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. 2017 Jun;3(2):193-203.
doi: 10.21037/jss.2017.06.05.

Accuracy of minimally invasive percutaneous thoracolumbar pedicle screws using 2D fluoroscopy: a retrospective review through 3D CT analysis

Mark J Winder  1 , Paul M Gilhooly  2
Affiliations

Accuracy of minimally invasive percutaneous thoracolumbar pedicle screws using 2D fluoroscopy: a retrospective review through 3D CT analysis

Mark J Winder et al. J Spine Surg. 2017 Jun.

Abstract

Background: In the literature, there is a large variation in the reported misplacement rates of pedicle screws. The use of minimally invasive surgical techniques is increasing and as such there has only been a small amount of data to look at the misplacement rate of percutaneously inserted thoracic and lumbar pedicle screws.

Methods: A retrospective analysis of post-operative computed tomography (CT) scans were performed on 108 patients who underwent minimally invasive percutaneously inserted thoracic and lumbar pedicle screws by a single surgeon. Analysis of the screw trajectory using strict guidelines was performed using multiplanar reconstruction CT scan data to determine the accuracy of the pedicle screws.

Results: A total of 614 screws were inserted in vertebral levels T2 to S1. Twenty-five (4.07%) screws were considered misplaced having breached the pedicular cortex. Thoracic pedicle screws had a statistically higher misplacement rate than lumbar pedicle screws (14.67% vs. 2.60% respectively, P<0.001). A single screw required replacement (0.16%) and there were no permanent neurological deficits. The misplacement rates were lower than those reported for open screw placement and equivalent to 3D CT navigated misplacement rates.

Conclusions: Percutaneously inserted pedicle screws using 2D fluoroscopy offers a safe and accurate option for spinal stabilisation with an extremely low misplacement rate and morbidity. Overall, the low misplacement rates were equivalent and in most cases lower compared to open and computer assisted navigation techniques. However, we would recommend that given a misplacement rate of 14.67% for thoracic pedicle screws that computer assisted navigation may be able to offer further improvements in accuracy.

Keywords: Minimally invasive surgery; computed tomography (CT); lumbar spine; misplacement rates; pedicular screw misplacement; percutaneous pedicle screws; posterior stabilisation; thoracic spine.

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Conflict of interest statement

Conflicts of Interest: MJ Winder is a Consultant and Educator for Nuvasive Pty Ltd.

Figures

Figure 1
Figure 1
Intraoperative fluoroscopy and percutaneous pedicle screw placement.
Figure 2
Figure 2
Screw distribution in vertebral levels.
Figure 3
Figure 3
Time line for misplaced screws.
Figure 4
Figure 4
CT pedicle screw analysis. (A) Axial plane; (B) coronal plane; (C) sagittal plane.
Figure 5
Figure 5
Medially misplaced right T3 pedicle screw.
Figure 6
Figure 6
Laterally misplaced thoracic screw not impinging on surrounding structures.
Figure 7
Figure 7
Obesity represents a challenge for spinal instrumentation.
Figure 8
Figure 8
CT analysis of revised screw (L5). (A) Axial L5 showing misplaced right sided screw; (B) well positioned S1 screws; (C) coronal view.
See this image and copyright information in PMC

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