The complications associated with guidewire use in spine surgeries involving pedicle screw placement: A comprehensive literature review

Abstract

Guidewires (Kirschner or “K” wires) are often required during minimally invasive spine surgery to facilitate percutaneous pedicle screw placement. The use of guidewires involves a multi-step process that carries the risk of complications and their associated consequences. To date, the reporting of such information has been limited, and the literature has not been thoroughly evaluated. The objective of this study was to conduct a narrative review and assess the burden associated with guidewire use in spine surgeries. Databases searched included PubMed and Embase between the years of 1988 and 2017. In addition to databases, recent data from relevant trade journals were hand-searched. Inclusion criteria were broad to avoid potential exclusion of relevant publications. In total, 31 articles were included. This review found that the risk of complications associated with guidewire use in spine procedures ranged from 0.4% to 14.8%. Complication types included guidewire fracture, cerebrospinal fluid leakage, post-operative ileus, infection, and other spinal hardware failure (e.g., pedicle screw pull-out). Causes of complications typically included breakage and migration of the guidewire (metal fatigue), inexperience with guidewire use, or lack of tactile or visual feedback. Specific surgery types or patient populations may be more susceptible to guidewire-related complications (e.g., L5-S1 level operations). Complications associated with guidewire use may also lead to healthcare resource utilization, including additional operating time, radiation exposure, and re-operations. Solutions to help minimize the risk of such complications and associated consequences are required.