How Accurately Do Novice Surgeons Place Thoracic Pedicle Screws With the Free Hand Technique?

Abstract

Novice resident surgeons placing thoracic pedicle screws in cadavers were able to significantly improve by the fourth cadaver to accuracy levels documented in the literature. Surgeons in training shouldpractice these skills in the laboratory before proceeding to the operating room.

Use of the Universal Clamp for deformity correction and as an adjunct to fusion: Preliminary results in scoliosis

“…Nevertheless, despite the possibility of good sagittal outcome with thoracic pedicle screws [33,34], significantly lower values of thoracic kyphosis have been demonstrated in patients with all-screw constructs compared to hybrid instrumentation [2,7,13,14]. In addition, neurovascular risks related to free-hand insertion of pedicle screws into the thoracic spine [9][10][11][12] are obviated using sublaminar fixation techniques, including the Universal Clamp. To reduce the risk of neurovascular complications related to the placement of screws outside of the pedicles, the use of imaging techniques such as fluoroscopy, preoperative computed tomography or neuronavigation has been recommended by several authors for insertion of pedicle screws [35][36][37].…”

“…Aside from risks associated with placing screws outside of the pedicle [9][10][11][12], there is growing concern over the low values of thoracic kyphosis often reported in patients with all-screw constructs [2,7,13,14]. Other treatments consist of various types of hybrid constructs with pedicle-screw fixation in the lumbar spine and other anchors in the thoracic spine [3,13,15].…”

Morphologic evaluation of the thoracic vertebrae for safe free-hand pedicle screw placement in adolescent idiopathic scoliosis: a CT-based anatomical study

“…This technique reduces the insertion time, thereby reducing the length of the entire surgery, and reduces blood loss without increasing the complication rate, compared to the other techniques. However, there is still a significant learning curve for thoracic PS placement in the deformed spine [4,25,42]. The accuracy of thoracic PS placement was only 71% for novice surgeons using the free-hand technique [4].…”

“…However, there is still a significant learning curve for thoracic PS placement in the deformed spine [4,25,42]. The accuracy of thoracic PS placement was only 71% for novice surgeons using the free-hand technique [4]. Although pedicle wall violation during PS placement is more frequently observed in the outer cortex than in the inner cortex, the medial wall perforation is more serious because it may cause injuries to the dura, nerve root, or spinal cord, with catastrophic neurological sequelae [3,28,49].…”

Retrospective Analysis of Screw Malposition Following Instrumented Correction of Thoracic and Lumbar Spine Deformities

“…По другим данным, необхо-димо установить 80 транспедику-лярных винтов, чтобы существенно минимизировать риск мальпозиций [13]. Некоторые авторы рекоменду-ют проводить с молодыми хирургами занятия по введению винтов на тру-пах, отмечая, что после четырех заня-тий уровень мальпозиций сокращает-ся до величины, сопоставимой с той, которая бывает у опытных врачей [5]. Наибольшую осторожность следует проявлять при введении винтов в груд-ном отделе позвоночника.…”