Accuracy and technical limits of percutaneous pedicle screw placement in the thoracolumbar spine.
Fluoroscopy
Minimal invasive surgery
Percutaneous pedicle screw
Reliability
Screw malposition
Thoracolumbar pedicle anatomy
Journal
Surgical and radiologic anatomy : SRA
ISSN: 1279-8517
Titre abrégé: Surg Radiol Anat
Pays: Germany
ID NLM: 8608029
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
04
09
2020
accepted:
29
12
2020
pubmed:
16
1
2021
medline:
11
9
2021
entrez:
15
1
2021
Statut:
ppublish
Résumé
The two-dimensional fluoroscopic method of percutaneous pedicle screw instrumentation has been clinically described as reliable method in the caudal thoracic and lumbosacral spine. Its accuracy has not been clearly reported in the cranial thoracic spine. The aim of this in vitro study was to investigate percutaneous pedicle screw placement accuracy according to pedicle dimensions and vertebral levels. Six fresh-frozen human specimens were instrumented with 216 screws from T1 to S1. Pedicle isthmus widths, heights, transversal pedicles and screws were measured on computed tomography. Pedicle cortex violation ≥ 2 mm was defined as screw malposition. The narrowest pedicles were at T3-T5. A large variability between transversal pedicle axes and percutaneous pedicle screw was present, depending on the spinal level. Screw malposition rates were 36.1% in the cranial thoracic spine (T1-T6), 16.7% in the caudal thoracic spine (T7-T12), and 6.9% in the lumbosacral spine (L1-S1). The risk for screw malposition was significantly higher at cranial thoracic levels compared to caudal thoracic (p = 0.006) and lumbosacral (p < 0.0001) levels. Cortex violation ≥ 2 mm was constantly present if the pedicle width was < 4.8 mm. Percutaneous pedicle screw placement appears safe in the caudal thoracic and lumbosacral spine. The two-dimensional fluoroscopic method has a limited reliability above T7 because of smaller pedicle dimensions, difficulties in visualizing radiographic pedicle landmarks and kyphosis.
Identifiants
pubmed: 33449140
doi: 10.1007/s00276-020-02673-7
pii: 10.1007/s00276-020-02673-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
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