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L5 spinal nerve injury caused by misplacement of outwardly-inserted S1 pedicle screws

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  • Published:
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Abstract

Purpose

To evaluate L5 nerve root injuries caused by outwardly misplaced S1 pedicle screws.

Summary of Background Data

Pedicle screws remain the criterion standard for fixation of L5–S1 to correct lumbosacral instability. When inserting S1 pedicle screws, it is possible to injure the L5 nerve root if screws are inserted outwardly and the tip of the screw perforates the anterior cortex of the sacrum. Despite this risk, to our knowledge this type of injury has never been reported as a case series.

Methods

We experienced 2 cases of L5 nerve root injury caused by outwardly-inserted S1 pedicle screws. In both cases, bilateral S1 pedicle screws were inserted outwardly using a free-hand technique, and on one side, screws induced severe pain by impinging on an L5 root. Computed tomography after the selective rootgraphy of the injured nerve showed the nerve compressed laterally by screw threads in Case 1 and crushed between the screw threads and the sacral body in Case 2.

Results

In both cases, leg pain disappeared immediately after the infiltration of the nerve with lidocaine, but symptoms recurred within a few days in Case 1 and within an hour in Case 2. Conservative treatment of three spinal nerve infiltrations was effective in Case 1, but reinsertion of the rogue screw was necessary in Case 2.

Conclusions

Surgeons should recognize that lateral inclination of S1 pedicle screws can cause L5 nerve root injury, which may require reinsertion of the screw, especially in cases where insertion is difficult because of overlapping surrounding muscle or bony tissue.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

    Masahiro Inoue, Masayuki Miyagi, Hiroto Kamoda, Tetsuhiro Ishikawa, Miyako Suzuki, Yoshihiro Sakuma, Yasuhiro Oikawa, Kazuyo Yamauchi, Sumihisa Orita, Kazuhisa Takahashi & Seiji Ohtori

  2. Department of Orthopaedic Surgery, Kitasato University, School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Gen Inoue & Masashi Takaso

  3. Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan

    Tomoyuki Ozawa & Tomoaki Toyone

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  1. Masahiro Inoue
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  2. Gen Inoue
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  3. Tomoyuki Ozawa
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  4. Masayuki Miyagi
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  14. Kazuhisa Takahashi
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  15. Seiji Ohtori
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Correspondence to Gen Inoue.

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Inoue, M., Inoue, G., Ozawa, T. et al. L5 spinal nerve injury caused by misplacement of outwardly-inserted S1 pedicle screws. Eur Spine J 22 (Suppl 3), 461–465 (2013). https://doi.org/10.1007/s00586-012-2634-z

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  • DOI: https://doi.org/10.1007/s00586-012-2634-z

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