Anatomic Considerations of Pedicle Screw Placement in the Thoracic Spine

Xu, Rongming; Ebraheim, Nabil A.; Ou, Yianjia; Yeasting, Richard A.

doi:10.1097/00007632-199805010-00021

Cited by 192 publications

(120 citation statements)

References 16 publications

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“…These include the ''anatomical'' techniques such as the free hand method [24] and the openlamina technique [59]. The latter provides direct visualization of the medial wall of the pedicle.…”

Section: Discussionmentioning

confidence: 99%

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

et al. 2008

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The treatment of thoracic adolescent idiopathic scoliosis (AIS) of more than 80°traditionally consisted of a combined procedure, an anterior release performed through an open thoracotomy followed by a posterior fusion. Recently, some studies have reassessed the role of posterior fusion only as treatment for severe thoracic AIS; the correction rate of the thoracic curves was comparable to most series of combined anterior and posterior surgery, with shorter surgery time and without the negative effect on pulmonary function of anterior transthoracic exposure. Compared with other studies published so far on the use of posterior fusion alone for severe thoracic AIS, the present study examines a larger group of patients (52 cases) reviewed at a longer follow-up (average 6.7 years, range 4.5-8.5 years). The aim of the study was to evaluate the clinical and radiographic outcome of surgical treatment for severe thoracic ([80°) AIS treated with posterior spinal fusion alone, and compare comprehensively the results of posterior fusion with a hybrid construct (proximal hooks and distal pedicle screws) versus a pedicle screw instrumentation. All patients (n = 52) with main thoracic AIS curves greater than 80°(Lenke type 1, 2, 3, and 4), surgically treated between 1996 and 2000 at one institution, by posterior spinal fusion either with hybrid instrumentation (PSF-H group; n = 27 patients), or with pedicle screw-only construct (PSF-S group; n = 25 patients) were reviewed. There were no differences between the two groups in terms of age, Risser's sign, Cobb preoperative main thoracic (MT) curve magnitude (PSF-H: 92°vs. PSF-S: 88°), or flexibility on bending films (PSF-H: 27% vs. PSF-S: 25%). Statistical analysis was performed using the t test (paired and unpaired), Wilcoxon test for nonparametric paired analysis, and the Mann-Whitney test for non-parametric unpaired analysis. At the last follow-up, the PSF-S group, when compared to the PSF-H group had a final MT correction rate of 52.4 versus 44.52% (P = 0.001), with a loss of -1.9°versus -11.3°( P = 0.0005), a TL/L correction of 50 versus 43% (ns), a greater correction of the lowest instrumented vertebra translation (-1.00 vs. -0.54 cm; P = 0.04), and tilt (-19°vs. -10°; P = 0.005) on the coronal plane. There were no statistically significant differences in sagittal and global coronal alignment between the two groups (C7-S1 offset: PSF-H = 0.5 cm vs. PSF-S = 0 cm). In the hybrid series (27 patients) surgery-related complications necessitated three revision surgeries, whereas in the screw group (25 patients) one revision surgery was performed. No neurological complications or deep wound infection occurred in this series. In conclusion, posterior spinal fusion for severe thoracic AIS with pedicle screws only, when compared to hybrid construct, allowed a greater coronal correction of both main thoracic and secondary lumbar curves, less loss of the postoperative correction achieved, and fewer revision surgeries. Posterior-only fusion with pedicle screws enabled a good and...

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Section: Discussionmentioning

confidence: 99%

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

et al. 2008

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“…The open-lamina technique described by Xu et al [25] allows direct visualization and palpation of the medial and superior pedicle walls. Although this technique gives additional anatomical information to the surgeon, it does not provide the anatomical alignment featured by the TDG.…”

Section: Discussionmentioning

confidence: 99%

“…Vaccaro et al [22] found that the failure rate was highly variable between surgeons and that most of their own 41.1% misplaced screws violated the medial wall, some by as much as 8.5 mm. Xu et al [25] showed a decreased incidence of pedicle perforation with the open lamina technique (16.0%), as compared to the Roy-Camille technique (54.7%). Cinotti et al…”

Section: Introductionmentioning

confidence: 97%

Evaluation of a transpedicular drill guide for pedicle screw placement in the thoracic spine

Mac-Thiong

Rooze²,

Feipel³

et al. 2003

European Spine Journal

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“…Previous studies evaluating thoracic placement have focused mostly in the lower thoracic region [1,4,12,16,17,19,26,29]. Furthermore, accuracy of thoracic pedicle screw instrumentation has been reported in several cadaveric populations [5,7,21,22,25,28,29,31,32], and with the use of assisted-navigation techniques [2,5,6,8,25]. While there is data on thoracic screw placement accuracy in the literature, we found little information specifically reporting on upper thoracic screws inserted in vivo on nondeformed spines.…”

Section: Discussionmentioning

confidence: 87%

Inserting pedicle screws in the upper thoracic spine without the use of fluoroscopy or image guidance. Is it safe?

2006

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Several studies have looked at accuracy of thoracic pedicle screw placement using fluoroscopy, image guidance, and anatomical landmarks. To our knowledge the upper thoracic spine (T1-T6) has not been specifically studied in the context of screw insertion and placement accuracy without the use of either image guidance or fluoroscopy. Our objective was to study the accuracy of upper thoracic screw placement without the use of fluoroscopy or image guidance, and report on implant related complications. A single surgeon inserted 60 screws in 13 consecutive non-scoliotic spine patients. These were the first 60 screws placed in the high thoracic spine in our institution. The most common diagnosis in our patient population was trauma. All screws were inserted using a modified RoyCamille technique. Post-operative axial computed tomography (CT) images were obtained for each patient and analyzed by an independent senior radiologist for placement accuracy. Implant related complications were prospectively noted. No pedicle screw misplacement was found in 61.5% of the patients. In the remaining 38.5% of patients some misplacements were noted. Fifty-three screws out of the total 60 implanted were placed correctly within all the pedicle margins. The overall pedicle screw placement accuracy was 88.3% using our modified Roy-Camille technique. Five medial and two lateral violations were noted in the seven misplaced screws. One of the seven misplaced screws was considered to be questionable in terms of pedicle perforation. No implant related complications were noted. We found that inserting pedicle screws in the upper thoracic spine based solely on anatomical landmarks was safe with an accuracy comparable to that of published studies using imageguided navigation at the thoracic level.

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Anatomic Considerations of Pedicle Screw Placement in the Thoracic Spine

Cited by 192 publications

References 16 publications

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

Evaluation of a transpedicular drill guide for pedicle screw placement in the thoracic spine

Inserting pedicle screws in the upper thoracic spine without the use of fluoroscopy or image guidance. Is it safe?

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