Vertebral fracture after removing pedicle screws used for posterior lumbar interbody fusion: A case report

Kentaro Mataki, Makoto Fukushima, Koji Kaneoka, Kotaro Ikeda, Hiroshi Kumagai, Katsuya Nagashima, Kousei Miura, Hiroshi Noguchi, Toru Funayama, Tetsuya Abe, Masao Koda, Masashi Yamazaki

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Abstract

It is uncommon to remove pedicle screws after posterolateral lumbar interbody fusion (PLIF), and there are a few case reports of vertebral fracture involving holes remaining after screw removal. We report a case of the vertebral fracture after removing pedicle screws instrumented for PLIF. A 66-year-old woman with osteopenia, who underwent PLIF at L4–S1 10 years earlier, underwent PLIF at L3–L4 to correct adjacent-segment degeneration. We removed L5 and S1 pedicle screws, and inserted L3 pedicle screws. After surgery, she presented with severe progressive low back pain. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed an L5 body fracture involving the pedicle screw holes. Revision surgery, including posterolateral fusion from L3 to S2 alar iliac and L5 vertebroplasty, was performed. One year after the revision surgery, the patient remained pain-free and returned to normal activity. Possible reasons for instrumented vertebral body fracture after pedicle screw removal are decrease of vertebral mass, increased mechanical stress caused by PLIF at the adjacent segment, stress-shielding-related osteopenia, and spinal imbalance. Vertebral body fractures associated with spinal implant removal are rare, but possible, especially in elderly patients with osteopenia and osteoporosis.

Original languageEnglish
JournalJournal of Clinical Neuroscience
DOIs
Publication statusAccepted/In press - 2018 Jan 1

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Keywords

  • Pedicle screw removal
  • Posterolateral lumbar interbody fusion
  • Vertebral fracture

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Cite this

Mataki, K., Fukushima, M., Kaneoka, K., Ikeda, K., Kumagai, H., Nagashima, K., Miura, K., Noguchi, H., Funayama, T., Abe, T., Koda, M., & Yamazaki, M. (Accepted/In press). Vertebral fracture after removing pedicle screws used for posterior lumbar interbody fusion: A case report. Journal of Clinical Neuroscience. https://doi.org/10.1016/j.jocn.2018.04.019