The accuracy and safety of fluoroscopically guided percutaneous pedicle screws in the lumbosacral junction and the lumbar spine: a review of 880 screws.

We undertook a retrospective study investigating the accuracy and safety of percutaneous pedicle screws placed under fluoroscopic guidance in the lumbosacral junction and lumbar spine. The CT scans of patients were chosen from two centres: European patients from University Medical Center Hamburg-Eppendorf, Germany, and Asian patients from the University of Malaya, Malaysia. Screw perforations were classified into grades 0, 1, 2 and 3. A total of 880 percutaneous pedicle screws from 203 patients were analysed: 614 screws from 144 European patients and 266 screws from 59 Asian patients. The mean age of the patients was 58.8 years (16 to 91) and there were 103 men and 100 women. The total rate of perforation was 9.9% (87 screws) with 7.4% grade 1, 2.0% grade 2 and 0.5% grade 3 perforations. The rate of perforation in Europeans was 10.4% and in Asians was 8.6%, with no significant difference between the two (p = 0.42). The rate of perforation was the highest in S1 (19.4%) followed by L5 (14.9%). The accuracy and safety of percutaneous pedicle screw placement are comparable to those cited in the literature for the open method of pedicle screw placement. Greater caution must be taken during the insertion of L5 and S1 percutaneous pedicle screws owing to their more angulated pedicles, the anatomical variations in their vertebral bodies and the morphology of the spinal canal at this location.

[1]  Constantin Schizas,et al.  Computer tomography assessment of pedicle screw insertion in percutaneous posterior transpedicular stabilization , 2007, European Spine Journal.

[2]  U Weber,et al.  Clinical Relevance of Accuracy of Pedicle Screw Placement: A Computed Tomographic‐Supported Analysis , 1998, Spine.

[3]  S R Garfin,et al.  Placement of pedicle screws in the thoracic spine. Part II: An anatomical and radiographic assessment. , 1995, The Journal of bone and joint surgery. American volume.

[4]  S. Gertzbein,et al.  Accuracy of Pedicular Screw Placement In Vivo , 1990, Spine.

[5]  V. P. Kumar,et al.  A CADAVER STUDY , 2008 .

[6]  R. Mobbs,et al.  Complications With K-Wire Insertion for Percutaneous Pedicle Screws , 2014, Journal of spinal disorders & techniques.

[7]  A. Alho,et al.  Accuracy of pedicle screw insertion: A prospective CT study in 30 low back patients , 2005, European Spine Journal.

[8]  C. Bono,et al.  Thoracic pedicle screws: postoperative computerized tomography scanning assessment. , 2004, Journal of neurosurgery.

[9]  Kevin T Foley,et al.  Three-dimensional fluoroscopy-guided percutaneous thoracolumbar pedicle screw placement. Technical note. , 2003, Journal of neurosurgery.

[10]  S. Chung,et al.  Validation of the Korean Version of the Oswestry Disability Index , 2005, Spine.

[11]  R. Castelein,et al.  Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations , 2002, European Spine Journal.

[12]  R. Meffert,et al.  Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures: a prospective trial , 2013, European Spine Journal.

[13]  Constantin Schizas,et al.  Pedicle Screw Placement Accuracy: A Meta-analysis , 2007, Spine.

[14]  C. Krettek,et al.  Accuracy of Pedicle Screw Placement in Thoracic Spine Fractures , 2004, European Journal of Trauma.

[15]  Ganesh Rao,et al.  Comparison of computerized tomography and direct visualization in thoracic pedicle screw placement. , 2002, Journal of neurosurgery.

[16]  J H Kim,et al.  Thoracic Pedicle Screw Fixation in Spinal Deformities: Are They Really Safe? , 2001, Spine.

[17]  John J Carbone,et al.  Fluoroscopically Assisted Pedicle Screw Fixation for Thoracic and Thoracolumbar Injuries: Technique and Short-Term Complications , 2003, Spine.

[18]  W. Tirakotai,et al.  The accuracy of computer-assisted pedicle screw placement in degenerative lumbrosacral spine using single-time, paired point registration alone technique combined with the surgeon's experience. , 2011, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[19]  A. Dhawan,et al.  In Vivo Accuracy of Thoracic Pedicle Screws , 2001, Spine.

[20]  Kevin T Foley,et al.  Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results. , 2002, Journal of neurosurgery.

[21]  G. Deuretzbacher,et al.  Computer Navigation of Parapedicular Screw Fixation in the Thoracic Spine: A Cadaver Study , 2001, Spine.

[22]  Charles Kuntz,et al.  Accuracy of Thoracic Vertebral Body Screw Placement Using Standard Fluoroscopy, Fluoroscopic Image Guidance, and Computed Tomographic Image Guidance: A Cadaver Study , 2003, Spine.

[23]  P. I. Lee,et al.  Accuracy of the funnel technique of thoracic pedicle screws insertion in scoliosis surgery--an evaluation by CT-scans. , 2005, The Medical journal of Malaysia.

[24]  A. Vaccaro,et al.  Accuracy of pedicle screw placement with the assistance of lateral plain radiography. , 1996, Journal of spinal disorders.

