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Mallepally AR, Marathe N, Menon S, Das K. Misplaced S1 screw causing L5 radiculopathy, rare and unusual presentation: a report of 2 cases. Br J Neurosurg 2024; 38:131-135. [PMID: 34396884 DOI: 10.1080/02688697.2021.1967286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Many spine surgeons are not optimally acquainted with anatomy anterior to sacrum. Screw malposition injuring these structures can lead to unwanted lethal consequences. We report unusual cases of acute radiculopathy due to misplaced bicortical sacral screw causing L5 nerve root impingement on anterior sacrum. A 39/M patient complained of severe rest pain (VAS 9/10) post TLIF in region of L5 dermatome with sensory deficit along the right lateral leg and straight leg raise less than 30°. X-ray revealed S1 screw protruding beyond the second cortex with a straight trajectory. CT scan revealed a protrusion of 11.4mm beyond anterior cortex. The patient was taken for re-surgery and the trajectory and length of screw was revised. Sciatic pain completely disappeared immediately after surgery. A 61/M patient operated elsewhere with instrumented decompression and fusion with screws passed at L4, L5 and S1 level for lumbar canal stenosis, post-surgery patient developed new onset radicular symptoms in right lower limb. Patient was managed conservatively in the form of L5 selective nerve root block. Pain and numbness improved. Bicortical purchase of S1 screw though improves pull out strength, is associated with a risk of neurovascular complications. Surgeons should be alerted to the misplacement of S1 pedicle screws to avoid involvement not only anterior to the anteromedial neurovascular tissue, but also anterolateral to the arrangement of the L5 nerve root.
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Affiliation(s)
| | - Nandan Marathe
- Department of spine services, Indian Spinal Injuries Centre, New Delhi, India
| | - Sreejith Menon
- Department of spine services, Indian Spinal Injuries Centre, New Delhi, India
| | - Kalidutta Das
- Department of spine services, Indian Spinal Injuries Centre, New Delhi, India
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Zhao L, Wan C, Han S, Li B, Zheng S. The study of distance changes between lumbar bi-cortical pedicle screws and anterior large vessels in patients with lumbar spondylolisthesis. BMC Musculoskelet Disord 2021; 22:920. [PMID: 34724945 PMCID: PMC8561981 DOI: 10.1186/s12891-021-04811-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This paper was a anatomical radiographic study of distance between lumbar bi-cortical pedicle screws (BPSs) and anterior large vessels (ALVs) in patients with lumbar spondylolisthesis, and to provide clinical basis for evaluating the safety of bi-cortical pedicle screw implantation during lumbar spondylolisthesis. METHODS Complete Computed tomography (CT) data of 104 patients with grade I lumbar spondylolisthesis (L4 52 and L5 52) and 107 non-spondylolisthesis patients (control group) were collected in this study. The distances between lumbar 4,5(L4,5) and sacrum 1(S1) BPSs and ALVs (abdominal aorta, inferior vena cava, left and right common iliac artery, internal and external iliac artery) were respectively measured at different transverse screw angles (TSAs) (L4:5°,10°; L5:10°,15°; S1:0°,5°,10°) and analyzed by SPSS (v25.0). There were three types of distances from the anterior vertebral cortex (AVC) to the ALVs (DAVC-ALV): DAVC-ALV N, DAVC-ALV ≥ 0.50 cm, and DAVC-ALV < 0.50 cm; these different distances represented non-contact, distant and close ALV respectively. RESULTS We calculated the incidences of screw tip contacting large vessels at different TSAs and provided the appropriate angle of screw implantation. In non-spondylolisthesis group, in L4, the appropriate left TSA was 5°, and the incidence of the close ALV was 4.62%. In S1, the appropriate left TSA was 0° and the incidence of the close ALV was 22.4%, while the appropriate right TSA was 10° and the incidence of the close ALV was 17.8%. In L4 spondylolisthesis group, in L4, the appropriate left TSA was 5°, and the incidence of the close ALV was 3.8%. In L5 spondylolisthesis group, in S1, the appropriate left TSA was 0° and the incidence of the close ALV was 19.2%, while the appropriate right TSA was 10° and the incidence of the close ALV was 21.2%. The use of BPS was not appropriate on the right side of L4 or on the either side of L5 both in spondylolisthesis and control group. In patients with lumbar 4 spondylolisthesis, the incidences of screw tip contacting large vessels were less than the control group in both L4 and 5. In patients with lumbar 5 spondylolisthesis, the incidences of screw tip contacting large vessels were less than the control group in L5, while there were no significant difference in S1. CONCLUSION It is very important that considering the anatomical relationship between the AVC and the ALVs while planning BPSs. The use of BPS does not apply to every lumbar vertebra. In patients with lumbar spondylolisthesis and non-spondylolisthesis patients, the incidences of screw tip contacting large vessels are different.
