Posterior Pedikül Vida Fiksasyonu Cerrahisi Sonrası Enstrumandan Ses Gelmesi: Dört Olguluk Bir Seri
Özet
Posterior pedikül vida fiksasyonu yaygın olarak uygulanan bir cerrahi tekniktir. Omurganın stabilizasyonu posterior pedikül vida fiksasyonunun yaygın endikasyonlarından biridir. Enstrümana bağlı komplikasyonlar arasında vidanın kırılması ve gevşemesi bulunmaktadır. Bu çalışmada, posterior pedikül vida fiksasyonu ile cerrahi tedavi edilen dört vaka sunulmaktadır. Dört hastanın tamamı, ameliyat sonrası dönemde vida fiksasyon yerinde duyulabilir gıcırtı sesinden şikayetçi olmuştur. İlk üç vakada ağrı ve hareket güçlüğü gibi diğer semptomlar da mevcuttu. Enstrüman yetmezliğini (kırık vida) gösteren ameliyat öncesi radyolojik veri yalnızca ilk hastada (sağ S1 vidası) bulunmuştur. Üçüncü hastada vida gevşemesi (sağ L5), İkinci hastada kırık vida (L5) ameliyat sırasında tesbit edilmiştir. Söz konusu üç hastada revizyon cerrahisi (kırık vidasının değiştirilmesi ve gevşek vidanın sıkılması) yapılmıştır. Ameliyat sonrası takip dönemi üç hastada sorunsuz geçmiştir. Dördüncü hastada ciddi semptomlar ve klinik/radyolojik anormallikler olmadığı için müdahale yapılmamıştır.
Posterior pedicle screw fixation is a widely performed surgery. Stabilization of the spine is one of the common indications of posterior pedicle screw fixation. Common implant-related complications include breakage and loosening of the screws. Here, we present a case series describing four cases managed with posterior pedicle screw fixation. All the four patients complained of audible creaking sound at the site of screw fixation during postoperative period. In the first three cases other symptoms like pain, and difficulty in movement were also present. Radiological evidence of implant failure (broken screw) was only present in the first patient (right S1 screw). In the third patient, loosening of the right L5 screw, and in the second patient, a broken L5 screw were detected during surgery. Corrective surgeries (replacement of the broken screw and tightening of the loose screw) were performed on these three patients. The postoperative follow-up period was uneventful for all three patients. No intervention was carried out in the fourth patient due to the absence of debilitating symptoms and clinical/radiological abnormalities.
Referanslar
Mohi Eldin MM, Ali AM. Lumbar transpedicular implant failure: a clinical and surgical challenge and its radiologicalassessment. Asian Spine J 2014; 8 (3): 281-297.
Gaines RW., Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg Am 2000; 82-A (10): 1458–1476.
Aebi M, Thalgott JS, Webb JK. Modular stabilization system: the universal spine system. In: Aebi M, Thalgott JS, Webb JK, editors. AO ASIF principles in spine surgery. Berlin: Springer-Verlag; 1998. pp. 123–196.
Faraj AA, Webb JK. Early complications of spinal pedicle screw. Eur Spine J 1997; 6 (5): 324–326.
Duncan JD, MacDonald JD. Extraction of broken pedicle screws: technical note. Neurosurgery 1998; 42 (6): 1399–1400.
Abumi K, Kaneda K. Pedicle screw fixation for nontraumatic lesions of the cervical spine. Spine (Phila Pa 1976) 1997;22 (16): 1853–1863
Schnee CL, Freese A, Ansell LV. Outcome analysis for adults with spondylolisthesis treated with posterolateral fusion and transpedicular screw fixation. J Neurosurg 1997; 86 (1): 56–63.
Sadiq S, Meir A, Hughes SP. Surgical management of spondylolisthesis overview of literature. Neurol India 2005 ;53(4): 506-511.
Marchetti PG, Bartolozzi P. Classification of spondylolisthesis as a guideline for treatment. In : Bridwell KH, Dewald RL, Hammerberg KW et al, editors. Textbook of Spinal Surgery, 2nd edn. Philadelphia: Lippincott-Raven; 1997. p. 1211-1254
Meyerding HW. Spondylolisthesis; surgical fusion of lumbosacral portion of spinal column and interarticular facets; use of autogenous bone grafts for relief of disabling backache. J Int Coll Surg 1956; 26 (5 Part 1):566-591.
Fredrickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am 1984; 66 (5): 699-707.
