Potential Risk Factors in Development of the “Halo Sign” in Patients Performed Transpedicular Screw Fixation Through the Posterior Spinal Approach

Year 2020, Volume: 42 Issue: 2, 212 - 221, 17.03.2020

Mustafa Öğden Ulaş Yüksel İbrahim Akkurt Ahmet Turan Dağlı Bülent Bakar Mehmet Faik Özveren

https://doi.org/10.20515/otd.551271

Abstract

It has been shown in literature that a
fibrous tissue called "halo sign" in the radiological terminology can
develop around the transpedicular screws implanted incompletely and/or incorrectly,
which appears after movement of the screw in the cancellous bone. In this
retrospective clinical study, 141 patients who underwent posterior spinal
instrumentation for thoracic, lumbar or thoracolumbar vertebrae were evaluated
using computed tomography (CT) and direct X-rays images for "halo
sign" formation which refers in probable failure of spinal
instrumentation. Hospital records included in the year 2014-2018 were examined
and adult patients who were performed lumbar, thoracal, and thoracolumbar
spinal instrumentation via posterior approach due to reasons such as
"spine fracture", "spondylosis",
"spondylolisthesis" and "intervertebral disc hernia" were
included and evaluated in this study. The age and sex of the patients were
recorded. Spinal X-ray and spinal CT images obtained during the postoperative
follow-up period were examined. Halo sign was seen in 13 patients. Age
(p=0.013), number of instrumented vertebrae (p=0.001) and number of
transpedicular screws (p<0.001) values were different between the patients
with halo sign and patients without halo sign. As a result, it was observed in
this study that the formation of the halo sign in posterior spinal
instrumentation system could develop in proportion to the number of
transpedicular screw and patients' age. It was thought that the halo sign
formation was not connected with the parameters called performed laminectomy,
gender, inserted intervertebral cage, or vertebral region which were inserted
transpedicular screws.

Keywords

transpedicular screw, spinal instrumentation, halo sign, posterior approach

Potential Risk Factors in Development of the “Halo Sign” in Patients Performed Transpedicular Screw Fixation Through the Posterior Spinal Approach

Abstract

Omurgaya doğru şekilde yerleştirilmeyen transpediküler vidaların kemik
yapı içerisinde hareketine ikincil olarak vidaların etrafında ortaya çıkabilen
fibröz dokuya radyolojik terminolojide "halo işareti" adı
verilmektedir. Bu retrospektif klinik çalışmada, torasik, lomber veya
torakolomber vertebra için posterior spinal enstrümantasyon yapılan 141 hasta
incelendi ve bu hastalardaki spinal enstrümantasyonun muhtemel başarısızlığını
ortaya koyan "halo işareti" oluşumu bilgisayarlı tomografi (BT) ve
direkt grafi görüntüleri kullanılarak değerlendirildi. Bu klinik çalışmada
2014-2018 yıllarına ait hastane kayıtları incelenerek  "omurga kırığı",
"spondiloz", "spondilolistez" ve “intervertebral disk
hernisi”  gibi nedenlerle posterior
yaklaşımla lomber, torakal ve torakolomber spinal enstrümantasyon uygulanan
yetişkin hastalar çalışmaya dahil edildi. Hastaların omurgaları, ameliyat
sonrası takip döneminde elde edilen direkt grafi görüntüleri ve BT görüntüleri
kullanılarak değerlendirildi.  Bulgular:
13 hastada halo belirtisi görüldü. Halo işareti olan ve halo işareti olmayan
hastalar arasında yaş (p = 0.013), vida kullanılan omurga sayısı (p = 0.001) ve
transpediküler vida sayısı (p <0.001) değerleri farklıydı. Bu çalışmanın
sonucunda, posterior spinal enstrümantasyon sisteminde halo işaretinin
oluşumunun transpediküler vida sayısı ve hasta yaşı ile orantılı olarak
gelişebileceği gözlendi. Halo işareti oluşumunda “laminektomi” uygulanmasının,
“intervertebral kafes” uygulanmasının, cinsiyetin veya “transpediküler vidanın
uygulandığı omurga seviyesi”nin etkili olmadığı düşünüldü.

Keywords

transpediküler vida, spinal enstrümentasyon, halo işareti, posterior yaklaşım

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