Comparative analysis of clinical factors associated with pedicle screw pull‐out during or immediately after surgery between intraoperative cone‐beam computed tomography and postoperative computed tomography

• Main Authors: Satoshi Sumiya, Kazuyuki Fukushima, Yoshiro Kurosa, Takashi Hirai, Hiroyuki Inose, Toshitaka Yoshii, Atsushi Okawa
• Format: Article
• Language: English
• Published: BMC 2021-01-01
• Series: BMC Musculoskeletal Disorders
• Subjects: Pedicle screw pull‐out; Cone‐beam computed tomography (CBCT); Diffuse idiopathic skeletal hyperostosis (DISH); Connecting rod
• Online Access: https://doi.org/10.1186/s12891-020-03916-9

Abstract Background No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors. Methods This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis. Results Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval 1.12–10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out. Conclusions Our findings suggest that age, number of fused segments, presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.