Comparative Study of the Complications of Pedicular Screw Fixation Techniques in the Thoracolumbar Spine: A Systematic Review  

作　　者：Vanessa Cavazana Takata João Vitor Lois Balestrieri Pedro Bastos Neto Rodrigo Eduardo Souza Garcia Idiberto José Zotarelli Filho Luis Fernando Ricci Boer Fabiano Morais Nogueira Vanessa Cavazana Takata;João Vitor Lois Balestrieri;Pedro Bastos Neto;Rodrigo Eduardo Souza Garcia;Idiberto José Zotarelli Filho;Luis Fernando Ricci Boer;Fabiano Morais Nogueira(FAMERP-Faculty of Medicine of Sã,o José do Rio Preto, Orthopedics and Traumatology at Hospital de Base, Sã,o José do Rio Preto, Sã,o Paulo, Brazil;ABRAN-Brazilian Association of Nutrology, Catanduva, Sao Paulo, Brazil;Clinical Research and Biostatistical Department, College of Palliative Medicine of Sri Lanka, Colombo, Sri Lanka)

机构地区：[1]FAMERP-Faculty of Medicine of Sã,o José do Rio Preto, Orthopedics and Traumatology at Hospital de Base, Sã,o José do Rio Preto, Sã,o Paulo, Brazil [2]ABRAN-Brazilian Association of Nutrology, Catanduva, Sao Paulo, Brazil [3]Clinical Research and Biostatistical Department, College of Palliative Medicine of Sri Lanka, Colombo, Sri Lanka

出　　处：《Open Journal of Orthopedics》2023年第8期343-353,共11页矫形学期刊（英文）

摘　　要：Introduction: The use of pedicle screws increases postoperative stability and consolidation of arthrodesis. Pedicle arthrodesis is currently the standard treatment for the thoracolumbar spine, presenting the best fusion and stiffness rates, and among its main indications is the possibility of better correction of spine deformities in the thoracic and lumbar region. However, due to different definitions and the lack of a control group, many of these studies have limited comparative analysis, resulting in the scarcity of comparative studies with standardized methodology. Objective: It was to analyze, through a systematic review, the safety and efficacy of instrumentation with pedicle screws in the spine which have been questioned, despite its wide use for stabilization of the spine, comparing the complications present in the insertion techniques of pedicle screws. Methods: The rules of the Systematic Review-PRISMA were followed. The literary search process was carried out from January to March 2023. A bibliographic search was carried out in MEDLINE, PubMed, and Scielo for articles produced between 2001 and 2023. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. The Cohen test (Funnel Plot) and The Heterogeneity Test (Chi-Square Test – X²) were performed, with p Results and Conclusion: A total of 134 articles were found. A total of 67 articles were evaluated in full and 12 were selected to compose the results of this systematic review. According to the GRADE instrument, most studies (X² = 90.2% > 50%) followed a controlled clinical study model and had a good methodological design, with p < 0.05. It was shown that poor positioning of pedicle screws is the most common cause of complications. The surgeon’s skills and the length and diameter of the pedicle screw can also affect the different modes of placement. Robotic computer assistance has the potential to reduce the incidence of postoperative revisions. MiniIntroduction: The use of pedicle screws increases postoperative stability and consolidation of arthrodesis. Pedicle arthrodesis is currently the standard treatment for the thoracolumbar spine, presenting the best fusion and stiffness rates, and among its main indications is the possibility of better correction of spine deformities in the thoracic and lumbar region. However, due to different definitions and the lack of a control group, many of these studies have limited comparative analysis, resulting in the scarcity of comparative studies with standardized methodology. Objective: It was to analyze, through a systematic review, the safety and efficacy of instrumentation with pedicle screws in the spine which have been questioned, despite its wide use for stabilization of the spine, comparing the complications present in the insertion techniques of pedicle screws. Methods: The rules of the Systematic Review-PRISMA were followed. The literary search process was carried out from January to March 2023. A bibliographic search was carried out in MEDLINE, PubMed, and Scielo for articles produced between 2001 and 2023. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. The Cohen test (Funnel Plot) and The Heterogeneity Test (Chi-Square Test – X²) were performed, with p Results and Conclusion: A total of 134 articles were found. A total of 67 articles were evaluated in full and 12 were selected to compose the results of this systematic review. According to the GRADE instrument, most studies (X² = 90.2% > 50%) followed a controlled clinical study model and had a good methodological design, with p < 0.05. It was shown that poor positioning of pedicle screws is the most common cause of complications. The surgeon’s skills and the length and diameter of the pedicle screw can also affect the different modes of placement. Robotic computer assistance has the potential to reduce the incidence of postoperative revisions. Mini

关 键 词：Pedicular Arthrodesis COMPLICATIONS Spinal Instrumentation 

分 类 号：R68[医药卫生—骨科学]