腰椎椎弓根螺钉位置不佳与术后神经症状的相关性分析

doi:10.3969/j.issn.1006-5725.2025.20.011

Abstract

Abstract:

Objective To analyze the correlation between the poor position of pedicle screw after lumbar internal fixation and the occurrence of postoperative neurological symptoms. Methods The clinical data of patients who underwent lumbar pedicle screw surgery in our hospital from January 2017 to December 2023 were analyzed retrospectively. Record the patient's sex， age， diagnosis， surgical segment， the presence of postoperative neurological complications， the types of neurological complications. According to the postoperative CT， the screw penetration zone and grade were evaluated， and the distribution of different pedicle screw penetration types was recorded. The correlation between different types of pedicle screw penetration and postoperative neurological symptoms was analyzed. Results A total of 184 patients were included， including 80 males and 104 females. Age ranged from 18 to 82 years， with an average of 60.1 ± 14.2 years. 35 patients developed new neurological symptoms after operation. The incidence of postoperative neurological symptoms caused by pedicle medial quadrant screw penetration and lower quadrant screw penetration was higher than that of pedicle superior quadrant and lateral quadrant screw penetration. From L1 to L5， the risk of postoperative neurological symptoms caused by screw penetration in the medial quadrant of the pedicle increases gradually. When the penetration distance of pedicle medial quadrant screws in L4 and L5 segments is ≥ 2mm， the risk of postoperative neurological symptoms is high. When the penetration distance of pedicle medial quadrant screws in L1， L2 and L3 segments is greater than 4mm， the risk of postoperative neurological symptoms is high. The distance of pedicle screw penetrating the medial quadrant of pedicle was positively correlated with the incidence of postoperative neurological symptoms （P < 0.05）. Conclusion The lateral and superior quadrants of the pedicle may be regarded as safety zones for lumbar pedicle screw placement. For the L1 ~ L3 segments， screw penetration depth should not exceed 4 mm； whereas for the L4 ~ L5 segments， the safety threshold must be strictly controlled within 2 mm.

Key words: lumbar spine, pedicle screws, neurological symptoms, screw malposition

CLC Number:

R687.3

Wen WAN,Weicheng CHEN,Weiwen CHEN,Ning ZHANG,Liuxue DU,Jiangwei CHEN,Rongping ZHOU,Zhili LIU,Shanhu HUANG,Jiaming. LIU. Correlation between poor position of lumbar pedicle screws and postoperative neurological symptoms[J]. The Journal of Practical Medicine, 2025, 41(20): 3220-3227.

