Accuracy of Computed Tomography in Assessing Thoracic Pedicle Screw Malposition

Fayyazi, Amir H.; Hugate, Ronald R.; Pennypacker, Jason; Gelb, Daniel E.; Ludwig, Steven C.

doi:10.1097/01.bsd.0000112049.36255.bc

Cited by 28 publications

(17 citation statements)

References 7 publications

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“…[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Extensive literature has been published describing the technique, benefits, and drawbacks of each method, as well as comparisons between different approaches. [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] With its increasing use has come a multitude of studies regarding the safety of this technique. Proper screw placement is imperative in order to avoid complications such as CSF leak, and pedicle fractures.…”

Section: Introductionmentioning

confidence: 99%

Reliability of the Planned Pedicle Screw Trajectory versus the Actual Pedicle Screw Trajectory using Intra-operative 3D CT and Image Guidance

et al. 2016

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Section: Introductionmentioning

confidence: 99%

Reliability of the Planned Pedicle Screw Trajectory versus the Actual Pedicle Screw Trajectory using Intra-operative 3D CT and Image Guidance

et al. 2016

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“…In a study presented by Fayyazi and colleagues using a simple "in" or "out" classification for pedicle screw placement, the authors found a fair to moderate degree of interobserver and intraobserver agreement using CT and the kappa statistic [7]. The authors of that study, using cadaveric specimens to compare the accuracy of CT with open dissection, concluded that assessment beyond axial CT may be necessary.…”

Section: Discussionmentioning

confidence: 94%

“…Advances in imaging have led to computed tomography (CT) image assessment methods being regarded as the current gold standard in evaluating in vivo pedicle screw placement success [7,15]. When compared with radiographs, CT image-based evaluations have been reported to improve accuracy [21].…”

Section: Introductionmentioning

confidence: 99%

Observer reliability in evaluating pedicle screw placement using computed tomography

Kosmopoulos

Theumann

Binaghi

et al. 2006

International Orthopaedics (SICO

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Pedicle screw insertion in spinal surgery is a demanding technique with potential risks to neurological structures, for example, within the spinal canal. Assessing screw placement in clinical practice has been performed using plain radiographs and/or mainly axial computed tomography (CT) images. Screw placement using CT image reconstructions in multiple planes has been described, but its reliability has yet to be studied. This study aimed at addressing the clinical issue of interobserver and intraobserver reliability in the use of axial and coronal CT images for the assessment of pedicle screw placement. Fifty nine pedicle screws were studied by two experienced radiologists on two separate occasions. Screw placement was classified as "in", "out" or "questionable". On average, 88% and 92% of the screws were classified as "in" by the first and second radiologist, respectively. Intraobserver agreement strength was almost perfect for both observers using either axial or coronal images. Interobserver agreement strength was almost perfect (axial) and substantial (coronal) in the first reading and substantial (axial, coronal) in the second reading. Assessing screw placement in more than one CT imaging plane is not only useful but reliable. Routine use may enhance reporting quality of screw placement by surgeons and radiologists. Résumé L'insertion des vis pédiculaires dans la chirurgie rachidienne est une technique nécessitant une bonne expérience, avec des risques potentiels, de lésions des structures neurologiques dans le canal rachidien. Le positionnement des vis pédiculaires peut être évalué à l'aide des radiographies ou du scanner avec reconstruction. Le but de cette étude et de ce travail est de réaliser une étude inter observateurs du positionnement des vis pédicu-laires en utilisant le scanner. 59 vis pédiculaires ont été étudiées par des radiologues expérimentés et lors de deux épisodes d'analyse séparés. Le placement des vis a été classé en vis à l'intérieur ou à l'extérieur des pédicules ou en position douteuse. 88 et 92% des vis ont été classées respectivement dans le pédicule par le premier et le deuxième radiologue. Il en est de même des différentes lectures. Evaluer la position des vis pédiculaires à l'aide du CT dans plusieurs plans est non seulement utile mais fiable. Les examens pratiqués de routine pourraient améliorer la qualité des rapports sur le positionnement des vis pédicu-laires à la fois pour les chirurgiens et pour les radiologues.

