early failure ; cortical trajectory bone screw ; pedicle screws ; lumbar spinal stenosis
Abstract
Purpose: Pedicle screw insertion has been traditionally used as a surgical treatment for degenerative lumbar spine disease. As an
alternative, the cortical-bone trajectory screw allows less invasive posterior lumbar fixation and excellent mechanical stability, as reported
in several biomechanical studies. This study evaluated the clinical and radiological results of a case of early failure of cortical-bone screw
fixation in posterior fixation and union after posterior decompression.
Materials and Methods: This study examined 311 patients who underwent surgical treatment from 2013 to 2018 using cortical orbital
screws as an alternative to traditional pedicle screw fixation for degenerative spinal stenosis and anterior spine dislocation of the lumbar
spine. Early fixation failure after surgery was defined as fixation failure, such as loosening, pull-out, and breakage of the screw on
computed tomography (CT) and radiographs at a follow-up of six months.
Results: Early fixation failure occurred in 46 out of 311 cases (14.8%), screw loosening in 46 cases (14.8%), pull-out in 12 cases (3.9%),
and breakage in four cases (1.3%). An analysis of the site where the fixation failure occurred revealed the following, L1 in seven cases
(15.2%), L2 in three cases (6.5%), L3 in four cases (8.7%), L4 in four cases (8.7%), L5 in four cases (8.7%), and S1 in 24 cases (52.2%).
Among the distal cortical bone screws, fixation failures such as loosening, pull-out, and breakage occurred mainly in the S1 screws.
Conclusion: Cortical-bone trajectory screw fixation may be an alternative with comparable clinical outcomes or fewer complications
compared to conventional pedicle screw fixation. On the other hand, in case with osteoporosis and no anterior support structure particularly
at L5-S1 fusion sites were observed to have result of premature fixation failures such as relaxation, pull-out, and breakage.