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01.05.2015 | Review Article

Pedicle screw loosening: a clinically relevant complication?

verfasst von: Fabio Galbusera, David Volkheimer, Sandra Reitmaier, Nikolaus Berger-Roscher, Annette Kienle, Hans-Joachim Wilke

Erschienen in: European Spine Journal | Ausgabe 5/2015

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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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Titel: Pedicle screw loosening: a clinically relevant complication?
verfasst von: Fabio Galbusera
David Volkheimer
Sandra Reitmaier
Nikolaus Berger-Roscher
Annette Kienle
Hans-Joachim Wilke
Publikationsdatum: 01.05.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 5/2015
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-015-3768-6

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