Preoperative CT Determination of Angles for Sacral Screw Placement

Morse, Bradley; Ebraheim, Nabil A.; Jackson, William T.

doi:10.1097/00007632-199403000-00017

Cited by 28 publications

(16 citation statements)

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“…The early anatomic studies by Saillant [144] first established that the diameter and structure of the pedicle is large enough in the lumbar and lower thoracic spine to allow anchorage of vertebral screws via the transpedicular route. These results were later confirmed by other researchers, and there is now convincing evidence regarding pedicle morphology to verify this view [67,82,88,116,129,149,176,193].…”

Section: Rationales For Pedicle Screw Fixationsupporting

confidence: 74%

Pedicle screw fixation in spinal disorders: A European view

1997

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Continuing controversy over the use of pedicular fixation in the United States is promoted by the lack of governmental approval for the marketing of these devices due to safety and efficacy concerns. These implants have meanwhile become an invaluable part of spinal instrumentation in Europe. With regard to the North American view, there is a lack of comprehensive reviews that consider the historical evolution of pedicle screw systems, the rationales for their application, and the clinical outcome from a European perspective. This literature review suggests that pedicular fixation is a relatively safe procedure and is not associated with a significantly higher complication risk than non-pedicular instrumentation. Pedicle screw fixation provides short, rigid segmental stabilization that allows preservation of motion segments and stabilization of the spine in the absence of intact posterior elements, which is not possible with non-pedicular instrumentation. Fusion rates and clinical outcome in the treatment of thoracolumbar fractures appear to be superior to that achieved using other forms of treatment. For the correction of spinal deformity (i.e., scoliosis, kyphosis, spondylolisthesis, tumor), pedicular fixation provides the theoretical benefit of rigid segmental fixation and of facilitated deformity correction by a posterior approach, but the clinical relevance so far remains unknown. In low-back pain disorders, a literature analysis of 5,600 cases of lumbar fusion with different techniques reveals a trend that pedicle screw fixation enhances the fusion rate but not clinical outcome. The most striking finding in the literature is the large range in the radiological and clinical results. For every single fusion technique poor and excellent results have been described. This review argues that European spine surgeons should begin to back up the evident benefits of pedicle screw systems for specific spinal disorders by controlled prospective clinical trials. This may prevent forthcoming medical licensing authorities from restricting the use of pedicle screw devices and dictating the practice of spinal surgery in Europe in the near future.

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Section: Rationales For Pedicle Screw Fixationsupporting

confidence: 74%

Pedicle screw fixation in spinal disorders: A European view

1997

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“…It is generally agreed that medially oriented placement of S1 pedicle screws provides greater stability than either centrally or laterally oriented positions because the mean bone mineral density in the central region of the sacrum is approximately 30 to 60 % higher than that in the alar region [25,26]. By contrast, several authors have recommended that placement of S1 pedicle screws in a central position should be avoided because of the risk this placement carries of damage to the iliac vessels, the sympathetic chain, and the lumbosacral trunk, which are all close to the sacrum [19][20][21][22][23][24]. Therefore, from both biomechanical and anatomical points of view, it is recommended that S1 pedicle screws should be inserted inwardly with an acceptable angle reported as about 30°to 40°, almost the same as that of the S1 facet angle [27][28][29][30][31].…”

Section: Discussionmentioning

confidence: 99%

“…Bicortical or tricortical methods that penetrate the anterior sacral cortex or cranial S1 endplate are evidently more stable than monocortical methods that penetrate the posterior cortex alone. However, these methods carry a risk of nerve or vascular injury in front of the sacrum when sacral pedicle screws are inserted inwardly [15][16][17][18][19][20][21][22][23][24]. Conversely, on the anterolateral side of the S1 sacral bone, L5 nerve roots are arranged from the center cranially to laterally and can be injured if an S1 pedicle screw is inserted outwardly and perforates the anterior cortex.…”

Section: Introductionmentioning

confidence: 99%

L5 spinal nerve injury caused by misplacement of outwardly-inserted S1 pedicle screws

Inoue

Ozawa

et al. 2012

Eur Spine J

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“…They proposed preoperative CT scan verification to determine safe angles to minimize the risks. 3 The S1 pedicle height is greater than other pedicles. The height of the S1 vertebral body has been reported to be 28.9 mm for men and 27.7 mm for women.…”

Section: The S1 Pediclementioning

confidence: 95%

“…[1][2][3] Sacral screws can be inserted into the S1sacral wing (anterolaterally) or into the S1 promontorium (anteromedially). If the S1 vertebra is inadequate for screw placement, screws can be inserted into the S2 sacral wing or the vertebral body to stabilize the lumbosacral junction.…”

Section: Introductionmentioning

confidence: 99%