• Bungo Otsuki, Shunsuke Fujibayashi, Shimei Tanida, Takayoshi Shimizu, Koichi Murata, and Shuichi Matsuda.
• Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. Electronic address: bungo@kuhp.kyoto-u.ac.jp.
• World Neurosurg. 2021 Jun 1; 150: e155-e161.

BackgroundAlthough pedicle screw sizes may affect the rate of bone union after lumbar fusion surgery, there is currently no supportive clinical evidence.MethodsEighty-five patients older than 50 years who underwent single-level L4/5 transforaminal lumbar interbody fusion with posterior pedicle screw (PS) fixation were analyzed. Patients with factors that potentially inhibit bone fusion, such as Parkinson disease, were excluded. Bone union was assessed using computed tomography and dynamic radiographs 1 year after surgery. Explanatory factors considered included sex, age, smoking, bone density, material of the cage, PS diameter (PSD), relative PS length, theoretical maximum PSD (PSDmax), which was defined as the maximum diameter of the screw that may be inserted without breaking cortical bone around the pedicle, and the filling index, which was defined as the difference between the cross-sectional area of maximum PS and actual PS (PSDmaxˆ 2 - PSD ˆ 2). Japanese Orthopaedic Association scores before and 1 year after surgery were evaluated as a clinical outcome.ResultsNineteen levels were diagnosed as pseudoarthrosis. A multivariate logistic regression analysis identified a larger filling index (P = 0.016) and older age (P = 0.047) as risk factors for pseudoarthrosis. The Japanese Orthopaedic Association score 1 year after surgery and its recovery rate were significantly worse in patients with pseudoarthrosis than in those with fusion.ConclusionsThe selection of an appropriately sized screw is important for achieving rigid fusion after transforaminal lumbar interbody fusion. Preoperative planning using multiplanar reconstruction computed tomography is an important approach for ensuring good clinical results.Copyright © 2021 Elsevier Inc. All rights reserved.

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