Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jun;6(4):322-8.
doi: 10.1055/s-0035-1563405. Epub 2015 Sep 22.

Accuracy of Percutaneous Pedicle Screw Insertion Technique with Conventional Dual Fluoroscopy Units and a Retrospective Comparative Study Based on Surgeon Experience

Masayuki Nakahara  1 , Takao Yasuhara  2 , Takafumi Inoue  1 , Yuichi Takahashi  2 , Shinji Kumamoto  2 , Yasukazu Hijikata  2 , Akira Kusumegi  2 , Yushi Sakamoto  2 , Koichi Ogawa  2 , Kenki Nishida  2
Affiliations

Accuracy of Percutaneous Pedicle Screw Insertion Technique with Conventional Dual Fluoroscopy Units and a Retrospective Comparative Study Based on Surgeon Experience

Masayuki Nakahara et al. Global Spine J. 2016 Jun.

Abstract

Study Design Retrospective comparative study. Objective To evaluate the accuracy of percutaneous pedicle screw (PPS) placement and intraoperative imaging time using dual fluoroscopy units and their differences between surgeons with more versus less experience. Methods One hundred sixty-one patients who underwent lumbar fusion surgery were divided into two groups, A (n = 74) and B (n = 87), based on the performing surgeon's experience. The accuracy of PPS placement and radiation time for PPS insertion were compared. PPSs were inserted with classic technique under the assistance of dual fluoroscopy units placed in two planes. The breach definition of PPS misplacement was based on postoperative computed tomography (grade I: no breach; grade II: <2 mm; grade III: ≤2 to <4 mm). Results Of 658 PPSs, only 21 screws were misplaced. The breach rates of groups A and B were 3.3% (grade II: 3.4%, grade III: 0%) and 3.1% (grade II: 2.6%, grade III: 0.6%; p = 0.91). One patient in grade III misplacement had a transient symptom of leg numbness. Median radiation exposure time during PPS insertion was 25 seconds and 51 seconds, respectively (p < 0.01). Conclusions Without using an expensive imaging support system, the classic technique of PPS insertion using dual fluoroscopy units in the lumbar and sacral spine is fairly accurate and provides good clinical outcomes, even among surgeons lacking experience.

Keywords: accuracy; dual fluoroscopy units; percutaneous pedicle screw; radiation exposure; surgeon experience.

PubMed Disclaimer

Conflict of interest statement

Disclosures Masayuki Nakahara, none Takao Yasuhara, none Takafumi Inoue, none Yuichi Takahashi, none Shinji Kumamoto, none Yasukazu Hijikata, none Akira Kusumegi, none Yushi Sakamoto, none Koichi Ogawa, none Kenki Nishida, none

Figures

Fig. 1
Fig. 1
The classic technique of pedicle screw insertion using fluoroscopy. Point A is the needle insertion point, and the tip is located on the lateral margin of the pedicle on the perfect anteroposterior view. Point B shows that the tip of the needle has reached the vertebral body, and it should be within the medial margin of the pedicle on the anteroposterior view.
Fig. 2
Fig. 2
The distribution of screw misplacement and the grading scale. Most screws are installed at L4 and L5. The highest ratio of screw deviation is seen at L2, and grade III perforations are seen only at L5 and S1.
Fig. 3
Fig. 3
The direction of pedicular breaches is shown for the two groups. Lateral breaches are the most common in the two groups. The numbers in parentheses in group B represent grade III misplacements.
Fig. 4
Fig. 4
The computed tomography shows lateral breach of screw due to the hypertrophy of facet and the recess in the lateral pedicular wall.
See this image and copyright information in PMC

References

    1. Grass R, Biewener A, Dickopf A, Rammelt S, Heineck J, Zwipp H. [Percutaneous dorsal versus open instrumentation for fractures of the thoracolumbar border. A comparative, prospective study] Unfallchirurg. 2006;109(4):297–305. - PubMed
    1. Kim D Y, Lee S H, Chung S K, Lee H Y. Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation. Spine (Phila Pa 1976) 2005;30(1):123–129. - PubMed
    1. Isaacs R E Hyde J Goodrich J A Rodgers W B Phillips F M A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications Spine (Phila Pa 1976) 201035(26, Suppl):S322–S330. - PubMed
    1. Schwarzenbach O, Berlemann U, Jost B. et al. Accuracy of computer-assisted pedicle screw placement. An in vivo computed tomography analysis. Spine (Phila Pa 1976) 1997;22(4):452–458. - PubMed
    1. Ravi B, Zahrai A, Rampersaud R. Clinical accuracy of computer-assisted two-dimensional fluoroscopy for the percutaneous placement of lumbosacral pedicle screws. Spine (Phila Pa 1976) 2011;36(1):84–91. - PubMed

LinkOut - more resources