Abstract
There are now quite a range of randomized trials investigating spinal fusion and instrumentation of the lumbar spine in degenerative disorders. A meta-analysis of eight studies supports the conclusion that instrumentation increases fusion rates (Odds Ratio 2.3 (95% CI 1.1–4.8)), but not clinical outcome. My conclusion, looking at four studies where the role of pedicle screws can be analyzed, would be that using posterior instrumentation that includes pedicle screws will increase the fusion rate. But, it also increases length of surgery, the complication rate, the revision rate, and hence, the cost of surgery over an uninstrumented fusion. If we look down the line at the clinical outcome, there seems little to favour instrumentation over non-instrumented fusion. Pedicle screws are widely used to secure fixation of implants to the spine. Most spinal implant systems include pedicle screws in their inventory. This article summarizes evidence that pedicle screws work or fail in a variety of applications. Biomechanical test generally finds screws to be superior to other methods of fixation. Posterior implant systems seem more secure than no fixation, either with rigid or non-rigid systems.
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Wilke H-J, Drumm J, Häussler K, Mack C, Steudel W-I, Kettler A (2008) Biomechanical effect of different lumbar interspinous implants on flexibility and intradiscal pressure. Eur Spine J 17(8):1049–1056
Verlaan J, Diekerhof C, Buskens E, van der Tweel I, Verbout A, Dhert W et al (2004) Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine 29(7):803–814
Suk S, Lee C, Kim W, Chung Y, Park Y (1995) Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine 20(12):1399–1405
Lehman R, Lenke L, Keeler K, Kim Y, Buchowski J, Cheh G et al (2008) Operative treatment of adolescent idiopathic scoliosis with posterior pedicle screw-only constructs: minimum three-year follow-up of one hundred fourteen cases. Spine 33(14):1598–1604
Winter R, Lonstein J, Denis F (2007) How much correction is enough? Spine 32(24):2641–2643
Zdeblick TA (1993) A prospective, randomized study of lumbar fusion. Preliminary results. Spine 18(8):983–991
Angevine P, Dickman C, McCormick P (2007) Lumbar fusion with and without pedicle screw fixation: comments on a prospective, randomized study. Spine 32(13):1466–1471
Fischgrund J, Mackay M, Herkowitz H, Brower R, Montgomery D, Kurz L (1997) Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective randomized study comparing decompressive laminectomy and arthrodesis with or without spinal instrumentation. Spine 22: 2807–2812
Kornblum M, Fischgrund J, Herkowitz H, Abraham D, Berkower D, Ditkoff J (2004) Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion and pseudarthrosis. Spine 29(7): 726–733
France JC, Michael J, Lauerman WC, Cain JE, Glover JM, Lawson KJ, Coe JD et al (1999) A randomized prospective study of posterolateral lumbar fusion: outcomes with and without pedicle screw instrumentation. Spine 24(6): 553–560
Fritzell P, Hagg O, Wessburg P, Nordwall A, Group SLSS (2002) Chronic back pain and fusion: a comparison of three surgical techniques: a prospective multicentre randomized study from the Swedish Lumbar Spine Study Group. Spine 27:1131–1141
Brox J, Sørensen R, Friis A, Nygaard Ø, Indahl A, Keller A et al (2003) Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine 28(17):1913–1921
Brox J, Reikerås O, Nygaard Ø, Sørensen R, Indahl A, Holm I et al (2006) Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study. Pain 122(1–2): 145–155
Wilson-MacDonald J, Fairbank J, Frost H, Yu L-M, Barker K, Collins R et al (2008) The MRC spine stabilization trial: surgical methods, outcomes, costs, and complications of surgical stabilization. Spine 33(21):2334–2340
Gibson J, Waddell G (2005) Surgery for degenerative lumbar spondylosis: updated cochrane review. Spine 30(20): 2312–2320
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Fairbank, J. (2010). Evidence for Efficacy of Pedicle-Based Systems. In: Szpalski, M., Gunzburg, R., Rydevik, B., Le Huec, JC., Mayer, H. (eds) Surgery for Low Back Pain. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-04547-9_16
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DOI: https://doi.org/10.1007/978-3-642-04547-9_16
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