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Pedicle screw fixation in thoracolumbar and lumbar spine assisted by lateral fluoroscopic imaging: a study to evaluate the accuracy of screw placement

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MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Background

The purpose of this study was to evaluate the accuracy of pedicle screw placement, its advantages, and limitations in posterior instrumentation of thoracolumbar and lumbar burst fractures assisted only by lateral fluoroscopic imaging.

Materials and methods

Pre- and postoperative computerized tomographic (CT) scans of 117 patients with thoracolumbar and lumbar burst fractures, who underwent posterior instrumentation with pedicle screw fixation, were prospectively analyzed. Accuracy of screw placement, reconstruction of the vertebral height, and correction of the kyphotic angle were studied. Position of the pedicle screws were determined, and cortical breach was graded on the postoperative axial CT scans. Percentage of vertebral height reconstruction and kyphotic angle correction were calculated from the postoperative midsagittal CT scans.

Results

Four hundred and sixty-eight pedicle screws in 234 motion segments were included in this study. 427 screws were centrally placed with an accuracy rate of 91.24%. Out of the 41 (8.76%) screws that breached the pedicle wall, 32 (6.84%) screws had violated the medial wall, while 9 (1.92%) screws breached the lateral wall. There were no “air-ball” screws. No screw penetrated the anterior wall. Postoperatively, none of the patients deteriorated neurologically, and no screw required revision. Postoperatively, there was significant restoration of vertebral height and correction of kyphosis (P < 0.05).

Conclusion

Pedicle fixation performed on a Relton-Hall frame is relatively simple and, when performed carefully using only lateral fluoroscopic imaging, has a lower potential for complications due to cortical breach.

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References

  1. Steffee AD, Biscup RS, Sitkowskj DJ (1986) Segmental spine plates with pedicle screw fixation a new internal fixation device for disorders of the lumbar and thoracolumbar spine. Clin Orthop Relat Res 203:45–53

    Google Scholar 

  2. Roy-Camille R, Saillant G, Berteaux D, Salgado V (1976) Osteosynthesis of thoraco-lumbar spine fractures with metal plates screwed through the vertebral pedicles. Reconstr Surg Traumatol 15:2–16

    CAS  PubMed  Google Scholar 

  3. Gertzbein SD, Robbins SE (1990) Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976) 15:11–14

    Article  CAS  Google Scholar 

  4. Yahiro MA (1994) Comprehensive literature review: pedicle screw fixation devices. Spine 19(20):2274S–2278S

    Article  CAS  PubMed  Google Scholar 

  5. Puvanesarajah V, Liauw JA, Lo SF, Lina IA, Witham TF (2014) Techniques and accuracy of thoracolumbar pedicle screw placement. World J Orthop 5(2):112

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kalfas IH, Kormos DW, Murphy MA et al (1995) Application of frameless stereotaxy to pedicle fixation of the spine. J Neurosurg 83:641–647

    Article  CAS  PubMed  Google Scholar 

  7. Amiot LP, Lang K, Zippel H, Labelle H (1998) Comparative accuracy between conventional and computer-assisted pedicle screw installation. Presented at the annual meeting of the international society for the study of the lumbar spine, Brussels, Belgium

  8. Merloz P, Tonetti J, Pittet L et al (1998) Pedicle screw placement using image guided techniques. Clin Orthop 354:39–48

    Article  Google Scholar 

  9. Schwarzenbach O, Berleman U, Jost B et al (1997) Accuracy of computer-assisted pedicle screw placement. An in vivo computed tomography analysis. Spine 22:452–458

    Article  CAS  PubMed  Google Scholar 

  10. Laine T, Schlenzka D, Mäkitalo K et al (1997) Improved accuracy of pedicle screw insertion with computer-assisted surgery. Spine 22:1254–1258

    Article  CAS  PubMed  Google Scholar 

  11. Maynard FM et al (1997) International standards for neurological and functional classification of spinal cord injury. Spinal Cord 35:266–274

    Article  PubMed  Google Scholar 

  12. Cobb JR (1948) Outline for the study of scoliosis. In: Edwards JW (ed) Instructional course lectures, vol 5. The American Academy of Orthopedic Surgeons, Ann Arbor, pp 261–275

