Freehand Juxtapedicular Screws Placed in the Apical Concavity of Adult Idiopathic Scoliosis Patients: Technique, Computed Tomography Confirmation, and Radiographic Results

Abstract

Objective: The purpose of this study is to highlight our technique for freehand placement of juxtapedicular screws along with intraoperative computed tomography (CT) and radiographic results.Methods: Consecutive patients with adult idiopathic scoliosis undergoing primary surgery by the senior author were identified. All type D (absent/slit like channel) pedicles were identified on preoperative CT. Three-dimensional visualization software was used to measure screw angulation and purchase. Radiographs were measured by a fellowship trained spine surgeon. The freehand technique was used to place all screws in a juxtapedicular fashion without any fluoroscopic, radiographic, navigational or robotic assistance.Results: Seventy-three juxtapedicular screws were analyzed. The most common level was T7 (9 screws) on the left and T5 (12 screws) on the right. The average medial angulation was 20.7° (range, 7.1°–36.3°), lateral vertebral body purchase was 13.4 mm (range, 0–28.9 mm), and medial vertebral body purchase was 21.1 mm (range, 8.9–31.8 mm). More than half (53.4%) of the screws had bicortical purchase. Two screws were lateral on CT scan, defined by the screw axis lateral to the lateral vertebral body cortex. No screws were medial. There was a difference in medial angulation between screws with (n = 58) and without (n = 15) lateral body purchase (22.0 ± 4.9 vs. 15.5 ± 4.5, p < 0.001). Three of 73 screws were repositioned after intraoperative CT. There were no neurovascular complications. The mean coronal cobb corrections for main thoracic and lumbar curves were 83.0% and 80.5%, respectively, at an average of 17.5 months postoperative.Conclusion: Freehand juxtapedicular screw placement is a safe technique for type D pedicles in adult idiopathic scoliosis patients.

Minimally Invasive Controlled Growing Rods for the Surgical Treatment of Early-Onset Scoliosis—A Surgical Technique Video

“…If the pedicles are completely missing or dysplastic, we additionally place hooks at the highest level on the transverse processes to minimize the risk of pull-out and PJK. If the pedicles are missing or they are dysplastic, the screws are usually inserted using an extra-pedicular technique in accordance with the methods described in the literature [ 22 , 23 ]. The surgical technique for MICGRs is similar to the implantation of the SGR [ 4 , 10 ] and MCGR implantation techniques that we have previously described [ 21 ].…”

“…We do not routinely use a proximal cross-connector between the rods. In patients with poor bone quality or missing pedicles at the top of the structure, when inserting juxtapedicular screws [ 22 ], we use transverse process hooks at the top to prevent the upper implant from breaking out. We then complete the final irrigation, bone decortication at the screws, coating of the bone grafts with vancomycin powder, and standard closure.…”

Long-term Outcomes of Posterior Multilevel Crack Osteotomy: Revisional Surgery for Scoliosis With a Fusion Mass

“…However, revisional scoliosis surgery is challenged with the presence of spinal fusion masses and difficulty in screw insertion due to the distorted anatomy from the previous surgery [ 5 ]. The screw insertion point is frequently indistinguishable in revisional scoliosis surgery, even though C-arm images are used to identify the pedicle for screw insertion points [ 6 , 7 ]. For mobilization of fused spinal segments, various spinal osteotomy techniques, such as Smith-Petersen osteotomy (SPO) [ 8 ], pedicle subtraction osteotomy (PSO) [ 9 , 10 ], vertebral column resection (VCR) [ 11 ], and posterior VCR (PVCR) [ 12 ] have been introduced.…”

“…5 The screw insertion point is frequently indistinguishable in revisional scoliosis surgery, even though C-arm images are used to identify the pedicle for screw insertion points. 6,7 Neurospine eISSN 2586-6591 pISSN This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.…”