Prospective Evaluation of Thoracic Pedicle Screw Placement Using Fluoroscopic Imaging

Kuntz, Charles; Maher, P. Colby; Levine, Nicholas B.; Kurokawa, Ryu

doi:10.1097/00024720-200406000-00007

Cited by 54 publications

(29 citation statements)

References 25 publications

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“…In a study of Guzey et al [16], the rate of misplacement was 20.3 % for 113 upper and middle thoracic screws placed under uniplanar or biplanar fluoroscopy. An in vivo study of non-deformed spines reported on 27 and 109 screws placed at T1-T2 and between T3 and T9, respectively, from a total of 209 screws placed between T1 and T12 [22]. With fluoroscopy support, the placement accuracy was 88 % for the T1-T2 screws (15 screws solely contained in the pedicle and 9 lateral perforations less than 4 mm), and 66 % for the T3-T9 screws (15 screws completely intrapedicular, 55 lateral perforations less than 4 mm).…”

Section: Accuracy Of Placement: Thoracic Spinementioning

confidence: 99%

CT-navigation versus fluoroscopy-guided placement of pedicle screws at the thoracolumbar spine: single center experience of 4,500 screws

et al. 2012

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Purpose Single center evaluation of the placement accuracy of thoracolumbar pedicle screws implanted either with fluoroscopy or under CT-navigation using 3D-reconstruction and intraoperative computed tomography control of the screw position. There is in fact a huge variation in the reported placement accuracy of pedicle screws, especially concerning the screw placement under conventional fluoroscopy most notably due to the lack of the definition of screw misplacement, combined with a potpourri of postinstrumentation evaluation methods. Methods The operation data of 1,006 patients operated on in our clinic between 1995 and 2005 is analyzed retrospectively. There were 2,422 screws placed with the help of CT-navigation compared to 2,002 screws placed under fluoroscopy. The postoperative computed tomography images were reviewed by a radiologist and an independent spine surgeon. Results In the lumbar spine, the placement accuracy was 96.4 % for CT-navigated screws and 93.9 % for pedicle screws placed under fluoroscopy, respectively. This difference in accuracy was statistically significant (Fishers Exact Test, p = 0.001). The difference in accuracy became more impressing in the thoracic spine, with a placement accuracy of 95.5 % in the CT-navigation group, compared to 79.0 % accuracy in the fluoroscopy group (p \ 0.001). Conclusion This study underlines the relevance of CT-navigation-guided pedicle screw placement, especially when instrumentation of the middle and upper thoracic spine is carried out.

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Section: Accuracy Of Placement: Thoracic Spinementioning

confidence: 99%

CT-navigation versus fluoroscopy-guided placement of pedicle screws at the thoracolumbar spine: single center experience of 4,500 screws

et al. 2012

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“…Seven studies had different patient groups with alternative treatment options. [2][3][4][5][6][7][8]10,11,16,20,21,[24][25][26][29][30][31][32][33][34][35][36]38,43,44,47,48,51,52,54,55,57,58,[62][63][64][65] Thirteen studies were prospective, 25 were retrospective, and 1 study was both pro-and retrospective. 3 Seventeen studies reported a follow-up (mean follow-up 19.0 months, range 1-118 months).…”

Section: Resultsmentioning

confidence: 99%

Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management: a literature review of 35,630 pedicle screws

Gautschi

Schatlo²,

Schaller³

et al. 2011

FOC

206

149

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Object The technique of pedicle screw insertion is a mainstay of spinal instrumentation. Some of its potential complications are clinically relevant and may require reoperation or further postoperative care. Methods A literature search was performed using MEDLINE (between 1999 and June 2011) for studies on pedicle screw placement in thoracolumbar surgery. The authors included randomized controlled trials, case-control studies, and case series (≥ 20 patients) from the English-, German-, and French-language literature. The authors assessed study type, the number of patients, the anatomical area, the number of pedicle screws, duration of follow-up, type of pedicle screw placement, incidence of complications, and type of complication. The management of specific complications is discussed. Results Thirty-nine articles with 46 patient groups were reviewed with a total of 35,630 pedicle screws. One study was a randomized controlled trial, 8 were case-control studies, and the remaining articles were case series. Dural lesions and irritation of nerve roots were reported in a mean of 0.18% and 0.19% per pedicle screws, respectively. Thirty-two patients in 10 studies (of 5654 patients from all 39 studies) required further revision surgeries for misplaced pedicle screws causing neurological problems. None of the analyzed studies reported vascular complications, and only 2 studies reported visceral complications of clinical significance. Conclusions Pedicle screw placement in the thoracolumbar region is a safe procedure with an overall high accuracy and a very low rate of clinically relevant complications.

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“…It should be noted however, this placement accuracy reported does include some deformity cases in the final statistic. An in vivo study of non-deformed spines [11] reported on 27 and 109 screws placed at T1-T2 and between T3 and T9, respectively, from a total of 209 placed between T1 and T12. The use of fluoroscopy was employed which resulted in an approximate placement accuracy of 56% for the T1-T2 screws, and 14% for the T3-T9 screws.…”

Section: Discussionmentioning

confidence: 99%

Inserting pedicle screws in the upper thoracic spine without the use of fluoroscopy or image guidance. Is it safe?

2006

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Several studies have looked at accuracy of thoracic pedicle screw placement using fluoroscopy, image guidance, and anatomical landmarks. To our knowledge the upper thoracic spine (T1-T6) has not been specifically studied in the context of screw insertion and placement accuracy without the use of either image guidance or fluoroscopy. Our objective was to study the accuracy of upper thoracic screw placement without the use of fluoroscopy or image guidance, and report on implant related complications. A single surgeon inserted 60 screws in 13 consecutive non-scoliotic spine patients. These were the first 60 screws placed in the high thoracic spine in our institution. The most common diagnosis in our patient population was trauma. All screws were inserted using a modified RoyCamille technique. Post-operative axial computed tomography (CT) images were obtained for each patient and analyzed by an independent senior radiologist for placement accuracy. Implant related complications were prospectively noted. No pedicle screw misplacement was found in 61.5% of the patients. In the remaining 38.5% of patients some misplacements were noted. Fifty-three screws out of the total 60 implanted were placed correctly within all the pedicle margins. The overall pedicle screw placement accuracy was 88.3% using our modified Roy-Camille technique. Five medial and two lateral violations were noted in the seven misplaced screws. One of the seven misplaced screws was considered to be questionable in terms of pedicle perforation. No implant related complications were noted. We found that inserting pedicle screws in the upper thoracic spine based solely on anatomical landmarks was safe with an accuracy comparable to that of published studies using imageguided navigation at the thoracic level.

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Prospective Evaluation of Thoracic Pedicle Screw Placement Using Fluoroscopic Imaging

Abstract: Guided by intraoperative fluoroscopic imaging and anatomic landmarks, thoracic pedicle screws can be placed safely. Early clinical follow-up reveals excellent results with minimal loss of kyphosis correction.

Cited by 54 publications

References 25 publications

CT-navigation versus fluoroscopy-guided placement of pedicle screws at the thoracolumbar spine: single center experience of 4,500 screws

CT-navigation versus fluoroscopy-guided placement of pedicle screws at the thoracolumbar spine: single center experience of 4,500 screws

Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management: a literature review of 35,630 pedicle screws

Inserting pedicle screws in the upper thoracic spine without the use of fluoroscopy or image guidance. Is it safe?

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