Kim, Spine (Phila Pa 1976) 2004 - Free Hand Pedicle Screw Placement in the Thoracic Spine: Is IT Safe? - Article Summary

Free Hand Pedicle Screw Placement in the Thoracic Spine: Is IT Safe?

Kim, Riew, et al.·Spine (Phila Pa 1976)·2004·703 citations·Retrospective cohort

Background

Thoracic pedicle screw fixation techniques are still controversial for thoracic deformities because of possible complications including neurologic.

Purpose

To evaluate the safety of a free hand technique of pedicle screw placement in the thoracic spine at a single institution over a 10-year experience.

Methods

Study Design: A retrospective study.

Materials and Methods:

394 consecutive patients who underwent posterior stabilization utilizing 3204 transpedicular thoracic screws by 2 surgeons from 1992 to 2002 were analyzed.
The mean age was 27 + 10 years (range 5 + 3-87 + 0 years) at the time of surgery.
Etiologic diagnoses were: scoliosis in 273, kyphosis in 53, other spinal disease in 68.
Pedicle screws were inserted using a free hand technique similar to that used in the lumbar spine in which anatomic landmarks and specific entry sites were used to guide the surgeon.
A 2-mm tip pedicle probe was carefully advanced free hand down the pedicle into the body.
Careful palpation of all bony borders (floor and 4 pedicle walls) was performed before and after tapping.
Next, the screw was placed, followed by neurophysiologic (screw stimulation with rectus abdominus muscle recording) and radiographic (anteroposterior and lateral) confirmation.
An independent spine surgeon using medical records and roentgenograms taken during treatment and follow-up reviewed all the patients.

Results

The number of the screws inserted at each level were as follows (total n = 3204): T1, n = 13; T2, n = 60; T3, n = 192; T4, n = 275; T5, n = 279; T6, n = 240; T7, n = 230; T8, n = 253; T9, n = 259; T10, n = 341; T11, n = 488; T12, n = 572.
577 screws inserted into the deformed thoracic spine were randomly evaluated by thoracic computed tomography scan to assess for screw position.
36 screws (6.2%) were inserted with moderate cortical perforation, which meant the central line of the pedicle screw was out of the outer cortex of the pedicle wall and included 10 screws (1.7%) that violated the medial wall.
There were no screws (out of the entire study group of 3204) with any neurologic, vascular, or visceral complications with up to 10 years follow-up.

Conclusions

The free hand technique of thoracic pedicle screw placement performed in a step-wise, consistent, and compulsive manner is an accurate, reliable, and safe method of insertion to treat a variety of spinal disorders, including spinal deformity.

Supplemental

Free Hand Pedicle Screw Placement in the Thoracic Spine: Is IT Safe?

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Free Hand Pedicle Screw Placement in the Thoracic Spine: Is IT Safe?

Kim, Riew, et al.·Spine (Phila Pa 1976)·2004·703 citations·Retrospective cohort

DOI·PubMed

Background

Thoracic pedicle screw fixation techniques are still controversial for thoracic deformities because of possible complications including neurologic.

Purpose

To evaluate the safety of a free hand technique of pedicle screw placement in the thoracic spine at a single institution over a 10-year experience.

Methods

Study Design: A retrospective study.

Materials and Methods:

394 consecutive patients who underwent posterior stabilization utilizing 3204 transpedicular thoracic screws by 2 surgeons from 1992 to 2002 were analyzed.
The mean age was 27 + 10 years (range 5 + 3-87 + 0 years) at the time of surgery.
Etiologic diagnoses were: scoliosis in 273, kyphosis in 53, other spinal disease in 68.
Pedicle screws were inserted using a free hand technique similar to that used in the lumbar spine in which anatomic landmarks and specific entry sites were used to guide the surgeon.
A 2-mm tip pedicle probe was carefully advanced free hand down the pedicle into the body.
Careful palpation of all bony borders (floor and 4 pedicle walls) was performed before and after tapping.
Next, the screw was placed, followed by neurophysiologic (screw stimulation with rectus abdominus muscle recording) and radiographic (anteroposterior and lateral) confirmation.
An independent spine surgeon using medical records and roentgenograms taken during treatment and follow-up reviewed all the patients.

