Accuracy and technical limits of percutaneous pedicle screw placement in the thoracolumbar spine

Charles, Yann Philippe; Ntilikina, Yves; Collinet, Arnaud; Schuller, S.; Garnon, Julien; Godet, Julien; Clavert, P

doi:10.1007/s00276-020-02673-7

Cited by 8 publications

(5 citation statements)

References 30 publications

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“…22 However, the trends were seen in PETD (where the mid-thoracic levels (T4 to T7) showed the lowest mean PETD values) were similar to the ones in the American, Indian, and French populations. 23 This trend is further supported by other researchers who stated that the mid-thoracic levels were the most susceptible site for a breach due to the narrowness of their pedicles. 24 This study on the Zimbabwean population suggests that to avoid medial and lateral breaches during pedicle screw placement, screws with a diameter of 5mm or less are used from T2-T10 while screws with a diameter of 7mm or less are used elsewhere (T1, T11, and T12).…”

Section: Discussionmentioning

confidence: 53%

Pedicle Dimensions of the Thoracic Vertebrae in the Zimbabwean Adult Male Population: A Cadaveric Study

Khan¹,

Nyamandi²,

Makosa³

2022

JRMC

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Objective: To record the dimensions of thoracic-vertebrae pedicles in the grown-up community of Zimbabwe. Study design: A cross-sectional descriptive study. Place and duration of study: A six-month study carried out in the Anatomy Department (Gross Anatomy Laboratory), University of Zimbabwe, College of Health Sciences, Harare (from May 2019 to November 2019). Material and Methods:. The thoracic vertebrae from 15 adult male cadavers were dissected out and Pedicle External Sagittal Diameter (PESD), Pedicle External Transverse Diameter (PETD) and chord length were measured using a vernier caliper and compared (on right and left sides). The statistical analysis was done using SPSS version 23, with data expressed as means, standard deviation and ranges. Student’s t-test was used to estimate the difference in pedicle dimensions of the right and left sides of the thoracic vertebrae. Results: There was a significant difference between the right and left pedicle dimensions in chord length at the level of T9, PESD at levels T6 and T7, and PETD at levels T2, T6, T7 and T11. PESD values were noted to be increasing from thoracic vertebrae T1 to T12 with a plateau phase noted from T2-T7. PETD values decreased from T1-T5 and then gradually increased to T12. Chord length increased gradually from T1-T12. Conclusion: Pedicle dimensions differ between the Zimbabwean population and other ethnic groups of earlier investigations. Furthermore, there was a significant difference between the right and left pedicles in terms of PETD, PESD and Chord length.

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Section: Discussionmentioning

confidence: 53%

Pedicle Dimensions of the Thoracic Vertebrae in the Zimbabwean Adult Male Population: A Cadaveric Study

Khan¹,

Nyamandi²,

Makosa³

2022

JRMC

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“…So far, the narrowest pedicles have been observed at the T3-T5 level, and there is considerable variability in the angles between the transverse pedicle axes and the PPSs. Moreover, it has been noted that the risk of screw malposition is significantly higher in the upper thoracic spine compared to the lower thoracic spine [35]. Our research did not include lateral decubitus PPS placements in this upper thoracic spine, potentially influencing the accuracy of our findings.…”

Section: Discussionmentioning

confidence: 91%

“…Previous research has reported thoracic PPS misplacement rates ranging from 4.2% to 25.7% in the prone position [35][36][37][38]. These data were derived when patients were prone, casting doubt on their applicability in the lateral position.…”

Section: Discussionmentioning

confidence: 93%

Assessing Procedural Accuracy in Lateral Spine Surgery: A Retrospective Analysis of Percutaneous Pedicle Screw Placement with Intraoperative CT Navigation

Hiyama,

Sakai,

Katoh

et al. 2023

JCM

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Percutaneous pedicle screws (PPSs) are commonly used in posterior spinal fusion to treat spine conditions such as trauma, tumors, and degenerative diseases. Precise PPS placement is essential in preventing neurological complications and improving patient outcomes. Recent studies have suggested that intraoperative computed tomography (CT) navigation can reduce the dependence on extensive surgical expertise for achieving accurate PPS placement. However, more comprehensive documentation is needed regarding the procedural accuracy of lateral spine surgery (LSS). In this retrospective study, we investigated patients who underwent posterior instrumentation with PPSs in the thoracic to lumbar spine, utilizing an intraoperative CT navigation system, between April 2019 and September 2023. The system’s methodology involved real-time CT-based guidance during PPS placement, ensuring precision. Our study included 170 patients (151 undergoing LLIF procedures and 19 trauma patients), resulting in 836 PPS placements. The overall PPS deviation rate, assessed using the Ravi scale, was 2.5%, with a notably higher incidence of deviations observed in the thoracic spine (7.4%) compared to the lumbar spine (1.9%). Interestingly, we found no statistically significant difference in screw deviation rates between upside and downside PPS placements. Regarding perioperative complications, three patients experienced issues related to intraoperative CT navigation. The observed higher rate of inaccuracies in the thoracic spine suggests that various factors may contribute to these differences in accuracy, including screw size and anatomical variations. Further research is required to refine PPS insertion techniques, particularly in the context of LSS. In conclusion, this retrospective study sheds light on the challenges associated with achieving precise PPS placement in the lateral decubitus position, with a significantly higher deviation rate observed in the thoracic spine compared to the lumbar spine. This study emphasizes the need for ongoing research to improve PPS insertion techniques, leading to enhanced patient outcomes in spine surgery.

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“…Higher misplacement rates are usually seen in the thoracic spine compared to the lumbar spine ( Winder and Gilhooly, 2017 ; Waschke et al, 2013 ; Charles et al, 2021 ). Charles et al found perforation rates of 16.7 % in the caudal thoracic spine (T7–T12) and 6.9 % in the lumbosacral spine (L1–S1) in an in vitro model for percutaneous placement of pedicle screws using fluoroscopic guidance ( Charles et al, 2021 ). In the current study the accuracy of pedicle screw placement was also significantly higher in the lumbar spine compared to the thoracic spine in both groups.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 3D-navigation and fluoroscopic guidance in percutaneous pedicle screw placement for traumatic fractures of the thoracolumbar junction

Brunken,

Mandelka,

Bullert

et al. 2024

Brain and Spine

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Accuracy and technical limits of percutaneous pedicle screw placement in the thoracolumbar spine

Cited by 8 publications

References 30 publications

Pedicle Dimensions of the Thoracic Vertebrae in the Zimbabwean Adult Male Population: A Cadaveric Study

Pedicle Dimensions of the Thoracic Vertebrae in the Zimbabwean Adult Male Population: A Cadaveric Study

Assessing Procedural Accuracy in Lateral Spine Surgery: A Retrospective Analysis of Percutaneous Pedicle Screw Placement with Intraoperative CT Navigation

Comparison of 3D-navigation and fluoroscopic guidance in percutaneous pedicle screw placement for traumatic fractures of the thoracolumbar junction

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