Document Detail


Accuracy of Fluoroscopically Assisted Pedicle Screw Placement: Analysis of 1218 Screws in 198 Patients.
MedLine Citation:
PMID:  24704680     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND CONTEXT: We retrospectively analyzed a total of 1218 pedicle screws for accuracy, with postoperative computed tomography, in 198 patients who were operated on between March of 2004 and September of 2012.
PURPOSE: The purpose of this study was to determine the incidence of screw misplacement in patients who received a transpedicular screw fixation with intraoperative fluoroscopy in the lateral and lateral with anteroposterior positions. The results are compared between two groups.
STUDY DESIGN: Retrospective comparative study of accuracy of pedicle screw placement in thoracal and lumbar spine.
PATIENT SAMPLE: The sample consists of 198 consecutive patients who underwent transpedicular screw fixation.
OUTCOME MEASURES: Accuracy of screw placement was evaluated by postoperative CT scan. Misplacement was defined in cases where more than 25% of the screw size was residing outside of the pedicle.
METHODS: The indications for hardware placement, radiologic studies, patient demographics, and reoperation rates were recorded. Five hundred and twenty-eight screws (Group A, n=81) were inserted into the vertebral body with the assistance of lateral fluoroscopy only, whereas six hundred and ninety screws (Group B, n=117) were inserted with the assistance of lateral fluoroscopy, and the final positions of the screws were checked with anteroposterior fluoroscopy.
RESULTS: A total of 1218 screws were analyzed, with 962 screws having been placed at the lumbosacral region, and 256 screws at the thoracal region. According to the postoperative CT-scan, twenty-seven screws (2.2%) were identified as breaching the pedicle. Nineteen of them (3.6%) were in Group A, whereas eight of them (1.16%) were in Group B. The rate of pedicle breaches was significantly different between Group A and Group B (p=0.0052). In Group A, the lateral violation of the pedicle was seen in 10 screws (1.9%), whereas the medial violation was seen in 9 screws (1.7%). In Group B, the lateral violation of the pedicle was seen in 6 screws (0.87%), whereas the medial violation was seen in 2 screws (0.29%). The medial and lateral penetration of screws was significantly different between Groups A and B (p<0.05). A pedicle breach occurred in 21 patients, and 15 of them underwent a revision surgery to correct the misplaced screw. Of these patients 11 of them (13.6%) were in Group A, and 4 of them (3.4%) were in Group B (p=0.0335).
CONCLUSIONS: In this study we evaluated and clarified the diagnostic value of intra-operative fluoroscopy in both the lateral and anteroposterior imaging, which have not yet been evaluated in any comparative study. We concluded that the intraoperative use of fluoroscopy, especially in the anteroposterior position, significantly decreases the risk of screw misplacement and the results are comparable with other advanced techniques.
Authors:
Ender Koktekir; Davut Ceylan; Necati Tatarli; Hakan Karabagli; Fahri Recber; Gokhan Akdemir
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-4-3
Journal Detail:
Title:  The spine journal : official journal of the North American Spine Society     Volume:  -     ISSN:  1878-1632     ISO Abbreviation:  Spine J     Publication Date:  2014 Apr 
Date Detail:
Created Date:  2014-4-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101130732     Medline TA:  Spine J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Elsevier Inc. All rights reserved.
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