Correlation between pedicle size and the rate of pedicle screw misplacement in the treatment of thoracic fractures: Can we predict how difficult the task will be?

Gonzalvo, Augusto; Fitt, Gregory J; Liew, Susan; Harpe, David de la; Vrodos, Nikitas; McDonald, Matthew J.; Rogers, Myron; Wilde, Peter

doi:10.3109/02688697.2015.1019414

Cited by 13 publications

(20 citation statements)

References 38 publications

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“…This seems to be necessary particularly in patients with concomitant sternal fractures [30]. Based on the findings on the association of pedicle diameters and penetration rates, navigated techniques or intraoperative 3D-Imaging should be particularly used in pedicle diameters of less than 5 mm [2,16,35,45]. In small pedicles, translaminar screws at the upper thoracic spine or parapedicular screws might be a viable alternative [7,22].…”

Section: Discussionmentioning

confidence: 99%

“…However, it has to be kept in mind that biomechanical tests are traditionally performed under ideal conditions, including optimal pedicle screw positioning. In contrast, it has been shown that pedicle screw placement was insufficient in a relevant number of patients with small pedicle including a penetration rate of 33% in pedicle diameters of less than 5 mm [16]. This can affect the screw hold considerably leading to impaired construct stability in patients treated with short-segment stabilization.…”

Section: Discussionmentioning

confidence: 99%

“…In a clinical setting, Bransfold et al [4] reported of 1.2% revision surgery rate due to screw misplacement in 245 patients treated because of thoracic fractures in an open technique under fluoroscopic control. Thereby, there seems to be a correlation between pedicle diameter and penetration rate with a 33% misplacement rate in pedicle diameters of less than 5 mm to 11% in diameters between 5 and 7 mm and no misplacement in diameters above 7 mm [16]. Altogether, there seems to be no difference in accuracy of screw placement in thoracic spine between the open and percutaneous technique [23].…”

Section: Transpedicular Pedicle Screwsmentioning

confidence: 95%

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Biomechanics and clinical outcome after posterior stabilization of mid-thoracic vertebral body fractures: a systematic literature review

Spiegl¹,

Osterhoff²,

Bula

et al. 2020

Eur J Trauma Emerg Surg

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Purpose The aim of this review is to systematically screen the literature for clinical and biomechanical studies dealing with posterior stabilization of acute traumatic mid-thoracic vertebral fractures in patients with normal bone quality. Methods This review is based on articles retrieved by a systematic search in the PubMed and Web of Science database for publications up to December 2018 dealing with the posterior stabilization of fractures of the mid-thoracic spine. Results Altogether, 1012 articles were retrieved from the literature search. A total of 960 articles were excluded. A total of 16 articles were dealing with the timing of surgery in polytraumatized patients, patients suffering of neurologic deficits after midthoracic fractures, and the impact of concomitant thoracic injuries and were excluded. Thus, 36 remaining original articles were included in this systematic review depicting the topics biomechanics, screw insertion, and outcome after posterior stabilization. The overall level of evidence of the vast majority of studies is low. Conclusion High quality studies are lacking. Long-segmental stabilization is indicated in unstable midthoracic fractures with concomitant sternal fractures. Generally, long-segmental constructs seem to be the safer treatment strategy considering the relative high penetration rate of pedicle screws in this region. Thereby, navigated insertion techniques and intraoperative 3D-imaging help to improve pedicle screw placement accuracy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Transpedicular Pedicle Screwsmentioning

confidence: 95%

See 1 more Smart Citation

Biomechanics and clinical outcome after posterior stabilization of mid-thoracic vertebral body fractures: a systematic literature review

Spiegl¹,

Osterhoff²,

Bula

et al. 2020

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

show abstract

“…This produces two clinically relevant difficulties for everyday practice: ▪ Firstly, this narrow corridor can result in an increased rate of screw misplacements, posing a challenge for the operating surgeon. Thus, Gonzalvo et al [35] found a rate of pedicle screw misplacement of 33 % for a pedicle diameter of less than 5 mm and a misplacement rate of 11 % with a pedicle diameter between 5-7 mm. Misplacements can be significantly reduced by the use of navigation and/or intra-operative 3D imaging [36,37].…”

