Pedicle Screws Fixation in Patients with Spinal Disorders at the National Orthopaedic Hospital Dala, Kano, Nigeria

Background: Pedicle screw fixation is the gold standard for spinal stabilization, but outcome data from West African tertiary centres are scarce. This study evaluated the clinical and radiological outcomes of freehand pedicle screw fixation with post‑insertion C‑arm fluoroscopy at a major Nigerian orthopaedic hospital.
Methods: A retrospective review was conducted of consecutive patients who underwent thoracic or lumbar pedicle screw fixation between 1st January 2018 and 31st December 2024 at National Orthopaedic Hospital Dala, Kano, Nigeria. All screws were inserted freehand and confirmed with intraoperative C‑arm imaging. Screw accuracy was graded on postoperative CT using Gertzbein‑Robbins classification. Clinical outcomes included VAS back pain, Oswestry Disability Index (ODI), complications, and fusion rates. Multivariate analysis identified predictors of poor functional outcome.
Results: One hundred forty‑two patients had 754 screws (592 lumbar, 162 thoracic). Indications: trauma (62.0%), degenerative (18.3%), scoliosis (2.1%), others (17.6%). Overall screw accuracy (grades A/B) was 88.1%. Grade C–E breaches occurred in 11.9%, mostly lateral thoracic. The complication rate was 11.3% (dural tears 3.5%, superficial infection 2.8%, screw revision 2.1%, transient neurology 1.4%). No permanent deficits occurred. At mean 20.5 months, VAS improved from 7.5 to 3.3 (p<0.001) and ODI from 55.4 to 27.6 (p<0.001). Fusion rate was 90.8%. Screw malposition (OR 2.95) and preoperative psychological distress (OR 2.68) independently predicted poor outcome.
Conclusions: Freehand pedicle screw fixation with C‑arm confirmation is safe and effective in this Nigerian tertiary centre, achieving outcomes comparable to international benchmarks. Accuracy and psychological status are key determinants of success.

Pedicle screws, C-Arm, Gertzbein‑Robbins classification, National Orthopaedic Hospital, Outcome

1. Nwankwo OE, Umaru H, Onyemaechi N, Nottidge T. Pattern of spinal disorders in a tertiary hospital in Nigeria. Niger J Clin Pract. 2020;23(4):499–504. [Google Scholar] [Crossref]

2. Akinyemi RO, Ige OK, Adeyinka AO, Odebode TO. Pattern of spinal injuries in a Nigerian tertiary hospital. J Neurosci Rural Pract. 2013;4(3):268–72. [Google Scholar] [Crossref]

3. Orlandi V, Galieri G, Mazzucchi E, Pignotti F, Carcagnì A, Bazzu P, et al. Comparative Analysis of Pedicle Screw Fixation and Interspinous Devices in Lumbar Spinal Fusion: Clinical and Surgical Outcomes in Degenerative Spine Conditions. J Pers Med. 2025;15(3):95. [Google Scholar] [Crossref]

4. Gaines RW Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg Am. 2000;82(10):1458–76. [Google Scholar] [Crossref]

5. Hicks JM, Singla A, Shen FH, Arlet V. Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976). 2010;35(11):E465–70. [Google Scholar] [Crossref]

6. Jutte PC, Castelein RM. Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations. Eur Spine J. 2002;11(6):594–8. [Google Scholar] [Crossref]

7. Modi HN, Suh SW, Fernandez H, Yang JH, Song HR. Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique. Eur Spine J. 2008;17(12):1686–96. [Google Scholar] [Crossref]

8. Kim YJ, Lenke LG, Cho YS, Bridwell KH, Sides B, Blanke K. Free hand pedicle screw placement in the thoracic spine: a prospective study of accuracy in 702 screws. Spine (Phila Pa 1976). 2005;30(8):918–22. [Google Scholar] [Crossref]

