Accuracy of Using Computed Tomography to Identify Pedicle Screw Placement in Cadaveric Human Lumbar Spine

Background: Transpedicular screws are extensively utilized in lumbar spine surgery. The placement of these screws is typically guided by anatomical landmarks and intraoperative fluoroscopy. Here, we utilized 2-week postoperative computed tomography (CT) studies to confirm the accuracy/inaccuracy of lumbar pedicle screw placement in 145 patients and correlated these findings with clinical outcomes. Methods: Over 6 months, we prospectively evaluated the location of 612 pedicle screws placed in 145 patients undergoing instrumented lumbar fusions addressing diverse pathology with instability. Routine anteroposterior and lateral plain radiographs were obtained 48 h after the surgery, while CT scans were obtained at 2 postoperative weeks (i.e., ideally these should have been performed intraoperatively or within 24–48 h of surgery). Results: Of the 612 screws, minor misplacement of screws (≤2 mm) was seen in 104 patients, moderate misplacement in 34 patients (2–4 mm), and severe misplacement in 7 patients (>4 mm). Notably, all the latter 7 (4.8% of the 145) patients required repeated operative intervention. Conclusion: Transpedicular screw insertion in the lumbar spine carries the risks of pedicle medial/lateral violation that is best confirmed on CT rather than X-rays/fluoroscopy alone. Here, we additional found 7 patients (4.8%) who with severe medial/lateral pedicle breach who warranting repeated operative intervention. In the future, CT studies should be performed intraoperatively or within 24–48 h of surgery to confirm the location of pedicle screws and rule in our out medial or lateral pedicle breaches.

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Percutaneous Minimally Invasive (MIS) Guide Wire-less Self-Tapping Pedicle Screw Placement in the Thoracic and Lumbar Spine: Safety and Initial Clinical Experience: Technical Note

Operative Neurosurgery ◽

10.1227/neu.0000000000000977 ◽

2015 ◽

Vol 11 (4) ◽

pp. 530-536 ◽

Cited By ~ 7

Author(s):

Joshua M Beckman ◽

Gisela Murray ◽

Konrad Bach ◽

Armen Deukmedjian ◽

Juan S Uribe

Keyword(s):

Computed Tomography ◽

Lumbar Spine ◽

Minimally Invasive ◽

Pedicle Screw ◽

Guide Wire ◽

The Body ◽

Screw Placement ◽

Spinal Diseases ◽

Pedicle Screw Placement ◽

Thoracic And Lumbar Spine

Abstract BACKGROUND Multiple methods for minimally invasive (MIS) thoracic and lumbar pedicle screw placement exist. The guide wire is almost universally used for most insertion techniques; however, its use is not without complication and potentially prolongs surgical procedures. OBJECTIVE To evaluate the safety of percutaneous MIS guide wire-less pedicle screw placement in the thoracic and lumbar spine at a single institution over a 3-year experience. METHODS Forty-one patients who underwent posterior instrumentation with 110 transpedicular MIS thoracic and lumbar screws by a single surgeon from 2011 to 2014 were analyzed. The mean age was 63 years at the time of surgery. Etiological diagnoses were adult spinal deformity, trauma, spondylosis/spondylolisthesis, and other spinal diseases. Pedicle screws were inserted with the use of a guide wire-free technique in which anatomy-specific entry sites and fluoroscopic landmarks were used to guide the surgeon. A square, sharp-tipped pedicle screw was carefully advanced under biplanar fluoroscopic image (anteroposterior and lateral) down the pedicle into the body. No tapping or any type of electromonitoring was performed. An independent spine surgeon using medical records and thoracic/lumbar computed tomography taken during the postoperative period reviewed all patients. RESULTS The number of the screws inserted at each level was as follows: total, 110; thoracic, 30; and lumbar, 80. All screws were evaluated by computed tomography to assess screw position. Seven screws (6.3%) were inserted with moderate cortical perforation, including 3 screws (2.7%) that violated the medial wall. There were no neurological, vascular, or visceral complications with up to 3 years of follow-up. CONCLUSION The percutaneous MIS guide wire-less technique of lumbar and thoracic pedicle screw placement performed using a biplanar fluoroscopic guidance in a stepwise, consistent manner is an accurate, safe, and reproducible method of insertion to treat a variety of spinal disorders.

