胸椎经"椎弓根-肋骨间"螺钉与椎弓根螺钉固定的抗拔出力比较

目的比较胸椎经"椎弓根-肋骨间"螺钉与椎弓根螺钉固定的抗拔出力.方法5例新鲜尸体脊柱(T6～T10)标本,自椎间盘、小关节及上位椎体下肋椎关节处分解为单椎体(附带双侧肋骨)25个.根据配对随机分组的原则,随机选取椎体一侧作椎弓根螺钉固定组,另一侧则为配对的"椎弓根-肋骨间"螺钉固定组,共组成25个配对组.同组中"椎弓根-肋骨间"螺钉长度较椎弓根螺钉长10mm,直径与椎弓根螺钉相同.将25组的50个螺钉分别进行拔出测试(5mm/min的速度垂直方向拔出).结果"椎弓根-肋骨间"螺钉的抗拔出力为423.1±198.7N;椎弓根螺钉的抗拔出力为783.3±199.5N.前者的抗拔出力显著小于后者(P＜0.01).结论"椎弓根-肋骨间"螺钉的力学性能不及椎弓根螺钉,建议仅将前者作为后者的一种补充,特别是在无法完成椎弓根螺钉置入的部分胸椎节段.     

椎弓根螺钉把持椎弓根皮质骨对其固定强度的影响

目的：了解椎弓根螺钉把持椎弓根皮质骨对椎弓根螺钉固定强度的影响。方法：将成年羊腰椎椎弓根48个依据椎弓根皮质骨内径和椎弓根螺钉直径（6．25mm）的相对关系分为三组：A组，螺钉直径小于椎弓根皮质骨内径：B组．螺钉直径超出椎弓根皮质骨内径0.01～0．50mm；C组，螺钉直径超出椎弓根皮质骨内径0.51～1．00mm。每组再根据进钉深度与椎弓根长度（平均约8mm）的相对关系分为Ⅰ（进钉深度为16mm）、Ⅱ（进钉深度为8mm）两组。将椎弓根螺钉置入椎弓根中，观察钉道结构、膨胀情况，测量椎弓根螺钉最大轴向拔出力。结果：椎弓根螺钉置入后，椎弓根发生不同程度膨胀；椎弓根螺纹能够切入皮质骨中；C Ⅰ组最大轴向拔出力比A Ⅰ组和B Ⅰ组大（P〈0．05），C Ⅱ组最大轴向拔出力比A Ⅱ组和B Ⅱ组大（P〈0．05），B Ⅱ组比A Ⅱ组大（P〈0.05）。结论：椎弓根螺钉把持椎弓根皮质骨能够增加椎弓根螺钉的固定强度；且椎弓根螺钉把持椎弓根皮质骨量越大，固定强度越大。     

两种长度的颈椎椎弓根螺钉与侧块螺钉拔出试验比较

目的:比较两种长度的颈椎椎弓根螺钉和侧块螺钉的抗拔出力,探讨颈椎经椎弓根短螺钉固定的可行性。方法:5具C3~C5共15节新鲜颈椎标本,用长度为28mm和20mm的皮质骨螺钉分别置入椎弓根,并用20mm的螺钉行侧块双皮质固定,螺钉进入侧块深度约14mm。行拔出试验,比较螺钉的最大轴向拔出力。结果:椎弓根长螺钉的最大拔出力为650N,椎弓根短螺钉为585N,两者比较无显著性差异(P>0.01);侧块螺钉的最大拔出力为360N,与椎弓根短螺钉比较有显著性差异(P<0.0001)。结论:颈椎椎弓根短螺钉固定可提供足够的稳定性,其安全性相对较高。     

枢椎椎板螺钉与椎弓根螺钉抗拔出强度的比较

目的:比较枢椎椎板螺钉与枢椎椎弓根螺钉的抗拔出强度,为临床应用枢椎椎板螺钉固定提供生物力学依据。方法:在7具成年男性新鲜尸体枢椎标本上进行枢椎单皮质椎弓根螺钉和双皮质椎板螺钉固定,测试螺钉拔出力。结果:单皮质枢椎椎弓根螺钉的最大拔出力平均为875.3±403.2N,双皮质枢椎椎板螺钉的最大拔出力平均为679.5±308.2N;椎弓根螺钉的最大拔出力大于椎板螺钉,但二者之间无统计学差异。结论:枢椎椎板螺钉进行双皮质固定具有可靠的力学固定强度,可作为枢椎椎弓根螺钉的补充固定技术。     

