Misplaced cervical screws requiring reoperation

Jeremy C. Peterson, Paul M. Arnold, Zachary A. Smith, Wellington K. Hsu, Michael G. Fehlings, Robert Hart, Alan S. Hilibrand, Ahmad Nassr, Ra'Kerry K. Rahman, Chadi A. Tannoury, Tony Tannoury, Thomas E. Mroz, Bradford L. Currier, Anthony F. De Giacomo, Jeremy L. Fogelson, Bruce C. Jobse, Eric M. Massicotte, K. Daniel Riew

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Study Design: A multicenter, retrospective case series. Objective: In the past several years, screw fixation of the cervical spine has become commonplace. For the most part, this is a safe, low-risk procedure. While rare, screw backout or misplaced screws can lead to morbidity and increased costs. We report our experiences with this uncommon complication. Methods: A multicenter, retrospective case series was undertaken at 23 institutions in the United States. Patients were included who underwent cervical spine surgery from January 1, 2005, to December 31, 2011, and had misplacement of screws requiring reoperation. Institutional review board approval was obtained at all participating institutions, and detailed records were sent to a central data center. Results: A total of 12 903 patients met the inclusion criteria and were analyzed. There were 11 instances of screw backout requiring reoperation, for an incidence of 0.085%. There were 7 posterior procedures. Importantly, there were no changes in the health-related quality-of-life metrics due to this complication. There were no new neurologic deficits; a patient most often presented with pain, and misplacement was diagnosed on plain X-ray or computed tomography scan. The most common location for screw backout was C6 (36%). Conclusions: This study represents the largest series to tabulate the incidence of misplacement of screws following cervical spine surgery, which led to revision procedures. The data suggest this is a rare event, despite the widespread use of cervical fixation. Patients suffering this complication can require revision, but do not usually suffer neurologic sequelae. These patients have increased cost of care. Meticulous technique and thorough knowledge of the relevant anatomy are the best means of preventing this complication.

Original languageEnglish (US)
Pages (from-to)46S-52S
JournalGlobal Spine Journal
Volume7
Issue number1_suppl
DOIs
StatePublished - Apr 1 2017

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Reoperation
Spine
Costs and Cost Analysis
X Ray Computed Tomography
Research Ethics Committees
Incidence
Neurologic Manifestations
Nervous System
Anatomy
Quality of Life
Morbidity
Pain

Keywords

  • cervical spine
  • complication
  • fusion
  • instrumentation
  • misplaced screw
  • screw backout

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Peterson, J. C., Arnold, P. M., Smith, Z. A., Hsu, W. K., Fehlings, M. G., Hart, R., ... Riew, K. D. (2017). Misplaced cervical screws requiring reoperation. Global Spine Journal, 7(1_suppl), 46S-52S. https://doi.org/10.1177/2192568216687527

Misplaced cervical screws requiring reoperation. / Peterson, Jeremy C.; Arnold, Paul M.; Smith, Zachary A.; Hsu, Wellington K.; Fehlings, Michael G.; Hart, Robert; Hilibrand, Alan S.; Nassr, Ahmad; Rahman, Ra'Kerry K.; Tannoury, Chadi A.; Tannoury, Tony; Mroz, Thomas E.; Currier, Bradford L.; De Giacomo, Anthony F.; Fogelson, Jeremy L.; Jobse, Bruce C.; Massicotte, Eric M.; Riew, K. Daniel.

In: Global Spine Journal, Vol. 7, No. 1_suppl, 01.04.2017, p. 46S-52S.

Research output: Contribution to journalArticle

Peterson, JC, Arnold, PM, Smith, ZA, Hsu, WK, Fehlings, MG, Hart, R, Hilibrand, AS, Nassr, A, Rahman, RKK, Tannoury, CA, Tannoury, T, Mroz, TE, Currier, BL, De Giacomo, AF, Fogelson, JL, Jobse, BC, Massicotte, EM & Riew, KD 2017, 'Misplaced cervical screws requiring reoperation', Global Spine Journal, vol. 7, no. 1_suppl, pp. 46S-52S. https://doi.org/10.1177/2192568216687527
Peterson JC, Arnold PM, Smith ZA, Hsu WK, Fehlings MG, Hart R et al. Misplaced cervical screws requiring reoperation. Global Spine Journal. 2017 Apr 1;7(1_suppl):46S-52S. https://doi.org/10.1177/2192568216687527
Peterson, Jeremy C. ; Arnold, Paul M. ; Smith, Zachary A. ; Hsu, Wellington K. ; Fehlings, Michael G. ; Hart, Robert ; Hilibrand, Alan S. ; Nassr, Ahmad ; Rahman, Ra'Kerry K. ; Tannoury, Chadi A. ; Tannoury, Tony ; Mroz, Thomas E. ; Currier, Bradford L. ; De Giacomo, Anthony F. ; Fogelson, Jeremy L. ; Jobse, Bruce C. ; Massicotte, Eric M. ; Riew, K. Daniel. / Misplaced cervical screws requiring reoperation. In: Global Spine Journal. 2017 ; Vol. 7, No. 1_suppl. pp. 46S-52S.
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abstract = "Study Design: A multicenter, retrospective case series. Objective: In the past several years, screw fixation of the cervical spine has become commonplace. For the most part, this is a safe, low-risk procedure. While rare, screw backout or misplaced screws can lead to morbidity and increased costs. We report our experiences with this uncommon complication. Methods: A multicenter, retrospective case series was undertaken at 23 institutions in the United States. Patients were included who underwent cervical spine surgery from January 1, 2005, to December 31, 2011, and had misplacement of screws requiring reoperation. Institutional review board approval was obtained at all participating institutions, and detailed records were sent to a central data center. Results: A total of 12 903 patients met the inclusion criteria and were analyzed. There were 11 instances of screw backout requiring reoperation, for an incidence of 0.085{\%}. There were 7 posterior procedures. Importantly, there were no changes in the health-related quality-of-life metrics due to this complication. There were no new neurologic deficits; a patient most often presented with pain, and misplacement was diagnosed on plain X-ray or computed tomography scan. The most common location for screw backout was C6 (36{\%}). Conclusions: This study represents the largest series to tabulate the incidence of misplacement of screws following cervical spine surgery, which led to revision procedures. The data suggest this is a rare event, despite the widespread use of cervical fixation. Patients suffering this complication can require revision, but do not usually suffer neurologic sequelae. These patients have increased cost of care. Meticulous technique and thorough knowledge of the relevant anatomy are the best means of preventing this complication.",
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AU - Hart, Robert

AU - Hilibrand, Alan S.

AU - Nassr, Ahmad

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