    Google Scholar 

  13. Mumford J, Weinstein JN, Spratt KF, Goel VK (1993) Thoracolumbar burst fractures: the clinical efficacy and outcome of non-operative management. Spine 18:955–970

    Article  CAS  PubMed  Google Scholar 

  14. Hashimoto T, Kaneda K, Abumi K (1988) Relationship between traumatic spinal canal stenosis and neurologic deficits in thoracolumbar burst fractures. Spine 13:1268–1272

    Article  CAS  PubMed  Google Scholar 

  15. Olsewski JM, Simmons EH, Kallen FC, Mendel FC, Severin CM, Berens DL (1990) Morphometry of the lumbar spine: anatomical perspectives related to transpedicular fixation. J Bone Joint Surg 72(4):541–549

    Article  CAS  PubMed  Google Scholar 

  16. Gaines RW (2000) The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg Am 82-A:1458–1476

    Article  PubMed  Google Scholar 

  17. Krag MH, Weaver DL, Beynnon BD, Haugh LD (1988) Morphometry of the thoracic and lumbar spine related to transpedicular screw placement for surgical spinal fixation. Spine (Phila Pa 1976) 13:27–32

    Article  CAS  Google Scholar 

  18. Zou D, Yoo JU, Edwards WT, Donovan DM, Chang KW, Bayley JC, Fredrickson BE, Yuan HA (1993) Mechanics of anatomic reduction of thoracolumbar burst fractures| comparison of distraction versus distraction plus lordosis, in the anatomic reduction of the thoracolumbar burst fracture. Spine 18(2):195–203

    Article  CAS  PubMed  Google Scholar 

  19. Harrington RM, Budorick T, Hoyt J, Anderson PA, Tencer AF (1993) Biomechanics of indirect reduction of bone retropulsed into the spinal canal in vertebral fracture. Spine 18(6):692–699

    Article  CAS  PubMed  Google Scholar 

  20. Mohanty SP, Bhat SN, Ishwara-Keerthi C (2011) The effect of posterior instrumentation of the spine on canal dimensions and neurological recovery in thoracolumbar and lumbar burst fractures. Musculoskelet Surg 95(2):101–106

    Article  CAS  PubMed  Google Scholar 

  21. Odgers CJ, Vaccaro AR, Pollack ME, Cotler JM (1996) Accuracy of pedicle screw placement with the assistance of lateral plain radiography. J Spinal Disord 9(4):334–338

    Article  PubMed  Google Scholar 

  22. Castro WH, Halm H, Jerosch J, Malms J, Steinbeck J, Blasius S (1996) Accuracy of pedicle screw placement in lumbar vertebrae. Spine 21:1320–1324

    Article  CAS  PubMed  Google Scholar 

  23. Weinstein JN, Spratt KF, Spengler D, Brick C (1998) Spinal pedicle fixation: reality and validity of roentgenogram – based assessment and surgical factors on successful screw placement. Spine 13:1012–1016

    Article  Google Scholar 

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Authors and Affiliations

  1. Orthopaedics Unit-3, Division of Spine and Hip, Kasturba Medical College, Manipal University, Manipal, 576104, India

    S. P. Mohanty

  2. Orthopaedics Unit-3, Kasturba Medical College, Manipal University, Manipal, 576104, India

    S. N. Bhat

  3. Department of Orthopaedics Kasturba Medical College, Manipal University, Manipal, 576104, India

    M. Pai Kanhangad & G. S. Gosal

Authors
  1. S. P. Mohanty
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  2. S. N. Bhat
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  3. M. Pai Kanhangad
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  4. G. S. Gosal
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Correspondence to M. Pai Kanhangad.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Institutional ethical clearance was obtained before starting the study.

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Informed consent was obtained from all individual participants included in the study.

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This article does not contain any studies with animals performed by any of the authors.

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Mohanty, S.P., Bhat, S.N., Pai Kanhangad, M. et al. Pedicle screw fixation in thoracolumbar and lumbar spine assisted by lateral fluoroscopic imaging: a study to evaluate the accuracy of screw placement. Musculoskelet Surg 102, 47–55 (2018). https://doi.org/10.1007/s12306-017-0498-4

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  • DOI: https://doi.org/10.1007/s12306-017-0498-4

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