Cargando…
The Optimal Screw Length of Lumbar Pedicle Screws during Minimally Invasive Surgery Fixation: A Computed Tomography-Guided Evaluation of 771 Screws
STUDY DESIGN: A retrospective study of radiographic parameters of patients who underwent lumbar spinal pedicle screw insertion. PURPOSE: The optimal length of pedicle screws is often determined by the lateral radiograph during minimally invasive surgery (MIS). Compared with open techniques, measurin...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Korean Society of Spine Surgery
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894981/ https://www.ncbi.nlm.nih.gov/pubmed/31309769 http://dx.doi.org/10.31616/asj.2018.0276 |
_version_ | 1783476497255759872 |
---|---|
author | Chua, Min Jia Siddiqui, Shiblee Yu, Chun Sing Nolan, Colum Patrick Oh, Jacob Yoong-Leong |
author_facet | Chua, Min Jia Siddiqui, Shiblee Yu, Chun Sing Nolan, Colum Patrick Oh, Jacob Yoong-Leong |
author_sort | Chua, Min Jia |
collection | PubMed |
description | STUDY DESIGN: A retrospective study of radiographic parameters of patients who underwent lumbar spinal pedicle screw insertion. PURPOSE: The optimal length of pedicle screws is often determined by the lateral radiograph during minimally invasive surgery (MIS). Compared with open techniques, measuring the precise length of screws or assessing the cortical breach is challenging. This study aims to ascertain the optimal pedicle screw lengths on intraoperative lateral radiographs for L1–L5. OVERVIEW OF LITERATURE: Research has revealed that optimal pedicle screw length is essential to optimize fixation, especially in osteoporotic patients; however, it must be balanced against unintentional breach of the anterior cortex, risking injury to adjacent neurovascular structures as demonstrated by case reports. METHODS: We reviewed intra- and postoperative computed tomography scans of 225 patients who underwent lumbar pedicle screw insertion to ascertain which of the inserted screws were ‘optimal screws.’ The corresponding lengths of these screws were analyzed on postoperative lateral radiographs to ascertain the ideal position that a screw should attain (expressed as a percentage of the entire vertebral body length). RESULTS: We reviewed 880 screws of which 771 were optimal screws. We noted a decreasing trend in average optimal percentages of insertion into the vertebral body for pedicle screws going from L1 (average=87.60%) to L5 (average=78.87%). The subgroup analysis revealed that there was an increasing percentage of screws directed in a straight trajectory from L1 to L5, compared to a medially directed trajectory. CONCLUSIONS: During MIS pedicle screw fixation, this study recommends that pedicle screws should not exceed 85% of the vertebral body length on the lateral view for L1, 80% for L2–L4, and 75% for L5; this will minimize the risk of anterior cortical breach yet maximize pedicle screw purchase for fixation stability. |
format | Online Article Text |
id | pubmed-6894981 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Korean Society of Spine Surgery |
record_format | MEDLINE/PubMed |
spelling | pubmed-68949812019-12-11 The Optimal Screw Length of Lumbar Pedicle Screws during Minimally Invasive Surgery Fixation: A Computed Tomography-Guided Evaluation of 771 Screws Chua, Min Jia Siddiqui, Shiblee Yu, Chun Sing Nolan, Colum Patrick Oh, Jacob Yoong-Leong Asian Spine J Clinical Study STUDY DESIGN: A retrospective study of radiographic parameters of patients who underwent lumbar spinal pedicle screw insertion. PURPOSE: The optimal length of pedicle screws is often determined by the lateral radiograph during minimally invasive surgery (MIS). Compared with open techniques, measuring the precise length of screws or assessing the cortical breach is challenging. This study aims to ascertain the optimal pedicle screw lengths on intraoperative lateral radiographs for L1–L5. OVERVIEW OF LITERATURE: Research has revealed that optimal pedicle screw length is essential to optimize fixation, especially in osteoporotic patients; however, it must be balanced against unintentional breach of the anterior cortex, risking injury to adjacent neurovascular structures as demonstrated by case reports. METHODS: We reviewed intra- and postoperative computed tomography scans of 225 patients who underwent lumbar pedicle screw insertion to ascertain which of the inserted screws were ‘optimal screws.’ The corresponding lengths of these screws were analyzed on postoperative lateral radiographs to ascertain the ideal position that a screw should attain (expressed as a percentage of the entire vertebral body length). RESULTS: We reviewed 880 screws of which 771 were optimal screws. We noted a decreasing trend in average optimal percentages of insertion into the vertebral body for pedicle screws going from L1 (average=87.60%) to L5 (average=78.87%). The subgroup analysis revealed that there was an increasing percentage of screws directed in a straight trajectory from L1 to L5, compared to a medially directed trajectory. CONCLUSIONS: During MIS pedicle screw fixation, this study recommends that pedicle screws should not exceed 85% of the vertebral body length on the lateral view for L1, 80% for L2–L4, and 75% for L5; this will minimize the risk of anterior cortical breach yet maximize pedicle screw purchase for fixation stability. Korean Society of Spine Surgery 2019-12 2019-07-17 /pmc/articles/PMC6894981/ /pubmed/31309769 http://dx.doi.org/10.31616/asj.2018.0276 Text en Copyright © 2019 by Korean Society of Spine Surgery This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Clinical Study Chua, Min Jia Siddiqui, Shiblee Yu, Chun Sing Nolan, Colum Patrick Oh, Jacob Yoong-Leong The Optimal Screw Length of Lumbar Pedicle Screws during Minimally Invasive Surgery Fixation: A Computed Tomography-Guided Evaluation of 771 Screws |
title | The Optimal Screw Length of Lumbar Pedicle Screws during Minimally Invasive Surgery Fixation: A Computed Tomography-Guided Evaluation of 771 Screws |
title_full | The Optimal Screw Length of Lumbar Pedicle Screws during Minimally Invasive Surgery Fixation: A Computed Tomography-Guided Evaluation of 771 Screws |
title_fullStr | The Optimal Screw Length of Lumbar Pedicle Screws during Minimally Invasive Surgery Fixation: A Computed Tomography-Guided Evaluation of 771 Screws |
title_full_unstemmed | The Optimal Screw Length of Lumbar Pedicle Screws during Minimally Invasive Surgery Fixation: A Computed Tomography-Guided Evaluation of 771 Screws |
title_short | The Optimal Screw Length of Lumbar Pedicle Screws during Minimally Invasive Surgery Fixation: A Computed Tomography-Guided Evaluation of 771 Screws |
title_sort | optimal screw length of lumbar pedicle screws during minimally invasive surgery fixation: a computed tomography-guided evaluation of 771 screws |
topic | Clinical Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894981/ https://www.ncbi.nlm.nih.gov/pubmed/31309769 http://dx.doi.org/10.31616/asj.2018.0276 |
work_keys_str_mv | AT chuaminjia theoptimalscrewlengthoflumbarpediclescrewsduringminimallyinvasivesurgeryfixationacomputedtomographyguidedevaluationof771screws AT siddiquishiblee theoptimalscrewlengthoflumbarpediclescrewsduringminimallyinvasivesurgeryfixationacomputedtomographyguidedevaluationof771screws AT yuchunsing theoptimalscrewlengthoflumbarpediclescrewsduringminimallyinvasivesurgeryfixationacomputedtomographyguidedevaluationof771screws AT nolancolumpatrick theoptimalscrewlengthoflumbarpediclescrewsduringminimallyinvasivesurgeryfixationacomputedtomographyguidedevaluationof771screws AT ohjacobyoongleong theoptimalscrewlengthoflumbarpediclescrewsduringminimallyinvasivesurgeryfixationacomputedtomographyguidedevaluationof771screws AT chuaminjia optimalscrewlengthoflumbarpediclescrewsduringminimallyinvasivesurgeryfixationacomputedtomographyguidedevaluationof771screws AT siddiquishiblee optimalscrewlengthoflumbarpediclescrewsduringminimallyinvasivesurgeryfixationacomputedtomographyguidedevaluationof771screws AT yuchunsing optimalscrewlengthoflumbarpediclescrewsduringminimallyinvasivesurgeryfixationacomputedtomographyguidedevaluationof771screws AT nolancolumpatrick optimalscrewlengthoflumbarpediclescrewsduringminimallyinvasivesurgeryfixationacomputedtomographyguidedevaluationof771screws AT ohjacobyoongleong optimalscrewlengthoflumbarpediclescrewsduringminimallyinvasivesurgeryfixationacomputedtomographyguidedevaluationof771screws |