Accuracy and safety of pedicle screw fixation in thoracic spine trauma

2006 ◽  
Vol 5 (6) ◽  
pp. 520-526 ◽  
Author(s):  
Charles G. Fisher ◽  
Vic Sahajpal ◽  
Ory Keynan ◽  
Michael Boyd ◽  
Douglas Graeb ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Spine Fractures ◽  
Chi Square ◽  
Clinical Safety ◽  
Thoracic Spine Fractures ◽  
Screw Position ◽  
Pedicle Wall

Object The authors evaluated the accuracy of placement and safety of pedicle screws in the treatment of unstable thoracic spine fractures. Methods Patients with unstable fractures between T-1 and T-10, which had been treated with pedicle screw (PS) placement by one of five spine surgeons at a referral center were included in a prospective cohort study. Postoperative computed tomography scans were obtained using 3-mm axial cuts with sagittal reconstructions. Three independent reviewers (C.B., V.S., and D.G.) assessed PS position using a validated grading scale. Comparison of failure rates among cases grouped by selected baseline variables were performed using Pearson chi-square tests. Independent peri- and postoperative surveillance for local and general complications was performed to assess safety. Twenty-three patients with unstable thoracic fractures treated with 201 thoracic PSs were analyzed. Only PSs located between T-1 and T-12 were studied, with the majority of screws placed between T-5 and T-10. Of the 201 thoracic PSs, 133 (66.2%) were fully contained within the pedicle wall. The remaining 68 screws (33.8%) violated the pedicle wall. Of these, 36 (52.9%) were lateral, 27 (39.7%) were medial, and five (7.4%) were anterior perforations. No superior, inferior, anteromedial, or anterolateral perforations were found. When local anatomy and the clinical safety of screws were considered, 98.5% (198 of 201) of the screws were probably in an acceptable position. No baseline variables influenced the incidence of perforations. There were no adverse neurological, vascular, or visceral injuries detected intraoperatively or postoperatively. Conclusions In the vast majority of cases, PSs can be placed in an acceptable and safe position by fellowship-trained spine surgeons when treating unstable thoracic spine fractures. However, an unacceptable screw position can occur.

42. Accuracy and safety of pedicle screw fixation in thoracic spine fractures

2004 ◽  
Vol 4 (5) ◽  
pp. S23-S24
Author(s):  
Fisher Charles ◽  
Vic Sahajpal ◽  
Bailey Christoper ◽  
Michael Boyd ◽  
Brian Kwon ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Spine Fractures ◽  
Thoracic Spine Fractures

Pedicle screw insertion in the thoracolumbar spine: comparison of 4 guidance techniques in the intact cadaveric spine

2011 ◽  
Vol 14 (5) ◽  
pp. 664-669 ◽  
Author(s):  
Husam Alhabib ◽  
Andrew Nataraj ◽  
Mohammed Khashab ◽  
James Mahood ◽  
Frank Kortbeek ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Thoracolumbar Spine ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Anatomical Landmarks ◽  
Imaging Data ◽  
Anatomical Dissection ◽  
Screw Insertion ◽  
Fluoroscopic Navigation ◽  
Screw Position

Object Pedicle screw fixation is a mainstay of thoracolumbar stabilization. Screw insertion using anatomical landmarks and fluoroscopy is common but can be technically challenging and generally involves substantial exposure to ionizing radiation. Computerized navigation has been reported to improve accuracy but is expensive and complex. The authors undertook this study to evaluate these 3 methods in comparison with a fourth technique using standard cervical distractor screws to mark the entry point and trajectory. Methods Four cadaveric human spines were used for this study. After an initial CT scan, 34 pedicle screws were inserted in each intact spine from T-1 to L-5 using the following 4 screw insertion guidance techniques (1 technique per specimen): use of anatomical landmarks, use of cervical distractor screws and spot fluoroscopy, fluoroscopy-based navigation, and fluoroscopy- and CT-based navigation (using merged imaging data). Postprocedural CT and anatomical dissection were then performed to evaluate screw position for site and degree of breach. Results The cervical distractor screw method had a breach rate of 5.9% versus 29.4%, 32.4%, and 20.6% for use of anatomical landmarks, fluoroscopic navigation, and fluoroscopic-CT navigation, respectively (p < 0.05). There is also a significant association between degree of medial and distal breach and the method of screw insertion (p < 0.05). Conclusions Cervical distractor screws as pedicle markers offer favorable insertion accuracy and reduction of radiation exposure compared with the other 3 methods used in clinical practice.

scholarly journals Adjacent-segment disease after thoracic pedicle screw fixation

2018 ◽  
Vol 28 (3) ◽  
pp. 280-286 ◽  
Author(s):  
Nitin Agarwal ◽  
Robert F. Heary ◽  
Prateek Agarwal
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Spine Deformity ◽  
Fracture Stabilization ◽  
Thoracic Pedicle Screw

