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. 2019 Apr 30;13(2):132-145.
doi: 10.14444/6018. eCollection 2019 Apr.

Currently Adopted Criteria for Pedicle Screw Diameter Selection

Giovanni F Solitro  1 , Keith Whitlock  2 , Farid Amirouche  3 , Ankit I Mehta  4 , Annie McDonnell  5
Affiliations

Currently Adopted Criteria for Pedicle Screw Diameter Selection

Giovanni F Solitro et al. Int J Spine Surg. .

Abstract

Background: Transpedicular screw insertion has become widely accepted for the correction of spinal deformity as well as degenerative and traumatic injury, but adoption of this technique has remained less widespread in the thoracic compared to the lumbar spine. This is thought to be associated with the relative technical difficulty of screw insertion into the narrower widths of the thoracic pedicles and the neurologic and mechanical risks associated with breach of the pedicle wall. The surgical decision making involves determining the appropriate sized screw for maximum fixation strength while simultaneously respecting the structural integrity of the vertebral pedicles to prevent a breach and provide better fixation. This paper presents a systematic review of criteria for thoracic pedicle screw diameter (SD) selection in order to orient inexperienced surgeons on the impact of this selection on pedicle breaching and fixation strength.

Methods: We performed a systematic literature review focused on studies reporting SD selection in relation to pedicle dimensions, measures of fixation strength, and breach rate.

Results: Twenty-nine articles that measured fixation strength, breach rate, and/or provided SD in relation to pedicle width were selected for inclusion.

Conclusions: A commonly accepted criteria for pedicle SD selection has not yet been proposed. Screw diameters approximately 80% of the pedicle width have been adopted, but this proportion is rarely reported in the midthoracic vertebrae for which smaller pedicles and inadequate hardware specificity result in higher breach rates. Depending upon the insertion technique adopted, greater specificity in diameter selection by vertebral level should be pursued in order to maximally target cortical bone purchase.

Clinical relevance: Based on this review of the literature, we believe that proper selection of the SD for individual vertebral level directly affects the insertion technique and the potential breach.

Keywords: bone fixation; fusion; pedicle screws; spine instrumentation; thoracic spine.

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Figures

Figure 1
Figure 1
Pedicle screw insertion on computer generated images of (a) successfully placed screws and (b) misplaced screws: laterally for the right pedicle and medially for the left pedicle.
Figure 2
Figure 2
Systematic review procedure: the exclusion criteria allowed the narrowing to a limited number of papers with detailed information on pedicle width, breach rate, and fixation strength.
Figure 3
Figure 3
Average values calculated for screw diameter (SD) to pedicle width (PW), breach rate, and PW.
Figure 4
Figure 4
Breach rate correlation with (a) pedicle width and (b) screw diameter to pedicle width ratio.
See this image and copyright information in PMC

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