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Development and validation of a quantitative method to assess pedicle screw loosening in posterior spine instrumentation on plain radiographs

European Spine Journal volume 23, pages 689–694 (2014)Cite this article

Abstract

Purpose

Currently, the diagnosis of pedicle screw (PS) loosening is based on a subjectively assessed halo sign, that is, a radiolucent line around the implant wider than 1 mm in plain radiographs. We aimed at development and validation of a quantitative method to diagnose PS loosening on radiographs.

Methods

Between 11/2004 and 1/2010 36 consecutive patients treated with thoraco-lumbar spine fusion with PS instrumentation without PS loosening were compared with 37 other patients who developed a clinically manifesting PS loosening. Three different angles were measured and compared regarding their capability to discriminate the loosened PS over the postoperative course. The inter-observer invariance was tested and a receiver operating characteristics curve analysis was performed.

Results

The angle measured between the PS axis and the cranial endplate was significantly different between the early and all later postoperative images. The Spearman correlation coefficient for the measurements of two observers at each postoperative time point ranged between 0.89 at 2 weeks to 0.94 at 2 months and 1 year postoperative. The angle change of 1.9° between immediate postoperative and 6-month postoperative was 75 % sensitive and 89 % specific for the identification of loosened screws (AUC = 0.82).

Discussion

The angle between the PS axis and the cranial endplate showed good ability to change in PS loosening. A change of this angle of at least 2° had a relatively high sensitivity and specificity to diagnose screw loosening.

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Conflict of interest

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Affiliations

  1. Institute for Evaluative Research in Orthopaedic Surgery, University of Bern, Stauffacherstrasse 78, 3014, Bern, Switzerland

    Emin Aghayev, Peter Diel & Daniel Dietrich

  2. Department for Spine Surgery, Inselspital, University Hospital of Bern, 3008, Bern, Switzerland

    Nicolas Zullig, Peter Diel & Lorin M. Benneker

  3. BG Unfallklinik Frankfurt am Main, Center for Spinal Surgery and Neurotraumatology, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany

    Peter Diel

  4. Institute for Mathematical Statistics and Actuarial Science, University of Bern, Sidlerstrasse 5, 3012, Bern, Switzerland

    Daniel Dietrich

Authors
  1. Emin Aghayev
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  2. Nicolas Zullig
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  3. Peter Diel
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  4. Daniel Dietrich
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  5. Lorin M. Benneker
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Correspondence to Emin Aghayev.

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Aghayev, E., Zullig, N., Diel, P. et al. Development and validation of a quantitative method to assess pedicle screw loosening in posterior spine instrumentation on plain radiographs. Eur Spine J 23, 689–694 (2014). https://doi.org/10.1007/s00586-013-3080-2

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  • DOI: https://doi.org/10.1007/s00586-013-3080-2

Keywords

  • Pedicle screw loosening
  • Pedicle screw complication
  • Pedicle screw angle
  • Pedicle screw position
  • Posterior spine instrumentation