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“…Routine anteroposterior and lateral views are inadequate to evaluate screw position 23,24 . CT is the most accurate study; however, its sensitivity and specificity varied from 76% to 86% and 75% to 88%, respectively [25][26][27] . Inferior wall violations are the most difficult to detect on CT scans 25 .…”

Section: Discussionmentioning

confidence: 99%

“…CT is the most accurate study; however, its sensitivity and specificity varied from 76% to 86% and 75% to 88%, respectively [25][26][27] . Inferior wall violations are the most difficult to detect on CT scans 25 . It is our opinion that the only way to accurately demonstrate a satisfactory placement of thoracic screws is using postoperative CT scans; medial and lateral violations can be easily seen with this technique.…”

Section: Discussionmentioning

confidence: 99%

Free-hand placement of high thoracic pedicle screws with the aid of fluoroscopy: evaluation of positioning by CT scans in a four-year consecutive series

Braga

Morais²,

Vilela

2010

Arq. Neuro-Psiquiatr.

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Objective: To evaluate the feasibility, safety and accuracy of pedicle screw placement in the upper thoracic spine using the free-hand technique with the aid of fluoroscopy; to analyze the methods used to verify correct screw positioning intra and postoperatively. Method: All patients with instability of the cervicothoracic or upper thoracic spine and at least one screw placed in the segment T1-T6 as part of a posterior construct entered the study. Only C-arm intraoperative fluoroscopy was used to guide screw placement. Results: We obtained excellent positioning in 98.07% of the screws. CT scans precisely demonstrated pedicle wall and anterolateral body violations. There was no hardware failure, no neurological or vascular injury and no loss of alignment during the follow-up period. Conclusion: Pedicle screws can be safely placed in the upper thoracic spine when strict technical principles are followed. Only a CT scan can precisely demonstrate vertebral body and medial pedicle cortical violations. Key words: pedicle screws, transpedicular fixation, thoracic spine, cervicothoracic junction, spinal instability.Colocação de parafusos pediculares na coluna torácica alta utilizando fluoroscopia: avaliação do posicionamento dos parafusos por tomografia computadorizada em uma série de casos durante quatro anos RESUMO Objetivo: Avaliar a factibilidade, segurança e eficácia da colocação de parafusos pediculares na coluna torácia alta utilizando apenas a fluoroscopia; analisar os métodos intra e pós-operatórios de verficação do posicionamento de parafusos. Método: Todos os pacientes com instabilidade da coluna cervico-torácica ou torácica alta e pelo menos um parafuso colocado no segmento T1-T6 foram incluídos no estudo. Apenas fluoroscopia intra-operatória foi utilizada para guiar a colocação dos parafusos. Resultados: Obtivemos excelente posicionamento em 98,07% dos parafusos. TC axial mostrou precisamente violações pediculares e da parede anterolateral do corpo vertebral. Não houve falência do instrumental, lesões neurológicas ou vasculares, ou perda do alinhamento sagital no período de seguimento. Conclusão: Os parafusos pediculares podem ser colocados com segurança na coluna torácica alta desde que técnicas operatórias precisas sejam executadas. Somente a TC pode demonstrar precisamente violações do corpo vertebral e da parede pedicular. Palavras-chave: parafusos pediculares, fixação transpedicular, coluna torácica alta, junção cervico-torácica, instabilidade espinhal.

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Accuracy of Computed Tomography in Assessing Thoracic Pedicle Screw Malposition

Abstract: Computed tomography was found to be relatively insensitive in assessing thoracic pedicle screw position. In the face of postoperative complications, surgical exploration and hardware removal may still be necessary despite negative computed tomography.

Cited by 28 publications

References 7 publications

Reliability of the Planned Pedicle Screw Trajectory versus the Actual Pedicle Screw Trajectory using Intra-operative 3D CT and Image Guidance

Reliability of the Planned Pedicle Screw Trajectory versus the Actual Pedicle Screw Trajectory using Intra-operative 3D CT and Image Guidance

Observer reliability in evaluating pedicle screw placement using computed tomography

Free-hand placement of high thoracic pedicle screws with the aid of fluoroscopy: evaluation of positioning by CT scans in a four-year consecutive series

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