The positioning of pedicle screws in the first instrumented lumbar vertebra influences the reoperation rate due to the development of adjacent segment disease: a retrospective study with an average follow-up of 6 year
Introduction: Adjacent Segment Disease (ASD) is a significant concern following lumbar arthrodesis, particularly in patients aged 55 and older. While various risk factors for ASD have been investigated, modifiable surgical factors related to pedicle screw (PS) positioning remain underexplored.Object...
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2026
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/49006 |
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I10-R327-article-49006 |
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Universidad Nacional de Córdoba |
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Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Inglés |
| format |
Artículo revista |
| topic |
lumbosacral region pedicle screws reoperationarthrodesis. arthrodesis Lumbosacral Region Pedicle Screws Reoperation Arthrodesis região lombossacral parafusos pediculars reoperação artrodese Região Lombossacral Parafusos pediculars Reoperação Artrodese región lumbar tornillos pediculares reoperación artrodesis Región Lumbar Tornillos pediculares Reoperación Artrodesis |
| spellingShingle |
lumbosacral region pedicle screws reoperationarthrodesis. arthrodesis Lumbosacral Region Pedicle Screws Reoperation Arthrodesis região lombossacral parafusos pediculars reoperação artrodese Região Lombossacral Parafusos pediculars Reoperação Artrodese región lumbar tornillos pediculares reoperación artrodesis Región Lumbar Tornillos pediculares Reoperación Artrodesis Latallade, Valentino Pereira Duarte, Matías Huespe , Ivan Alfredo Kido, Gonzalo Petracchi, Matías Gruenberg , Marcelo Sola, Carlos Latallade, Valentino The positioning of pedicle screws in the first instrumented lumbar vertebra influences the reoperation rate due to the development of adjacent segment disease: a retrospective study with an average follow-up of 6 year |
| topic_facet |
lumbosacral region pedicle screws reoperationarthrodesis. arthrodesis Lumbosacral Region Pedicle Screws Reoperation Arthrodesis região lombossacral parafusos pediculars reoperação artrodese Região Lombossacral Parafusos pediculars Reoperação Artrodese región lumbar tornillos pediculares reoperación artrodesis Región Lumbar Tornillos pediculares Reoperación Artrodesis |
| author |
Latallade, Valentino Pereira Duarte, Matías Huespe , Ivan Alfredo Kido, Gonzalo Petracchi, Matías Gruenberg , Marcelo Sola, Carlos Latallade, Valentino |
| author_facet |
Latallade, Valentino Pereira Duarte, Matías Huespe , Ivan Alfredo Kido, Gonzalo Petracchi, Matías Gruenberg , Marcelo Sola, Carlos Latallade, Valentino |
| author_sort |
Latallade, Valentino |
| title |
The positioning of pedicle screws in the first instrumented lumbar vertebra influences the reoperation rate due to the development of adjacent segment disease: a retrospective study with an average follow-up of 6 year |
| title_short |
The positioning of pedicle screws in the first instrumented lumbar vertebra influences the reoperation rate due to the development of adjacent segment disease: a retrospective study with an average follow-up of 6 year |
| title_full |
The positioning of pedicle screws in the first instrumented lumbar vertebra influences the reoperation rate due to the development of adjacent segment disease: a retrospective study with an average follow-up of 6 year |
| title_fullStr |
The positioning of pedicle screws in the first instrumented lumbar vertebra influences the reoperation rate due to the development of adjacent segment disease: a retrospective study with an average follow-up of 6 year |
| title_full_unstemmed |
The positioning of pedicle screws in the first instrumented lumbar vertebra influences the reoperation rate due to the development of adjacent segment disease: a retrospective study with an average follow-up of 6 year |
| title_sort |
positioning of pedicle screws in the first instrumented lumbar vertebra influences the reoperation rate due to the development of adjacent segment disease: a retrospective study with an average follow-up of 6 year |
| description |
