Free Hand Pedicle Screw Placement in the Thoracic Spine: Is it Safe?

Kim, Yongjung J.; Lenke, Lawrence G.; Bridwell, Keith H.; Cho, Yongsun S.; Riew, K. Daniel

doi:10.1097/01.brs.0000109983.12113.9b

Cited by 659 publications

(575 citation statements)

References 47 publications

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“…The use of intra-operative fluoroscopy for placement of pedicle screws has resulted in prolonged fluro time and radiation exposure to the surgical personnel and patient [32]. However, we have found that free-hand technique is relatively easy to learn and is as accurate [22] as the other methods, which were implemented in our study. There are also various intraoperative methods, such as SSEP, MEP or computer assisted surgery [11,29], described to detect pedicle violation or neural injury.…”

Section: Introductionmentioning

confidence: 75%

“…So, accurate and safe placement of screw within the pedicle is a crucial step during the surgery. Various methods such as free hand technique, Penfield outside-in technique, under C-arm control, computer assisted navigational surgery and stereotectic surgery, etc., to put the pedicle screw have been described in the literature [20,22,29]. The use of intra-operative fluoroscopy for placement of pedicle screws has resulted in prolonged fluro time and radiation exposure to the surgical personnel and patient [32].…”

Section: Introductionmentioning

confidence: 99%

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Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

et al. 2008

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It is a retrospective analytic study of 1,009 transpedicular screws (689 thoracic and 320 lumbosacral), inserted with free-hand technique in neuromuscular scoliosis using postoperative CT scan. The aim of paper was to determine the accuracy and safety of transpedicular screw placement with free-hand technique in neuromuscular scoliosis and to compare the accuracy at different levels in such population. All studies regarding accuracy and safety of pedicle screw in scoliosis represent idiopathic scoliosis using various techniques such as free-hand, navigation, image intensifier, etc., for screw insertion. Anatomies of vertebrae and pedicle are distorted in scoliosis, hence accurate and safe placement of pedicle screw is prerequisite for surgery. Between 2004 and 2006, 37 consecutive patients, average age 20 years (9-44 years), of neuromuscular scoliosis were operated with posterior pedicle screw fixation using free-hand technique. Accuracy of pedicle screws was studied on postoperative CT scan. Placement up to 2 mm medial side and 4 mm lateral side was considered within-safe zone. Of the 1,009 screws, 273 screws were displaced medially, laterally or on the anterior side showing that 73% screws (68% in thoracic and 82.5% in lumbar spine) were accurately placed within pedicle. Considering the safe zone, 93.3% (942/1009, 92.4% in thoracic and 95.3% in lumbar spine) of the screws were within the safe zone. Comparing accuracy according to severity of curve, accuracy was 75% in group 1 (curve \90°) and 69% in group 2 (curve [90°) with a safety of 94.8 and 91.2%, respectively (P = 0.35). Comparing the accuracy at different thoracic levels, it showed 67, 64 and 72% accuracy in upper, middle and lower thoracic levels with safety of 96.6, 89.2 and 93.1%, respectively, exhibiting no statistical significant difference (P = 0.17). Pedicle screw placement in neuromuscular scoliosis with free-hand technique is accurate and safe as other conditions.

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Section: Introductionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

et al. 2008

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“…Most of these studies, however, describe different entry points at different levels as well as different insertion techniques. In our department, we used the method reported by Kim et al [9] to determine thoracic entry point, and the method reported by Magerl [10] to determine the lumbar entry point. This resulted in a high accuracy rate and a low complication rate in placement of screw in patients with moderate scoliosis.…”

Section: Introductionmentioning

confidence: 99%

Use of computed tomographic reconstruction to establish the ideal entry point for pedicle screws in idiopathic scoliosis

Zhang²,

Peng

et al. 2011

Eur Spine J

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Objective To determine the ideal entry point for individual pedicle screw in the surgical treatment of idiopathic scoliosis using computed tomographic (CT) three-dimensional (3D) reconstruction. Methods Twenty patients with moderate or severe idiopathic scoliosis from two groups received surgical treatment using ''Free Hand technique'' and ''Assisted Free Hand technique''. Computed tomographic scanning with 3D reconstruction of the thoracic and lumbar spine was conducted to determine the entry point and to evaluate the placement accuracy. Results The accuracy of placement was 88.2% in convexity and 84.5% in concavity for the ''Free Hand'' group, and 94.1% in convexity and 94% in concavity for the ''Assisted Free Hand'' group. Evidence showed that ''Assisted Free Hand'' group had higher accuracy when screws were placed in the thoracic spine (P = 0.02), while no obvious difference was seen in the lumbar spine placement (P = 0.47). Conclusions We conclude that in the surgical treatment of severe scoliosis, individual screw placement guided by entry points determined by CT reconstruction can result in improved accuracy and ease of the procedure.

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“…In a report by Suk et al 24 , the perforation rate of pedicle screw inserted by free hand in AIS posterior fusion was 1.5%; however, only 10% of cases were evaluated by CT, and thus this reported rate is not highly reliable. In report by Kim et al 25 In contrast, the perforation rates of reports of surgeries that employed navigation system [28][29][30] were between 1.8 and 11.4%. In the present report, the rate was as low as 2.8%.…”

Section: Discussionmentioning

confidence: 99%

Computer-assisted hemivertebral resection for congenital spinal deformity

Takahashi

Ebara

Hashidate

et al. 2011

Journal of Orthopaedic Science

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Free Hand Pedicle Screw Placement in the Thoracic Spine: Is it Safe?

Abstract: The free hand technique of thoracic pedicle screw placement performed in a step-wise, consistent, and compulsive manner is an accurate, reliable, and safe method of insertion to treat a variety of spinal disorders, including spinal deformity.

Cited by 659 publications

References 47 publications

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

Use of computed tomographic reconstruction to establish the ideal entry point for pedicle screws in idiopathic scoliosis

Computer-assisted hemivertebral resection for congenital spinal deformity

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