Boos N, Webb JK. Pedicle screw fixation in spinal disorders: a European view. Eur Spine J 1997; 6(1): 2-18.
Roy-Camille R. Ostéosynthése du rachis dorsal, lombaire et lombosacré par plaque métalliques visées dans pédicules vertébraux et les apophyses articulaires. Presse Méd 1970; 78: 1447–1448.
Louis R, Maresca C. Stabilisation chirurgicale avec reduction des spondylolyses et des spondylolisthe sis. Int Orthop 1977; 1: 215–225.
Louis R, Maresca C. Les arthrodèse stables de la lombo-sacrée (70 cas). Rev Chir Orthop. 1976; 62(Suppl 11): 70.
Louis R. Fusion of the lumbar and sacral spine by internal fixation with screw plates. Clin Orthop 1986;203 :18–33.
Harrington PR, Dickson JH. Spinal instrumentation in the treatment of severe progressive spondylolisthesis. Clin Orthop 1976; 117: 157–163.
Harrington PR, Tullos HS. Reduction of severe spondylolisthesis in children. South Med J 1969; 62 (1) : 1–7.
Cunningham BW, Kotani Y, McNulty PS, Cappuccino A, McAfee PC. The effect of spinal destabilization and instrumentation on lumbar intradiscal pressure: an in vitro biomechanical analysis. Spine (Phila Pa 1976) 1997; 22(22): 2655-2663.
Masferrer R, Gomez CH, Karahalios DG, Sonntag VK. Efficacy of pedicle screw fixation in the treatment of spinal instability and failed back surgery: a 5-year review. J Neurosurg 1998 ; 89 (3) :371-377.
Barber JW, Boden SD, Ganey T, Hutton WC. Biomechanical study of lumbar pedicle screws: does convergence affect axial pullout strength? J Spinal Disord 1998; 11 (3): 215–220.
Dick JC, Zdeblick TA, Bartel BD, Kunz DN. Mechanical evaluation of cross-link designs in rigid pedicle screw systems. Spine (Phila Pa 1976) 1997; 22(4): 370–375.
Imbuldeniya A, Munir S, Chow J, Walter WL, Zicat BA, Walter WK. Factors affecting squeaking in metal on metal hip resurfacings. Hip Int 2014; 24(4): 340-346.
Toni A, Traina F, Stea S, Sudanese A, Visentin M, Bordini B, Squarzoni S. Early diagnosis of ceramic liner fracture. Guidelines based on a twelve-year clinical experience. J Bone Joint Surg Am 2006; 88(Suppl 4): 55-63.
Back DL, Dalziel R, Young D, Shimmin A. Early results of primary Birmingham hip resurfacings. An independent prospective study of the first 230 hips. J Bone Joint Surg Br 2005; 87(3): 324-329.
Okamoto T, Neo M, Fujibayashi S, Ito H, Takemoto M, Nakamura T. Mechanical implant failure in posterior cervical spine fusion. Eur Spine J 2012; 21(2):328-334.
Kaya AH, Dagcinar A, Celik F, Senel A. Simple technique for removing broken pedicular screw with plain and serviceable screwdriver. Eur Spine J 2008; 17(8): 1116-1118.
Chen CS, Chen WJ, Cheng CK, Jao SH, Chueh SC, Wang CC. Failure analysis of broken pedicle screws on spinal instrumentation. Medical engineering & physics 2005; 27 (6): 487–496.
Referanslar
Mohi Eldin MM, Ali AM. Lumbar transpedicular implant failure: a clinical and surgical challenge and its radiologicalassessment. Asian Spine J 2014; 8 (3): 281-297.
Gaines RW., Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg Am 2000; 82-A (10): 1458–1476.
Aebi M, Thalgott JS, Webb JK. Modular stabilization system: the universal spine system. In: Aebi M, Thalgott JS, Webb JK, editors. AO ASIF principles in spine surgery. Berlin: Springer-Verlag; 1998. pp. 123–196.
Faraj AA, Webb JK. Early complications of spinal pedicle screw. Eur Spine J 1997; 6 (5): 324–326.
Duncan JD, MacDonald JD. Extraction of broken pedicle screws: technical note. Neurosurgery 1998; 42 (6): 1399–1400.
Abumi K, Kaneda K. Pedicle screw fixation for nontraumatic lesions of the cervical spine. Spine (Phila Pa 1976) 1997;22 (16): 1853–1863
Schnee CL, Freese A, Ansell LV. Outcome analysis for adults with spondylolisthesis treated with posterolateral fusion and transpedicular screw fixation. J Neurosurg 1997; 86 (1): 56–63.
