Simple New Screw Insertion Technique without Extraction for Broken Pedicle Screws

Publication date: May 2018
Source:World Neurosurgery, Volume 113
Author(s): Jin-Sang Kil, Jong-Tae Park
ObjectiveSpinal transpedicular screw fixation is widely performed. Broken pedicle screw rates range from 3%–7.1%. Several techniques have been described for extraction of broken pedicle screws. However, most of these techniques require special instruments. We describe a simple, modified technique for management of broken pedicle screws without extraction. No special instruments or drilling in an adjacent pedicle are required.MethodsWe used a high-speed air drill with a round burr. With C-arm fluoroscopy guidance, the distal fragment of a broken pedicle screw was palpated using free-hand technique through the screw entry hole. A high-speed air drill with a round burr (not a diamond burr) was inserted through the hole. Drilling began slowly and continued until enough space was obtained for new screw insertion. Using this space, we performed new pedicle screw fixation medially alongside the distal fragment of the broken pedicle screw. We performed the insertion with a previously used entry hole and pathway in the pedicle. The same size pedicle screw was used.ResultsThree patients were treated with this modified technique. New screw insertion was successful in all cases after partial drilling of the distal broken pedicle screw fragment. There were no complications, such as screw loosening, dural tears, or root injury.ConclusionWe describe a simple, modified technique for management of broken pedicle screws without extraction. This technique is recommended in patients who require insertion of a new screw.



from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2I8CagJ