Korean J Spine.  2012 Sep;9(3):300-303. 10.14245/kjs.2012.9.3.300.

Screw loosening and Migration after Dynesys Implantation

Affiliations
  • 1Department of Neurosurgery, Seoul National University Hospital, Neuroscience Research Institute, Seoul National University Medical Research Center, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea. chungc@snu.ac.kr

Abstract

Due to the problems associated with rigid fixation, the concept of dynamic stabilization was introduced. Dynesys is one of the pedicle screw-based dynamic stabilization systems. In spite of the dynamic nature of Dynesys, there are concerns about the rigidity of the Dynesys system. We present a case of vertebral body split fracture after Dynesys implantation in a 74-year-old woman. She had undergone L2-L5 laminectomy and Dynesys implantation for spinal stenosis 15 months ago. She was discharged with improvement in lower back pain and claudication. Follow-up X-ray images were taken at 1, 3 and 6 months and there was no evidence of screw migration. During the follow-up period, she received selective root block due to persistent leg pain. Eight months after the operation, she visited our hospital due to severe lower back pain. Magnetic resonance imaging showed the features of lumbar spondylitis from L2 to L5. Plain X-ray and computed tomography images showed the presence of a superiorly migrated screw at L5. The screws migrated superiorly into the intervertebral disc space creating a bony defect resembling a sagittal migrated fracture. The Dynesys system was removed and lumbar spondylitis was treated with antibiotics. The aim of the present case was to demonstrate the problems caused due to rigidity of the Dynesys system, when postoperative infection occurs after Dynesys implantation.

Keyword

Dynesys; Screw loosening & migration; Infection

MeSH Terms

Aged
Anti-Bacterial Agents
Female
Follow-Up Studies
Humans
Intervertebral Disc
Laminectomy
Leg
Low Back Pain
Magnetic Resonance Imaging
Spinal Stenosis
Spondylitis
Anti-Bacterial Agents
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