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Peterson JC, Arnold PM, Smith ZA, et al. Misplaced Cervical Screws Requiring Reoperation. Global Spine J. 2017;7(1):46S-52Sdoi: 10.1177/2192568216687527.
Peterson, J. C., Arnold, P. M., Smith, Z. A., Hsu, W. K., Fehlings, M. G., Hart, R. A., Hilibrand, A. S., Nassr, A., Rahman, R. K., Tannoury, C. A., Tannoury, T., Mroz, T. E., Currier, B. L., De Giacomo, A. F., Fogelson, J. L., Jobse, B. C., Massicotte, E. M., & Riew, K. D. (2017). Misplaced Cervical Screws Requiring Reoperation. Global spine journal, 7(1), 46S-52S. https://doi.org/10.1177/2192568216687527
Peterson, Jeremy C, et al. "Misplaced Cervical Screws Requiring Reoperation." Global spine journal vol. 7,1 (2017): 46S-52S. doi: https://doi.org/10.1177/2192568216687527
Peterson JC, Arnold PM, Smith ZA, Hsu WK, Fehlings MG, Hart RA, Hilibrand AS, Nassr A, Rahman RK, Tannoury CA, Tannoury T, Mroz TE, Currier BL, De Giacomo AF, Fogelson JL, Jobse BC, Massicotte EM, Riew KD. Misplaced Cervical Screws Requiring Reoperation. Global Spine J. 2017 Apr;7(1):46S-52S. doi: 10.1177/2192568216687527. Epub 2017 Apr 01. PMID: 28451491; PMCID: PMC5400184.
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Global Spine J. 2017 Apr;7(1):46S-52S. doi: 10.1177/2192568216687527. Epub 2017 Apr 01.

Misplaced Cervical Screws Requiring Reoperation.

Global spine journal

Jeremy C Peterson, Paul M Arnold, Zachary A Smith, Wellington K Hsu, Michael G Fehlings, Robert A Hart, Alan S Hilibrand, Ahmad Nassr, Ra'Kerry K Rahman, Chadi A Tannoury, Tony Tannoury, Thomas E Mroz, Bradford L Currier, Anthony F De Giacomo, Jeremy L Fogelson, Bruce C Jobse, Eric M Massicotte, K Daniel Riew

Affiliations

  1. University of Kansas Medical Center, Kansas City, KS, USA.
  2. Northwestern University, Chicago, IL, USA.
  3. Toronto Western Hospital, Toronto, Ontario, Canada.
  4. Oregon Health & Science University, Portland, OR, USA.
  5. Jefferson Medical College, The Rothman Institute, Philadelphia, PA, USA.
  6. Mayo Clinic, Rochester, MN, USA.
  7. Springfield Clinic, LLP, Springfield, IL, USA.
  8. Southern Illinois University, Springfield, IL, USA.
  9. Boston University Medical Center, Boston, MA, USA.
  10. Cleveland Clinic, Cleveland, OH, USA.
  11. Boston University, Boston, MA, USA.
  12. University of Toronto, Toronto, Ontario, Canada.
  13. Columbia University, New York, NY, USA.
  14. New York-Presbyterian/The Allen Hospital, New York, NY, USA.

PMID: 28451491 PMCID: PMC5400184 DOI: 10.1177/2192568216687527

Abstract

STUDY DESIGN: A multicenter, retrospective case series.

OBJECTIVE: In the past several years, screw fixation of the cervical spine has become commonplace. For the most part, this is a safe, low-risk procedure. While rare, screw backout or misplaced screws can lead to morbidity and increased costs. We report our experiences with this uncommon complication.

METHODS: A multicenter, retrospective case series was undertaken at 23 institutions in the United States. Patients were included who underwent cervical spine surgery from January 1, 2005, to December 31, 2011, and had misplacement of screws requiring reoperation. Institutional review board approval was obtained at all participating institutions, and detailed records were sent to a central data center.

RESULTS: A total of 12 903 patients met the inclusion criteria and were analyzed. There were 11 instances of screw backout requiring reoperation, for an incidence of 0.085%. There were 7 posterior procedures. Importantly, there were no changes in the health-related quality-of-life metrics due to this complication. There were no new neurologic deficits; a patient most often presented with pain, and misplacement was diagnosed on plain X-ray or computed tomography scan. The most common location for screw backout was C6 (36%).

CONCLUSIONS: This study represents the largest series to tabulate the incidence of misplacement of screws following cervical spine surgery, which led to revision procedures. The data suggest this is a rare event, despite the widespread use of cervical fixation. Patients suffering this complication can require revision, but do not usually suffer neurologic sequelae. These patients have increased cost of care. Meticulous technique and thorough knowledge of the relevant anatomy are the best means of preventing this complication.

Keywords: cervical spine; complication; fusion; instrumentation; misplaced screw; screw backout

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Jeremy C. Peter

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