Pedicle Screw Fusion Surgery: Indications, Procedure, Risks & Recovery
Pedicle screw fixation (PSF) with posterolateral or interbody fusion is the workhorse of spinal stabilization surgery.
Indications
- Degenerative spondylolisthesis (with stenosis)
- Isthmic spondylolisthesis (Grade II+)
- Degenerative disc disease (refractory, with instability)
- Spinal stenosis (with instability/deformity)
- Scoliosis / Kyphosis (adult or adolescent)
- Trauma (burst fractures, fracture-dislocations)
- Infection (TB, pyogenic — after debridement)
- Tumor (metastatic, primary — stabilization ± decompression)
- Pseudoarthrosis (failed prior fusion)
Procedure Overview (Posterior Approach)
- Midline incision, subperiosteal exposure.
- Pedicle screw placement (fluoroscopy/navigation/robot-guided) — trajectory critical.
- Decompression (laminectomy, foraminotomy, discectomy) if neural compression.
- Interbody fusion (TLIF, PLIF, OLIF, ALIF) — optional but increases fusion rate.
- Rod contouring & fixation; cross-links for rotational stability.
- Bone graft (autograft, allograft, BMP, synthetic) placed laterally (posterolateral) and/or in interbody cage.
- Closure over drains.
Risks & Complications
| Risk | Rate | Notes |
|---|---|---|
| Infection (superficial/deep) | 1–4% | Higher with revision, diabetes, obesity, instrumentation |
| Neurologic injury | 0.5–2% | Root injury > cord; navigation reduces |
| Dural tear | 2–8% | More common revision, severe stenosis |
| Screw malposition | 5–15% (imaging) | Clinically significant <2% |
| Non-union (pseudoarthrosis) | 5–15% | Smoking, osteoporosis, multilevel, no interbody |
| Adjacent Segment Disease (ASD) | 2–4%/yr | Long-term; motion preservation alternatives |
| Hardware failure | 1–5% | Rod breakage, screw loosening — often asymptomatic |