Pedicle Screw-Related Complications in Thoracolumbar and Lumbosacral Spine Surgery

Background Data: Pedicle screw instrumentation of the thoracolumbar and lumbosacral spine is a well-known technique used to achieve rigid fixation for a wide variety of spinal disorders. However, it is technically demanding and may be associated with potential operative risks and complications.Study Design: A retrospective clinical case study.Purpose: To determine the incidence of complications related to pedicle screw fixation of thoracolumbar and lumbosacral spine, and if it affects the final decision of the surgeons.Patients and Methods: The reported complications in 108 transpedicular thoracolumbar and lumbosacral fixation procedures were analyzed. All medical files, operative notes, and radiographs were examined.Results: Varied complications were observed in 35.2% of patients during and after surgery. General complications were found in 13.8%, most were trivial. Infection rate was 4.6%, all cured with antibiotics except one patient who required screws removal. Neurological complications were noted in 2.7% of patients. Transient root paresis developed in 1 patient due to pedicle wall perforation. Radicular pain was noted in one patient secondary to irritation from misplaced screw. Dural tears were reported in 0.9% of our patients during screws insertion. None of  patients developed permanent deficit. Device-related complications occurred in 18.5% of patients, 55% of them occurred at thoracolumbar junction. Screw false passage was seen intra-operatively in 4.6%, pedicle fracture in 0.9%. Misplaced screw was reported in 5.5% and screw breakage in 3.7% of patients. Screw breakage occurred mainly in multi-level procedures which did not involve anterior column restoration (P<0.001).Conclusion: Pedicle screws instrumentation is associated with significant complication rate. However, most complications are trivial and can be avoided through applying careful operative techniques and awareness of spinal anatomy. (2016ESJ118)