Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique |
| |
Authors: | Hitesh N Modi Seung Woo Suh Harry Fernandez Jae Hyuk Yang Hae-Ryong Song |
| |
Institution: | (1) Department of Orthopedics, Scoliosis Research Institute, Korea University Guro Hospital, # 80, Guro-Dong, Guro-Gu, Seoul, 152-703, South Korea;(2) Department of Orthopedics, Rare Disease Institute, Korea University Guro Hospital, Seoul, South Korea |
| |
Abstract: | It is a retrospective analytic study of 1,009 transpedicular screws (689 thoracic and 320 lumbosacral), inserted with free-hand
technique in neuromuscular scoliosis using postoperative CT scan. The aim of paper was to determine the accuracy and safety
of transpedicular screw placement with free-hand technique in neuromuscular scoliosis and to compare the accuracy at different
levels in such population. All studies regarding accuracy and safety of pedicle screw in scoliosis represent idiopathic scoliosis
using various techniques such as free-hand, navigation, image intensifier, etc., for screw insertion. Anatomies of vertebrae
and pedicle are distorted in scoliosis, hence accurate and safe placement of pedicle screw is prerequisite for surgery. Between
2004 and 2006, 37 consecutive patients, average age 20 years (9–44 years), of neuromuscular scoliosis were operated with posterior
pedicle screw fixation using free-hand technique. Accuracy of pedicle screws was studied on postoperative CT scan. Placement
up to 2 mm medial side and 4 mm lateral side was considered within-safe zone. Of the 1,009 screws, 273 screws were displaced
medially, laterally or on the anterior side showing that 73% screws (68% in thoracic and 82.5% in lumbar spine) were accurately
placed within pedicle. Considering the safe zone, 93.3% (942/1009, 92.4% in thoracic and 95.3% in lumbar spine) of the screws
were within the safe zone. Comparing accuracy according to severity of curve, accuracy was 75% in group 1 (curve <90°) and
69% in group 2 (curve >90°) with a safety of 94.8 and 91.2%, respectively (P = 0.35). Comparing the accuracy at different thoracic levels, it showed 67, 64 and 72% accuracy in upper, middle and lower
thoracic levels with safety of 96.6, 89.2 and 93.1%, respectively, exhibiting no statistical significant difference (P = 0.17). Pedicle screw placement in neuromuscular scoliosis with free-hand technique is accurate and safe as other conditions. |
| |
Keywords: | Neuromuscular scoliosis Pedicle screw fixation Free-hand technique Postoperative CT scan Accuracy Safe |
本文献已被 SpringerLink 等数据库收录! |
|