Thoracic Pedicle Screw Instrumentation

Lonner, Baron S.; Auerbach, Joshua D.; Estreicher, Michael; Kean, Kristin E.

doi:10.1097/brs.0b013e3181b4f7e8

Cited by 72 publications

(22 citation statements)

References 37 publications

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“…There is a significant learning curve associated with pedicle screw placement [34], and all screws in this study were placed by experienced surgeons.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of pedicle screw placement in patients with Marfan syndrome

Qiao

Zhu

et al. 2017

BMC Musculoskelet Disord

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BackgroundThere is no study concerning safety and accuracy of pedicle screw placement in Marfan syndrome. The objective of this study is to investigate accuracy and safety of pedicle screw placement in scoliosis associated with Marfan syndrome.MethodsCT scanning was performed to analyze accuracy of pedicle screw placement. Pedicle perforations were classified as medial, lateral or anterior and categorized to four grades: ≤ 2 mm as Grade 1, 2.1–4.0 mm as Grade 2, 4.1–6.0 mm as Grade 3, ≥6.1 mm as Grade 4. Fully contained screws or with medial wall perforation ≤ 2 mm or with lateral wall perforation ≤ 6 mm and without injury of visceral organs were considered acceptable, otherwise were unacceptable.Results976 pedicle screws were placed, 713 screws (73.1%) were fully contained within the cortical boundaries of the pedicle. 924 (94.7%) screws were considered as acceptable, and 52 (5.3%) as unacceptable. The perforation rate was higher using free-hand technique than O-arm navigation technique (30.8% VS. 11.4%, P < 0.05), higher in lumbar region than in thoracic region (34.1% VS. 22.3%, P < 0.05) and higher in concave side than in convex side (33.5% VS. 21.9%, P < 0.05). No injury of visceral organs especially aorta erosion was noted in the series. 7 cases of dural tear caused by misplaced screws occurred, and 4 cases developed cerebro-spinal fluid leak. Drainage and pressure dressings were applied for these patients, and no infection was observed. Leg pain was observed in 7 cases, and 2 cases simultaneously complained of leg weakness. Revision surgery was conducted to remove the misplaced screws for these 2 patients. Conservative treatment was applied for the 5 patients without leg weakness. Symptoms of leg weakness and pain resolved in all patients.ConclusionPlacement of pedicle screw in Marfan syndrome is accuracy and safe. O-arm navigation was an effective modality to ensure the safety and accuracy of screw placement. Special attention should be paid when screws were placed at the lumber spine and the concave side of spine deformity to avoid the higher rate of complications.

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“…There is a significant learning curve associated with pedicle screw placement [34], and all screws in this study were placed by experienced surgeons.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of pedicle screw placement in patients with Marfan syndrome

Qiao

Zhu

et al. 2017

BMC Musculoskelet Disord

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“…Entendemos que este parâmetro seja útil para o equilíbrio do tronco no plano coronal, o que poderia elevar os escores de avaliação clínica. A escolha de utilizar somente parafusos monoaxiais (de cabeça fixa) nas montagens foi baseada no maior poder de "derrotação" vertebral que esses parafusos apresentam, quando comparados aos parafusos do tipo poliaxiais, permitindo maior correção da gibosidade 21,23 . Diab et al 24 demonstraram, em uma grande série de casos, o baixo risco de complicações neurológicas com uso de parafusos pediculares.…”

Section: Médiaunclassified

Tratamento cirúrgico da escoliose idiopática do adolescente utilizando parafusos pediculares: análise dos resultados clínicos e radiográficos