9. Parker SL, McGirt MJ, Farber SH, Amin AG, Rick AM, Suk I, et al. Accuracy of free-hand pedicle screw placement in the thoracic and lumbar spine: a systematic review and meta-analysis. J Neurosurg Spine. 2011;14(1):15–21. [Google Scholar] [Crossref]

10. Nnadi C, Orakwe S, Nwadinigwe C, Ede O. Challenges of spinal surgery in a developing country: a Nigerian perspective. J Spine Surg. 2019;5(Suppl 2):S210–S215. [Google Scholar] [Crossref]

11. Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD. Free hand pedicle screw placement in the thoracic spine: is it safe? Spine (Phila Pa 1976). 2004;29(3):333–42. [Google Scholar] [Crossref]

12. Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976). 1990;15(1):11–4. [Google Scholar] [Crossref]

13. Carreon LY, Glassman SD, Djurasovic M. Reliability and agreement between fine-cut CT scans and plain radiography in the evaluation of posterolateral fusions. Spine J. 2007;7(1):39–43. [Google Scholar] [Crossref]

14. Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J. 2008;8(6):968–74. [Google Scholar] [Crossref]

15. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70. [Google Scholar] [Crossref]

16. Smith JS, Shaffrey CI, Ames CP, Lenke LG. Treatment of adult thoracolumbar spinal deformity: past, present, and future. J Neurosurg Spine. 2019;30(5):551–67. [Google Scholar] [Crossref]

17. Belmont PJ Jr, Klemme WR, Dhawan A, Polly DW Jr. In vivo accuracy of thoracic pedicle screws. Spine (Phila Pa 1976). 2001;26(21):2340–6. [Google Scholar] [Crossref]

18. Zindrick MR, Wiltse LL, Doornik A, Widell EH, Knight GW, Patwardhan AG, et al. Analysis of the morphometric characteristics of the thoracic and lumbar pedicles. Spine (Phila Pa 1976). 1987;12(2):160–6. [Google Scholar] [Crossref]

19. Hwang YH, Ha BJ, Kim HC, Lee BH, Park JY, Chin DK, et al. A Propensity Score-Matched Cohort Study Comparing 3 Different Spine Pedicle Screw Fixation Methods: Freehand, Fluoroscopy-Guided, and Robot-Assisted Techniques. Neurospine. 2024;21(1):83–94. [Google Scholar] [Crossref]

20. Guerin P, El Fegoun AB, Obeid I, Gille O, Lelong L, Luc S, et al. Incidental durotomy during spine surgery: incidence, surgical management and outcome. Orthop Traumatol Surg Res. 2012;98(6 Suppl):S129–34. [Google Scholar] [Crossref]

21. Puvanesarajah V, Hassanzadeh H. The True Cost of a Dural Tear: Medical and Economic Ramifications. Clin Spine Surg. 2017;30(10):445–7. [Google Scholar] [Crossref]

22. Impact of pedicle screw accuracy on clinical outcomes after 1- or 2-level minimally invasive transforaminal lumbar interbody fusion. J Neurosurg Spine. 2025 Jan 17:1–9. [Google Scholar] [Crossref]

23. Celestin J, Edwards RR, Jamison RN. Pretreatment psychosocial variables as predictors of outcomes following lumbar surgery and spinal cord stimulation: a systematic review and meta-analysis. Pain Med. 2009;10(4):639–53. [Google Scholar] [Crossref]

• Influence of Korean Popular Culture on Filipino Millennials: An Assessment Across Food, Fashion, Entertainment, and Beauty Products
• Narrating the Self and Constructing History: A Biography Appreciation Theory Analysis of Gandhi, Chaplin, and Hitler
• Food and Culture in Kashmiri Writings
• When East Meets West: Cross-Cultural Challenges in a Tourist’s Guide to Love
• Cultural Mapping of Movable and Immovable Tangible Cultural Properties of Morong, Bataan: Basis for the Development of Information, Education, and Communication Materials