金属松质骨螺钉拔出力的研究

金属松质骨螺钉是应用于骨折内固定最广泛的材料之一，临床上有许多螺钉的松动、脱出导致内固定的失败的病例报道。螺钉的松动、脱出与螺钉的拔出力有关。螺钉拔出力与螺钉的材料、螺纹的几何形态、骨质量、螺钉操作技术等密切相关。     

Characteristics of pullout failure in conical and cylindrical pedicle screws after full insertion and back-out

BACKGROUND CONTEXT: Biomechanical studies show that bone-mineral density, pedicle morphology, and screw thread area affect pedicle screw pullout failure. The current literature is based on studies of cylindrical pedicle screw designs. Conical screws have been introduced that may provide better "fit and fill" of the dorsal pedicle as well as improved resistance to screw bending failure. However, there is concern about loss of fixation if conical screws must be backed out after insertion. PURPOSE: To determine that conical screws have comparable initial stiffness and fixation strength compared with standard, cylindrical screws, and to assess whether conical screw fixation deteriorates when screws are backed out from full insertion. STUDY DESIGN/SETTING: This biomechanical analysis compared pullout strength of cylindrical and conical pedicle screw designs, using porcine lumbar vertebrae in a paired testing format. METHODS: Porcine lumbar vertebrae were instrumented with conical and cylindrical pedicle screws with the same thread pitch, area and contour, and an equivalent diameter at the pedicle isthmus, 1.2 cm distal to the hub. Axial pullout was performed at 1.0 mm/minute displacement. Pullout loads, work and stiffness were recorded at 0.02-second intervals. Conical versus cylindrical screws were tested using three paired control configurations: fully inserted, backed out 180 degrees and backed out 360 degrees. Fully inserted values were compared with each set of back-out values to determine relative loss of fixation strength. Screw pullout data were analyzed using a Student's t test. RESULTS: Pullout loads in these porcine specimens were comparable to data from healthy human vertebrae. Conical screws provided a 17% increase in the pullout strength compared with cylindrical screws (P<.10) and a 50% increase in initial stiffness (P<.05) at full insertion. There was no loss in pullout strength, stiffness or work to failure when conical or cylindrical screws were backed out 180 or 360 degrees from full insertion. CONCLUSIONS: Conical screws offer improved initial fixation strength compared with cylindrical screws of the same size and thread design. Our results suggest that appropriately designed conical screws can be backed out 180 to 360 degrees for intraoperative adjustment without loss of pullout strength, stiffness or work to failure. Intraoperative adjustments of these specific conical screws less than 360 degrees should not affect initial fixation strength. These results may not hold true for screws with a smaller thread area or larger minor diameter.     

直入式注入PMMA骨水泥强化椎弓根钉内固定生物力学研究

【摘要】 目的 分析直入式骨水泥注入椎体强化方法在体外提高螺钉稳定性的效果。方法采用新鲜尸体脊柱标本共24个椎体,一侧椎弓根采用直入式注入PMMA骨水泥强化椎弓根钉固定作(试验组),另一侧椎弓根采用常规椎弓根螺钉固定(对照组),两侧进行最大轴向拔出力试验、最大旋出力矩试验、周期抗屈试验生物力学测试,比较两组测试结果。结果〓骨水泥强化组中螺钉的稳定性均显著强于单纯常规椎弓根螺钉组(P < 0.05)。结论〓应用PMMA行椎体强化椎弓根钉固定有利于增强对椎弓根钉的把持力,可有效防止椎弓根钉的松动及脱落,具有良好的临床效果。     

Impact of bone quality on the performance of integrated fixation cage screws

Background Context

Commercially available lumbar integrated fixation cages (IFCs) have variable designs. For example, screw-based designs have up to four screws inserted at different locations across the vertebral end plate as well as at different angles in the sagittal and transverse planes. This is important as end plate and trabecular bone quality may vary across the vertebra and may affect the screw's fixation ability, particularly if bone purchase at the bone-screw interface is poor.