et al. 2011

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RESUMOObjetivo: Realizar avaliação clínica e radiográfica de pacientes com escoliose idiopática do adolescente (EIA) submetidos à artrodese por via posterior utilizando parafusos pediculares e correlacionar os resultados por imagem com os escores obtidos através do questionário SRS-24. Métodos: Foram avaliados 25 pacientes com diagnóstico de escoliose idiopática do adolescente, submetidos à artrodese da coluna por via posterior com parafusos pediculares. O seguimento médio foi de 23,7 meses, variando entre 12 e 35. Analisamos critérios radiográficos referentes à correção das deformidades e aplicamos o questionário SRS-24, específico para esta doença, padronizado pela Scoliosis Research Society. Resultados: A amostra foi composta por 92% de pacientes do gênero feminino e a média de idade foi de 14,2 anos. A média do índice de Cobb na radiografia ântero-posterior pré-operatória foi de 24,4° para curva torácica proximal, 54,9° para torácica principal e 38,5° para curva lombar. Os valores angulares médios no pós-operatório foram 11,0°; 16,7° e 12,2° respectivamente, com porcentagem de correção média da curva torácica principal de 69,9%. O valor médio final do questionário SRS-24 foi 98,1 pontos. Dois pacientes apresentaram complicações pós-operatórias, entretanto, nenhuma do tipo neurológica. Conclusão: A técnica se mostrou eficaz para tratamento cirúrgico da EIA, proporcionando alto percentual de correção das deformidades, com baixo risco de complicações e resultado clínico satisfatório. Não foi encontrada relação estatisticamente significante entre a porcentagem de correção da curva (torácica principal ou lombar) ou seu valor angular pós-operatório com o valor final do questionário SRS-24 nem com os domínios "satisfação" e "auto-imagem pós-operatória". RESUMENObjetivo: Evaluar clínica y radiográficamente a pacientes portadores de escoliosis idiopática del adolescente sometidos a artrodesis por vía posterior, utilizando solamente tornillos pediculares, y correlacionar el resultado radiográfico con los valores obtenidos a través del cuestionario SRS-24. Métodos: Fueron evaluados 25 pacientes portadores de escoliosis idiopáticas del adolescente, sometidos a artrodesis de la columna por vía posterior. El seguimiento promedio fue de 23,7 meses, con variación entre 12 y 35. Analizamos criterios radiográficos referentes a la corrección de las deformidades y aplicamos el cuestionario SRS-24, específico para la patología en cuestión, estandarizada por la Scoliosis Research Society. Resultados: La muestra fue compuesta por 92% de pacientes del sexo

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“…The learning curve for thoracic pedicle screw insertion has recently been studied regarding improvement of different parameters such as duration of surgery, amount of blood loss, major curve correction, hospital stay, and complication rate (Lonner et al 2009) but we could not find any studies on the learning curve regarding accurate screw placement. We found an average misplacement rate of 14%, with a clear learning curve.…”

Section: Discussionmentioning

confidence: 99%

The rate of screw misplacement in segmental pedicle screw fixation in adolescent idiopathic scoliosis

Abul-Kasim¹,

Ohlin²

2010

Acta Orthopaedica

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Background and purpose There are no reports in the literature on the influence of learning on the pedicle screw insertion. We studied the effect of learning on the rate of screw misplacement in patients with adolescent idiopathic scoliosis treated with segmental pedicle screw fixation.Method We retrospectively evaluated low-dose spine computed tomography of 116 consecutive patients (aged 16 (12–24) years, 94 females) who were operated during 4 periods over 2005–2009 (group 1: patients operated autumn 2005–2006; group 2: 2007; group 3: 2008; and group 4: 2009). 5 types of misplacement were recorded: medial cortical perforation, lateral cortical perforation, anterior cortical perforation of the vertebral body, endplate perforation, and perforation of the neural foramen.Reslts 2,201 pedicle screws were evaluated, with an average of 19 screws per patient. The rate of screw misplacement for the whole study was 14%. The rate of lateral and medial cortical perforation was 7% and 5%. There was an inverse correlation between the occurrence of misplacement and the patient number, i.e. the date of operation (r = –0.35; p < 0.001). The skillfulness of screw insertion improved with reduction of the rate of screw misplacement from 20% in 2005–2006 to 11% in 2009, with a breakpoint at the end of the first study period (34 patients).Interpretation We found a substantial learning curve; cumulative experience may have contributed to continued reduction of misplacement rate.

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Thoracic Pedicle Screw Instrumentation

Cited by 72 publications

References 37 publications

Accuracy of pedicle screw placement in patients with Marfan syndrome

Accuracy of pedicle screw placement in patients with Marfan syndrome

Tratamento cirúrgico da escoliose idiopática do adolescente utilizando parafusos pediculares: análise dos resultados clínicos e radiográficos

The rate of screw misplacement in segmental pedicle screw fixation in adolescent idiopathic scoliosis

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