OBJECTIVEPedicle screw fixation is a technique widely used to treat conditions ranging from spine deformity to fracture stabilization. Pedicle screws have been used traditionally in the lumbar spine; however, they are now being used with increasing frequency in the thoracic spine as a more favorable alternative to hooks, wires, or cables. Although safety concerns, such as the incidence of adjacent-segment disease (ASD) after cervical and lumbar fusions, have been reported, such issues in the thoracic spine have yet to be addressed thoroughly. Here, the authors review the literature on ASD after thoracic pedicle screw fixation and report their own experience specifically involving the use of pedicle screws in the thoracic spine.METHODSSelect references from online databases, such as PubMed (provided by the US National Library of Medicine at the National Institutes of Health), were used to survey the literature concerning ASD after thoracic pedicle screw fixation. To include the authors’ experience at Rutgers New Jersey Medical School, a retrospective review of a prospectively maintained database was performed to determine the incidence of complications over a 13-year period in 123 consecutive adult patients who underwent thoracic pedicle screw fixation. Children, pregnant or lactating women, and prisoners were excluded from the review. By comparing preoperative and postoperative radiographic images, the occurrence of thoracic ASD and disease within the surgical construct was determined.RESULTSDefinitive radiographic fusion was detected in 115 (93.5%) patients. Seven incidences of instrumentation failure and 8 lucencies surrounding the screws were observed. One patient was observed to have ASD of the thoracic spine. The mean follow-up duration was 50 months.CONCLUSIONSThis long-term radiographic evaluation revealed the use of pedicle screws for thoracic fixation to be an effective stabilization modality. In particular, ASD seems to be less of a problem in the relatively immobile thoracic spine than in the more mobile cervical and lumbar spines.

scholarly journals Hybrid Stabilization of Thoracic Spine Fractures with Sublaminar Bands and Transpedicular Screws: Description of a Surgical Alternative and Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Marie-Therese Unterweger ◽  
Frank Kandziora ◽  
Klaus J. Schnake
Keyword(s):  
Thoracic Spine ◽  
Pedicle Screws ◽  
Spine Fractures ◽  
Review Of The Literature ◽  
Hybrid Stabilization ◽  
Loss Of Reduction ◽  
Thoracic Spine Fractures ◽  
Vertebral Bodies ◽  
Sublaminar Bands

Stabilization of unstable thoracic fractures with transpedicular screws is widely accepted. However, placement of transpedicular screws can cause complications, particularly in the thoracic spine with physiologically small pedicles. Hybrid stabilization, a combination of sublaminar bands and pedicle screws, might reduce the rate of misplaced screws and can be helpful in special anatomic circumstances, such as preexisting scoliosis and osteoporosis. We report about two patients suffering from unstable thoracic fractures, of T5 in one case and T3, T4, and T5 in the other case, with preexisting scoliosis and extremely small pedicles. Additionally, one patient had osteoporosis. Patients received hybrid stabilization with pedicle screws adjacent to the fractured vertebral bodies and sublaminar bands at the level above and below the pedicle screws. No complications occurred. Follow-up was 12 months with clinically uneventful postoperative courses. No signs of implant failure or loss of reduction could be detected. In patients with very small thoracic pedicles, scoliosis, and/or osteoporosis, hybrid stabilization with sublaminar bands and pedicle screws can be a viable alternative to long pedicle screw constructs.

Accuracy of Pedicle Screw Placement in Thoracic Spine Fractures

2004 ◽  
Vol 30 (4) ◽  
pp. 241-247 ◽  
Author(s):  
Marty Zdichavsky ◽  
Michael Blauth ◽  
Christian Knop ◽  
Joachim Lotz ◽  
Christian Krettek ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Screw Placement ◽  
Spine Fractures ◽  
Pedicle Screw Placement ◽  
Thoracic Spine Fractures

scholarly journals Anatomic Study of Individualized and Improved Pedicle Screw Implantation in the Lower Cervical Spine

2015 ◽  
Vol 100 (2) ◽  
pp. 328-333 ◽  
Author(s):  
Yuan Liu ◽  
Bin Zhang ◽  
Min Dai ◽  
Han-chu Xiong ◽  
Song Gao ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Lower Cervical Spine ◽  
Optimal Position ◽  
Screw Position ◽  
Cervical Pedicle ◽  
Picture Archiving And Communication ◽  
Ct Classification

The objective of this study was to explore a safe, reliable, and effective method for pedicle screw implantation in the lower cervical spine. Recently, a number of studies have shown that cervical pedicle screw fixation is better than roadside steel plate after cervical screw internal fixation within the scope of its indications. However, the difficulty of the former surgery technology is relatively higher and it is much easier to cause many complications. Therefore, domestic and foreign scholars have been positively exploring safer, easier operations and cheaper methods of pedicle screw implantation in the lower cervical spine. The lower cervical spine areas (C3–C7) of 7 adult cadavers were carried out with computed tomography (CT) scans of 1-mm slices. The entry point, angle, and length of the screws were determined by the measurement of CT images in a picture archiving and communication system. The pedicle screws were implanted with the technique of improved Abumi pedicle screw placement in the lab. The accuracy of the screws was evaluated by the Andrew CT classification criteria of pedicle screw position and gross observation after the experiment. A total of 66 screws were implanted in the lower cervical spine, and 90.9% of the screws inserted were found to be in an optimal position. The method of individualized and improved pedicle screw implantation in the lower cervical spine is relatively safe and reliable, which can be considered to be used in the clinic.

