Safe and accurate placement of thoracic and thoracolumbar percutaneous pedicle screws without image-navigation

Background: Percutaneous pedicle screw placement is now commonly used to treat spinal instability. It is imperative, especially at thoracic levels, to avoid damage to adjacent neurovascular structures. Although more technically demanding when compared with the lumbar spine, we believe that the percutaneous placement of thoracic pedicle screws can be performed safely without image-navigation. Purpose: The purpose was to evaluate the safety of percutaneous pedicle screw placement in the thoracic and thoracolumbar spine without image-navigation. Study Design / Setting: A retrospective study at a single institution. Patient Sample: Patients over the age of 18 years who presented with degenerative disease, trauma or tumor that required surgical stabilization. Outcome Measures: Our outcomes included postoperative plain film X-rays and computerized tomography (CT). Materials and Methods: We performed a retrospective study of patients who underwent percutaneous pedicle screw placement without image-navigation between T2 and L2. Results: Between 2005 and 2011, a total of 507 pedicle screws were placed in 120 patients. The indications included trauma (17%), tumor (8%), and degenerative conditions (75%). The mean age was 61.3 years (range: 20-81 years). Fifty-seven percent were male, and 43% were female. The mean blood loss was 297 ± 40 ml. All patients underwent postoperative anterior-posterior and lateral films that showed safe placement of pedicle screws. Moreover, 57% of patients underwent postoperative CT imaging. There was 1 (0.4%) medial breach and 13 (5%) lateral breaches of the pedicle screw patients who underwent CT imaging as read by an independent neuroradiologist. None of the breaches resulted in adverse neurological sequelae either immediately after or at most recent follow-up. Conclusion: Thoracic and thoracolumbar percutaneous pedicle screw placement can be performed safely and accurately without image-navigation.

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