How immediate or delayed postoperative x-ray affect reoperation for pedicle screws misplacement following lumbar spine surgery at the National Orthopedic Hospital Dala Kano, Nigeria
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20262894Keywords:
Lumbar spine surgery, Nigeria, Pedicle screw, Postoperative x-ray, Reoperation, Screw misplacement, Timing of imagingAbstract
Background: Pedicle screw misplacement is a recognised complication of lumbar spine surgery. The timing of postoperative imaging may influence the detection and subsequent management of misplaced screws. This study aimed to determine whether immediate (within 48 hours) versus delayed (after 48 hours) postoperative x‑ray affects the reoperation rate for pedicle screw misplacement following lumbar spine surgery at a Nigerian tertiary hospital.
Methods: A retrospective review of 397 consecutive lumbar spine surgeries performed at the National Orthopedic Hospital Dala, Kano, from January 2019 to December 2025 was conducted. Patients with pedicle screw misplacement detected on postoperative x‑ray were identified. Patients were divided into two groups: those who had x‑ray within 48 hours of surgery (early group) and those who had x‑ray after 48 hours (delayed group). The primary outcome was reoperation for screw misplacement. Multivariate logistic regression was used to identify factors influencing reoperation.
Results: Pedicle screw misplacement was identified in 39 patients (9.8% of all surgeries). In the early x‑ray group (n=11), 2 patients (18.2%) required reoperation. In the delayed x‑ray group (n=28), 19 patients (67.9%) required reoperation (p<0.001). On multivariate analysis, delayed x‑ray was the strongest independent predictor of reoperation (adjusted OR = 8.9, 95% CI: 2.4-33.1, p=0.001). Other significant predictors included the severity of screw breach (Gertzbein‑Robbins grade C-E) (OR=5.6, 95% CI: 1.8-17.4) and the presence of neurological symptoms (OR=4.2, 95% CI: 1.4-12.6).
Conclusions: Delayed postoperative x‑ray (>48 hours) is strongly associated with a higher reoperation rate for pedicle screw misplacement. Early detection within 48 hours allows timely intervention and potentially reduces the need for reoperation. Routine early postoperative imaging should be considered to optimize patient outcomes.
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