Accuracy of Thoracic Pedicle Screws in Patients with and Without Coronal Plane Spinal Deformities

Belmont, Philip J.; Klemme, William R.; Robinson, Mark; Polly, David W.

doi:10.1097/00007632-200207150-00015

Cited by 125 publications

(88 citation statements)

References 37 publications

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“…Figure 1 a-c provides examples of typical breaches encountered. This is similar to what others have reported [1].…”

Section: Evaluation Of Pedicle Breachsupporting

confidence: 93%

“…However, the vast majority of these were evaluated with plain X-rays. Belmont et al [1], using postoperative CT, reported a breach rate of 58% in patients with coronal plane deformity. A few other studies report on breach rates for thoracic screw placement in deformity utilizing postoperative CT [9,14,20,26].…”

Section: Introductionmentioning

confidence: 99%

“…However, the accurate placement of thoracic pedicle screws in the deformed spine poses unique challenges. The breach rates for thoracic pedicle screw placement vary from a low of 1.5% up to 58% [1,8,20,29]. This large variability likely reflects the radiographic method used to detect a breach, with plain X-rays underestimating the incidence.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Accuracy of free-hand placement of thoracic pedicle screws in adolescent idiopathic scoliosis: how much of a difference does surgeon experience make?

et al. 2009

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The use of thoracic pedicle screws for the treatment of adolescent idiopathic scoliosis (AIS) has gained widespread popularity. However, the placement of pedicle screws in the deformed spine poses unique challenges, and surgeons experience a learning curve. The in vivo accuracy as determined by computed tomography (CT) of placement of thoracic pedicle screws in the deformed spine as a function of surgeon experience is unknown. We undertook a retrospective review to determine the effect of surgeon experience on the accuracy of thoracic pedicle screw placement in AIS. In 2005, we started to obtain routine postoperative CT scans on patients undergoing a spinal fusion. From a database of these patients, we selected AIS patients, who underwent a posterior spinal fusion. Fifteen consecutive patients for each of the following three groups stratified by attending surgeon experience were selected (N = 45): A) less than 20 cases of all pedicle screw constructs for AIS (surgeons \2 years of practice), B) 20-50 cases (surgeons 2-5 years of practice), and C) greater than 50 cases (surgeons greater than 5 years of practice). Intraoperative evaluation of all screws included probing of the pedicle screw tract, neurophysiologic monitoring, and fluoroscopic confirmation. A total of 856 thoracic pedicle screws were studied. Postoperative CT scans were evaluated by two spine surgeons and a consensus read established as follows: (1) In: intraosseous placement or B2-mm breach, (2) Out: [2-mm breach, either medial or lateral. Of the 856 screws, 104 demonstrated a [2-mm breach, for an overall rate of 12.1% (medial = 55, lateral = 49, P = 0.67). When the breach rates were stratified by surgeon experience, there was a trend toward decreased rate of breach for the most experienced surgeons, although this did not attain statistical significance (Group A: 12.7%, Group B: 12.9%, Group C: 10.8%, P = 0.58). However, the most experienced group (C) had a markedly decreased rate of medial breaches (3.5 vs. 7.4% and 8.4% for groups A and B, respectively, P \ 0.01). The breach rate for the concave periapical screws was not statistically different from the overall breach rate (13.0% vs. 12.1%, P = 0.93). In conclusion, the overall accuracy of placement of pedicle screws in the deformed spine was 87.9%, with no neurologic, vascular, or visceral complications. Meticulous technique allows spine surgeons with a range of surgical experience to accurately and safely place thoracic pedicle screws in the deformed spine. The most experienced surgeons demonstrated the lowest rate of medial breaches.

