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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)

Pedicle Screw-Related Complications in Thoracolumbar and Lumbosacral Spine Surgery