Figures/Tables 11

Fig.1

Fig.2

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

Tab.6

Tab.7

Fig.3

Fig.4

References 28

[1]	ROY-CAMILLE R， SAILLANT G， BERTEAUX D， et al. Osteosynthesis of thoraco-lumbar spine fractures with metal plates screwed through the vertebral pedicles［J］. Reconstr Surg Traumatol， 1976， 15： 2-16.
[2]	ROY-CAMILLE R， SAILLANT G， MAZEL C. Internal fixation of the lumbar spine with pedicle screw plating［J］. Clin Orthop Relat Res， 1986（203）： 7-17. doi:10.1097/00003086-198602000-00003 doi: 10.1097/00003086-198602000-00003
[3]	梁庆芝. 应用椎弓根装置治疗胸腰段骨折合并脊髓损伤［J］. 实用医学杂志， 1998，14（5）： 357-358.
[4]	朱慧锋，王珠美，潘子毅，等. 椎弓根螺钉应用于腰椎间盘突出症研究进展［J］. 实用医学杂志， 2005，21（9）： 991-993.
[5]	刘正蓬，王雅辉，明颖，等. 基于3D打印的椎弓根螺钉置钉技术治疗胸腰段脊柱骨折的价值［J］. 实用医学杂志， 2019， 35（9）： 1453-1457.
[6]	LEDONIO C G T， POLLY D W， VITALE M G， et al. Pediatric pedicle screws： Comparative effectiveness and safety： A systematic literature review from the scoliosis research society and the pediatric orthopaedic society of North America task force［J］. J Bone Joint Surg Am， 2011， 93（13）： 1227-1234. doi:10.2106/jbjs.j.00678 doi: 10.2106/jbjs.j.00678
[7]	HICKS J M， SINGLA A， SHEN F H， et al. Complications of pedicle screw fixation in scoliosis surgery： A systematic review［J］. Spine， 2010， 35（11）： E465-E470. doi:10.1097/brs.0b013e3181d1021a doi: 10.1097/brs.0b013e3181d1021a
[8]	MERLOZ P， TONETTI J， PITTET L， et al. Pedicle screw placement using image guided techniques［J］. Clin Orthop Relat Res， 1998（354）： 39-48. doi:10.1097/00003086-199809000-00006 doi: 10.1097/00003086-199809000-00006
[9]	AUSTIN M S， VACCARO A R， BRISLIN B， et al. Image-guided spine surgery： A cadaver study comparing conventional open laminoforaminotomy and two image-guided techniques for pedicle screw placement in posterolateral fusion and nonfusion models［J］. Spine， 2002， 27（22）： 2503-2508. doi:10.1097/00007632-200211150-00015 doi: 10.1097/00007632-200211150-00015
[10]	KWAN M K， CHIU C K， GANI S M A， et al. Accuracy and safety of pedicle screw placement in adolescent idiopathic scoliosis patients： A review of 2020 screws using computed tomography assessment［J］. Spine， 2017， 42（5）： 326-335. doi:10.1097/brs.0000000000001738 doi: 10.1097/brs.0000000000001738
[11]	NAIK A， MACINNIS B R， SHAFFER A， et al. Trends in technology for pedicle screw placement： A temporal meta-analysis［J］. Spine， 2023， 48（11）： 791-799. doi:10.1097/brs.0000000000004604 doi: 10.1097/brs.0000000000004604
[12]	LOTFINIA I， SAYAHMELLI S， GAVAMI M. Postoperative computed tomography assessment of pedicle screw placement accuracy［J］. Turk Neurosurg， 2010， 20（4）： 500-507.
[13]	RAO G， BRODKE D S， RONDINA M， et al. Comparison of computerized tomography and direct visualization in thoracic pedicle screw placement［J］. J Neurosurg， 2002， 97（2 ）： 223-226. doi:10.3171/spi.2002.97.2.0223 doi: 10.3171/spi.2002.97.2.0223
[14]	MIRZA S K， WIGGINS G C， KUNTZ C， et al. Accuracy of thoracic vertebral body screw placement using standard fluoroscopy， fluoroscopic image guidance， and computed tomographic image guidance： A cadaver study［J］. Spine， 2003， 28（4）： 402-413. doi:10.1097/01.brs.0000048461.51308.cd doi: 10.1097/01.brs.0000048461.51308.cd
[15]	AHMADZADEH HESHMATI A， ILKA S. Accuracy assessment of freehand pedicular screw placement［J］. Arch Bone Jt Surgy， 2020， 8（4）： 519-523.
[16]	SÖYÜNCÜ Y， YILDIRIM F B， SEKBAN H， et al. Anatomic evaluation and relationship between the lumbar pedicle and adjacent neural structures： An anatomic study［J］. J Spinal Disord Tech， 2005， 18（3）： 243-246.
[17]	ATTAR A， UGUR H C， UZ A， et al. Lumbar pedicle： Surgical anatomic evaluation and relationships［J］. Eur Spine J， 2001， 10（1）： 10-15. doi:10.1007/s005860000198 doi: 10.1007/s005860000198
[18]	MATUR A V， PALMISCIANO P， DUAH H O， et al. Robotic and navigated pedicle screws are safer and more accurate than fluoroscopic freehand screws： A systematic review and meta-analysis［J］. Spine J， 2023， 23（2）： 197-208. doi:10.1016/j.spinee.2022.10.006 doi: 10.1016/j.spinee.2022.10.006
[19]	DAI Y， SHEN G， WANG J， et al. Efficacy and safety of robot-assisted pedicle screw placement in lumbar spondylolisthesis： A meta-analysis［J］. J Robot Surg， 2025， 19（1）： 369. doi:10.1007/s11701-025-02558-0 doi: 10.1007/s11701-025-02558-0
[20]	ZAMORANO L， LI Q， JAIN S， et al. Robotics in neurosurgery： State of the art and future technological challenges［J］. Int J Med Robot， 2004， 1（1）： 7-22. doi:10.1002/rcs.2 doi: 10.1002/rcs.2
[21]	李厚坤，闫亮，单乐群，等. 机器人与导航技术辅助椎弓根螺钉置入的准确性和疗效比较［J］. 中华骨科杂志， 2024， 44（13）：851-857.
[22]	AMATO V， GIANNACHI L， IRACE C， et al. Accuracy of pedicle screw placement in the lumbosacral spine using conventional technique： Computed tomography postoperative assessment in 102 consecutive patients［J］. J Neurosurg Spine， 2010， 12（3）： 306-313. doi:10.3171/2009.9.spine09261 doi: 10.3171/2009.9.spine09261
[23]	RAVI B， ZAHRAI A， RAMPERSAUD R. Clinical accuracy of computer-assisted two-dimensional fluoroscopy for the percutaneous placement of lumbosacral pedicle screws［J］. Spine， 2011， 36（1）： 84-91. doi:10.1097/brs.0b013e3181cbfd09 doi: 10.1097/brs.0b013e3181cbfd09
[24]	DEVITO D P， KAPLAN L， DIETL R， et al. Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot： Retrospective study［J］. Spine， 2010， 35（24）： 2109-2115. doi:10.1097/brs.0b013e3181d323ab doi: 10.1097/brs.0b013e3181d323ab
[25]	ABE Y， ITO M， ABUMI K， et al. A novel cost-effective computer-assisted imaging technology for accurate placement of thoracic pedicle screws［J］. J Neurosurg Spine， 2011， 15（5）： 479-485. doi:10.3171/2011.6.spine10721 doi: 10.3171/2011.6.spine10721
[26]	王邦. 骨盆解剖学参数对椎弓根螺钉置钉精确性的影响［D］. 大连：大连医科大学， 2024.
[27]	AO Y， ESFANDIARI H， CARRILLO F， et al. SafeRPlan： Safe deep reinforcement learning for intraoperative planning of pedicle screw placement［J］. Med Image Anal， 2025， 99： 103345. doi:10.1016/j.media.2024.103345 doi: 10.1016/j.media.2024.103345
[28]	AIGNER R， BICHLMAIER C， OBERKIRCHER L， et al. Pedicle screw accuracy in thoracolumbar fractures- is routine postoperative CT scan necessary？［J］. BMC Musculoskelet Disord， 2021， 22（1）： 986. doi:10.1186/s12891-021-04860-y doi: 10.1186/s12891-021-04860-y

