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KMID : 1150320210170010001
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Journal of Korean Society of Geriatric Neurosurgery
2021 Volume.17 No. 1 p.1 ~ p.6
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Percutaneous implantation of pedicle screws via a different trajectory: a minimally invasive surgical option for screw loosening in osteopenic or osteoporotic conditions
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Yoo Kyoung-Hwan
Kim Pius
Ju Chang-Il
Kim Seok-Won
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Abstract
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Objective: The aim of this study was to evaluate the feasibility and safety of screw reimplantation via a different trajectory as a minimally invasive alternative to extensive open surgery for symptomatic low-grade screw loosening.
Methods: Among patients who underwent single-level posterior lumbar interbody fusion and percutaneous screw fixation, a consecutive series of 10 patients in whom percutaneous screw reimplantation was performed via a different trajectory due to pedicle screw loosening were included in this study. Pedicle screw loosening was deemed clinically relevant in cases of continuous back pain with radiolucent halo zones at a vertebral level. All patients were treated via a posterior approach with removal of the loosened screws and augmentation of the allograft bone chips, followed by reimplantation with a different downward and medial trajectory using a larger-diameter screw. Demographic, preoperative, and postoperative data were collected and analyzed.
Results: The loosened screws could be removed without difficulty, and reimplantation was successfully performed via a new trajectory with larger screws in all patients. All patients reported significant pain relief at the final follow-up. Moreover, no severe complications, such as wound infection or repeated screw loosening, were observed during the follow-up period.
Conclusion: Percutaneous reimplantation of screws via a different trajectory for pedicle screw loosening with larger screws can be safely attempted in selected patients to relieve pain and avoid extensive long-level screw fixation.
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KEYWORD
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Pedicle, Loosening, Trajectory
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