寰椎椎弓根髓腔大小对椎弓根螺钉置入的影响

目的:评估寰椎椎弓根髓腔大小对椎弓根螺钉置入的影响.方法:从2009年1月～2012年6月在本院行寰枢椎后路固定融合术的患者中,筛选出年龄≥20岁、术前影像学测量寰椎椎弓根高度＞4mm的患者97例,男41例,女56例,年龄20～79岁,平均41.6岁术中选择内固定方法时,寰椎首先选择椎弓根螺钉固定,若椎弓根螺钉置钉失败则改用椎板钩或侧块螺钉固定.其中145个椎弓根成功置入椎弓根螺钉,49个椎弓根因无法形成椎弓根螺钉通道,改用椎板钩或侧块螺钉固定.用CT 三维重建技术测量所有患者寰椎椎弓根髓腔的高度.根据髓腔高度将寰椎椎弓根分为3型:Ⅰ型,髓腔高度≥2mm;Ⅱ型,髓腔高度＜2mm;Ⅲ型,无髓腔.统计每型椎弓根成功置入椎弓根螺钉的比率,比较其差异.结果:椎弓根螺钉固定组中,Ⅰ、Ⅱ、Ⅲ型椎弓根个数(比率)分别为104个(71.7％)、39个(26.9％)、2个(1.4％);非椎弓根螺钉固定组中,Ⅰ、Ⅱ、Ⅲ型椎弓根个数(比率)分别为2个(4.1％)、28个(57.1％)、19个(38.8％).Ⅰ、Ⅱ、Ⅲ型椎弓根成功置入椎弓根螺钉的比率分别为98.1％(104/106)、58.2％(39/67)、9.5％(2/21),Ⅰ型明显高于Ⅱ型和Ⅲ型,Ⅱ型明显高于Ⅲ型,差异均有统计学意义(P＜0.001).结论:寰椎椎弓根髓腔大小对椎弓根螺钉的置入有一定影响.寰椎椎弓根髓腔高度≥2mm时建议行椎弓根螺钉固定,髓腔高度＜2mm时可根据术者情况选择固定方法;无髓腔时建议不行椎弓根螺钉固定.     

Biomechanical evaluation of an expansive pedicle screw in calf vertebrae

incetheintroductionofthetranspedicularscrewsystembyBoucher ,1theapplicationofthissysteminthetreatmentofdegenerativedisordersandunstablefractures ,tumorsofthespinehasbecomeverypopularinthelasttwodecades.2 Looseningandfailureofthescrewsareamongthemostcommoncomplicationsreported ,especiallyforosteoporosis .3Thesefailuresoftenleadtonon union ,sagittalcollapseoftheconstructandpainfulkyphosis .Revisionisoftennecessary .Increasingthediameterand/orlengthofthepediclescrewseemstobethebestsolution .Howe…     

自行研制的经皮胸腰椎椎弓根置钉三维定位器应用的可行性实验研究

目的 通过与"徒手"置钉进行比较,探讨自行研制的经皮胸腰椎椎弓根置钉三维定位器辅助在脊柱标本上进行经皮椎弓根穿刺的可行性.方法 对新鲜保留皮肤软组织的脊柱标本2具(32个椎体)行胸腰椎序列CT扫描,使用Mimics 13.1软件确定椎弓根轴心片,测定水平面椎弓根螺钉植入角度(TSA)及矢状面椎弓根螺钉植入角度(SSA).定位皮肤穿刺点,对应调节水平面及矢状面角度指示器刻度指导穿刺.椎弓根随机分为两组:一侧为自行研制的经皮胸腰椎椎弓根置钉三维定位器辅助组(定位器组),对侧为"徒手"置钉组(徒手组).定位器组在定位器及X线辅助下穿刺,徒手组在C型臂影像增强系统辅助下予"徒手"技术穿刺,置入克氏针,C型臂X线机证实穿刺成功.行椎弓根CT扫描,测量2种方法穿刺的实际TSA角及SSA角,将术前测定的椎弓根TSA角及SSA角与术后实际TSA角及SSA角对比,计算偏差率;比较两组的偏差率和X线曝光次数.结果 定位器组和徒手组的穿刺TSA角偏差率平均分别为10.83%±3.41%和19.08%±4.21%,差异有统计学意义(P＜0.05);定位器组和徒手组的穿刺SSA角偏差率平均分别为13.13%±4.37%和21.15%±6.78%,差异有统计学意义(P＜0.05).定位器组和徒手组接受X线辅助的次数平均分别为(3.0±1.2)次和(5.3±1.6)次,差异有统计学意义(P＜0.05).结论 与"徒手"置钉相比,应用自行研制的经皮胸腰椎弓根置钉三维定位器可有效提高手术准确度、降低手术难度、减少X线暴露.

