Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12

Pedicle screw fixation as an adjunct to posterolateral fusion

Michael W. Groff, Andrew T. Dailey, Zoher Ghogawala, Daniel K. Resnick, William C. Watters, Praveen V. Mummaneni, Tanvir F. Choudhri, Jason C. Eck, Alok Sharan, Jeffrey C. Wang, Sanjay S. Dhall, Michael G. Kaiser

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

The utilization of pedicle screw fixation as an adjunct to posterolateral lumbar fusion (PLF) has become routine, but demonstration of a definitive benefit remains problematic. The medical evidence indicates that the addition of pedicle screw fixation to PLF increases fusion rates when assessed with dynamic radiographs. More recent evidence, since publication of the 2005 Lumbar Fusion Guidelines, suggests a stronger association between radiographic fusion and clinical outcome, although, even now, no clear correlation has been demonstrated. Although several reports suggest that clinical outcomes are improved with the addition of pedicle screw fixation, there are conflicting findings from similarly classified evidence. Furthermore, the largest contemporary, randomized, controlled study on this topic failed to demonstrate a significant clinical benefit with the use of pedicle screw fixation in patients undergoing PLF for chronic low-back pain. This absence of proof should not, however, be interpreted as proof of absence. Several limitations continue to compromise these investigations. For example, in the majority of studies the sample size is insufficient to detect small increments in clinical outcome that may be observed with pedicle screw fixation. Therefore, no definitive statement regarding the efficacy of pedicle screw fixation as a means to improve functional outcomes in patients undergoing PLF for chronic low-back pain can be made. There appears to be consistent evidence suggesting that pedicle screw fixation increases the costs and complication rate of PLF. High-risk patients, including (but not limited to) patients who smoke, patients who are undergoing revision surgery, or patients who suffer from medical conditions that may compromise fusion potential, may appreciate a greater benefit with supplemental pedicle screw fixation. It is recommended, therefore, that the use of pedicle screw fixation as a supplement to PLF be reserved for those patients in whom there is an increased risk of nonunion when treated with only PLF.

Original languageEnglish (US)
Pages (from-to)75-78
Number of pages4
JournalJournal of Neurosurgery: Spine
Volume21
Issue number1
DOIs
StatePublished - 2014

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Spine
Guidelines
Low Back Pain
Pedicle Screws
Reoperation
Smoke
Sample Size
Publications
Costs and Cost Analysis

Keywords

  • Adjunct
  • Lumbar spine
  • Pedicle screw
  • Posterolateral fusion
  • Practice guidelines

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neurology

Cite this

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12 : Pedicle screw fixation as an adjunct to posterolateral fusion. / Groff, Michael W.; Dailey, Andrew T.; Ghogawala, Zoher; Resnick, Daniel K.; Watters, William C.; Mummaneni, Praveen V.; Choudhri, Tanvir F.; Eck, Jason C.; Sharan, Alok; Wang, Jeffrey C.; Dhall, Sanjay S.; Kaiser, Michael G.

In: Journal of Neurosurgery: Spine, Vol. 21, No. 1, 2014, p. 75-78.

Research output: Contribution to journalArticle

Groff, MW, Dailey, AT, Ghogawala, Z, Resnick, DK, Watters, WC, Mummaneni, PV, Choudhri, TF, Eck, JC, Sharan, A, Wang, JC, Dhall, SS & Kaiser, MG 2014, 'Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12: Pedicle screw fixation as an adjunct to posterolateral fusion', Journal of Neurosurgery: Spine, vol. 21, no. 1, pp. 75-78. https://doi.org/10.3171/2014.4.SPINE14277
Groff, Michael W. ; Dailey, Andrew T. ; Ghogawala, Zoher ; Resnick, Daniel K. ; Watters, William C. ; Mummaneni, Praveen V. ; Choudhri, Tanvir F. ; Eck, Jason C. ; Sharan, Alok ; Wang, Jeffrey C. ; Dhall, Sanjay S. ; Kaiser, Michael G. / Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 12 : Pedicle screw fixation as an adjunct to posterolateral fusion. In: Journal of Neurosurgery: Spine. 2014 ; Vol. 21, No. 1. pp. 75-78.
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abstract = "The utilization of pedicle screw fixation as an adjunct to posterolateral lumbar fusion (PLF) has become routine, but demonstration of a definitive benefit remains problematic. The medical evidence indicates that the addition of pedicle screw fixation to PLF increases fusion rates when assessed with dynamic radiographs. More recent evidence, since publication of the 2005 Lumbar Fusion Guidelines, suggests a stronger association between radiographic fusion and clinical outcome, although, even now, no clear correlation has been demonstrated. Although several reports suggest that clinical outcomes are improved with the addition of pedicle screw fixation, there are conflicting findings from similarly classified evidence. Furthermore, the largest contemporary, randomized, controlled study on this topic failed to demonstrate a significant clinical benefit with the use of pedicle screw fixation in patients undergoing PLF for chronic low-back pain. This absence of proof should not, however, be interpreted as proof of absence. Several limitations continue to compromise these investigations. For example, in the majority of studies the sample size is insufficient to detect small increments in clinical outcome that may be observed with pedicle screw fixation. Therefore, no definitive statement regarding the efficacy of pedicle screw fixation as a means to improve functional outcomes in patients undergoing PLF for chronic low-back pain can be made. There appears to be consistent evidence suggesting that pedicle screw fixation increases the costs and complication rate of PLF. High-risk patients, including (but not limited to) patients who smoke, patients who are undergoing revision surgery, or patients who suffer from medical conditions that may compromise fusion potential, may appreciate a greater benefit with supplemental pedicle screw fixation. It is recommended, therefore, that the use of pedicle screw fixation as a supplement to PLF be reserved for those patients in whom there is an increased risk of nonunion when treated with only PLF.",
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