Revision Pedicle Screw Strategies

  • Tiffany Grace Perry


Pedicle screw instrumentation has become the foundation of thoracolumbar fixation techniques. For different reasons, pedicle screw revisions may need to occur. Some of the primary reasons for revision surgery are pseudarthrosis, adjacent segment disease, fractures, and infection. Some surgeons are more comfortable with revision work than others, and usually it is best accomplished at the hands of a skilled spine surgeon. Revision surgeries need to be entered into with a plan A, plan B, plan C, and plan D. Starting a revision surgery with only one plan and no backup options can lead to poor outcomes post-op. Revision surgeries involving pedicle screws can be tedious and difficult. Conversely, when well-planned and well-executed, revision surgery can go as smoothly as a virgin surgery. This chapter will discuss everything from preoperative imaging and identification of hardware to the intraoperative nuances of the surgeries.


Screw pullout Haloing Revision Cement augmentation 


  1. 1.
    Wu X, Shi J, Wu J, Cheng Y, Peng K, Chen J, Jiang H. Pedicle screw loosening: the value of radiological imagings and the identification of risk factors assessed by extraction torque during screw removal surgery. J Orthop Surg Res. 2019;14:6.CrossRefGoogle Scholar
  2. 2.
    Renner SM, Lim TH, Kim WJ, Katolik L, An HS, Andersson GB. Augmentation of pedicle screw fixation strength using an injectable calcium phosphate cement as a function of injection timing and method. Spine (Phila Pa 1976). 2004;29(11):E212–6.CrossRefGoogle Scholar
  3. 3.
    Seng WRD, Chou SM, Siddiqui SS, Oh JYL. Pedicle screw designs in spinal surgery: is there a difference? A biomechanical study on primary and revision pull-out strength. Spine (Phila Pa 1976). 2019;44(3):E144–9.CrossRefGoogle Scholar
  4. 4.
    Mason A, Paulsen R, Babuska JM, Rajpal S, Burneikiene S, Nelson EL, Villavicencio AT. The accuracy of pedicle screw placement using intraoperative image guidance systems. J Neurosurg Spine. 2014;20(2):196–203.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Tiffany Grace Perry
    • 1
  1. 1.Department of NeurosurgeryCedars-Sinai Medical CenterLos AngelesUSA

Personalised recommendations