Introduction: Adjacent Segment Disease (ASD) is a significant concern following lumbar arthrodesis, particularly in patients aged 55 and older. While various risk factors for ASD have been investigated, modifiable surgical factors related to pedicle screw (PS) positioning remain underexplored.Objectives: This study aims to specifically evaluate the correlation between PS positioning and reoperation rates due to ASD in elderly patients undergoing lumbar arthrodesis, identifying specific surgical parameters that could mitigate the risk of ASD.Methods: We conducted a retrospective analysis of 48 patients aged 55 and older who underwent posterior lumbar arthrodesis from May 2013 to May 2021. Patients had 2 to 4 segments fused between L2 and S1 and a minimum follow-up of 2 years. We assessed PS positioning parameters, including the angle between the first PS and the upper vertebral endplate (VE) and the PS tip-VE distance, using logistic regression to analyze associations with reoperation rates. ROC curve analysis was performed to identify optimal cut-off points.Results: Out of the 48 patients, 7 (14.6%) required reoperations for ASD, with an average follow-up of 6.5 years. A greater PS tip-VE distance was significantly associated with a lower probability of reoperation (OR: 0.68; p = 0.001), while a higher PS-VE angle correlated with an increased risk (OR: 1.48; p = 0.001). Critical cut-off values identified included a PS tip-VE distance of ≥ 7.5% (sensitivity: 90.63%) and a PS-VE angle of ≥ 10° (sensitivity: 75.00%).Conclusions: Our findings indicate that optimizing pedicle screw positioning—specifically maintaining a PS tip-VE distance of at least 7.5% and a PS-VE angle below 10°—can significantly reduce reoperation rates due to ASD in patients over 55. Implementing these specific parameters in surgical practice may lead to improved patient outcomes and reduced incidence of ASD-related interventions. |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2026 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/49006 |
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I10-R327-article-490062026-03-03T21:38:47Z The positioning of pedicle screws in the first instrumented lumbar vertebra influences the reoperation rate due to the development of adjacent segment disease: a retrospective study with an average follow-up of 6 year O posicionamento dos parafusos pediculares na primeira vértebra lombar instrumentada influencia a taxa de reoperação devido ao desenvolvimento de doenças do segmento adjacente: um estudo retrospectivo com um seguimento médio de 6 anos La posición de los tornillos pediculares en la primera vértebra lumbar instrumentada influye en la tasa de reoperación debido al desarrollo de enfermedades del segmento adyacente: un estudio retrospectivo con un seguimiento promedio de 6 años Latallade, Valentino Pereira Duarte, Matías Huespe , Ivan Alfredo Kido, Gonzalo Petracchi, Matías Gruenberg , Marcelo Sola, Carlos Latallade, Valentino lumbosacral region pedicle screws reoperationarthrodesis. arthrodesis Lumbosacral Region Pedicle Screws Reoperation Arthrodesis região lombossacral parafusos pediculars reoperação artrodese Região Lombossacral Parafusos pediculars Reoperação Artrodese región lumbar tornillos pediculares reoperación artrodesis Región Lumbar Tornillos pediculares Reoperación Artrodesis Introduction: Adjacent Segment Disease (ASD) is a significant concern following lumbar arthrodesis, particularly in patients aged 55 and older. While various risk factors for ASD have been investigated, modifiable surgical factors related to pedicle screw (PS) positioning remain underexplored.Objectives: This study aims to specifically evaluate the correlation between PS positioning and reoperation rates due to ASD in elderly patients undergoing lumbar arthrodesis, identifying specific surgical parameters that could mitigate the risk of ASD.Methods: We conducted a retrospective analysis of 48 patients aged 55 and older who underwent posterior lumbar arthrodesis from May 2013 to May 2021. Patients had 2 to 4 segments fused between L2 and S1 and a minimum follow-up of 2 years. We assessed PS positioning parameters, including the angle between the first PS and the upper vertebral endplate (VE) and the PS tip-VE distance, using logistic regression to analyze associations with reoperation rates. ROC curve analysis was performed to identify optimal cut-off points.Results: Out of the 48 patients, 7 (14.6%) required reoperations for ASD, with an average follow-up of 6.5 years. A greater PS tip-VE distance was significantly associated with a lower probability of reoperation (OR: 0.68; p = 0.001), while a higher PS-VE angle correlated with an increased risk (OR: 1.48; p = 0.001). Critical cut-off values identified included a PS tip-VE distance of ≥ 7.5% (sensitivity: 90.63%) and a PS-VE angle of ≥ 10° (sensitivity: 75.00%).Conclusions: Our findings indicate that optimizing pedicle screw positioning—specifically maintaining a PS tip-VE distance of at least 7.5% and a PS-VE angle below 10°—can significantly reduce reoperation rates due to ASD in patients over 55. Implementing these specific parameters in surgical practice may lead to improved patient outcomes and reduced incidence of ASD-related interventions. Introdução: A Doença do Segmento Adjacente (ASD) é uma preocupação significativa após artrodese lombar, especialmente em pacientes com 55 anos ou mais. Embora vários fatores de risco para a ASD tenham sido investigados, fatores cirúrgicos modificáveis relacionados ao posicionamento dos parafusos pediculares (PP) ainda são