Risk of neurologic deficit in medially breached pedicle screws assessed by computed tomography: a systematic review
Pedicle screws are commonly used for vertebral instrumentation, and a postoperative computed tomography (CT) scan is used to evaluate their position within the pedicle. Medial pedicle screw breaching occurs in 20%–40% of cases. This study investigated the correlation between radiographically evident...
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| Format: | Article |
| Language: | English |
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Korean Spine Society
2024-12-01
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| Series: | Asian Spine Journal |
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| Online Access: | http://asianspinejournal.org/upload/pdf/asj-2024-0325.pdf |
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| author | Rahmad Mulyadi Witantra Dhamar Hutami Kevin Dilian Suganda Dhiya Farah Khalisha |
| author_facet | Rahmad Mulyadi Witantra Dhamar Hutami Kevin Dilian Suganda Dhiya Farah Khalisha |
| author_sort | Rahmad Mulyadi |
| collection | DOAJ |
| description | Pedicle screws are commonly used for vertebral instrumentation, and a postoperative computed tomography (CT) scan is used to evaluate their position within the pedicle. Medial pedicle screw breaching occurs in 20%–40% of cases. This study investigated the correlation between radiographically evident medial breaching and the incidence of nerve injury, shedding light on the clinical implications. A literature search was conducted on biomedical databases regarding neurologic deficits associated with medially breached pedicle screws with pre-defined inclusion and exclusion criteria. The methodology of the included studies was analyzed, and a systematic review and meta-analysis were performed to investigate the correlation between medial breach on axial CT and clinical neurologic deficits. Our study included thirteen articles. Medial breaches <2 mm caused no neurologic deficit. Medial breaches of 2–4 mm increased the risk of neurologic deficit by 83%, with a risk ratio of 0.17. Breaches exceeding 4 mm increased the risk by 90%, with a risk ratio of 0.1, and were associated with radiculopathy or muscle weakness in 25%–100% of cases. Medial pedicle screw breaches <2 mm are safe, carrying no risk of neurologic injury. Breaches exceeding ≥2 mm significantly increase this risk. For patients experiencing new neurologic deficit (sensory or motor) after pedicle screw instrumentation, particularly in lumbar vertebrae, a postoperative axial CT scan is recommended to identify breaches exceeding 2 mm as the potential cause of neurologic deficit. |
| format | Article |
| id | doaj-art-94e15c75f0ee4f64bb3ec67e566a585d |
| institution | OA Journals |
| issn | 1976-1902 1976-7846 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Korean Spine Society |
| record_format | Article |
| series | Asian Spine Journal |
| spelling | doaj-art-94e15c75f0ee4f64bb3ec67e566a585d2025-08-20T01:52:19ZengKorean Spine SocietyAsian Spine Journal1976-19021976-78462024-12-0118690391210.31616/asj.2024.03251692Risk of neurologic deficit in medially breached pedicle screws assessed by computed tomography: a systematic reviewRahmad Mulyadi0Witantra Dhamar Hutami1Kevin Dilian Suganda2Dhiya Farah Khalisha3 Department of Radiology, Dr. Cipto Mangunkusumo National Central Public Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo National Central Public Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia Department of Radiology, Dr. Cipto Mangunkusumo National Central Public Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia Department of Radiology, Dr. Cipto Mangunkusumo National Central Public Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, IndonesiaPedicle screws are commonly used for vertebral instrumentation, and a postoperative computed tomography (CT) scan is used to evaluate their position within the pedicle. Medial pedicle screw breaching occurs in 20%–40% of cases. This study investigated the correlation between radiographically evident medial breaching and the incidence of nerve injury, shedding light on the clinical implications. A literature search was conducted on biomedical databases regarding neurologic deficits associated with medially breached pedicle screws with pre-defined inclusion and exclusion criteria. The methodology of the included studies was analyzed, and a systematic review and meta-analysis were performed to investigate the correlation between medial breach on axial CT and clinical neurologic deficits. Our study included thirteen articles. Medial breaches <2 mm caused no neurologic deficit. Medial breaches of 2–4 mm increased the risk of neurologic deficit by 83%, with a risk ratio of 0.17. Breaches exceeding 4 mm increased the risk by 90%, with a risk ratio of 0.1, and were associated with radiculopathy or muscle weakness in 25%–100% of cases. Medial pedicle screw breaches <2 mm are safe, carrying no risk of neurologic injury. Breaches exceeding ≥2 mm significantly increase this risk. For patients experiencing new neurologic deficit (sensory or motor) after pedicle screw instrumentation, particularly in lumbar vertebrae, a postoperative axial CT scan is recommended to identify breaches exceeding 2 mm as the potential cause of neurologic deficit.http://asianspinejournal.org/upload/pdf/asj-2024-0325.pdfpedicle screwsmedial breachingaxial computed tomographyneurologic deficitrisk |
| spellingShingle | Rahmad Mulyadi Witantra Dhamar Hutami Kevin Dilian Suganda Dhiya Farah Khalisha Risk of neurologic deficit in medially breached pedicle screws assessed by computed tomography: a systematic review Asian Spine Journal pedicle screws medial breaching axial computed tomography neurologic deficit risk |
| title | Risk of neurologic deficit in medially breached pedicle screws assessed by computed tomography: a systematic review |
| title_full | Risk of neurologic deficit in medially breached pedicle screws assessed by computed tomography: a systematic review |
| title_fullStr | Risk of neurologic deficit in medially breached pedicle screws assessed by computed tomography: a systematic review |
| title_full_unstemmed | Risk of neurologic deficit in medially breached pedicle screws assessed by computed tomography: a systematic review |
| title_short | Risk of neurologic deficit in medially breached pedicle screws assessed by computed tomography: a systematic review |
| title_sort | risk of neurologic deficit in medially breached pedicle screws assessed by computed tomography a systematic review |
| topic | pedicle screws medial breaching axial computed tomography neurologic deficit risk |
| url | http://asianspinejournal.org/upload/pdf/asj-2024-0325.pdf |
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