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01-05-2013 | Case Report

L5 spinal nerve injury caused by misplacement of outwardly-inserted S1 pedicle screws

Authors: Masahiro Inoue, Gen Inoue, Tomoyuki Ozawa, Masayuki Miyagi, Hiroto Kamoda, Tetsuhiro Ishikawa, Miyako Suzuki, Yoshihiro Sakuma, Yasuhiro Oikawa, Kazuyo Yamauchi, Sumihisa Orita, Masashi Takaso, Tomoaki Toyone, Kazuhisa Takahashi, Seiji Ohtori

Published in: European Spine Journal | Special Issue 3/2013

Abstract

Purpose

To evaluate L5 nerve root injuries caused by outwardly misplaced S1 pedicle screws.

Summary of Background Data

Pedicle screws remain the criterion standard for fixation of L5–S1 to correct lumbosacral instability. When inserting S1 pedicle screws, it is possible to injure the L5 nerve root if screws are inserted outwardly and the tip of the screw perforates the anterior cortex of the sacrum. Despite this risk, to our knowledge this type of injury has never been reported as a case series.

Methods

We experienced 2 cases of L5 nerve root injury caused by outwardly-inserted S1 pedicle screws. In both cases, bilateral S1 pedicle screws were inserted outwardly using a free-hand technique, and on one side, screws induced severe pain by impinging on an L5 root. Computed tomography after the selective rootgraphy of the injured nerve showed the nerve compressed laterally by screw threads in Case 1 and crushed between the screw threads and the sacral body in Case 2.

Results

In both cases, leg pain disappeared immediately after the infiltration of the nerve with lidocaine, but symptoms recurred within a few days in Case 1 and within an hour in Case 2. Conservative treatment of three spinal nerve infiltrations was effective in Case 1, but reinsertion of the rogue screw was necessary in Case 2.

Conclusions

Surgeons should recognize that lateral inclination of S1 pedicle screws can cause L5 nerve root injury, which may require reinsertion of the screw, especially in cases where insertion is difficult because of overlapping surrounding muscle or bony tissue.

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Title: L5 spinal nerve injury caused by misplacement of outwardly-inserted S1 pedicle screws
Authors: Masahiro Inoue
Gen Inoue
Tomoyuki Ozawa
Masayuki Miyagi
Hiroto Kamoda
Tetsuhiro Ishikawa
Miyako Suzuki
Yoshihiro Sakuma
Yasuhiro Oikawa
Kazuyo Yamauchi
Sumihisa Orita
Masashi Takaso
Tomoaki Toyone
Kazuhisa Takahashi
Seiji Ohtori
Publication date: 01-05-2013
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue Special Issue 3/2013
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-012-2634-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

L5 spinal nerve injury caused by misplacement of outwardly-inserted S1 pedicle screws

Abstract

Purpose

Summary of Background Data

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Summary of Background Data

Methods

Results

Conclusions

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