Analysis of revisional surgical interventions in the thoracic and lumbar spine after transpedicular fixation

Background. Surgery on the thoracic and lumbar spine is an important method of treating a wide range of pathologies, but it can be accompanied by certain risks of complications that significantly affect treatment outcomes. The most common of these are problems with implants, diseases of the adjacent segment, pseudoarthrosis, or infections. Some of them lead to the need for reoperation. The purpose was based on retrospective studies, to determine the main types of revision interventions for complications after transpedicular fixation of the thoracic and lumbar spine. Materials and methods. A retrospective analysis was conducted of 2,128 medical records of patients who were treated at the Sytenko Institute of Spine and Joint Pathology of NAMSU from 2004 to 2018 and underwent transpedicular fixation of the thoracic and lumbar spine. Among them, 268 patients were identified who underwent revision surgery for various reasons. Complications associated with transpedicular construction, including problems with screws (instability, fracture, and incorrect placement), rods (instability and fracture), and combined problems (instability, fracture of the rod and screws) were analyzed in 143 patients. Results. It was found that the most common reasons for repeat interventions were complications directly related to the transpedicular structure (fracture of screws, rods, instability of the construction, incorrect placement of screws in the vertebra) in 143 (6.7 %) patients. Residual pain after the initial surgery was observed in 64 (3 %) interventions. Other complications did not exceed 1 % of the total number of surgeries. The main complications were instability and fracture of rods, instability and fracture of transpedicular screws, instability of all components of the structure, and incorrect placement of screws. The highest number of complications was observed after surgical treatment for spinal deformities — 21 (18.1 %). The second most frequent complication was spondylolisthesis — 27 (8.8 %), in which problems with screws were more common — 20 (6.51 %), including their instability — 14 (4.56 %) and incorrect screw placement — 6 (1.95 %). Conclusions. According to the results of the study, the overall rate of complications after transpedicular fixation that led to revision surgery was 12.6 %. It was found that the most common reasons for repeat interventions were complications related to the transpedicular construction (fracture of screws, rods, instability of the structure, incorrect placement of screws in the vertebra) in 143 (6.7 %) patients. The second most common complication was residual pain (“failed back” syndrome) after the initial spinal instrumentation, which accounted for 64 (3.0 %) cases. Other complications did not exceed 1 % of the total number of operations.