Biomechanical Comparison of Costotransverse Process Screw Fixation and Pedicle Screw Fixation of the Upper Thoracic Spine

2010 ◽  
Vol 66 (suppl_1) ◽  
pp. ons-178-ons-182
Author(s):  
Andrew S. Little ◽  
Leonardo B.C. Brasiliense ◽  
Bruno C.R. Lazaro ◽  
Phillip M. Reyes ◽  
Curtis A. Dickman ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Pedicle Screw ◽  
Thoracic Spine ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Lateral Bending ◽  
Upper Thoracic Spine ◽  
Pull Out ◽  
Upper Thoracic

Abstract Objective: To compare the biomechanics of costotransverse process screw fixation with those of pedicle screw fixation in a cadaveric model of the upper thoracic spine. Methods: Ten human thoracic spines were instrumented across the T3–T4 segment with costotransverse and pedicle screws. Nonconstraining pure moments (maximum, 6.0 Nm) were applied to induce flexion, extension, lateral bending, and axial rotation. The range of motion, lax zone, and stiff zone were determined in each specimen in the normal state, after 3-column destabilization, and after instrumentation. After flexibility testing was completed, axial screw pull-out strength was assessed. Results: In all directions of loading, both fixation techniques significantly decreased lax zone and range of motion at T3–T4 compared with the destabilized state (P &lt; .001). During all loading modes except lateral bending, pedicle screw fixation allowed significantly less range of motion than costotransverse screw fixation. Pedicle screws provided 62% greater resistance to axial pull-out than costotransverse screws. Conclusion: The costotransverse screw technique seems to provide only moderately stiff fixation of the destabilized thoracic spine. Pedicle screw fixation seems to have more favorable biomechanical properties. These data suggest that the costotransverse process construct is better used as a salvage procedure rather than as a primary fixation strategy.

Accuracy of Pedicle Screw Placement in Thoracic Spine Fractures

2004 ◽  
Vol 30 (4) ◽  
pp. 234-240 ◽  
Author(s):  
Marty Zdichavsky ◽  
Michael Blauth ◽  
Christian Knop ◽  
Martin Graessner ◽  
Hartmut Herrmann ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Screw Placement ◽  
Spine Fractures ◽  
Pedicle Screw Placement ◽  
Thoracic Spine Fractures

scholarly journals Novel free-hand T1 pedicle screw method: Review of 44 consecutive cases

2014 ◽  
Vol 05 (04) ◽  
pp. 349-354 ◽  
Author(s):  
Mark A. Rivkin ◽  
Jessica F. Okun ◽  
Steven S. Yocom
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Pedicle Screws ◽  
High Rate ◽  
Imaging Modalities ◽  
Neurological Deficits ◽  
Upper Thoracic Spine ◽  
Starting Point ◽  
Grade 3 ◽  
Upper Thoracic

ABSTRACT Summary of Background Data: Multilevel posterior cervical instrumented fusions are becoming more prevalent in current practice. Biomechanical characteristics of the cervicothoracic junction may necessitate extending the construct to upper thoracic segments. However, fixation in upper thoracic spine can be technically demanding owing to transitional anatomy while suboptimal placement facilitates vascular and neurologic complications. Thoracic instrumentation methods include free-hand, fluoroscopic guidance, and CT-based image guidance. However, fluoroscopy of upper thoracic spine is challenging secondary to vertebral geometry and patient positioning, while image-guided systems present substantial financial commitment and are not readily available at most centers. Additionally, imaging modalities increase radiation exposure to the patient and surgeon while potentially lengthening surgical time. Materials and Methods: Retrospective review of 44 consecutive patients undergoing a cervicothoracic fusion by a single surgeon using the novel free-hand T1 pedicle screw technique between June 2009 and November 2012. A starting point medial and cephalad to classic entry as well as new trajectory were utilized. No imaging modalities were employed during screw insertion. Postoperative CT scans were obtained on day 1. Screw accuracy was independently evaluated according to the Heary classification. Results: In total, 87 pedicle screws placed were at T1. Grade 1 placement occurred in 72 (82.8%) screws, Grade 2 in 4 (4.6%) screws and Grade 3 in 9 (10.3%) screws. All Grade 2 and 3 breaches were <2 mm except one Grade 3 screw breaching 2-4 mm laterally. Only two screws (2.3%) were noted to be Grade 4, both breaching medially by less than 2 mm. No new neurological deficits or returns to operating room took place postoperatively. Conclusions: This modification of the traditional starting point and trajectory at T1 is safe and effective. It attenuates additional bone removal or imaging modalities while maintaining a high rate of successful screw placement compared to historical controls.

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