The Reliability of the Ball-Tipped Probe for Detecting Pedicle Screw Tract Violations Prior to Instrumenting the Thoracic and Lumbar Spine

Sedory, David M.; Crawford, John J.; Topp, Raymond

doi:10.1097/brs.0b013e3181dbfe40

Cited by 10 publications

(16 citation statements)

References 33 publications

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“…An almost universally practised method of probing the pedicle tract with a ball-tipped probe has been shown to have a relatively poor accuracy, with medial breaches as high as upto 32% being missed out on the same [13]. Hence a combination of methods would yield a cumulative outcome of reasonably high accuracy and hence, safety.…”

Section: Discussionmentioning

confidence: 99%

Stimulation of Pedicle Screws with Diathermy: Is it a Viable Option to Detect Breaches?

Pithwa¹,

Venkatesh²

2015

J Spine 2015

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Section: Discussionmentioning

confidence: 99%

Stimulation of Pedicle Screws with Diathermy: Is it a Viable Option to Detect Breaches?

Pithwa¹,

Venkatesh²

2015

J Spine 2015

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“…Manual pedicle palpation with a ball-tip probe has low accuracy 25,26 and the potential for inadvertent neurological injury with the probe. 27 Even stereotactic image guidance cannot entirely prevent pedicle perforations. 28 Electrical neuromonitoring adds cost and time to surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Endoscopic Inspection of Pedicle Wall Integrity in a Live Surgery Model

et al. 2018

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Background: Perforations of the pedicle wall during cannulation can occur with experienced surgeons. Direct endoscopic visualization has not been used to inspect pedicles previously due to bone bleeding obscuring the camera visualization. The hypothesis of this study was that endoscopic visualization of pedicle wall integrity was technically feasible and would enable identification of clinically significant pedicle breaches.Methods: A live porcine model was used. Eight lumbar pedicles were cannulated. Clinically significant breaches were created. An endoscope was introduced and was used to inspect the pedicles.Results: All lumbar pedicles were endoscopically visible at a systolic pressure of 100 mm Hg. Clinically relevant anatomic structures and iatrogenic pathology, such as medial, lateral, and anterior breaches, were identified. There were no untoward events resulting from endoscopic inspection of the pedicle endosteal canal.Conclusions: Endoscopic inspection of lumbar pedicles was safe and effective. The findings on endoscopic inspection corresponded with the ball-tip probe palpation techniques. Additional techniques, such as selection between 2 tracts, was possible with the endoscopic technique.

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“…On the other hand, if the surgeon detects a breach during manual palpation, he or she may opt to 1) place a screw with a diameter smaller than originally planned, 2) revise the track by using the gearshift to create a secondary track along an alternate trajectory within the pedicle, or 3) abandon placing a screw in that particular pedicle altogether. 7,10,12,13,17 Despite widespread use of this method, few studies have focused on the accuracy of manual palpation of thoracic pedicle screw tracks to detect any violation in the cortical margins of the pedicle. 11,17 Of the two studies we are aware of, one concluded that the "standard ball-tipped probe was much less reliable than expected."…”

mentioning

confidence: 99%

“…7,10,12,13,17 Despite widespread use of this method, few studies have focused on the accuracy of manual palpation of thoracic pedicle screw tracks to detect any violation in the cortical margins of the pedicle. 11,17 Of the two studies we are aware of, one concluded that the "standard ball-tipped probe was much less reliable than expected." 17 Besides this conclusion, there was considerable variability between their surgeons with respect to correctly identifying pedicle track placements.…”

mentioning

confidence: 99%

“…11,17 If the surgeon deems the track to be acceptable, it is then ready for insertion of a pedicle screw, although some surgeons may further prepare the track with a threaded "tap" before placing the screw. On the other hand, if the surgeon detects a breach during manual palpation, he or she may opt to 1) place a screw with a diameter smaller than originally planned, 2) revise the track by using the gearshift to create a secondary track along an alternate trajectory within the pedicle, or 3) abandon placing a screw in that particular pedicle altogether.…”

mentioning

confidence: 99%

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Is in vivo manual palpation for thoracic pedicle screw instrumentation reliable?

Donohue

Moquin²,

Singla

et al. 2014

SPI

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Object Previous reports on the accuracy of manual palpation for thoracic pedicle screw placement have been restricted to cadaveric studies. Authors of the present novel study assessed the accuracy of manual palpation for the detection of medial and lateral pedicle breaches during thoracic spine surgery in living adult humans. Methods Pedicle tracks were created freehand and manually palpated using a ball-tipped probe. Postoperative CT scans of all implanted thoracic and L-1 screws were evaluated with respect to screw position and the pedicle wall. Results Five hundred twenty-five pedicle track/screw placements were compared. There were 21 pedicles with medial breaches measuring ≥ 2 mm. The surgeon correctly identified only 4 of these pedicle tracks as having a medial breach. The surgeon correctly identified 17 of 128 pedicles with a significant (≥ 2 mm) lateral breach. One hundred two screw placements had no measurable breach in any direction (medial, lateral, or foraminal). The surgeon correctly identified 98% of these ideally placed screws. Conclusions In this real-time study of thoracic pedicle screw placement, the accuracy of manual palpation for detecting medial or lateral breaches that were ≥ 2 mm was disturbingly low. These findings are consistent with those in recent cadaveric evaluations of palpation accuracy and point to the critical need for more reliable alternative methods to assess pedicle integrity during the placement of thoracic pedicle screws for spine instrumentation surgery.

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The Reliability of the Ball-Tipped Probe for Detecting Pedicle Screw Tract Violations Prior to Instrumenting the Thoracic and Lumbar Spine

Abstract: The standard ball-tipped probe was much less reliable than expected. This technique can be used to confirm an intact pedicle but has an unacceptably high false-positive rate and should be used with caution. Our study suggests that overconfidence in pedicle probing might be dangerous.

Cited by 10 publications

References 33 publications

Stimulation of Pedicle Screws with Diathermy: Is it a Viable Option to Detect Breaches?

Stimulation of Pedicle Screws with Diathermy: Is it a Viable Option to Detect Breaches?

Feasibility of Endoscopic Inspection of Pedicle Wall Integrity in a Live Surgery Model

Is in vivo manual palpation for thoracic pedicle screw instrumentation reliable?

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