[25]  Koichi Sugimoto,et al.  Incidence of Lumbar Spine Pedicle Breach After Percutaneous Screw Fixation: A Radiographic Evaluation of 601 Screws in 151 Patients , 2014, Journal of spinal disorders & techniques.

[26]  K. Foley,et al.  Percutaneous pedicle screw fixation of the lumbar spine. , 2001, Neurosurgical focus.

[27]  W. Castro,et al.  Accuracy of Pedicle Screw Placement in Lumbar Vertebrae , 1996, Spine.

[28]  Bernhard Meyer,et al.  Minimally Invasive Transmuscular Pedicle Screw Fixation of the Thoracic and Lumbar Spine , 2006, Neurosurgery.

[29]  E. Simmons,et al.  Reliability of Roentgenogram Evaluation of Pedicle Screw Position , 1997, Spine.

[30]  Robert A Hart,et al.  Pedicle Screw Placement in the Thoracic Spine: A Comparison of Image-Guided and Manual Techniques in Cadavers , 2005, Spine.

[31]  Nicholas B. Levine,et al.  Prospective Evaluation of Thoracic Pedicle Screw Placement Using Fluoroscopic Imaging , 2004, Journal of spinal disorders & techniques.

[32]  R. Schwend,et al.  Accuracy of fluoroscopically assisted laser targeting of the cadaveric thoracic and lumbar spine to place transpedicular screws. , 2000, Journal of spinal disorders.

[33]  S. Chung,et al.  Comparison of Multifidus Muscle Atrophy and Trunk Extension Muscle Strength: Percutaneous Versus Open Pedicle Screw Fixation , 2005, Spine.

[34]  L. Lenke,et al.  Free Hand Pedicle Screw Placement in the Thoracic Spine: Is it Safe? , 2004, Spine.

[35]  M. Millgram,et al.  Accuracy and Safety of Thoracic Pedicle Screw Placement in Spinal Deformities , 2005, Journal of spinal disorders & techniques.

[36]  Choll W. Kim,et al.  Nerve Injury to the Posterior Rami Medial Branch During the Insertion of Pedicle Screws: Comparison of Mini-Open Versus Percutaneous Pedicle Screw Insertion Techniques , 2009, Spine.

[37]  F. Langlotz,et al.  Accuracy of Computer‐Assisted Pedicle Screw Placement: An In Vivo Computed Tomography Analysis , 1997, Spine.

[38]  J. Rueger,et al.  Comparison of open versus percutaneous pedicle screw insertion in a sheep model , 2008, European Spine Journal.

[39]  H. Halm,et al.  Pedicle Screw Instrumentation of the Thoracic Spine in Idiopathic Scoliosis , 1997, Spine.

[40]  W Rüther,et al.  Clinical evaluation and computed tomography scan analysis of screw tracts after percutaneous insertion of pedicle screws in the lumbar spine. , 2000, Spine.

[41]  L. Lenke,et al.  Evaluation of Pedicle Screw Placement in the Deformed Spine Using Intraoperative Plain Radiographs: A Comparison With Computerized Tomography , 2005, Spine.

[42]  S. Chin,et al.  Tuberous sclerosis: a syndrome of incomplete tumor suppression. , 2006, Neurosurgical focus.

[43]  R. Mobbs,et al.  Percutaneous versus open pedicle screw fixation for treatment of thoracolumbar fractures: Systematic review and meta-analysis of comparative studies , 2015, Clinical Neurology and Neurosurgery.

[44]  V. Podichetty,et al.  Placement of percutaneous pedicle screws without imaging guidance. , 2006, Neurosurgical Focus.

[45]  R. Yeasting,et al.  Projection of the thoracic pedicle and its morphometric analysis. , 1997, Spine.

[46]  C. Aubin,et al.  Thoracic Pedicle Screw Insertion Using a Transpedicular Drill Guide: A Preliminary Study , 2004, Journal of spinal disorders & techniques.

[47]  Jin-Sung Kim,et al.  Comparison between the accuracy of percutaneous and open pedicle screw fixations in lumbosacral fusion. , 2013, The spine journal : official journal of the North American Spine Society.

[48]  R. Gaines,et al.  The Accuracy of Pedicle Screw Placement in the Thoracic Spine Using the “Funnel Technique”: Part 1. A Cadaveric Study , 2002, Journal of spinal disorders & techniques.

[49]  H N Herkowitz,et al.  Spinal pedicle fixation. Confirmation of an image-based technique for screw placement. , 1993, Spine.

[50]  Manabu Ito,et al.  Accuracy Analysis of Pedicle Screw Placement in Posterior Scoliosis Surgery: Comparison Between Conventional Fluoroscopic and Computer-Assisted Technique , 2007, Spine.

[51]  F. Q. Ribeiro.  The meta-analysis , 2017, Brazilian journal of otorhinolaryngology.

[52]  O. Boachie-Adjei,et al.  Safety and efficacy of pedicle screw placement for adult spinal deformity with a pedicle-probing conventional anatomic technique. , 2000, Journal of spinal disorders.