energy through the Central Innovation Program SME (project KF3180101JL3) is gratefully acknowledged.

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Authors and Affiliations

  1. IRCCS Istituto Ortopedico Galeazzi, via Galeazzi 4, 20161, Milan, Italy

    Fabio Galbusera

  2. Institute of Orthopaedic Research and Biomechanics, Center of Musculoskeletal Research Ulm (ZMFU), University of Ulm, Ulm, Germany

    David Volkheimer, Sandra Reitmaier, Nikolaus Berger-Roscher & Hans-Joachim Wilke

  3. SpineServ GmbH & Co. KG, Ulm, Germany

    Annette Kienle

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  1. Fabio Galbusera
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Galbusera, F., Volkheimer, D., Reitmaier, S. et al. Pedicle screw loosening: a clinically relevant complication?. Eur Spine J 24, 1005–1016 (2015). https://doi.org/10.1007/s00586-015-3768-6

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