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Multicenter Study
. 2021 Sep;9(5):1395-1402.
doi: 10.1007/s43390-021-00347-x. Epub 2021 Apr 23.

Power versus manual pedicle tract preparation: a multi-center study of early adopters

David L Skaggs  1   2 , Edward Compton  3 , Michael G Vitale  4 , Sumeet Garg  5 , Joseph Stone  6 , Nicholas D Fletcher  7 , Kenneth D Illingworth  3 , Han Jo Kim  8 , Jacob Ball  4 , Eun Bi Kim  5 , Lukas Keil  6 , Hilary Harris  7 , Sachin P Shah  8 , Lindsay M Andras  3
Affiliations
Multicenter Study

Power versus manual pedicle tract preparation: a multi-center study of early adopters

David L Skaggs et al. Spine Deform. 2021 Sep.

Abstract

Study design: Retrospective cohort, multicenter. A single surgeon study demonstrated that pedicle tract preparation with power tools was associated with lower fluoroscopy times and revision rates compared to manual tools, while maintaining patient safety.

Objective: Our purpose was to determine the safety of power-assisted pedicle tract preparation by early adopters of this technology.

Methods: Retrospective review comparing patients that underwent posterior spinal fusion by seven pediatric spine surgeons at six institutions between January 1, 2008 and August 31, 2019. The manual pedicle tract preparation used a pedicle awl. Power tract preparation used a flexible 2.0-2.4 mm drill bit, followed by a larger drill bit or a reamer. All screws were inserted with power technique.

Results: In the manual tract preparation group, 9424 screws were placed in 585 cases. In the power tract preparation group, 22,209 screws were placed in 1367 cases. Seven patients (7/1952; 0.36%; 95% CI: 0.14-0.74%) had 11 mal-positioned screws (11/31,633; 0.03%; 95% CI: 0.017-0.062%). Seven screws (7/9424; 0.07%; 95% CI: 0.030-0.15%) were in the manual cohort and four (4/22,209; 0.02%; 95% CI: 0.0049-0.046%) were in the power cohort. There were significantly more revisions per screw in the manual cohort (p = 0.02). However, there were not significantly more revisions per patient in the manual cohort (manual: 0.5%, 3/585 vs. power: 0.3%, 4/1,367; p = 0.43). Of these seven, three patients (3/585; 0.5%; 95% CI: 0.1-1.5%) experienced neurologic injury or neuro-monitoring changes requiring screw removal in the manual cohort, and 1 patient (1/1,367, 0.07%; 95% CI: 0.002-0.4%) in the power cohort (p = 0.08). Three additional patients underwent revision in the power cohort: 1 for an asymptomatic lateral breech, 1 for a spinal headache/medial breech that developed after an MVA, and 1 for an iliac vein injury during pedicle tract preparation.

Conclusion: This is the first multi-center study examining power pedicle preparation. Overall, 99.9% of pedicle screws placed with power pedicle preparation did not have complications or revision. Equivalent patient safety was demonstrated compared to manual technique.

Level of evidence: III.

Keywords: Drill; Over use injury; Pedicle preparation; Pedicle screw; Power; Surgeon preservation.

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References

    1. Seehausen DA et al (2015) Safety and efficacy of power-assisted pedicle tract preparation and screw placement. Spine Deform 3(2):159–165 - DOI
    1. Kim YJ et al (2004) Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 29(18):2040–2048 - DOI
    1. Kim YJ et al (2004) Free hand pedicle screw placement in the thoracic spine: is it safe? Spine (Phila Pa 1976) 29(3):333–342 (discussion 342)
    1. Suk SI et al (1995) Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine (Phila Pa 1976) 20(12):1399–1405 - DOI
    1. Bumpass DB, Lehman RAJ, Lenke LG (2016) Chapter 44: Pedicle screw insertion-manual and power techniques. In: Skaggs KM, McNaughton BL (eds) Master techniques in orthopaedic surgery: pediatrics. Wolters Kluwer, Philadephlia

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