Sadiq S, Meir A, Hughes SP. Surgical management of spondylolisthesis overview of literature. Neurol India 2005 ;53(4): 506-511.
Marchetti PG, Bartolozzi P. Classification of spondylolisthesis as a guideline for treatment. In : Bridwell KH, Dewald RL, Hammerberg KW et al, editors. Textbook of Spinal Surgery, 2nd edn. Philadelphia: Lippincott-Raven; 1997. p. 1211-1254
Meyerding HW. Spondylolisthesis; surgical fusion of lumbosacral portion of spinal column and interarticular facets; use of autogenous bone grafts for relief of disabling backache. J Int Coll Surg 1956; 26 (5 Part 1):566-591.
Fredrickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP. The natural history of spondylolysis and spondylolisthesis. J Bone Joint Surg Am 1984; 66 (5): 699-707.
Boos N, Webb JK. Pedicle screw fixation in spinal disorders: a European view. Eur Spine J 1997; 6(1): 2-18.
Roy-Camille R. Ostéosynthése du rachis dorsal, lombaire et lombosacré par plaque métalliques visées dans pédicules vertébraux et les apophyses articulaires. Presse Méd 1970; 78: 1447–1448.
Louis R, Maresca C. Stabilisation chirurgicale avec reduction des spondylolyses et des spondylolisthe sis. Int Orthop 1977; 1: 215–225.
Louis R, Maresca C. Les arthrodèse stables de la lombo-sacrée (70 cas). Rev Chir Orthop. 1976; 62(Suppl 11): 70.
Louis R. Fusion of the lumbar and sacral spine by internal fixation with screw plates. Clin Orthop 1986;203 :18–33.
Harrington PR, Dickson JH. Spinal instrumentation in the treatment of severe progressive spondylolisthesis. Clin Orthop 1976; 117: 157–163.
Harrington PR, Tullos HS. Reduction of severe spondylolisthesis in children. South Med J 1969; 62 (1) : 1–7.
Cunningham BW, Kotani Y, McNulty PS, Cappuccino A, McAfee PC. The effect of spinal destabilization and instrumentation on lumbar intradiscal pressure: an in vitro biomechanical analysis. Spine (Phila Pa 1976) 1997; 22(22): 2655-2663.
Masferrer R, Gomez CH, Karahalios DG, Sonntag VK. Efficacy of pedicle screw fixation in the treatment of spinal instability and failed back surgery: a 5-year review. J Neurosurg 1998 ; 89 (3) :371-377.
Barber JW, Boden SD, Ganey T, Hutton WC. Biomechanical study of lumbar pedicle screws: does convergence affect axial pullout strength? J Spinal Disord 1998; 11 (3): 215–220.
Dick JC, Zdeblick TA, Bartel BD, Kunz DN. Mechanical evaluation of cross-link designs in rigid pedicle screw systems. Spine (Phila Pa 1976) 1997; 22(4): 370–375.
Imbuldeniya A, Munir S, Chow J, Walter WL, Zicat BA, Walter WK. Factors affecting squeaking in metal on metal hip resurfacings. Hip Int 2014; 24(4): 340-346.
Toni A, Traina F, Stea S, Sudanese A, Visentin M, Bordini B, Squarzoni S. Early diagnosis of ceramic liner fracture. Guidelines based on a twelve-year clinical experience. J Bone Joint Surg Am 2006; 88(Suppl 4): 55-63.
Back DL, Dalziel R, Young D, Shimmin A. Early results of primary Birmingham hip resurfacings. An independent prospective study of the first 230 hips. J Bone Joint Surg Br 2005; 87(3): 324-329.
Okamoto T, Neo M, Fujibayashi S, Ito H, Takemoto M, Nakamura T. Mechanical implant failure in posterior cervical spine fusion. Eur Spine J 2012; 21(2):328-334.
Kaya AH, Dagcinar A, Celik F, Senel A. Simple technique for removing broken pedicular screw with plain and serviceable screwdriver. Eur Spine J 2008; 17(8): 1116-1118.
Chen CS, Chen WJ, Cheng CK, Jao SH, Chueh SC, Wang CC. Failure analysis of broken pedicle screws on spinal instrumentation. Medical engineering & physics 2005; 27 (6): 487–496.
