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Accuracy and Safety of Pedicle Screw Placement for Treating Adolescent Idiopathic Scoliosis: A Narrative Review Comparing Available Techniques

Posterior spinal fusion and segmental spinal instrumentation using pedicle screws (PS) is the most used procedure to correct adolescent idiopathic scoliosis. Computed navigation, robotic navigation, and patient-specific drill templates are available, besides the first described free-hand technique....

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Autores principales: Ansorge, Alexandre, Sarwahi, Vishal, Bazin, Ludmilla, Vazquez, Oscar, De Marco, Giacomo, Dayer, Romain
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10378125/
https://www.ncbi.nlm.nih.gov/pubmed/37510146
http://dx.doi.org/10.3390/diagnostics13142402
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author Ansorge, Alexandre
Sarwahi, Vishal
Bazin, Ludmilla
Vazquez, Oscar
De Marco, Giacomo
Dayer, Romain
author_facet Ansorge, Alexandre
Sarwahi, Vishal
Bazin, Ludmilla
Vazquez, Oscar
De Marco, Giacomo
Dayer, Romain
author_sort Ansorge, Alexandre
collection PubMed
description Posterior spinal fusion and segmental spinal instrumentation using pedicle screws (PS) is the most used procedure to correct adolescent idiopathic scoliosis. Computed navigation, robotic navigation, and patient-specific drill templates are available, besides the first described free-hand technique. None of these techniques are recognized as the gold standard. This review compares the PS placement accuracy and misplacement-related complication rates achieved with the techniques mentioned above. It further reports PS accuracy classifications and anatomic PS misplacement risk factors. The literature suggests a higher PS placement accuracy for robotic relative to computed navigation and for the latter relative to the free-hand technique (misplacement rates: 0.4–7.2% versus 1.9–11% versus 1.5–50.7%) using variable accuracy classifications. The reported PS-misplacement-related complication rates are, however, uniformly low (0–1.4%) for every technique, while robotic and computed navigation induce a roughly fourfold increase in the patient’s intraoperative radiation exposure relative to the free-hand technique with fluoroscopic implant positioning control. The authors, therefore, recommend dedicating robotic and computed navigation for complex deformities or revisions with altered landmarks, underline the need for a generally accepted PS accuracy classification, and advise against PS placement in grade 4 pedicles yielding higher misplacement rates (22.2–31.5%).
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spelling pubmed-103781252023-07-29 Accuracy and Safety of Pedicle Screw Placement for Treating Adolescent Idiopathic Scoliosis: A Narrative Review Comparing Available Techniques Ansorge, Alexandre Sarwahi, Vishal Bazin, Ludmilla Vazquez, Oscar De Marco, Giacomo Dayer, Romain Diagnostics (Basel) Review Posterior spinal fusion and segmental spinal instrumentation using pedicle screws (PS) is the most used procedure to correct adolescent idiopathic scoliosis. Computed navigation, robotic navigation, and patient-specific drill templates are available, besides the first described free-hand technique. None of these techniques are recognized as the gold standard. This review compares the PS placement accuracy and misplacement-related complication rates achieved with the techniques mentioned above. It further reports PS accuracy classifications and anatomic PS misplacement risk factors. The literature suggests a higher PS placement accuracy for robotic relative to computed navigation and for the latter relative to the free-hand technique (misplacement rates: 0.4–7.2% versus 1.9–11% versus 1.5–50.7%) using variable accuracy classifications. The reported PS-misplacement-related complication rates are, however, uniformly low (0–1.4%) for every technique, while robotic and computed navigation induce a roughly fourfold increase in the patient’s intraoperative radiation exposure relative to the free-hand technique with fluoroscopic implant positioning control. The authors, therefore, recommend dedicating robotic and computed navigation for complex deformities or revisions with altered landmarks, underline the need for a generally accepted PS accuracy classification, and advise against PS placement in grade 4 pedicles yielding higher misplacement rates (22.2–31.5%). MDPI 2023-07-18 /pmc/articles/PMC10378125/ /pubmed/37510146 http://dx.doi.org/10.3390/diagnostics13142402 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Ansorge, Alexandre
Sarwahi, Vishal
Bazin, Ludmilla
Vazquez, Oscar
De Marco, Giacomo
Dayer, Romain
Accuracy and Safety of Pedicle Screw Placement for Treating Adolescent Idiopathic Scoliosis: A Narrative Review Comparing Available Techniques
title Accuracy and Safety of Pedicle Screw Placement for Treating Adolescent Idiopathic Scoliosis: A Narrative Review Comparing Available Techniques
title_full Accuracy and Safety of Pedicle Screw Placement for Treating Adolescent Idiopathic Scoliosis: A Narrative Review Comparing Available Techniques
title_fullStr Accuracy and Safety of Pedicle Screw Placement for Treating Adolescent Idiopathic Scoliosis: A Narrative Review Comparing Available Techniques
title_full_unstemmed Accuracy and Safety of Pedicle Screw Placement for Treating Adolescent Idiopathic Scoliosis: A Narrative Review Comparing Available Techniques
title_short Accuracy and Safety of Pedicle Screw Placement for Treating Adolescent Idiopathic Scoliosis: A Narrative Review Comparing Available Techniques
title_sort accuracy and safety of pedicle screw placement for treating adolescent idiopathic scoliosis: a narrative review comparing available techniques
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10378125/
https://www.ncbi.nlm.nih.gov/pubmed/37510146
http://dx.doi.org/10.3390/diagnostics13142402
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