Fluoroscopically Assisted Pedicle Screw Fixation for Thoracic and Thoracolumbar Injuries: Technique and Short-Term Complications

Study Design. Retrospective review of charts and fluoroscopic, radiographic, and computed tomography images for 252 screws (41 patients). Objectives. To describe a fluoroscopically assisted technique of thoracic pedicle screw insertion and to determine the technique’s safety, short-term complications, and accuracy. Summary of Background Data. Pedicle screw instrumentation is safe and effective for lumbar spine stabilization, but evidence of its accuracy and complications in the thoracic spine is lacking. Methods. Between 1997 and 2000, 41 consecutive patients with unstable cervicothoracic, thoracic, and thoracolumbar spine injuries were admitted to a regional, level 1 trauma center. These patients underwent posterior spine arthrodesis and pedicle screw instrumentation placed via intraoperative multiplanar fluoroscopic imaging. Pedicle screw placement accuracy was determined by review of postoperative computed tomography scans. Instrumentation failure prevalence was determined by review of fluoroscopic images, postoperative radiographs, and computed tomography scans. Neurologic, infectious, vascular, and gastrointestinal complications were determined by review of operative reports, hospital records, and clinic notes. Results. Of the 126 (50%) thoracic screws (22 patients) with postoperative computed tomography scans, 16 (12.7%) penetrated the pedicle cortex (4 [2.4%] medially and 13 [10.3%] laterally) and 7 (5.6%) penetrated the vertebral body. There were four surgical complications: one instrumentation failure (broken rod, no loss of correction), one deep infection, and two superficial infections. The infections resolved with irrigation, debridement, and intravenous antibiotics. During the 6- to 24-month follow-up period, there were no neurologic, vascular, or gastrointestinal complications. Conclusions. Cervicothoracic, thoracic, and thoracolumbar spine injuries can be managed safely and effectively with thoracic pedicle screws inserted under multiplanar fluoroscopic imaging.

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

[2]  R. Winter,et al.  Complications associated with pedicle screws. , 1999, The Journal of bone and joint surgery. American volume.

[3]  A G Patwardhan,et al.  Analysis of the Morphometric Characteristics of the Thoracic and Lumbar Pedicles , 1987, Spine.

[4]  M H Krag,et al.  Morphometry of the Thoracic and Lumbar Spine Related to Transpedicular Screw Placement for Surgical Spinal Fixation , 1988, Spine.

[5]  U Liljenqvist,et al.  Pullout strength of pedicle screws versus pedicle and laminar hooks in the thoracic spine. , 2001, Acta orthopaedica Belgica.

[6]  R. Yeasting,et al.  Anatomic Relations of the Thoracic Pedicle to the Adjacent Neural Structures , 1997, Spine.

[7]  Kee D. Kim,et al.  Computer-Assisted Thoracic Pedicle Screw Placement: An In Vitro Feasibility Study , 2001, Spine.

[8]  C. K. Lee,et al.  Segmental Pedicle Screw Fixation in the Treatment of Thoracic Idiopathic Scoliosis , 1995, Spine.

[9]  Sang Min Lee,et al.  Restoration of thoracic kyphosis in the hypokyphotic spine: a comparison between multiple-hook and segmental pedicle screw fixation in adolescent idiopathic scoliosis. , 1999, Journal of spinal disorders.

[10]  D. Simon,et al.  Accuracy Requirements for Image-Guided Spinal Pedicle Screw Placement , 2001, Spine.

[11]  P Merloz,et al.  Pedicle Screw Placement Using Image Guided Techniques , 1998, Clinical orthopaedics and related research.

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

[13]  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.

[14]  H. An,et al.  Placement of pedicle screws in the thoracic spine. Part I: Morphometric analysis of the thoracic vertebrae. , 1995, The Journal of bone and joint surgery. American volume.

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

[16]  F. Girardi,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.

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

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

[19]  C. K. Lee,et al.  Comparison of Cotrel-Dubousset pedicle screws and hooks in the treatment of idiopathic scoliosis , 1994, International Orthopaedics.

[20]  L. Lenke,et al.  Complications of Pediatric Thoracolumbar and Lumbar Pedicle Screws , 1998, Spine.

[21]  A. Valdevit,et al.  Biomechanical analysis of screw load sharing in pedicle fixation of the lumbar spine. , 1994, Journal of spinal disorders.

[22]  R. Yeasting,et al.  Anatomic Considerations of Pedicle Screw Placement in the Thoracic Spine: Roy‐Camille Technique Versus Open‐Lamina Technique , 1998, Spine.