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Incidence of pedicle breach following open and minimally invasive spinal instrumentation: A postoperative CT analysis of 513 pedicle screws applied under fluoroscopic guidance
BACKGROUND: Even though pedicle screw application is a common procedure, and in-spite of spine surgeons being proficient with the technique, mal-positioning of pedicle screws can still occur. We intend to determine by postoperative CT analysis, the incidence of pedicle screw breach in the thoracolum...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
China Medical University
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7608845/ https://www.ncbi.nlm.nih.gov/pubmed/33854918 http://dx.doi.org/10.37796/2211-8039.1016 |
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author | Chong, Xue Ling Kumar, Aravind Yang, Eugene Wei Ren Kaliya-Perumal, Arun-Kumar Oh, Jacob Yoong-Leong |
author_facet | Chong, Xue Ling Kumar, Aravind Yang, Eugene Wei Ren Kaliya-Perumal, Arun-Kumar Oh, Jacob Yoong-Leong |
author_sort | Chong, Xue Ling |
collection | PubMed |
description | BACKGROUND: Even though pedicle screw application is a common procedure, and in-spite of spine surgeons being proficient with the technique, mal-positioning of pedicle screws can still occur. We intend to determine by postoperative CT analysis, the incidence of pedicle screw breach in the thoracolumbar spine despite satisfactory intraoperative placement confirmed by fluoroscopy. MATERIALS AND METHODS: Consecutive patients diagnosed with thoracolumbar fractures who underwent open or minimally invasive posterior stabilization under fluoroscopic guidance were retrospectively reviewed. Postoperative CT scans of patients were analysed to determine the incidence of pedicle breach despite satisfactory intraoperative placement, and also to determine the factors that can predict a breach during intraoperative assessment. RESULTS: A total of 61 patients with 513 thoracolumbar pedicle screws were available for analysis. Based on our postoperative CT assessment, 28 screws (5.5%; 18 thoracic screws; 10 lumbar screws) had breached the pedicle. There were 14 minor (<3 mm) and 14 major (≥3 mm) breaches. The minimally invasive technique had a significantly lower breach rate compared to open surgery (1.9% vs. 7.9%). By retrospectively analysing the intra-operative fluoroscopic images, we determined certain parameters that could predict a breach during surgery. CONCLUSION: Pedicle breaches can still be present despite satisfactory placement of screws visualized intra-operatively. A medial breach is most likely when the length of the pedicle screw spans only up to 50% of the vertebral body as seen on the lateral view but the pedicle screw tip has already transgressed the midline as seen on an AP view. A lateral breach is likely when the tip of the pedicle screw is overlapped by the screw head or is only minimally visualized on an AP view. |
format | Online Article Text |
id | pubmed-7608845 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | China Medical University |
record_format | MEDLINE/PubMed |
spelling | pubmed-76088452020-12-09 Incidence of pedicle breach following open and minimally invasive spinal instrumentation: A postoperative CT analysis of 513 pedicle screws applied under fluoroscopic guidance Chong, Xue Ling Kumar, Aravind Yang, Eugene Wei Ren Kaliya-Perumal, Arun-Kumar Oh, Jacob Yoong-Leong Biomedicine (Taipei) Original Article BACKGROUND: Even though pedicle screw application is a common procedure, and in-spite of spine surgeons being proficient with the technique, mal-positioning of pedicle screws can still occur. We intend to determine by postoperative CT analysis, the incidence of pedicle screw breach in the thoracolumbar spine despite satisfactory intraoperative placement confirmed by fluoroscopy. MATERIALS AND METHODS: Consecutive patients diagnosed with thoracolumbar fractures who underwent open or minimally invasive posterior stabilization under fluoroscopic guidance were retrospectively reviewed. Postoperative CT scans of patients were analysed to determine the incidence of pedicle breach despite satisfactory intraoperative placement, and also to determine the factors that can predict a breach during intraoperative assessment. RESULTS: A total of 61 patients with 513 thoracolumbar pedicle screws were available for analysis. Based on our postoperative CT assessment, 28 screws (5.5%; 18 thoracic screws; 10 lumbar screws) had breached the pedicle. There were 14 minor (<3 mm) and 14 major (≥3 mm) breaches. The minimally invasive technique had a significantly lower breach rate compared to open surgery (1.9% vs. 7.9%). By retrospectively analysing the intra-operative fluoroscopic images, we determined certain parameters that could predict a breach during surgery. CONCLUSION: Pedicle breaches can still be present despite satisfactory placement of screws visualized intra-operatively. A medial breach is most likely when the length of the pedicle screw spans only up to 50% of the vertebral body as seen on the lateral view but the pedicle screw tip has already transgressed the midline as seen on an AP view. A lateral breach is likely when the tip of the pedicle screw is overlapped by the screw head or is only minimally visualized on an AP view. China Medical University 2020-06-05 /pmc/articles/PMC7608845/ /pubmed/33854918 http://dx.doi.org/10.37796/2211-8039.1016 Text en © the Author(s) This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Original Article Chong, Xue Ling Kumar, Aravind Yang, Eugene Wei Ren Kaliya-Perumal, Arun-Kumar Oh, Jacob Yoong-Leong Incidence of pedicle breach following open and minimally invasive spinal instrumentation: A postoperative CT analysis of 513 pedicle screws applied under fluoroscopic guidance |
title | Incidence of pedicle breach following open and minimally invasive spinal instrumentation: A postoperative CT analysis of 513 pedicle screws applied under fluoroscopic guidance |
title_full | Incidence of pedicle breach following open and minimally invasive spinal instrumentation: A postoperative CT analysis of 513 pedicle screws applied under fluoroscopic guidance |
title_fullStr | Incidence of pedicle breach following open and minimally invasive spinal instrumentation: A postoperative CT analysis of 513 pedicle screws applied under fluoroscopic guidance |
title_full_unstemmed | Incidence of pedicle breach following open and minimally invasive spinal instrumentation: A postoperative CT analysis of 513 pedicle screws applied under fluoroscopic guidance |
title_short | Incidence of pedicle breach following open and minimally invasive spinal instrumentation: A postoperative CT analysis of 513 pedicle screws applied under fluoroscopic guidance |
title_sort | incidence of pedicle breach following open and minimally invasive spinal instrumentation: a postoperative ct analysis of 513 pedicle screws applied under fluoroscopic guidance |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7608845/ https://www.ncbi.nlm.nih.gov/pubmed/33854918 http://dx.doi.org/10.37796/2211-8039.1016 |
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