TY  - JOUR
A1  - Rometsch, Elke
A1  - Spruit, Maarten
A1  - Zigler, Jack
A1  - Menon, Venugopal K.
A1  - Ouellet, Jean A.
A1  - Mazel, Christian
A1  - Härtl, Roger
A1  - Espinoza, Kathrin
A1  - Kandziora, Frank
T1  - Screw-related complications after instrumentation of the osteoporotic spine: A systematic literature review with meta-analysis
T2  - Global spine journal
N2  - Study Design: Systematic literature review with meta-analysis.
Objective: Osteoporosis is common in elderly patients, who frequently suffer from spinal fractures or degenerative diseases and often require surgical treatment with spinal instrumentation. Diminished bone quality impairs primary screw purchase, which may lead to loosening and its sequelae, in the worst case, revision surgery. Information about the incidence of spinal instrumentation-related complications in osteoporotic patients is currently limited to individual reports. We conducted a systematic literature review with the aim of quantifying the incidence of screw loosening in osteoporotic spines.
Methods: Publications on spinal instrumentation of osteoporotic patients reporting screw-related complications were identified in 3 databases. Data on screw loosening and other local complications was collected. Pooled risks of experiencing such complications were estimated with random effects models. Risk of bias in the individual studies was assessed with an adapted McHarm Scale.
Results: From 1831 initial matches, 32 were eligible and 19 reported screw loosening rates. Studies were heterogeneous concerning procedures performed and risk of bias. Screw loosening incidences were variable with a pooled risk of 22.5% (95% CI 10.8%-36.6%, 95% prediction interval [PI] 0%-81.2%) in reports on nonaugmented screws and 2.2% (95% CI 0.0%-7.2%, 95% PI 0%-25.1%) in reports on augmented screws.
Conclusions: The findings of this meta-analysis suggest that screw loosening incidences may be considerably higher in osteoporotic spines than with normal bone mineral density. Screw augmentation may reduce loosening rates; however, this requires confirmation through clinical studies. Standardized reporting of prespecified complications should be enforced by publishers.
KW  - osteoporosis
KW  - aged
KW  - pedicle screws
KW  - spinal fusion
KW  - screw augmentation
KW  - screw loosening
KW  - adverse effects
KW  - complications
Y1  - 2019
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/53076
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-530768
SN  - 2192-5690
SN  - 2192-5682
N1  - Creative Commons Non Commercial No Derivs CC BY-NC-ND: This article is distributed under the terms of the Creative Commons Attribution-Non Commercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
VL  - 10
IS  - 1
SP  - 69
EP  - 88
PB  - Sage Publications
CY  - Thousand Oaks, CA
ER  -