象限	穿透分级	穿透螺钉/枚	产生神经症状数/例	神经症状发生率/%
上方象限
	1级	0	0	0.00
	2级	0	0	0.00
	3级	0	0	0.00
	合计	0	0	0.00
下方象限
	1级	15	2	13.30
	2级	8	1	12.50
	3级	1	1	100.00
	合计	24	4	16.70
内侧象限
	1级	60	2	3.30
	2级	71	11	15.50
	3级	28	18	64.30
	合计	159	31	19.50
外侧象限
	1级	13	0	0.00
	2级	16	0	0.00
	3级	7	0	0.00
	合计	36	0	0.00
总计		219	35	16.00

变量	单因素分析		多因素分析
变量	OR（95%CI）	P值	OR（95%CI）	P值
位置
内侧象限	1		1
外侧象限	0.06（0.00 ~ 0.41）	0.001	0.03（0.00 ~ 0.26）	< 0.001
下方象限	0.90（0.27 ~ 2.48）	0.842	2.03（0.53 ~ 6.81）	0.285
分级
1级	1		1
2级	2.81（0.98 ~ 9.64）	0.056	3.15（1.07 ~ 11.08）	0.037
3级	20.92（7.17 ~ 74.06）	< 0.001	33.17（10.21 ~ 131.97）	< 0.001

节段	穿透螺钉数/枚	产生神经症状螺钉数/枚	发生率/%	P值
L1	25	1	4.0	0.003
L2	29	2	6.9
L3	30	4	13.3
L4	39	11	28.2
L5	36	13	36.1

