Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures: a prospective trial

PurposeThe percutaneous insertion technique requires surgical skill and experience. However, there have been few clinical reports evaluating the accuracy of minimally invasive pedicle screw placement using the conventional fluoroscopy method. The purpose of this study was to evaluate the accuracy of percutaneous pedicle screw placement in the treatment of thoracic and lumbar spine fractures using two-plane conventional fluoroscopy.MethodsA prospective clinical trial was performed. A total of 502 percutaneous pedicle screws in 111 patients, all inserted with the assistance of conventional fluoroscopy, were evaluated. The safety and accuracy of pedicle screw placement were based on the evaluation of postoperative axial 3-mm slice computed tomography scans using the scoring system described by Zdichavsky et al. [Eur J Trauma 30:234–240, 2004; Eur J Trauma 30:241–247, 2004].Results427/502 pedicle screws (85 %) were classified as good and excellent concerning the best possible screw length and 494/502 (98 %) were found to have good or excellent position. One screw had to be revised due to medial position with a neurological deficit.ConclusionsThis study demonstrates the feasibility of placing percutaneous posterior thoracolumbar pedicle screws with the assistance of conventional fluoroscopy. Minimally invasive transpedicular instrumentation is an accurate, reliable and safe method to treat a variety of spinal disorders, including thoracic and lumbar spine fractures.

[1]  Kevin T Foley,et al.  Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications. , 2006, Neurosurgical focus.

[2]  A. Herrera,et al.  Perioperative and short-term advantages of mini-open approach for lumbar spinal fusion , 2009, European Spine Journal.

[3]  T. Blattert,et al.  Perkutane Techniken an der Brust- und Lendenwirbelsäule , 2011, Der Unfallchirurg.

[4]  M. Aebi,et al.  A comprehensive classification of thoracic and lumbar injuries , 2005, European Spine Journal.

[5]  F. Magerl,et al.  Percutaneous diagnostic stabilization for low back pain. Correlation with results after fusion operations. , 1994, Clinical orthopaedics and related research.

[6]  J. Kostuik,et al.  The Role of External Spinal Skeletal Fixation in the Assessment of Low-Back Disorders , 1989, Spine.

[7]  L. Sjöström,et al.  Spontaneous effect of increased stability of the lower lumbar spine in cases of severe chronic back pain. The answer of an external transpeduncular fixation test. , 1986, Clinical orthopaedics and related research.

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

[9]  D J Quint,et al.  Stereotactic Navigation for Placement of Pedicle Screws in the Thoracic Spine , 2001, Neurosurgery.

[10]  S. Seitsalo,et al.  The external fixation test of the lumbar spine. 30 complications in 25 of 100 consecutive patients. , 1993, Acta orthopaedica Scandinavica.

[11]  T. Washio,et al.  Structural Characteristics of the Pedicle and Its Role in Screw Stability , 1997, Spine.

[12]  K. Yonenobu,et al.  Lumbar Fusion and Stabilization , 1993, Springer Japan.

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

[14]  T. Blattert,et al.  Perkutane Techniken an der Brust- und Lendenwirbelsäule , 2011, Der Unfallchirurg.

[15]  D. Bednar,et al.  External Spinal Skeletal Fixation in the Management of Back Pain , 1996, Clinical orthopaedics and related research.

[16]  A. Prokop,et al.  Minimal-invasive perkutane Instrumentation bei Wirbelsäulenfrakturen , 2009, Der Unfallchirurg.

[17]  F. Zhao,et al.  Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach , 2010, European Spine Journal.

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

[19]  F. Magerl.  120. Verletzungen der Brust- und Lendenwirbelsäule , 1980, Langenbecks Archiv für Chirurgie.

[20]  F. Zhao,et al.  Comparison of paraspinal muscle injury in one‐level lumbar posterior inter‐body fusion: modified minimally invasive and traditional open approaches , 2010, Orthopaedic surgery.

[21]  Yung Park,et al.  Comparison of One-Level Posterior Lumbar Interbody Fusion Performed With a Minimally Invasive Approach or a Traditional Open Approach , 2007, Spine.

[22]  F. Magerl.  Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. , 1984, Clinical orthopaedics and related research.

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

[24]  H. Nakashima,et al.  Comparison of the Percutaneous Screw Placement Precision of Isocentric C-arm 3-dimensional Fluoroscopy-navigated Pedicle Screw Implantation and Conventional Fluoroscopy Method With Minimally Invasive Surgery , 2009, Journal of spinal disorders & techniques.

[25]  J N Weinstein,et al.  Anatomic and technical considerations of pedicle screw fixation. , 1992, Clinical orthopaedics and related research.

[26]  D. Polly,et al.  Volumetric Spinal Canal Intrusion: A Comparison Between Thoracic Pedicle Screws and Thoracic Hooks , 2004, Spine.

[27]  J. Webb,et al.  The Role of External Fixation as a Predictor of Fusion Success , 1993 .

[28]  H. Zwipp,et al.  Perkutane dorsale versus offene Instrumentation bei Frakturen des thorakolumbalen Übergangs , 2006, Der Unfallchirurg.

[29]  B. T. Field,et al.  A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine. , 1986, Clinical orthopaedics and related research.

[30]  A. Prokop,et al.  [Minimally invasive percutaneous instrumentation for spine fractures]. , 2009, Der Unfallchirurg.