Screw-related complications after instrumentation of the osteoporotic spine: A systematic literature review with meta-analysis

  • 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.

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Author:Elke Rometsch, Maarten Spruit, Jack Zigler, Venugopal K. Menon, Jean A. Ouellet, Christian Mazel, Roger Härtl, Kathrin Espinoza, Frank KandzioraORCiDGND
Pubmed Id:
Parent Title (English):Global spine journal
Publisher:Sage Publications
Place of publication:Thousand Oaks, CA
Document Type:Article
Year of Completion:2019
Date of first Publication:2019/01/03
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2020/03/09
Tag:adverse effects; aged; complications; osteoporosis; pedicle screws; screw augmentation; screw loosening; spinal fusion
Page Number:20
First Page:69
Last Page:88
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 ( 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 (
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung-Nicht kommerziell - Keine Bearbeitung 4.0