Frequency of Misplacement of Percutaneously Placed Pedicle Screws in Thoracolumbar Fractures

Authors

  • Syed Ahmad Faizan
  • Ajlan Ali
  • Tariq Imran
  • Zubair Mustafa
  • Muhammad Aqeel Natt
  • Asif Bashir

DOI:

https://doi.org/10.36552/pjns.v27i2.871

Keywords:

Thoracolumbar Fracture, Percutaneous Placed Pedicle Screw

Abstract

of thoracolumbar fractures. Material and Methods:  A descriptive case series was conducted at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore. The study comprised all individuals who had minimally invasive percutaneously implanted thoracic or lumbar pedicle screws placed. CT scans were conducted on the patient 24 hours after surgery as part of their usual post-operative care to capture axial pictures to find Pedicular cortical breaches in any direction.

Results:  Mean age of the patients was 32 years. 82.7% were male whereas 17.3% were females. We found that the frequency of misplacement was 10.9% in the management of thoracolumbar fractures. 110 patients received 600 pedicle screws placed percutaneously. Of these, 534 screws (89.1%) were ideally placed inside the pedicle. 7% showed minor pedicle penetration, 3.6% showed moderate pedicle penetration and only 0.3% showed severe penetration. Out of misplaced screws (10.9%), 7.3% of patients were between 15 – 40 years, and 3.6% were between 41 – 50 years. Out of misplaced screws (10.9%), 9.7% were male patients and 1.3% were female patients. For thoracic injury, 4.5% of patients suffered from misplaced screws, and for lumbar injury, 6.5% of patients were observed for misplaced screws (p-value: 0.008).

Conclusion:  The frequency of misplacement was 10.9% in the management of thoracolumbar fractures. The misplacement rate of the percutaneously placed screw is low. Therefore, we concluded that the percutaneously placed screw is safe to use.

 

References

Fu Z, Zhang X, Shi Y, Dong Q. Comparison of surgical outcomes between short-segment open and percutaneous pedicle screw fixation techniques for thoracolumbar fractures. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 2016; 22: 3177.

Wang B, Fan Y, Dong J, Wang H, Wang F, Liu Z, Liu H, Feng Y, Chen F, Huang Z, Chen R. A retrospective study comparing percutaneous and open pedicle screw fixation for thoracolumbar fractures with spinal injuries. Medicine, 2017; 96 (38).

Tian F, Tu LY, Gu WF, Zhang EF, Wang ZB, Chu G, Ka H, Zhao J. Percutaneous versus open pedicle screw instrumentation in treatment of thoracic and lumbar spine fractures: A systematic review and meta-analysis. Medicine, 2018 Oct; 97 (41).

Scheer JK, Bakhsheshian J, Fakurnejad S, Oh T, Dahdaleh NS, Smith ZA. Evidence-Based Medicine of Traumatic Thoracolumbar Burst Fractures: A Systematic Review of Operative Management across 20 Years. Global Spine J. 2015; 5 (1): 73-82.

Chapman JR, Agel J, Jurkovich GJ, Bellabarba C. Thoracolumbar flexion-distraction injuries: associated morbidity and neurological outcomes. Spine (Phila Pa 1976), 2008; 33 (6): 648- 57.

Nakahara M, Yasuhara T, Inoue T, Takahashi Y, Kumamoto S, Hijikata Y, Kusumegi A, Sakamoto Y, Ogawa K, Nishida K. Accuracy of percutaneous pedicle screw insertion technique with conventional dual fluoroscopy units and a retrospective comparative study based on surgeon experience. Global Spine Journal, 2016; 6 (4): 322-8.

Spitz SM, Sandhu FA, Voyadzis JM. Percutaneous “K-wireless” pedicle screw fixation technique: an evaluation of the initial experience of 100 screws with assessment of accuracy, radiation exposure, and procedure time. Journal of Neurosurgery: Spine, 2015; 22 (4): 422- 31.

Winder MJ, Gilhooly PM. Accuracy of minimally invasive percutaneous thoracolumbar pedicle screws using 2D fluoroscopy: a retrospective review through 3D CT analysis. Journal of Spine Surgery, 2017; 3 (2): 193.

Yoshii T, Hirai T, Yamada T, Sumiya S, Mastumoto R, Kato T, Enomoto M, Inose H, Kawabata S, Shinomiya K, Okawa A. Lumbosacral pedicle screw placement using a fluoroscopic pedicle axis view and a cannulated tapping device. Journal of Orthopaedic Surgery and Research, 2015; 10: 1-7.

Hansen-Algenstaedt N, Chiu CK, Chan CY, Lee CK, Schaefer C, Kwan MK. Accuracy and safety of fluoroscopic guided percutaneous pedicle screws in thoracic and lumbosacral spine. Spine, 2015; 40 (17): E954-63.

Wood KB, Li W, Lebl DS, Ploumis A. Management of thoracolumbar spine fractures. Spine J. 2014; 14: 145–64.

Rajasekaran S, Kanna RM, Shetty AP. Management of thoracolumbar spine trauma: An overview. Indian Journal of Orthopaedics, 2015; 49: 72-82.

Sasso RC, Renkens K, Hanson D, Reilly T, McGuire Jr RA, Best NM. Unstable thoracolumbar burst fractures: anterior-only versus short-segment posterior fixation. Clinical Spine Surgery, 2006; 19 (4): 242-8.

Raley DA, Mobbs RJ. Retrospective computed tomography scan analysis of percutaneously inserted pedicle screws for posterior transpedicular stabilization of the thoracic and lumbar spine: accuracy and complication rates. Spine, 2012; 37 (12): 1092-100.

McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine, 1994; 19 (15): 1741-4.

Gotzen L, Puplat D, Junge A. Indications, technique and results of monosegmental dorsal spondylodesis in wedge compression fractures (grade II) of the thoracolumbar spine. Der Unfallchirurg. 1992; 95 (9): 445-54.

Kaneda K, Taneichi H, Abumi K, Hashimoto T, Satoh S, Fujiya M. Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits. JBJS. 1997; 79 (1): 69-83.

Hitchon PW, Torner J, Eichholz KM, Beeler SN. Comparison of anterolateral and posterior approaches in the management of thoracolumbar burst fractures. Journal of Neurosurgery: Spine, 2006; 5 (2): 117-25.

Kossmann T, Jacobi D, Trentz O. The use of a retractor system (SynFrame) for open, minimal invasive reconstruction of the anterior column of the thoracic and lumbar spine. European Spine Journal, 2001; 10: 396-402.

Bühren V, Beisse R, Potulski M. Minimally invasive ventral spondylodesis in injuries to the thoracic and lumbar spine. Der Chirurg; Zeitschrift fur Alle Gebiete der Operativen Medizen. 1997; 68 (11): 1076-84.

Downloads

Published

2023-06-09

Issue

Section

Original Articles