Retrospective single-institution study evaluating the safety of free-hand thoracic pedicle screw placement — without fluoroscopy or image guidance — in 394 consecutive patients who received 3,204 transpedicular screws over a 10-year period (1992–2002), spanning T1 through T12 for deformity and other spinal pathologies.
When placing free-hand thoracic pedicle screws, rely on stepwise tactile confirmation (five-wall palpation before and after tapping) as your primary safety mechanism — triggered EMG and plain films are insensitive screens that will miss most medial wall violations, so if you need to verify screw position definitively, postoperative CT is required.
A minor cortical breach alone does not mandate screw revision; use the authors' proposed safe-zone framework (≤2 mm medial encroachment generally tolerated) alongside clinical and electrophysiologic context to guide that decision.
Retrospective single-institution study evaluating the safety of free-hand thoracic pedicle screw placement — without fluoroscopy or image guidance — in 394 consecutive patients who received 3,204 transpedicular screws over a 10-year period (1992–2002), spanning T1 through T12 for deformity and other spinal pathologies.
When placing free-hand thoracic pedicle screws, rely on stepwise tactile confirmation (five-wall palpation before and after tapping) as your primary safety mechanism — triggered EMG and plain films are insensitive screens that will miss most medial wall violations, so if you need to verify screw position definitively, postoperative CT is required.
A minor cortical breach alone does not mandate screw revision; use the authors' proposed safe-zone framework (≤2 mm medial encroachment generally tolerated) alongside clinical and electrophysiologic context to guide that decision.