节段	不同穿透等级导致神经症状出现的螺钉率/%			P值
节段	1级	2级	3级	P值
P值*	0.180	0.029	0.328
L1	0.0	0.0	33.3	0.018
L2	0.0	0.0	40.0	0.003
L3	0.0	0.0	100.0	< 0.001
L4	7.1	31.6	66.7	0.021
L5	20.0	23.8	70.0	0.030

螺钉穿透分级	穿透螺钉数/枚	发生神经症状螺钉数/枚	发生率/%	P值
1级	60	2	3.3	< 0.001
2级	71	11	15.5
3级	18	18	64.3

Correlation between poor position of lumbar pedicle screws and postoperative neurological symptoms

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 11

References 28

Related Articles 10

Recommended Articles

Metrics

Comments

[1]	Gaokai HU,Ya'nan NIU,Yukang GONG,Yang HU,Ruixuan XU,Wenshan. GAO. Research progress on the application of deep learning in lumbar spine disease [J]. The Journal of Practical Medicine, 2025, 41(6): 921-928.
[2]	Bin ZHANG,Wei HU,Rongzhen TAN,Panpan YANG,Jun HU,Zhong YUAN,Gongtao. JIANG. Effects of Yishen Huayu Xugu prescription combined with Dixumab on IL-6， β-CTX and bone mineral density in elderly patients operated for osteoporotic lumbar vertebral compression fractures [J]. The Journal of Practical Medicine, 2024, 40(19): 2766-2771.
[3]	Wei ZHENG,Na LI,Lei LIU,Songtao LIU,Hai ZHOU,Jie LIU,Zhengquan HU,Liwei. WANG. Feasibility of monitoring the baseline of motor evoked potentials immediately after tracheal intubation without muscle relaxants in lumbar spine surgery [J]. The Journal of Practical Medicine, 2024, 40(16): 2298-2304.
[4]	WANG Xiaolu, YIN Zongsheng, LIU Yiming, MA Li, YU Xianshun.. Analysis of the curative effect and changes of spinopelvic parameters after multilevel lumbosacral fusion [J]. The Journal of Practical Medicine, 2023, 39(2): 224-229.
[5]	Mengxin XU,Wei WANG,Rongxiong. DAI. Construction of a column chart model for predicting postoperative delirium in patients with lumbar vertebral fractures based on novel inflammatory composite scoring [J]. The Journal of Practical Medicine, 2023, 39(18): 2306-2311.
[6]	PU Qingping, GUO Tao, SHI Xiangchun, TIAN Jin. . Application of CT angiography in anatomical study of anterior iliac vessels in the lower lumbar spine [J]. The Journal of Practical Medicine, 2023, 39(14): 1786-1792.
[7]	YANG Zhenyuan, ZHANG Jiwei, DENG Qiang.. Efficacy of 3D printing guide plate assisted percutaneous minimally invasive pedicle screw placement in the treatment of multi ⁃segment lumbar fractures [J]. The Journal of Practical Medicine, 2022, 38(15): 1930-1935.
[8]	WANG Weiwei, LIAN Hongkai. A prospective study of percutaneous transforaminal endoscopy on functional recovery and trauma degree of patients with huge lumbar disc herniation [J]. The Journal of Practical Medicine, 2021, 37(5): 648-653.
[9]	YU Hongwei, ZHOU Xuelian, CUI Xuewen. Establishment of a line chart prediction model for incisional complications after traditional open lumbar interbody fusion [J]. The Journal of Practical Medicine, 2021, 37(4): 513-517.
[10]	CHANG Yulin. Clinical observation of orthopedic traction combined with Sanchi spine reconstruction in the treatment of lumbar intervertebral disc protrusion#br# [J]. The Journal of Practical Medicine, 2020, 36(20): 2866-2870.

节段	螺钉总数	穿透1级	穿透2级	穿透3级
L1	25	10	12	3
L2	29	16	8	5
L3	30	15	11	4
L4	39	14	19	6
L5	36	5	21	10

节段	螺钉总数	穿透1级	穿透2级	穿透3级
L1	1	0	0	1
L2	2	0	0	2
L3	4	0	0	4
L4	11	1	6	4
L5	13	1	5	7