Complications of pedicle screw fixation in reconstructive surgery of the cervical spine
Complications of pedicle screw fixation in reconstructive surgery of the cervical spine
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DOI：
10.1097/00007632-200004150-00011
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发表时间：
2000-04-15
期刊：
影响因子：
3
通讯作者：
Kaneda, K
中科院分区：
文献类型：
--
作者：
Abumi, K;Shono, Y;Kaneda, K
研究设计。回顾性评价180例连续使用椎弓根螺钉固定系统治疗颈椎病患者的并发症。目的。确定与颈椎椎弓根螺钉固定相关的风险，并强调术前计划和手术技术在降低该手术风险方面的重要性。背景数据摘要。一般来说，颈椎椎弓根螺钉固定对于神经血管结构来说风险太大。有几份报告描述了侧块螺钉板固定的并发症。然而，尚无研究详细探讨颈椎椎弓根螺钉固定相关的并发症。方法。对 180 名接受颈椎椎弓根螺钉固定进行颈椎重建手术的患者进行了回顾，以明确与椎弓根螺钉固定手术相关的并发症。 70 名患者的颈椎疾病为脊柱损伤，110 名患者的颈椎疾病为非创伤性病变。 712枚螺钉被插入颈椎椎弓根，并对669枚螺钉的位置进行了放射学评估。 结果。一名患者发生椎动脉损伤。骨蜡止血，术后未出现神经系统并发症。计算机断层扫描 (CT) 发现 45 颗螺钉 (6.7%) 穿透椎弓根，45 颗螺钉中的 2 颗引起神经根病。除了这三种直接归因于螺钉插入的神经血管并发症外，一名患者还观察到因平移畸形过度减少而导致医源性椎间孔狭窄引起的神经根病。结论。椎弓根螺钉置入引起的临床显着并发症的发生率较低。通过充分的术前椎弓根影像学研究和严格控制螺钉插入，可以最大限度地减少与颈椎椎弓根螺钉固定相关的并发症。椎弓根螺钉固定对于各种疾病的颈椎重建来说是一种有用的手术，并且可以安全地进行。
Study Design. Retrospective evaluation of complications in 180 consecutive patients with cervical disorders who had been treated by using pedicle screw fixation systems.Objectives. To determine the risks associated with pedicle screw fixation in the cervical spine and to emphasize the importance of preoperative planning and surgical techniques in reducing the risks of this procedure.Summary of Background Data. Generally, pedicle screw fixation in the cervical spine has been considered too risky for the neurovascular structures. There have been several reports describing the complications of lateral mass screw-plate fixation. However, no studies have examined in detail the complications associated with cervical pedicle screw fixation.Methods. One hundred eighty patients who underwent cervical reconstructive surgery using cervical pedicle screw fixation were reviewed to clarify the complications associated with the pedicle screw fixation procedure. Cervical disorders were spinal injuries in 70 patients and nontraumatic lesions in 110 patients. Seven hundred twelve screws were inserted into the cervical pedicles, and the locations of 669 screws were radiologically evaluated.Results. Injury of the vertebral artery occurred in one patient. The bleeding was stopped by bone wax, and no neurologic complication developed after surgery. On computed tomographic (CT) scan, 45 screws (6.7%) were found to penetrate the pedicle, and 2 of 45 screws caused radiculopathy. Besides these three neurovascular complications directly attributed to screw insertion, radiculopathy caused by iatrogenic foraminal stenosis from excessive reduction of the translational deformity was observed in one patient.Conclusions. The incidence of the clinically significant complications caused by pedicle screw insertion was low. Complications associated with cervical pedicle screw fixation can be minimized by sufficient preoperative imaging studies of the pedicles and strict control of screw insertion. Pedicle screw fixation is a useful procedure for reconstruction of the cervical spine in various kinds of disorders and can be performed safely.