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A novel system for accurate lumbar spine pedicle screw placement based on three-dimensional computed tomography reconstruction

Journal of Orthopaedic Translation ◽

10.1016/j.jot.2020.03.010 ◽

2020 ◽

Vol 23 ◽

pp. 101-106

Author(s):

Baozhi Ding ◽

Tangjun Zhou ◽

Jie Zhao

Keyword(s):

Computed Tomography ◽

Lumbar Spine ◽

Pedicle Screw ◽

Three Dimensional ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Tomography Reconstruction ◽

Computed Tomography Reconstruction

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Accuracy of Subaxial Cervical Pedicle Screw Placement Using Direct Visualization Versus Computed Tomography–Based Navigation

Clinical Spine Surgery ◽

10.1097/bsd.0000000000001141 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

S. Harrison Farber ◽

Jakub Godzik ◽

Randall J. Hlubek ◽

James J. Zhou ◽

Corey T. Walker ◽

...

Keyword(s):

Computed Tomography ◽

Pedicle Screw ◽

Screw Placement ◽

Direct Visualization ◽

Pedicle Screw Placement ◽

Cervical Pedicle Screw ◽

Cervical Pedicle

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Radiographic Accuracy of Percutaneous Pedicle Screw Placement in Fluoroscopic- Versus CT Navigation-Guided Lumbar Spine Instrumentation

Neurosurgery ◽

10.1093/neuros/nyz310_617 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Guang-Ting Cong ◽

Avani Vaishnav ◽

Joseph Barbera ◽

Hiroshi Kumagai ◽

James Dowdell ◽

...

Keyword(s):

Lumbar Spine ◽

Minimally Invasive ◽

Pedicle Screw ◽

Spinal Instrumentation ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Intraoperative Computed Tomography ◽

Percutaneous Pedicle Screw ◽

Spine Instrumentation ◽

Surgical Methods

Abstract INTRODUCTION Posterior spinal instrumentation for fusion using intraoperative computed tomography (CT) navigation is gaining traction as an alternative to the conventional two-dimensional fluoroscopic-guided approach to percutaneous pedicle screw placement. However, few studies to date have directly compared outcomes of these 2 minimally invasive instrumentation methods. METHODS A consecutive cohort of patients undergoing primary percutaneous posterior lumbar spine instrumentation for spine fusion was retrospectively reviewed. Revision surgeries or cases converted to open were excluded. Accuracy of screw placement was assessed using a postoperative CT scan with blinding to the surgical methods used. The Gertzbein-Robbins classification was used to grade cortical breach: Grade 0 (<0 mm cortical breach), Grade I (<2 mm), Grade II (2-4 mm), Grade III (4-6 mm), and Grade IV (>6 mm). RESULTS CT navigation was found to significantly improve accuracy of screw placement (P < .022). There was significantly more facet violation of the unfused level in the fluoroscopy group vs the CT group (9% vs 0.5%; P < .0001). There was also a higher proportion of poor screw placement in the fluoroscopy group (10.1% vs 3.6%). No statistical difference was found in the rate of tip breach, inferomedial breach, or lateral breach. Regression analysis showed that fluoroscopy had twice the odds of incurring poor screw placement as compared to CT navigation. CONCLUSION This radiographic study comparing screw placement in minimally invasive fluoroscopy- vs CT navigation-guided lumbar spine instrumentation provides evidence that CT navigation significantly improves accuracy of screw placement, especially in optimizing the screw trajectory so as to avoid facet violation. Long-term follow-up studies should be performed to ascertain whether this difference can contribute to an improvement in clinical outcomes.

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