Results

The number of the screws inserted at each level were as follows (total n = 3204): T1, n = 13; T2, n = 60; T3, n = 192; T4, n = 275; T5, n = 279; T6, n = 240; T7, n = 230; T8, n = 253; T9, n = 259; T10, n = 341; T11, n = 488; T12, n = 572.
577 screws inserted into the deformed thoracic spine were randomly evaluated by thoracic computed tomography scan to assess for screw position.
36 screws (6.2%) were inserted with moderate cortical perforation, which meant the central line of the pedicle screw was out of the outer cortex of the pedicle wall and included 10 screws (1.7%) that violated the medial wall.
There were no screws (out of the entire study group of 3204) with any neurologic, vascular, or visceral complications with up to 10 years follow-up.

Conclusions

Background

Thoracic pedicle screw fixation techniques are still controversial for thoracic deformities because of possible complications including neurologic.

Purpose

To evaluate the safety of a free hand technique of pedicle screw placement in the thoracic spine at a single institution over a 10-year experience.

Methods

Study Design: A retrospective study.

Materials and Methods:

394 consecutive patients who underwent posterior stabilization utilizing 3204 transpedicular thoracic screws by 2 surgeons from 1992 to 2002 were analyzed.
The mean age was 27 + 10 years (range 5 + 3-87 + 0 years) at the time of surgery.
Etiologic diagnoses were: scoliosis in 273, kyphosis in 53, other spinal disease in 68.
Pedicle screws were inserted using a free hand technique similar to that used in the lumbar spine in which anatomic landmarks and specific entry sites were used to guide the surgeon.
A 2-mm tip pedicle probe was carefully advanced free hand down the pedicle into the body.
Careful palpation of all bony borders (floor and 4 pedicle walls) was performed before and after tapping.
Next, the screw was placed, followed by neurophysiologic (screw stimulation with rectus abdominus muscle recording) and radiographic (anteroposterior and lateral) confirmation.
An independent spine surgeon using medical records and roentgenograms taken during treatment and follow-up reviewed all the patients.

Results

The number of the screws inserted at each level were as follows (total n = 3204): T1, n = 13; T2, n = 60; T3, n = 192; T4, n = 275; T5, n = 279; T6, n = 240; T7, n = 230; T8, n = 253; T9, n = 259; T10, n = 341; T11, n = 488; T12, n = 572.
577 screws inserted into the deformed thoracic spine were randomly evaluated by thoracic computed tomography scan to assess for screw position.
36 screws (6.2%) were inserted with moderate cortical perforation, which meant the central line of the pedicle screw was out of the outer cortex of the pedicle wall and included 10 screws (1.7%) that violated the medial wall.
There were no screws (out of the entire study group of 3204) with any neurologic, vascular, or visceral complications with up to 10 years follow-up.

Conclusions

Background

Thoracic pedicle screw fixation techniques are still controversial for thoracic deformities because of possible complications including neurologic.

Purpose

To evaluate the safety of a free hand technique of pedicle screw placement in the thoracic spine at a single institution over a 10-year experience.

Methods

Study Design: A retrospective study.

Materials and Methods:

394 consecutive patients who underwent posterior stabilization utilizing 3204 transpedicular thoracic screws by 2 surgeons from 1992 to 2002 were analyzed.
The mean age was 27 + 10 years (range 5 + 3-87 + 0 years) at the time of surgery.
Etiologic diagnoses were: scoliosis in 273, kyphosis in 53, other spinal disease in 68.
Pedicle screws were inserted using a free hand technique similar to that used in the lumbar spine in which anatomic landmarks and specific entry sites were used to guide the surgeon.
A 2-mm tip pedicle probe was carefully advanced free hand down the pedicle into the body.
Careful palpation of all bony borders (floor and 4 pedicle walls) was performed before and after tapping.
Next, the screw was placed, followed by neurophysiologic (screw stimulation with rectus abdominus muscle recording) and radiographic (anteroposterior and lateral) confirmation.
An independent spine surgeon using medical records and roentgenograms taken during treatment and follow-up reviewed all the patients.

Results

The number of the screws inserted at each level were as follows (total n = 3204): T1, n = 13; T2, n = 60; T3, n = 192; T4, n = 275; T5, n = 279; T6, n = 240; T7, n = 230; T8, n = 253; T9, n = 259; T10, n = 341; T11, n = 488; T12, n = 572.
577 screws inserted into the deformed thoracic spine were randomly evaluated by thoracic computed tomography scan to assess for screw position.
36 screws (6.2%) were inserted with moderate cortical perforation, which meant the central line of the pedicle screw was out of the outer cortex of the pedicle wall and included 10 screws (1.7%) that violated the medial wall.
There were no screws (out of the entire study group of 3204) with any neurologic, vascular, or visceral complications with up to 10 years follow-up.