Abstract：

Objective To test a self-designed 3-D guiding instrument for percutaneous insertion of thoracolumbar pedicle screws in cadaveric vertebrae. Methods Two fresh cadaveric vertebral specimens with skin and soft tissue were used first for standard CT lateral scanning ofT1 to L4.Software Mimics13.1 was used to create axial images of pedicles of vertebral arch.The points of percutaneous insertion of thoracolumbar pedicle screws,transverse screw angles (TSA) and sagittal screw angles (SSA) were measured.Thirty-two vertebral bodies were divided randomly into 2 equal groups for guiding instrument insertion and manual insertion with the aid of C-arm fluoroscopy.The quality of insertion was evaluated by postoperative CT scans.Angular deviations were determined by comparing the preoperative and postoperative TSA and SSA for the 2 groups.X-ray exposures were also compared between the 2 groups. Results The TSA angular deviation rate was ( 10.83 ± 3.41 ) ％ for the guiding instrument insertion group and ( 19.08 ± 4.21 ) ％ for the manual insertion group.The SSA angular deviation rate was (13.13 ±4.37) ％ for the guiding instrument insertion group and (21.15 ± 6.78) ％ for the manual insertion group.The guiding instrument insertion group needed 3.0 ± 1.2 X-ray exposures while the manual insertion group had 5.3 ± 1.6 X-ray exposures.All the differences were statistically significant. Conclusion The 3-D guiding instrument can facilitate the percutaneous insertion of the thoracolumbar pedicle screws by improving operation accuracy and reducing operation difficulty and X-ray exposures as well.     

Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws

A number of studies have shown increased accuracy of pedicle screw placement in spine with the help of computer-assisted navigation. The literature is lacking in regard to functional benefit derived from this technique. The aim of this systematic review was to look at the functional outcomes following computer-assisted pedicle screw placement in spine. A ‘Dialog Datastar’ search was used using optimized search strategy covering the period from 1950 to July 2009; 23 papers were finally included which met our inclusion criteria. We report on a total of 1,288 patients with 5,992 pedicle screws. The comparison of neurological complications in two groups demonstrated an odds ratio of 0.25 (95% CI 0.06, 1.14) in favour of using navigation for pedicle screw insertion (p = 0.07). Comparative trials demonstrated a significant advantage in terms of accuracy of navigation over conventional pedicle screw insertion with a relative risk of 1.12 (95% CI 1.09, 1.15) (p < 0.00001). Navigation does not show statistically significant benefit in reducing neurological complications and there was insufficient data in the literature to infer a conclusion in terms of fusion rate, pain relief and health outcome scores.     

膨胀式脊柱椎弓根螺钉固定的生物力学研究

目的:测试膨胀式椎弓根螺钉(expansivepediclescrew,EPS)的骨-器械界面强度及耐疲劳强度,评价EPS的脊柱后路固定强度。方法:100个新鲜小牛腰椎随机分成A、B、C三组,以USS,Tenor,CDH螺钉为对照螺钉,分别对EPS进行最大旋出力矩实验、轴向拔出实验和翻修实验,记录最大旋出力矩(Tmax)、最大轴向拔出力(Fmax)和翻修后最大轴向拔出力。并在超高分子聚乙烯材料上对螺钉进行150万次的周期载荷疲劳实验。结果:EPS的Tmax、Famx显著大于三种对照螺钉(P<0.01)。EPS翻修时的Fmax亦显著高于对照螺钉(P<0.05)。150万次周期载荷疲劳实验完成后,四种螺钉均未出现疲劳折断现象。结论:EPS较目前常使用的非膨胀椎弓根螺钉有更好的脊柱固定作用及翻修性能,其耐疲劳强度与其它三种螺钉相当。     