Section: Pedicle Screw Insertion and Their Dimensionsmentioning

confidence: 98%

“…Considering that, with a pedicle diameter of less than 5 mm, suboptimal or faulty screw positioning occurs in approx. one third of cases [35] and that the results of the biomechanical studies are usually based on optimal screw placements (▶ Fig. 4), any recommendation for short-segment management is certainly to be regarded with extreme caution.…”

Section: Associated Injuriesmentioning

confidence: 99%

Traumatic Fractures of the Thoracic Spine

et al. 2020

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The majority of traumatic vertebral fractures occur at the thoracolumbar junction and the lumbar spine and less commonly at the mid-thoracic and upper thoracic spine. In accordance, a high number of articles are dealing with thoracolumbar fractures focusing on the thoracolumbar junction. Nonetheless, the biomechanics of the thoracic spine differ from the thoracolumbar junction and the lumbar vertebral spine. The aim of this review is to screen the literature dealing with acute traumatic thoracic vertebral fractures in patients with normal bone quality. Thereby, the diagnostic of thoracic vertebral body fractures should include a CT examination. Ideally, the CT should include the whole thoracic cage particularly in patients suffering high energy accidents or in those with clinical suspicion of concomitant thoracic injuries. Generally, concomitant thoracic injuries are frequently seen in patients with thoracic spine fractures. Particularly sternal fractures cause an increase in fracture instability. In case of doubt, long segment stabilization is recommended in patients with unstable mid- und upper thoracic fractures, particularly in those patients with a high grade of instability.

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Robotic-assisted spine surgery allows for increased pedicle screw sizes while still improving safety as indicated by elevated triggered electromyographic thresholds

Kanaly

Backes²,

Toossi

et al. 2022

J Robotic Surg

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The present study used triggered electromyographic (EMG) testing as a tool to determine the safety of pedicle screw placement. In this Institutional Review Board exempt review, data from 151 consecutive patients (100 robotic; 51 non-robotic) who had undergone instrumented spinal fusion surgery of the thoracic, lumbar, or sacral regions were analyzed. The sizes of implanted pedicle screws and EMG threshold data were compared between screws that were placed immediately before and after adoption of the robotic technique. The robotic group had significantly larger screws inserted that were wider (7 ± 0.7 vs 6.5 ± 0.3 mm; p < 0.001) and longer (47.8 ± 6.4 vs 45.7 ± 4.3 mm; p < 0.001). The robotic group also had significantly higher stimulation thresholds (34.0 ± 11.9 vs 30.2 ± 9.8 mA; p = 0.002) of the inserted screws. The robotic group stayed in the hospital postoperatively for fewer days (2.3 ± 1.2 vs 2.9 ± 2 days; p = 0.04), but had longer surgery times (174 ± 37.8 vs 146 ± 41.5 min; p < 0.001). This study demonstrated that the use of navigated, robot-assisted surgery allowed for placement of larger pedicle screws without compromising safety, as determined by pedicle screw stimulation thresholds. Future studies should investigate whether these effects become even stronger in a later cohort after surgeons have more experience with the robotic technique. It should also be evaluated whether the larger screw sizes allowed by the robotic technology actually translate into improved long-term clinical outcomes.

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Correlation between pedicle size and the rate of pedicle screw misplacement in the treatment of thoracic fractures: Can we predict how difficult the task will be?

Abstract: The rate of PS misplacement in the mid thoracic spine (T4-T9) is high and correlates with pedicle transverse diameter.

Cited by 13 publications

References 38 publications

Biomechanics and clinical outcome after posterior stabilization of mid-thoracic vertebral body fractures: a systematic literature review

Biomechanics and clinical outcome after posterior stabilization of mid-thoracic vertebral body fractures: a systematic literature review

Traumatic Fractures of the Thoracic Spine

Robotic-assisted spine surgery allows for increased pedicle screw sizes while still improving safety as indicated by elevated triggered electromyographic thresholds

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