scholarly journals How is the trachea at risk of injury from pedicle screw insertion in proximal thoracic curve of adolescent idiopathic scoliosis patients?

2012 ◽  
Vol 22 (2) ◽  
pp. 338-344 ◽  
Author(s):  
Bangping Qian ◽  
Jun Jiang ◽  
Feng Zhu ◽  
Zezhang Zhu ◽  
Zhen Liu ◽  
...  
Keyword(s):  
At Risk ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screw ◽  
Thoracic Curve ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Risk Of Injury

scholarly journals Accuracy of Multilevel Registration in Image-Guided Pedicle Screw Insertion for Adolescent Idiopathic Scoliosis

Spine ◽  
2010 ◽  
Vol 35 (3) ◽  
pp. 347-352 ◽  
Author(s):  
Jun Takahashi ◽  
Hiroki Hirabayashi ◽  
Hiroyuki Hashidate ◽  
Nobuhide Ogihara ◽  
Hiroyuki Kato
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screw ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Image Guided

scholarly journals Effective dose of radiation per screw in surgery of adolescent idiopathic scoliosis: matched pair analysis of 293 pedicle screws inserted using three different techniques

2020 ◽  
Vol 14 (6) ◽  
pp. 554-561
Author(s):  
Markus Rafael Konieczny ◽  
Johannes Boos ◽  
Andrea Steuwe ◽  
Christoph Schleich ◽  
Max Prost ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Effective Dose ◽  
Pedicle Screw ◽  
Image Acquisition ◽  
Pedicle Screws ◽  
Matched Pair ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Group 1

Purpose Reports on heterogenous groups of patients have indicated that pedicle screw insertion guided by navigation (PIN) leads to, for the patient, higher doses of radiation compared with pedicle screw insertion guided by fluoroscopy (PIF). This would be a major concern, especially in paediatric deformity correction. Methods After a power analysis (aiming at > 0.8) 293 pedicle screws which were inserted in patients with adolescent idiopathic scoliosis were analyzed by comparing effective dose and fluoroscopy time per screw for three different techniques. Groups 2 and 3 were matched to Group 1 by Lenke type of scoliosis. Group 1 were prospectively enrolled consecutive patients that have been operated on by PIN with image acquisition by preoperative CT scan (CTS). Group 2 were consecutive retrospectively matched patients who have been operated on by PIN with image acquisition by an intraoperative 3D scan (3DS). Group 3 were consecutive retrospectively matched patients who have been operated on by PIF. Results Mean dose of radiation per screw was 1.0 mSv (sd 0.8) per screw in CTS patients, 0.025 mSv (sd 0.001) per screw in 3DS patients and 0.781 mSv (sd 0.12) per screw in PIF patients. The difference was significant (p < 0.0001). Conclusion When we compared different techniques of navigation, navigation by image acquisition with CTS showed a significantly higher (by 97.5%) dose of radiation per screw for the patient than navigation by image acquisition by a 3DS. Navigation by 3DS showed significantly lower effective dose per screw for the adolescent patients than the fluoroscopic technique. Level of Evidence: II

scholarly journals Safety of Pedicle Screws in Adolescent Idiopathic Scoliosis Surgery

2017 ◽  
Vol 11 (6) ◽  
pp. 998-1007 ◽  
Author(s):  
Chris Yin Wei Chan ◽  
Mun Keong Kwan
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screw ◽  
Computer Navigation ◽  
Pedicle Screws ◽  
Aortic Injury ◽  
Scoliosis Surgery ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Pedicle Perforation

<p>To review existing publications on the safety of pedicle screw insertions in adolescent idiopathic scoliosis (AIS). Despite having increased risk for neurological and visceral injuries, the use of pedicle screws have led to increased correction rates in scoliosis surgery. A review was performed on topics pertinent to pedicle screw insertion in AIS, which included pedicle morphometry in AIS, structures at risk during pedicle screw insertion, and accuracy and safety of various pedicle screw insertion techniques. The importance of computer navigation and future research regarding pedicle screw placement in AIS were also briefly reviewed. Many authors have reported abnormal pedicle anatomy in AIS. Injury to the neural structures was highest over the apical region, whereas aortic injury was the highest at T5 and T10. In the proximal thoracic spine, the esophagus could be injured even with screws as short as 25 mm. Overall pedicle perforation rates for perforations &gt;0 and &gt;2 mm (assessed by computed tomography) ranged from 6.4% to 65.0% and 3.7% to 29.9%, respectively. The critical pedicle perforation (&gt;2 mm excluding lateral thoracic) and anterior perforation (&gt;0 mm) rates was reported to range from 1.5% to 14.5% and 0.0% to 16.1%, respectively. Pedicle perforation rates were lower with the use of computer navigation. The incidence of neurological adverse events after scoliosis surgery was 0.06%–1.9%. Aortic injury has only been observed in case reports. According to the available literature, pedicle screw insertion in AIS is considered safe with low rates of clinical adverse events. Moreover, the use of navigation technology has been shown to reduce pedicle perforation rates.</p>

Comparison of 5-year outcomes between pedicle screw and hybrid constructs in adolescent idiopathic scoliosis

2012 ◽  
Vol 17 (3) ◽  
pp. 212-219 ◽  
Author(s):  
Steven W. Hwang ◽  
Amer F. Samdani ◽  
Ben Wormser ◽  
Hari Amin ◽  
Jeff S. Kimball ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Thoracic Curve ◽  
Patients Âgés ◽  
Thoracic Curvature ◽  
Main Thoracic

Object Pedicle screw fixation has been theorized to provide better correction of scoliotic deformity, but controversy over the benefits of pedicle screw–only constructs remains, and the longer-term impact of pedicle screw fixation as compared with hybrid constructs is unclear. In this study, a retrospective review of a prospectively collected database was conducted to determine the longer-term impact of pedicle screw fixation as compared with hybrid constructs in patients with adolescent idiopathic scoliosis (AIS). Methods The authors retrospectively reviewed a multicenter database of pediatric patients (ages ≤ 18) from 1995 to 2006 and identified 127 patients with Lenke Type 1–4 AIS curves with a minimum 5 years of follow-up. Patients were divided into 2 cohorts based on whether they had undergone pedicle screw fixation or fixation with hybrid constructs. Results The mean main thoracic curvature of 56.1° ± 13.0°, which corrected to 14.9° ± 9.3°, translated into a mean correction of 73% (p < 0.01). The curve was 19.4° ± 10.6° at 2-year follow-up and 20.5° ± 10.4° at 5 years. When comparing preoperative parameters between the groups, differences were noted in the magnitude of the main thoracic curve (p = 0.04), flexibility of the main thoracic curve (p = 0.02), coronal balance (p = 0.04), T2–12 kyphosis (p = 0.02), and sex (p = 0.02). The pedicle screw cohort had fewer spinal segments instrumented (p < 0.01), fewer anterior releases performed (p = 0.02), and fewer thoracoplasties performed (p < 0.01). By 5 years of follow-up, significant differences were apparent between the two cohorts with respect to upper thoracic curvature (p = 0.01), T2–12 (p = 0.02) and T5–12 (p = 0.02) kyphosis, lumbar lordosis (p < 0.01), and sagittal balance (p = 0.01). Conclusions Although some preoperative differences did exist, outcomes were comparable between hybrid and screw constructs at 2 and 5 years. However, hybrid constructs required more concurrent anterior releases and thoracoplasties to achieve similar results.

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