pouco explorados.Objetivos: Este estudo tem como objetivo avaliar especificamente a correlação entre o posicionamento dos PP e as taxas de reoperação devido à ASD em pacientes idosos submetidos à artrodese lombar, identificando parâmetros cirúrgicos específicos que possam reduzir o risco de ASD.Métodos: Foi realizada uma análise retrospectiva de 48 pacientes com 55 anos ou mais que foram submetidos à artrodese lombar posterior entre maio de 2013 e maio de 2021. Os pacientes apresentavam fusão de 2 a 4 segmentos entre L2 e S1, com seguimento mínimo de 2 anos. Avaliaram-se parâmetros de posicionamento dos PP, incluindo o ângulo entre o primeiro PP e a placa terminal vertebral superior (VE), e a distância entre a ponta do PP e a VE. Utilizou-se regressão logística para analisar associações com taxas de reoperação. Também foi realizada análise de curva ROC para identificar os pontos de corte ideais.Resultados: Dos 48 pacientes, 7 (14,6%) necessitaram de reoperação por ASD, com seguimento médio de 6,5 anos. Uma maior distância ponta do PP-VE esteve significativamente associada a uma menor probabilidade de reoperação (OR: 0,68; p = 0,001), enquanto um maior ângulo PP-VE correlacionou-se com risco aumentado (OR: 1,48; p = 0,001). Os valores críticos de corte identificados incluíram uma distância ponta do PP-VE ≥ 7,5% (sensibilidade: 90,63%) e um ângulo PP-VE ≥ 10° (sensibilidade: 75,00%).Conclusões: Nossos achados indicam que otimizar o posicionamento dos parafusos pediculares—especificamente mantendo uma distância ponta do PP-VE de pelo menos 7,5% e um ângulo PP-VE inferior a 10°—pode reduzir significativamente as taxas de reoperação por ASD em pacientes com mais de 55 anos. A implementação desses parâmetros específicos na prática cirúrgica pode levar a melhores resultados clínicos e menor incidência de intervenções relacionadas à ASD. Introducción: La enfermedad del segmento adyacente (ASD, por sus siglas en inglés) es una preocupación significativa tras la artrodesis lumbar, especialmente en pacientes de 55 años o más. Si bien se han investigado diversos factores de riesgo para la ASD, los factores quirúrgicos modificables relacionados con la colocación de los tornillos pediculares (TP) siguen siendo poco explorados.Objetivos: Este estudio tiene como objetivo evaluar específicamente la correlación entre la posición de los TP y las tasas de reoperación por ASD en pacientes mayores sometidos a artrodesis lumbar, identificando parámetros quirúrgicos específicos que podrían reducir el riesgo de desarrollar ASD.Métodos: Se realizó un análisis retrospectivo de 48 pacientes de 55 años o más que se sometieron a artrodesis lumbar posterior entre mayo de 2013 y mayo de 2021. Los pacientes tenían de 2 a 4 segmentos fusionados entre L2 y S1, y un seguimiento mínimo de 2 años. Se evaluaron parámetros de posicionamiento de los TP, incluyendo el ángulo entre el primer TP y la placa terminal vertebral superior (VE), y la distancia entre la punta del TP y la VE. Se utilizó regresión logística para analizar asociaciones con las tasas de reoperación. Se realizó un análisis de curvas ROC para identificar puntos de corte óptimos.Resultados: De los 48 pacientes, 7 (14.6%) requirieron reoperaciones por ASD, con un seguimiento promedio de 6.5 años. Una mayor distancia punta del TP-VE se asoció significativamente con una menor probabilidad de reoperación (OR: 0.68; p = 0.001), mientras que un ángulo TP-VE más alto se correlacionó con un mayor riesgo (OR: 1.48; p = 0.001). Se identificaron valores críticos de corte: una distancia punta del TP-VE ≥ 7.5% (sensibilidad: 90.63%) y un ángulo TP-VE ≥ 10° (sensibilidad: 75.00%).Conclusiones: Nuestros hallazgos indican que optimizar la colocación de los tornillos pediculares—específicamente mantener una distancia punta del TP-VE de al menos 7.5% y un ángulo TP-VE inferior a 10°—puede reducir significativamente las tasas de reoperación por ASD en pacientes mayores de 55 años. La implementación de estos parámetros específicos en la práctica quirúrgica puede mejorar los resultados clínicos y reducir la incidencia de intervenciones relacionadas con la ASD. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2026-03-03 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf text/html https://revistas.unc.edu.ar/index.php/med/article/view/49006 10.31053/1853.0605.v83.n1.49006 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 83 No. 1 (2026): Avance de publicación; e49006 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 83 Núm. 1 (2026): Avance de publicación; e49006 Revista da Faculdade de Ciências Médicas de Córdoba; v. 83 n. 1 (2026): Avance de publicación; e49006 1853-0605 0014-6722 10.31053/1853.0605.v83.n1 eng https://revistas.unc.edu.ar/index.php/med/article/view/49006/52444 https://revistas.unc.edu.ar/index.php/med/article/view/49006/52445 Derechos de autor 2026 Universidad Nacional de Córdoba https://creativecommons.org/licenses/by-nc/4.0 |