ArticleAsian spine journal2024
Risk of neurologic deficit in medially breached pedicle screws assessed by computed tomography: a systematic review.
Article in Asian spine journal, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Biomechanical effects of lateral pedicle wall violation and subsequent screw redirection on pedicle screw anchorage.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Comparative study of pedicle screw trajectory in scoliosis surgery: freehand technique versus navigated angular guidance using the PYTHEAS Your Guided Trajectory.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Patient-specific 3D-printed spinal models improve pedicle screw placement accuracy in severe kyphoscoliosis: a comparative study.Acta orthopaedica et traumatologica turcica · 2026Article
- An innovative 2D optical navigation workflow for percutaneous pedicle screw fixation in thoracolumbar fractures: comparison with O-arm 3D navigation.Frontiers in surgery · 2026Article
- Mini-review on human-centered assurance in robot-assisted orthopedics and neurosurgery.Frontiers in robotics and AI · 2026Review
- Early vs. Late Unplanned Returns to the Operating Room (URTOR) in Neurosurgery: Effect of Surgeon Experience and Complication Types.Medicina (Kaunas, Lithuania) · 2025Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Pedicle screws are commonly used for vertebral instrumentation, and a postoperative computed tomography (CT) scan is used to evaluate their position within the pedicle. Medial pedicle screw breaching occurs in 20%-40% of cases. This study investigated the correlation between radiographically evident medial breaching and the incidence of nerve injury, shedding light on the clinical implications. A literature search was conducted on biomedical databases regarding neurologic deficits associated with medially breached pedicle screws with pre-defined inclusion and exclusion criteria. The methodology of the included studies was analyzed, and a systematic review and meta-analysis were performed to investigate the correlation between medial breach on axial CT and clinical neurologic deficits. Our study included thirteen articles. Medial breaches <2 mm caused no neurologic deficit. Medial breaches of 2-4 mm increased the risk of neurologic deficit by 83%, with a risk ratio of 0.17. Breaches exceeding 4 mm increased the risk by 90%, with a risk ratio of 0.1, and were associated with radiculopathy or muscle weakness in 25%-100% of cases. Medial pedicle screw breaches <2 mm are safe, carrying no risk of neurologic injury. Breaches exceeding ≥2 mm significantly increase this risk. For patients experiencing new neurologic deficit (sensory or motor) after pedicle screw instrumentation, particularly in lumbar vertebrae, a postoperative axial CT scan is recommended to identify breaches exceeding 2 mm as the potential cause of neurologic deficit.
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