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Affiliation(s)
- Li Zhao
- Department of Cardiovascular surgery, Nanfang Hospital of Southern Medical University, Guangzhou, 510000, Guangdong, China
| | - Chenguang Wan
- Department of Neurosurgery, Tianjin First Central Hospital, Tianjin, 300000, China
| | - Shuhong Han
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical College, Chengde, 067000, Hebei, China
| | - Baofeng Li
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, The first School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, China.
| | - Shaoyi Zheng
- Department of Cardiovascular surgery, Nanfang Hospital of Southern Medical University, Guangzhou, 510000, Guangdong, China.
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Liu L, Wang H, Wang J, Wang Q, Cheng S, Li Y, Jin W, Wang Z, Zhou Q. The methods for inserting lumbar bicortical pedicle screws from the anatomical perspective of the prevertebral great vessels. BMC Musculoskelet Disord 2019; 20:380. [PMID: 31421678 PMCID: PMC6698330 DOI: 10.1186/s12891-019-2756-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 07/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND At present, bicortical pedicle screws (BPSs) are not used clinically because they carry the potential risk of damaging the prevertebral great vessels (PGVs). The authors observed the anatomical relationship between the PGVs and simulated BPSs at different transverse screw angles (TSAs), exploring the insertion method of the BPS. METHODS Computed tomography angiography (CTA) images from 65 adults were collected. A total of 4-5 TSAs of the BPSs were simulated on the left and right sides of L1-L5 (L1-L3: 0°, 5°, 10°, 15°; L4-L5: 0°, 5°, 10°, 15°, 20°). There were three types of distances from the anterior vertebral cortex (AVC) to the PGVs (DAVC-PGV); DAVC-PGV < 0.50 cm, DAVC-PGV ≥ 0.50 cm, and DAVC-PGV↑; these distances represented close, distant, and noncontact PGV, respectively. RESULTS The ratio of every type of PGV was calculated, and the appropriate TSA of the BPS was recommended. In L1, the recommended left TSA of the BPS was 0°, and the ratio of the close PGV was 7.69%, while the recommended right TSA was 0°-10°, and the ratio of the close PGV was 1.54-4.62%. In L2, the recommended left TSA of the BPS was 0° and the ratio of the close PGV was 1.54%, while the recommended right TSA was 0°-15° and the ratio of the close PGV was 3.08-9.23%. In L3, the recommended left TSA was 0°-5°, and the ratio of the close PGV was 1.54-4.62%. In L4, the recommended left TSA was 0°, and the ratio of the close PGV was 4.62%. BPS use was not recommended on the right side of either L3 or L4 or on the either side of L5. CONCLUSIONS From the anatomical perspective of the PGVs, BPSs were not suitable for insertion into every lumbar vertebra. Furthermore, the recommended methods for inserting BPSs were different in L1-L4.
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Affiliation(s)
- Liehua Liu
- Department of Spine Surgery, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), 1 Shuanghu Branch Road, Yubei District, Chongqing, 401120, China.,Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Haoming Wang
- Department of Orthopedics, Three Gorges Central Hospital, Chongqing, 404000, China
| | - Jiangang Wang
- Department of Orthopedics, No. 13 People's Hospital of Chongqing, Chongqing, 400053, China
| | - Qian Wang
- Hillsborough Community College, Tampa, FL, 33614, USA
| | - Shiming Cheng
- Department of Orthopedics, Chongqing Dongnan Hospital, Chongqing, 401336, China
| | - Ying Li
- Department of Radiology, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Weidong Jin
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Zili Wang
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Qiang Zhou
- Department of Spine Surgery, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), 1 Shuanghu Branch Road, Yubei District, Chongqing, 401120, China.
