Factors Affecting Pedicle Screw Insertional Torque in Spine Deformity Surgery.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
01 Sep 2021
01 Sep 2021
Historique:
entrez:
12
8
2021
pubmed:
13
8
2021
medline:
21
8
2021
Statut:
ppublish
Résumé
Retrospective observational study of consecutive patients. We sought to: (1) clarify the key factors predominantly associated with the insertional torque of pedicle screws; (2) compare the optimal factors for pedicle screw insertion to obtain rigid screw fixation in patients with adult spinal deformity (ASD) and in those with adolescent idiopathic scoliosis (AIS); (3) determine the optimal screw/pedicle ratio (S/P) to obtain rigid pedicle screw fixation. Rigid pedicle screw fixation is mandatory to perform corrections for spinal deformities properly and to allow successful fusion after surgery. The fixation depends mainly on screw position accuracy and patient bone quality. Traditionally, spinal surgeons have decided the screw size, trajectory, and tapping size based on their intuition. Insertional torque has been indicated as useful to predict screw fixation strength, and is correlated with screw pullout strength and frequency of postoperative screw loosening. We compared insertion torque at L1-L3 levels of 324 screws in 68 patients with ASD and 58 screws in 32 patients with AIS. We assessed the association between screw/pedicle ratio and insertion torque by constructing a spline curve. Pedicle and screw diameter correlated positively with insertion torque in patients with either ASD or AIS. The optimal screw/pedicle ratio to obtain rigid pedicle screw fixation in patients with ASD was close to, but less than one, and, by contrast, was about 1 to 1.25 in patients with AIS. We propose the concept of an optimal S/P ratio for obtaining rigid pedicle screw fixation during spinal corrective surgery, which is different for patients with ASD and patients with AIS. The S/P ratio is useful for deciding the appropriate diameter screw for each case in preoperative planning.Level of Evidence: 4.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective observational study of consecutive patients.
OBJECTIVE
OBJECTIVE
We sought to: (1) clarify the key factors predominantly associated with the insertional torque of pedicle screws; (2) compare the optimal factors for pedicle screw insertion to obtain rigid screw fixation in patients with adult spinal deformity (ASD) and in those with adolescent idiopathic scoliosis (AIS); (3) determine the optimal screw/pedicle ratio (S/P) to obtain rigid pedicle screw fixation.
SUMMARY OF BACKGROUND DATA
BACKGROUND
Rigid pedicle screw fixation is mandatory to perform corrections for spinal deformities properly and to allow successful fusion after surgery. The fixation depends mainly on screw position accuracy and patient bone quality. Traditionally, spinal surgeons have decided the screw size, trajectory, and tapping size based on their intuition. Insertional torque has been indicated as useful to predict screw fixation strength, and is correlated with screw pullout strength and frequency of postoperative screw loosening.
METHODS
METHODS
We compared insertion torque at L1-L3 levels of 324 screws in 68 patients with ASD and 58 screws in 32 patients with AIS. We assessed the association between screw/pedicle ratio and insertion torque by constructing a spline curve.
RESULTS
RESULTS
Pedicle and screw diameter correlated positively with insertion torque in patients with either ASD or AIS. The optimal screw/pedicle ratio to obtain rigid pedicle screw fixation in patients with ASD was close to, but less than one, and, by contrast, was about 1 to 1.25 in patients with AIS.
CONCLUSION
CONCLUSIONS
We propose the concept of an optimal S/P ratio for obtaining rigid pedicle screw fixation during spinal corrective surgery, which is different for patients with ASD and patients with AIS. The S/P ratio is useful for deciding the appropriate diameter screw for each case in preoperative planning.Level of Evidence: 4.
Identifiants
pubmed: 34384093
doi: 10.1097/BRS.0000000000004021
pii: 00007632-202109010-00011
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
E932-E938Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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