Complications of bilateral pedicle screw fixation and interbody fusion under intermuscular approach for lumbar disease
WU Hongfei, SONG Guohao, SONG Yongxing, GE Juntong, ZENG Zhongyou
Orthopedic Medical Center of Chinese People's Armed Police Force / Department of Spine and Joint, Coast Guard Hospital of Chinese People's Armed Police Force, Jiaxing 314000, China
Abstract：Objective To investigate the features and causes of complications of single or two-level lumbar lesions treated with bilateral pedicle screw fixation and interbody fusion under intermuscular approach.Methods Retrospective analysis was performed on 506 patients with lumbar vertebra diseases who underwent bilateral pedicle screw fixation and interbody fusion implant bone grafting in Coast Guard Hospital from June 2012 to June 2019. The clinical results, imaging results and complication were observed.Results Eleven cases were lost in the follow-up, and 495 cases were followed up for 6-84 months, with an average of (35.76±16.82) months. At the final follow-up, the VAS scores and ODI indexes of lumbago were well recovered, and the Cobb angle of coronal and sagittal lumbar spine was significantly improved, with statistical differences(P＜0.05)compared with the preoperative results. Complications were as follows, cerebrospinal fluid leakage appeared in 7 cases (1.38%); pedicle entry point fracture occurred in 11 cases (2.17%), with single level in 4 cases and two-level in 7 cases. End plate injury occurred in 15 cases (2.96%), of which 9 cases were caused by bone loss or osteoporosis, 5 cases were caused by banana fusion device, and 1 other case. There were 10 cases (1.98%) of incision problems, including 6 cases of local skin necrosis, 3 cases of poor incision healing, and 1 case of deep incision infection. In 5 cases (1%), 3 cases were considered to be due to incorrect pedicle screw position, and 2 cases were considered to be due to intraoperative manipulation. Two cases (0.40%) had the fusion device shifted backward. Four cases (0.78%) underwent reoperation, including 3 cases of internal fixation adjustment and 1 case of deep incision infection. A total of 54 complications occurred (9.88%).Conclusions Bilateral pedicle screw fixation with interbody fusion graft under posterior intermuscular space approach has good clinical effect and many clinical advantages in the treatment of single or two-level lumbar diseases, but there are also complications, especially in the early stage of development, which need to be prevented.
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2023, Vol. 34 
