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KMID : 1189320140080030281
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Asian Spine Journal
2014 Volume.8 No. 3 p.281 ~ p.297
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Lumbar Transpedicular Implant Failure: A Clinical and Surgical Challenge and Its Radiological Assessment
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Mohi Eldin Mohamed M.
Ali Abdel Mohsen Arafa
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Abstract
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Study Design: It is a multicenter, controlled case study review of a big scale of pedicle-screw procedures from January 2000 to June 2010. The outcomes were compared to those with no implant failure.
Purpose: The purpose of this study was to review retrospectively the outcome of 100 patients with implant failure in comparison to 100 control-patients, and to study the causes of failure and its prevention.
Overview of Literature: Transpedicular fixation is associated with risks of hardware failure, such as screw/rod breakage and/or loosening at the screw-rod interface and difficulties in the system assembly, which remain a significant clinical problem. Removal or revision of the spinal hardware is often required.
Methods: Two hundred patients (88 women, 112 men) were divided into 2 major groups, with 100 patients in group I (implant failure group G1) and 100 patients in group II (successful fusion, control group G2). We subdivided the study groups into two subgroups: subgroup a (single-level instrumented group) and subgroup b (multilevel instrumented group). The implant status was assessed based on intraoperative and follow-up radiographs.
Results: Implant failure in general was present in 36% in G1a, and in 64% in G1b, and types of implant failure included screw fracture (34%), rod fracture (24%), rod loosening (22%), screw loosening (16%), and failure of both rod and screw (4%). Most of the failures (90%) occurred within 6 months after surgery, with no reported cases 1 year postoperatively.
Conclusions: We tried to address the problem and study the causes of failure, and proposed solutions for its prevention.
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KEYWORD
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Lumbar, fixation, Screw, failure, Fusion, Fracture fixations, prosthesis, Loosening
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