Accuracy of pedicle screw placement in thoracolumbar spine with conventional open technique

Abstract

AIm: To demonstrate the incidence of screw misplacement and revision rates in a group of 72 patients that underwent pedicle screw fixation for spinal pathologies using the conventional, fluoroscopy-guided open technique. mATERIAL and mETHods: Data from 72 consecutive patients with spinal instability that received 472 screws between April 2011 and May 2013 were reviewed and pedicle wall breach was graded as mild (< 3 mm), moderate (3-6 mm) and severe (> 6 mm). Direction of misplacement was also assessed in reformatted images as medial, lateral, superior and inferior (or in combinations). REsuLTs:The indications for pedicle screw placement were as follows: degenerative (59.7%), trauma (13%) and tumor (9.7%). Pedicle screws were inserted between T9 and S1. In this series of the 472 screws, 29 (6.1%) screws were implanted with minimal pedicle wall violation (≤3mm) and 16 screws (3.4%) were implanted with moderate (3-6 mm) violations. There were no severe violations (more than 6 mm) in this series. Pedicle violations were significantly higher in thoracic pedicles and in trauma patients when compared to other groups. Only two patients required pedicle screw repositioning after their index surgery. CoNCLusIoN:Conventional open technique in pedicle screw placement is a safe and sound method with its low and acceptable complication rates BuLGuLAR: Hastaların %59,7 sinde dejeneratif patoloji, %13'ünde travma ve %9,7sinde tümöral patoloji bulunmaktaydı. Pedikül vidaları bu hasta grubunda T9 ile S1 arasına yerleştirilmiştir. 472 vidanın 29 (%6,1) tanesinde hafif; 16 (%3,4) tanesinde de orta dereceli malpozisyon olduğu tespit edildi. Bu seride ciddi malpozisyonlu hasta bulunmamakta idi (6 mm'den fazla). Yanlış yerleşimlerin büyük çoğunluğu istatistiksel olarak anlamlı şekilde torasik vertebrada ve travma hastalarında idi. Sadece 2 hastaya cerrahi sonrası malpozisyon nedeni ile ikinci bir revizyon cerrahisi uygulandı. soNuÇ: Geleneksel açık pedikül vidalama tekniği düşük ve kabul edilebilir komplikasyon oranları ile güvenli ve etkili bir cerrahi tekniktir.ANAHTAR sÖZCÜKLER: Açık pedikül vida yerleştirilmesi, Pedikül sıyırması, Pedikül vidası, Pedikül vidası malpozisyonu, Spinal instabilite, Torakolomber instabilite

Clinical Effects of Oblique Lateral Interbody Fusion by Conventional Open versus Percutaneous Robot‐Assisted Minimally Invasive Pedicle Screw Placement in Elderly Patients

“…Surgical treatment of spinal degenerative disease usually involves lumbar intervertebral fusion and pedicle screw internal fixation. However, this approach may be challenging in elderly patients, especially in those with severe orthopaedic degeneration and osteoporotic vertebrae, as pedicle screw insertion may breach the cortical wall, which can cause nerve damage, decrease the holding strength of the screw, and increase the risk of bone cement leakage. In addition, surgery in elderly patients can be associated with complications due to the presence of comorbidities and poor cardiopulmonary function.…”

Does the Use of Dynamic Surgical Guidance Assist Accurate Pedicle Screw Placement in Patients With Osteoporosis or Osteopenia?

“…The electrical properties of the tissue are influenced by environmental conditions (pH, moisture content, temperature) and biological variables such as microstructure and chemical bone composition. [16][17][18][19][20][21] The microstructure of osteoporotic and osteopenic bone is different from that of normal bone. These microstructural changes influence the electrical properties of bone.…”

“…Perforation of the pedicle wall can lead to complications such as dural tear, nerve root injury, paraplegia, or vascular injury; although in many instances, a misplaced screw does not result in these complications. 19,20 The importance of pedicle screw accuracy is well recognized; however, there is currently no gold standard method for accessing it. 21,22 Perforations less than 2 mm on CT scan are thought not to be associated with clinical outcome.…”

The causes and the results of revision surgery in lumbar spine: Experience with 72 consecutive cases

“…Bu hastaların hepsinin ortak özelliği dejeneratif hasta grubu olması ve skolyoza bağlı 10 ile 30 derece arasında vertebra rotasyonunun olması idi. Börcek ve arkadaşları yapmış olduğu çalışmada torakolomber cerrahi sırasında koyulan 472 pediküler vidadan 45'inin malposizyon gösterdiğini belirtmişlerdir (8). Bizim hasta grubumuzda hastaların önemli bir kısmının dış merkezde opere olmuş olması nedeniyle böylesi bir oran belirtmemiz mümkün değildir.…”