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“…Figure 1 a-c provides examples of typical breaches encountered. This is similar to what others have reported [1].…”

Section: Evaluation Of Pedicle Breachsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Accuracy of free-hand placement of thoracic pedicle screws in adolescent idiopathic scoliosis: how much of a difference does surgeon experience make?

et al. 2009

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“…The procedure of pedicle screw insertion is complicated and has a steep learning curve. Several institutions have reported the complication rates for pedicle screw surgery from 3% to 55%, with a rate of malpositioning from 1.5% to 6.7% [5][6][7][8][9][10][11][12][13] and breach rates from 1.5% to 58% [12,14,15,16]. However, these results were not comprehensive due to a lack of reports from small medical centers and newer surgeons.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Planning and Simulation for Pedicle Screw Insertion Using Computed Tomography-Based Patient Specific Volume Rendering Combined with Projection Fluoroscopy

Han

Bai

et al. 2017

IRATJ

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Background: It is still difficult to perform pedicle screw insertion on patients with abnormal spine morphology. There is an urgent need to provide projection fluoroscopy images to surgeons to practice pedicle screw insertion. Methods:The simulation software uses a volume rendering algorithm to generate a three-dimensional spine, and it uses a digitally reconstructed radiograph algorithm to simulate anteroposterior and lateral radiographs as the intraoperative image for minimally invasive surgery.Results: Pedicle screw insertion can be accomplished using a bone drill and multidimensional pedicle screws, and can be exhibited or evaluated in both two and three dimensions. Simultaneously, advanced expert preoperative planning can be shown in system. Conclusion:A simulator that develops a three-dimensional, patient-specific volume rendered simulation combined with the projection fluoroscopy for pedicle screw insertion is introduced. The simulator can help the surgeon to plan the operation trajectory and can help to predict the complex situation of the operation.

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“…9,[10][11][12] Many of the differences in the literature depend on the study methodology used to determine the perforation. Perforations can further lead to complications such as dural tear, 12 nerve root injuries, 12 paraplegia, [12][13][14][15] or vascular injury.…”

Section: Introductionmentioning

confidence: 99%

Reduction in radiation (fluoroscopy) while maintaining safe placement of pedicle screws during lumbar spine fusion

Chaput¹,

George²,

Samdani

et al. 2013

Coluna/Columna

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Objective: The purpose of this study is to report the results using PediGuard (electrical conductivity device) to reduce radiation exposure while drilling the pilot hole for pedicle screw placement. Method: Eighteen patients diagnosed with a degenerative lumbar spine, that required a posterior spinal fusion. Average age of the patients were 55 ± 12 years. Patients received postoperative CT scans of all screws. Scans were reviewed by an independent reviewer grading 'in' < 2 mm of breach , or 'out' > 2 mm of breach. In a randomized fashion, the surgeon created pilot holes with either his standard technique or by using the PediGuard. Fluoroscopy was used for each drilling as necessary. Once the pilot hole was created, the surgeon inserted titanium screws into the pedicle pilot holes. A total of 78 screws (39 standard probe and 39 PediGuard ) were analyzed. Results: 78 screws (39 standard probe and 39 PediGuard were analyzed. No significant difference in breach rate > 2mm by either method (p=1.000), with one screw out in each group. Fluoroscopy shots averaged 5.2 (range, 0 to 15), average decrease of 2.3 (30%) per screw in the PediGuard group vs. 7.5 (range, 2 to 17) in the standard group (p< .001). Conclusion: This trial to assess pedicle probe location within the pedicle and vertebral body showed the number of fluoroscopy shots were reduced by 30%, compared to a standard probe while maintaining a 97.5% screw placement accuracy.

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Accuracy of Thoracic Pedicle Screws in Patients with and Without Coronal Plane Spinal Deformities

Cited by 125 publications

References 37 publications

Accuracy of free-hand placement of thoracic pedicle screws in adolescent idiopathic scoliosis: how much of a difference does surgeon experience make?

Accuracy of free-hand placement of thoracic pedicle screws in adolescent idiopathic scoliosis: how much of a difference does surgeon experience make?

Preoperative Planning and Simulation for Pedicle Screw Insertion Using Computed Tomography-Based Patient Specific Volume Rendering Combined with Projection Fluoroscopy

Reduction in radiation (fluoroscopy) while maintaining safe placement of pedicle screws during lumbar spine fusion

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