Pedicle Screw Loosening After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis in Upper and Lower Instrumented Vertebrae Having Major Perforation

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Study Design.

A retrospective chart review.


The aim of this study was to investigate the incidence and characteristics of screw loosening in surgically treated adolescent idiopathic scoliosis (AIS) patients.

Summary of Background Data.

Pedicle screws are widely used in posterior spinal fusion for AIS, although postoperative loosening can occur. However, few reports exist on screw loosening after pedicle screw fixation in young scoliosis patients and the etiology of loosening is not well known.


One hundred twenty AIS patients (9 males, 111 females; mean age: 15.0 years) who had received pedicle screw fixation were retrospectively reviewed. All patients underwent routine computed tomography (CT) reconstruction scans at 6 months postoperatively to assess screw position, bony fusion, and the presence of screw loosening. The perforation status of each pedicle screw was assigned a grade of 0 to 3 using Rao classification.


Forty-three of 1624 (2.6%) screws showed evidence of loosening on CT. Screw loosening rates according to vertebral insertion level were upper instrumented vertebra (UIV): 9.6%; lower instrumented vertebra (LIV): 5.4%; one vertebra below the UIV: 1.8%; one vertebra above the LIV: 0.5%; two vertebrae below the UIV: 1.2%; and three vertebrae below the UIV: 0.9%. Screw loosening rates based on screw perforation grade were Grade 0: 1.4%; Grade 1: 3.1%; Grade 2: 15.5%; and Grade 3: 15.2%. Multivariate analysis revealed a distance from the UIV or LIV of one vertebra as well as the presence of major perforation to be independent factors affecting screw loosening. The odds ratios (ORs) of UIV/LIV insertion and major perforation were 73.4 and 17.2, respectively. When major perforations occurred in the UIV or LIV, the OR for loosening approached 1262.


Pedicle screw loosening after posterior spinal fusion in AIS patients tend to occur in the UIV or LIV. Major screw perforation is also significantly associated with screw loosening. The risk of loosening becomes compounded when major perforations are present in the UIV or LIV.


Level of Evidence: 4

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