Pedicle Screw Placement With a Free Hand Technique in Thoracolumbar Spine: Is It Safe?

Karapınar, Levent; Erel, Nuri; Öztürk, Hasan; Altay, Taşkın; Kaya, Ahmet

doi:10.1097/bsd.0b013e3181453dc6

Cited by 95 publications

(72 citation statements)

References 38 publications

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“…Whereas, some surgeons believe that there is no need to use navigation system for pedicle screw placement in lumbar spine as lumbar pedicles are large enough to guarantee accuracy and safety. In addition, conclusions reported in different literature are not consistent [17][18][19]. Inconsistent conclusions, as well as varying experiences in different research centers, result in application of three-dimensional fluoroscopy-based navigation in lumbar spine being questioned.…”

Section: Discussionmentioning

confidence: 99%

Placement of pedicle screws using three-dimensional fluoroscopy-based navigation in lumbar vertebrae with axial rotation

Tian

Lang

2010

Eur Spine J

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Despite potential advantages of three-dimensional fluoroscopy-based navigation, there still remain a lot of controversies about the indications of this technology, especially whether it is worthy of being used in placement of pedicle screws in lumbar spine. However, according to the inconsistent conclusions reported in the literature and our experiences, the traditional method relying on anatomical landmarks and fluoroscopic views to guide lumbar pedicle screw insertion is unable to meet the requirement of precise screw placement. Based on our observation, screw malposition seems to occur concomitant with vertebral axial rotation which is a ubiquitous phenomenon. Threedimensional fluoroscopy-based navigation can provide the most valuable axial images in real-time, so it may be useful for placement of pedicle screws in lumbar spine. This study was intended to evaluate the effect of axial rotation of lumbar vertebrae on the accuracy of pedicle screw placement using the traditional method, as well as assess the value of three-dimensional fluoroscopy-based navigation in improving the accuracy. Sixteen lumbar simulation models at different degrees of axial rotation (0°, 5°, 10°, and 20°), with every four assigned the same degree, were equally divided into two groups (traditional method group and three-dimensional fluoroscopy-based navigation group). Random placement of pedicle screws was carried out, followed by CT scan postoperatively. Then the outer pedicle cortex contours were depicted from reconstructed sectional pedicle images using Photoshop. The accuracy of pedicle screw placement was evaluated by determining the interrelationship between screw trajectory and pedicle cortex (quality), and measuring the shortest distance from pedicle screw axis to outer cortex of the pedicle (quantity). Eighty pedicle screws were implanted, respectively, in each group. In traditional method group, statistical difference existed in the accuracy of pedicle screw placement at different axial rotational degrees (P \ 0.05). With degrees increasing, the accuracy declined. The accuracy of threedimensional fluoroscopy-based navigation group was higher than traditional method group in vertebrae with axial rotation (P \ 0.01). In qualitative evaluation, the accuracy of the two methods had statistical difference when the degree was 20°, and in quantitative evaluation, statistical difference existed in 5°, 10°, and 20°of vertebral axial rotation.

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Section: Discussionmentioning

confidence: 99%

Placement of pedicle screws using three-dimensional fluoroscopy-based navigation in lumbar vertebrae with axial rotation

Tian

Lang

2010

Eur Spine J

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“…Additional usage of fluoroscopy by Weinstein et al in another cadaveric study of pedicle screw insertion from T11-S1 decreased the overall pedicle "miss" rate to 21% [15]. Further additional usage of pedicle probing with a flexible ball-tipped probe decreased the medial and inferior wall violation to 2% [thirteen of 640 screws] in a study by Karapinar et al [16]. In an analysis of 3204 thoracic pedicle screws inserted with "free-hand" technique with adjuvant pedicle probing, fluoroscopy and neurophysiologic monitoring, only 1.7% incidence of asymptomatic medial wall violation was noted [4].…”

Section: Discussionmentioning

confidence: 99%

Stimulation of Pedicle Screws with Diathermy: Is it a Viable Option to Detect Breaches?

Pithwa¹,

Venkatesh²

2015

J Spine 2015

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“…Seven studies had different patient groups with alternative treatment options. [2][3][4][5][6][7][8]10,11,16,20,21,[24][25][26][29][30][31][32][33][34][35][36]38,43,44,47,48,51,52,54,55,57,58,[62][63][64][65] Thirteen studies were prospective, 25 were retrospective, and 1 study was both pro-and retrospective. 3 Seventeen studies reported a follow-up (mean follow-up 19.0 months, range 1-118 months).…”

Section: Resultsmentioning

confidence: 99%

Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management: a literature review of 35,630 pedicle screws

Gautschi

Schatlo²,

Schaller³

et al. 2011

FOC

210

149

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Object The technique of pedicle screw insertion is a mainstay of spinal instrumentation. Some of its potential complications are clinically relevant and may require reoperation or further postoperative care. Methods A literature search was performed using MEDLINE (between 1999 and June 2011) for studies on pedicle screw placement in thoracolumbar surgery. The authors included randomized controlled trials, case-control studies, and case series (≥ 20 patients) from the English-, German-, and French-language literature. The authors assessed study type, the number of patients, the anatomical area, the number of pedicle screws, duration of follow-up, type of pedicle screw placement, incidence of complications, and type of complication. The management of specific complications is discussed. Results Thirty-nine articles with 46 patient groups were reviewed with a total of 35,630 pedicle screws. One study was a randomized controlled trial, 8 were case-control studies, and the remaining articles were case series. Dural lesions and irritation of nerve roots were reported in a mean of 0.18% and 0.19% per pedicle screws, respectively. Thirty-two patients in 10 studies (of 5654 patients from all 39 studies) required further revision surgeries for misplaced pedicle screws causing neurological problems. None of the analyzed studies reported vascular complications, and only 2 studies reported visceral complications of clinical significance. Conclusions Pedicle screw placement in the thoracolumbar region is a safe procedure with an overall high accuracy and a very low rate of clinically relevant complications.

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Pedicle Screw Placement With a Free Hand Technique in Thoracolumbar Spine: Is It Safe?

Abstract: Pedicle screw placement with a free hand technique after reviewing preoperative imaging seems to be accurate, reliable, and safe adjunct for the placement of thoracolumbar spine screws.

Cited by 95 publications

References 38 publications

Placement of pedicle screws using three-dimensional fluoroscopy-based navigation in lumbar vertebrae with axial rotation

Placement of pedicle screws using three-dimensional fluoroscopy-based navigation in lumbar vertebrae with axial rotation

Stimulation of Pedicle Screws with Diathermy: Is it a Viable Option to Detect Breaches?

Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management: a literature review of 35,630 pedicle screws

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