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

Abstract

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.