TY - JOUR
T1 - Adjacent-segment disease after thoracic pedicle screw fixation
AU - Agarwal, Nitin
AU - Heary, Robert F.
AU - Agarwal, Prateek
N1 - Funding Information:
The online database PubMed (provided by the US National Library of Medicine at the National Institutes of Health) was used with appropriate Medical Subject Headings and the free subject terms “pedicle screw,” “thoracic spine,” and “adjacent segment disease.” The following terms were combined interchangeably with the first 3 terms: “fusion,” “fixation,” “review,” “therapy,” “case report,” “meta-analysis,” and “complication.” Selected references were used to provide descriptions of experiences regarding ASD after pedicle screw fixation. Additional references were obtained from articles that we reviewed.
Publisher Copyright:
© AANS 2018.
PY - 2018/3
Y1 - 2018/3
N2 - OBJECTIVE: Pedicle screw fixation is a technique widely used to treat conditions ranging from spine deformity to fracture stabilization. Pedicle screws have been used traditionally in the lumbar spine; however, they are now being used with increasing frequency in the thoracic spine as a more favorable alternative to hooks, wires, or cables. Although safety concerns, such as the incidence of adjacent-segment disease (ASD) after cervical and lumbar fusions, have been reported, such issues in the thoracic spine have yet to be addressed thoroughly. Here, the authors review the literature on ASD after thoracic pedicle screw fixation and report their own experience specifically involving the use of pedicle screws in the thoracic spine. METHODS: Select references from online databases, such as PubMed (provided by the US National Library of Medicine at the National Institutes of Health), were used to survey the literature concerning ASD after thoracic pedicle screw fixation. To include the authors' experience at Rutgers New Jersey Medical School, a retrospective review of a prospectively maintained database was performed to determine the incidence of complications over a 13-year period in 123 consecutive adult patients who underwent thoracic pedicle screw fixation. Children, pregnant or lactating women, and prisoners were excluded from the review. By comparing preoperative and postoperative radiographic images, the occurrence of thoracic ASD and disease within the surgical construct was determined. RESULTS: Definitive radiographic fusion was detected in 115 (93.5%) patients. Seven incidences of instrumentation failure and 8 lucencies surrounding the screws were observed. One patient was observed to have ASD of the thoracic spine. The mean follow-up duration was 50 months. CONCLUSIONS: This long-term radiographic evaluation revealed the use of pedicle screws for thoracic fixation to be an effective stabilization modality. In particular, ASD seems to be less of a problem in the relatively immobile thoracic spine than in the more mobile cervical and lumbar spines.
AB - OBJECTIVE: Pedicle screw fixation is a technique widely used to treat conditions ranging from spine deformity to fracture stabilization. Pedicle screws have been used traditionally in the lumbar spine; however, they are now being used with increasing frequency in the thoracic spine as a more favorable alternative to hooks, wires, or cables. Although safety concerns, such as the incidence of adjacent-segment disease (ASD) after cervical and lumbar fusions, have been reported, such issues in the thoracic spine have yet to be addressed thoroughly. Here, the authors review the literature on ASD after thoracic pedicle screw fixation and report their own experience specifically involving the use of pedicle screws in the thoracic spine. METHODS: Select references from online databases, such as PubMed (provided by the US National Library of Medicine at the National Institutes of Health), were used to survey the literature concerning ASD after thoracic pedicle screw fixation. To include the authors' experience at Rutgers New Jersey Medical School, a retrospective review of a prospectively maintained database was performed to determine the incidence of complications over a 13-year period in 123 consecutive adult patients who underwent thoracic pedicle screw fixation. Children, pregnant or lactating women, and prisoners were excluded from the review. By comparing preoperative and postoperative radiographic images, the occurrence of thoracic ASD and disease within the surgical construct was determined. RESULTS: Definitive radiographic fusion was detected in 115 (93.5%) patients. Seven incidences of instrumentation failure and 8 lucencies surrounding the screws were observed. One patient was observed to have ASD of the thoracic spine. The mean follow-up duration was 50 months. CONCLUSIONS: This long-term radiographic evaluation revealed the use of pedicle screws for thoracic fixation to be an effective stabilization modality. In particular, ASD seems to be less of a problem in the relatively immobile thoracic spine than in the more mobile cervical and lumbar spines.
KW - Adjacent-segment disease
KW - Pedicle screw fixation
KW - Thoracic fusion
UR - http://www.scopus.com/inward/record.url?scp=85042692673&partnerID=8YFLogxK
U2 - 10.3171/2017.6.SPINE1492
DO - 10.3171/2017.6.SPINE1492
M3 - Review article
C2 - 29243998
AN - SCOPUS:85042692673
SN - 1547-5654
VL - 28
SP - 280
EP - 286
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 3
ER -