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Liu L, Wang H, Wang Q, Wang J, Liang Y, Li Y, Liang Q, Jin W, Zhou Q, Wang Z. A Study of the Sagittal Angle of Lumbar Bicortical Pedicle Screws from the Anatomic Perspective of the Lumbar Artery. World Neurosurg 2019; 125:e435-e441. [PMID: 30708080 DOI: 10.1016/j.wneu.2019.01.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To observe anatomic relationships between lumbar bicortical pedicle screws (BPSs) at 2 sagittal section angles (SSAs) and lumbar artery (LA). METHODS We observed 2 SSAs, vertical angle and cephalic angle, of the BPS. The positions at which the BPS breaks through the anterior vertebral cortex were defined as point A and point B. Distances from point A and point B to LAs were measured. The percentage of risk of injury to LAs was calculated according to these distances. RESULTS At the same transverse section angle on the left and right side in L1 and L2, distance from point A to LA was significantly greater than distance from point B to LA (P < 0.001) except at a transverse section angle of 0° on the right side in L2 (P > 0.05). At the same transverse section angle on the left in L3 and L4, distance from point B to LA was significantly greater than distance from point A to LA (P < 0.001). The percentages of high risk of injury to the LA resulting from BPSs at the vertical angle in L1 and L2 were 0%-6.2%. The percentages of high risk of injury to the LA resulting from BPSs at the cephalic angle on the left side in L3 and L4 were 0%-18.5%. CONCLUSIONS Lumbar BPSs present a risk of injury to the LA. The vertical angle is the recommended SSA for BPSs in L1 and L2, and the cephalic angle is the recommended SSA in L3 and L4.
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Affiliation(s)
- Liehua Liu
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, China; Department of Spine Surgery, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
| | - Haoming Wang
- Department of Orthopedics, Three Gorges Central Hospital, Chongqing, China
| | - Qian Wang
- Hillsborough Community College, Tampa, Florida, USA
| | - Jiangang Wang
- Department of Orthopedics, No. 13 People's Hospital of Chongqing, Chongqing, China
| | - Yong Liang
- Department of Radiology, Southwest Hospital, The Army (Third Military) Medical University, Chongqing, China
| | - Ying Li
- Department of Radiology, Southwest Hospital, The Army (Third Military) Medical University, Chongqing, China
| | - Qiang Liang
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Weidong Jin
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Qiang Zhou
- Department of Spine Surgery, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
| | - Zili Wang
- Department of Spinal Surgery, General Hospital of Ningxia Medical University, Yinchuan, China.
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Wang Y, Hu W, Hu F, Zhang H, Wang T, Wang Y, Zhang X. Proper detailed parameters for S1 sacral alar iliac screw placement in the Chinese population, a 3D imaging study. J Orthop Surg Res 2018; 13:39. [PMID: 29482590 PMCID: PMC6389092 DOI: 10.1186/s13018-018-0739-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/02/2018] [Indexed: 11/12/2022] Open
Abstract
Background S1-AI technique may be used as a salvage technique in pelvic fixation of complex spinal deformity surgery. However, the proper detailed parameters in the Chinese population has not been analyzed before to instruct S1-AI screws placement and to ensure the safety of clinical application while the trajectory in pelvic changes significantly at each angle. Results The ideal S1AI screw trajectory could be obtained in 28 of 30 female patient images (93.3%) and in all of the male patient images (100%). The screws that have already been used clinically in S2AI pathways can be applied in S1AI fixations. Conclusion It is feasible to place S1AI screws in 93.3% of female Chinese adult patients and in all male Chinese patients. Preoperative CT reconstruction should be performed to evaluate proper trajectory parameters and to avoid anterior violation.
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Affiliation(s)
- Yao Wang
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China
| | - Wenhao Hu
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China
| | - Fanqi Hu
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China
| | - Hao Zhang
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China
| | - Tianhao Wang
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China
| | - Yan Wang
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China.
| | - Xuesong Zhang
- Chinese PLA General Hospital, 28th Fuxing Road, Beijing, China.
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