Clinical Significance of the Radiolucent Zone Around the Pedicle Screws in the Lumbar Degenerative Disease

곽종일; 김현준; 선상규; 이규열

Study design: A retrospective study. Objective: To analyze the clinical significance of the radiolucent zones surrounding pedicle screws. Summary of Literature Review: Clear zones have been suggested in pseudoarthrosis and a loss of fixation. However, few reports have clearly described the long-term course and clinical significance of clear zones. Materials and Methods: The clear zones were evaluated in 399 patients with pedicle screw fixation after 6 months, 1 year, 2 years and 3 years. The patient was considered to be clear zone positive when 1 mm or greater circumferential lucency was confirmed around a screw on film from 2 or more directions. The time-course of the clear zones was examined with regard to age, number of levels fused, bone union, fusion method and reoperation. Results: After 6 months, clear zones were observed in 124 patients (31.1%) but the clear zone-positive rate decreased with time. Clear zones were observed in 89 patients(22.3%), 44 patients(11.0%) and 41 patients(10.3%) after 1 year, 2 years and 3 years, respectively. No new clear zones had developed after 6 months. At the final follow-up, pseudoarthrosis was observed in 12 patients(3.0%). Among them, 11 were clear zone-positive and 1 was clear zone-negative. There was a statistically significant relationship between the clear zone-positive rate and multi-levels, older age and nonunion during following up. In addition, there was a relatively lower clear zone-positive rate in posterolateral fusion combined with posterior lumbar interbody fusion than only posterolateral fusion. However, the difference between them was not statistically significant. Conclusion: The presence of clear zones does not always mean pseudoarthrosis but clear zones persisting for more than 2 years after surgery have a higher rate of pseudoarthrosis.

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* 2021년 이후 발행 논문의 참고문헌은 현재 구축 중입니다.

[journal] Tokuhashi Y / 2008 / Clinical course and significance of the clear zone around the pedicle screws in the lumbar degenerative disease / Spine 33 : 903~908

[journal] Fischgrund JS / 1997 / Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation / Spine 22 : 2807~2812

[journal] Tokuhashi Y / 2004 / Clinical results of more than 10 years after posterolateral fusion with pedicle screw fixation for degenerative lumbar spondylolisthesis / Spine 17 : 185~192

[journal] Bae SW / 2005 / Radiolucent Zones Surrounding Transpedicular Screws After Lumbar Spinal Instrumented Fusion / J Korean Soc Spine Surg 12 : 115~122

[journal] Alanay A / 2007 / Safety and efficacy of implant removal for patients with recurrent back pain after a failed degenerative lumbar spine surgery / J Spinal Disord Tech 20 : 271~277

[journal] Sande′n B / 2004 / The significance of radiolucent zones surrouding pedicle screws. Definition of screw loosenins in spinal instrumentation / J Bone Joint Surg Br 86 : 457~461

[journal] Slone RM / 1993 / Spinal fixation. Part3. Complications of spinal instrumentation / Radiographics 13 : 797~816

[journal] Ozawa T / 2005 / Insertional torque of the lumbar pedicle screw during surgery / J Orthop Sci 10 : 133~136

[journal] Steinmann JC / 1992 / Pseudoarthrosis of the spine / Clin Orthop Relat Res 284 : 80~90

[journal] Jang EC / 1999 / A Biomechanical Study of Two Kinds of Tapered Pedicle Screws in Osteoporotic Lumber Spine / J Korean Orthop Assoc 34 : 955~962

[journal] Kant AP / 1995 / Evaluation of lumbar spine fusion. Plain radiographs versus direct surgical exploration and observation / Spine 21 : 2313~2317

[journal] Foley MJ / 1983 / Thoracic and lumbar spine fusion: postoperative radiologic evaluation / Am J Roentgenol 141 : 373~380

[journal] C Lee / 2004 / Nonunion of the spine: A Review / Clin Orthop Relat Res 419 : 71~75

[journal] Glaser J / 2003 / A 10-year follow-up evaluation of lumbar spine fusion with pedicle screw fixation / Spine 28 : 1390~1395

[journal] Kim NH / 1994 / The effect of bone mineral density on instrumented spine fusion / J Kor Spine Surg 1 : 133~139

[journal] Pihlajamaki H / 1997 / Complications of transpedicular lumbosacral fixation for non-traumatic disorders / J Bone Joint Surg Br 79 : 183~189

[journal] Cook SD / 2001 / Lumbosacral fixation using expandable pedicle screws. an alternative in reoperation and osteoporosis / Spine J 1 : 109~114

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