钉道强化提高椎弓根螺钉固定强度的生物力学研究

目的 评价椎弓根钉道局部强化技术及其结合膨胀式椎弓根螺钉提高椎弓根螺钉固定强度的效果.方法 通过自行设计及加工的钉道局部强化装置,向钉道周壁点状注入CaSO4骨水泥以强化椎弓根钉道.5具新鲜冻存人体脊柱标本,每具随机选取4个腰椎共20个腰椎标本,采用随机区组设计方法分为10个区组.设计四种固定方法:A组(普通椎弓根螺钉)、B组(普通椎弓根螺钉+钉道局部强化)、C组(膨胀式椎弓根螺钉+钉道局部强化)、D组(普通椎弓根螺钉+钉道内灌注CaSO4骨水泥),随机应用在每个区组的2个椎体共4个椎弓根钉道.分别测试每个椎弓根螺钉的最大轴向拔出力及能量吸收值.从剩余腰椎标本中任意取两个腰椎,应用钉道局部强化技术后利用Micro-CT观察钉道周壁微观结构变化.结果 C、D两组的最大轴向拔出力均值及能量吸收值均值高于A组(P＜0.01)及B组(P＜0.05),B组最大轴向拔出力均值及能量吸收值均值高于A组(P＜0.01),C、D两组之间的差异无统计学意义(P＞0.05).结论 钉道局部强化技术可显著提高椎弓根螺钉的固定强度,结合使用膨胀式椎弓根螺钉可进一步提高螺钉的固定强度.     

经骶1-2侧块螺钉固定的最大拔出力测定

【摘要】 目的：测量经骶1-2侧块螺钉固定的最大拔出力,初步探讨该内固定方法的有效性。方法：8具甲醛溶液固定湿润成人骶骨标本,采用双能X线吸收测定仪（dual-energy X-ray absorptiometry, DEXA）测定S1椎体骨密度。在同一骶骨标本上随机置入3种骶骨螺钉：经骶1-2侧块螺钉（A组）、S1椎弓根螺钉（B组）、S1前外骶骨翼螺钉（C组）。将标本固定于858型MTS材料试验机上,对螺钉施加轴向拔出力,根据3种骶骨螺钉轴向拔出实验的数据绘制力（N）-位移（mm）曲线,取曲线的顶点作为最大拔出力数值。应用SPSS 16.0统计软件对3组骶骨螺钉的最大拔出力数值行方差分析。结果：8具骶骨标本S1椎体骨密度为0.43～0.74g/cm3,平均0.641±0.275g/cm3。3种骶骨螺钉固定的螺钉即刻平均最大拔出力：A组为379.62±73.10N,B组为829.12±170.74N,C组为230.62±98.52N,3组之间两两比较差异有统计学意义（P＜0.05）。结论：经骶1-2侧块螺钉固定的最大拔出力低于S1椎弓根螺钉固定,但高于S1前外骶骨翼螺钉固定,当S1椎弓根螺钉固定不能施行时,骶1-2侧块螺钉固定可作为一种有效的选择。     

腰骶椎弓根螺钉翻修及强化固定后稳定性比较

[目的]从生物力学角度评价腰骶椎弓根螺钉翻修及强化固定的稳定性。[方法]采用7具新鲜成人尸体L5S1椎体标本,于L5椎体首先置入5.5mm/45mm椎弓根螺钉,然后再置入7.0mm/55mm螺钉翻修,最后应用骨水泥强化固定;S1椎弓根置入初始螺钉为6.25mm/35mm、翻修螺钉为8.0mm/45mm、最后同样行骨水泥强化固定。在858MiniMTS生物力学实验机上分别测试各状态轴向最大拔出力及最大扭力矩。[结果](1)在L5,初始、翻修及骨水泥强化固定状态的最大把持力分别为(1680.7±242.8)N、(2410.3±366.1)N、(3273.0±688.5)N(P<0.05),最大扭力矩分别为(1006.1±205.3)N·mm、(1432.6±213.7)N·mm、(590.7±83.5)N·m(P<0.05);(2)在S1,初始、翻修及骨水泥强化的把持力分别为(926.3±274.2)N、(957.5±336.3)N、(1825.3±199.9)N,最大扭力矩分别为(667.6±88.3)N·mm、(681.4±79.4)N·mm、(558.8±97.2)N·mm;其中初始及翻修状态把持力及扭力矩均无明显差别(P>0.05),骨水泥强化固定后把持力明显增加、扭力矩明显减小(P<0.05)。[结论](1)L5椎弓根螺钉翻修时,螺钉直径增加1.5mm、长度增加10mm或骨水泥强化均可达到翻修固定的生物力学要求,增加脊椎稳定性,以骨水泥强化固定更为明显;(2)S1椎弓根螺钉翻修时,单纯增加螺钉直径和长度不能获得理想的稳定性,而骨水泥强化螺钉固定效果明显。     

