Radiographic verification of pedicle screw pilot hole placement using Kirshner wires versus beaded wires

STUDY DESIGN: Kappa statistics were used to compare the accuracy of two different techniques for verifying pedicle screw pilot hole placement in cadaveric vertebrae. OBJECTIVE: To determine whether clinicians radiographically detect misplaced pedicle screw holes with greater sensitivity and specificity when beaded wires rather than straight Kirschner wires are used. SUMMARY OF BACKGROUND DATA: Pedicle screws commonly are used in orthopedic surgery to obtain and maintain spinal stability. Pedicle screws are reportedly misplaced at a rate of 20% to 40%. Radiographic verification is commonly used to place pedicle screw pilot holes, but this technique is known to be less than 100% accurate. Computer-assisted techniques may allow more accurate screw placement, but these techniques require expensive equipment. METHODS: Pedicle screw pilot holes were drilled into 12 human lumbar and thoracic vertebrae. Some of the holes were misplaced deliberately so that they violated the pedicle walls. Lateral and posteroanterior radiographs of the vertebrae were evaluated by 13 experienced orthopedic spine surgeons and 3 inexperienced observers. At different times, the observers were shown radiographs depicting Kirschner wires or beaded wires placed in the pilot holes. Observers indicated whether they thought the pedicle screw pilot hole violated the pedicle. RESULTS: The sensitivity and specificity of using posteroanterior or lateral radiographs to detect misplaced pedicle screws were increased when beaded wires were placed in the pilot holes. CONCLUSIONS: Radiographic evaluation of beaded wires placed in pedicle screw pilot holes can be both sensitive and specific for misplaced screws. The highest sensitivity and specificity were found using posteroanterior radiographs.