拱桥弹性钢板椎弓根固定器的研制与临床应用

目的:探讨自行研制的椎弓根系统固定器的性能及临床效果。方法:对拱桥式弹性钢板椎弓根固定器(archbridgetypeelasticpediclefixationsystem,ABPF)进行生物力学实验与临床应用分析。结果:ABPF在应变、应力、位移、强度、刚度方面性能良好。应用ABPF治疗胸腰椎骨折57例,53例平均随访26个月,术前椎体前高度平均54郾36%,术后2周98郾5%,术后26个月97%。未发生弯钉、断钉。结论:ABPF利用拱形钢板和钉板角能对脊柱骨折产生过伸折顶复位与纵向撑开复位。术后对脊柱骨折产生持续向前的推力与弹性固定,可防止后凸畸形复发和椎体高度丢失。     

颈椎椎弓根皮质骨螺钉固定的钉道影像学测量与生物力学研究测试

目的:探讨颈椎椎弓根皮质骨螺钉在临床使用可行性、钉道的参数和置钉后生物力学分析.方法:随机选取我院2014年1月～2018年6月住院行颈椎CT三维重建的住院患者CT资料30例,男性16例,女性14例,年龄30～60岁(48.0±5.6岁),采集患者颈椎(选取C4～C6)CT连续扫描数据,测量每个椎弓根的形态学数据:椎弓...     

Verification of the position of pedicle screws in lumbar spinal fusion

Medial or lateral pedicle screw penetration with the potential to affect neural structures in a well-known and frequent problem associated with posterior spinal fusion. We evaluated the placement of pedicle screws (n = 141) in 36 patients following posterior lumbar spinal fusion with Socon or Kluger instrumentation via a lateral transpedicular approach. The examination was based on CT and MR images performed after removal of the instrumentation, on average 1 year after implantation. We found seven pedicle screws with lateral cortical penetration of the pedicle and five screws with medial cortical penetration of the pedicle (8.5% pedicle penetration overall). No severe radicular complications accompanied these pedicle penetrations. The mean insertion angles of the pedicle screws at the L4 level were 22.6° and 23.1° for the left and the right side, respectively. At the L5 level the mean insertion angle was 20.5° on the left side and 21.5° on the right, and at the S1 level the mean angle was 16.2° on the left and 15.2° on the right. The results of this study indicate that the lateral transpedicular approach is a safe procedure for pedicle screw insertion.     

Inserting pedicle screws in the upper thoracic spine without the use of fluoroscopy or image guidance. Is it safe?

Several studies have looked at accuracy of thoracic pedicle screw placement using fluoroscopy, image guidance, and anatomical landmarks. To our knowledge the upper thoracic spine (T1–T6) has not been specifically studied in the context of screw insertion and placement accuracy without the use of either image guidance or fluoroscopy. Our objective was to study the accuracy of upper thoracic screw placement without the use of fluoroscopy or image guidance, and report on implant related complications. A single surgeon inserted 60 screws in 13 consecutive non-scoliotic spine patients. These were the first 60 screws placed in the high thoracic spine in our institution. The most common diagnosis in our patient population was trauma. All screws were inserted using a modified Roy-Camille technique. Post-operative axial computed tomography (CT) images were obtained for each patient and analyzed by an independent senior radiologist for placement accuracy. Implant related complications were prospectively noted. No pedicle screw misplacement was found in 61.5% of the patients. In the remaining 38.5% of patients some misplacements were noted. Fifty-three screws out of the total 60 implanted were placed correctly within all the pedicle margins. The overall pedicle screw placement accuracy was 88.3% using our modified Roy-Camille technique. Five medial and two lateral violations were noted in the seven misplaced screws. One of the seven misplaced screws was considered to be questionable in terms of pedicle perforation. No implant related complications were noted. We found that inserting pedicle screws in the upper thoracic spine based solely on anatomical landmarks was safe with an accuracy comparable to that of published studies using image-guided navigation at the thoracic level.