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Research ArticleLumbar Spine

A Novel Intraoperative Technique to Determine Cranio-Caudal Angulation of Pedicle Screws in Thoracolumbar Spine? A Prospective Computerized Tomography–Based Analysis of 428 Screws

Nirmal D. Patil and Aditya Dahapute
International Journal of Spine Surgery October 2020, 7104; DOI: https://doi.org/10.14444/7104
Nirmal D. Patil
1Department of Spine surgery, Queens Medical Centre, Nottingham, UK
MBBS, MS (ORTHO), MRCS (ENG), DNB (ORTHO MNAMS), INTERNATIONAL ORTHOPEDIC DIPLOMA (SICOT)
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Aditya Dahapute
2Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, India
MBBS, MS (ORTHO), MRCS (ENG), DNB (ORTHO MNAMS)
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ABSTRACT

Background We report a novel technique of directing the sagittal profile of thoracic and lumbar pedicle screws using a freehand technique without the use of intraoperative monitoring.

Methods This is a prospective computerized tomography (CT)–based evaluation of pedicle screw insertion in the thoracic and lumbar spine of 64 patients operated upon for varied etiologies. All the patients were operated upon independently by 2 young surgeons with 1 year of spinal-fellowship experience. Intraoperatively, a right-angle retractor was positioned to determine the sagittal inclination of the pedicle screw. Postoperatively, sagittal CT scans were analyzed for the sagittal profile of the screw. The vertebral bodies were divided into 3 equidistant zones (A, B, and C) from the superior to inferior endplates, and the positions of the screw tips were noted.

Results There were 41 men and 23 women (mean age = 45.5 years). A total of 428 screws were inserted. There were 2 cases of superior pedicle wall violation in D1 and D5. The majority (96.97%) of the pedicle screws were inserted into zones A and B.

Conclusions We introduced a simple, accurate, and safe method of directing the sagittal inclination of the pedicle screw in the thoracic and lumbar spine without intraoperative image guidance.

  • pedicle
  • screw
  • thoracic
  • lumbar
  • spine
  • application
  • insertion
  • freehand
  • sagittal

Footnotes

  • Disclosures and COI: The authors received no funding for this study and report no conflicts of interest.

  • This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2020 ISASS.
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International Journal of Spine Surgery: 19 (S2)
International Journal of Spine Surgery
Vol. 19, Issue S2
1 Apr 2025
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A Novel Intraoperative Technique to Determine Cranio-Caudal Angulation of Pedicle Screws in Thoracolumbar Spine? A Prospective Computerized Tomography–Based Analysis of 428 Screws
Nirmal D. Patil, Aditya Dahapute
International Journal of Spine Surgery Oct 2020, 7104; DOI: 10.14444/7104

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A Novel Intraoperative Technique to Determine Cranio-Caudal Angulation of Pedicle Screws in Thoracolumbar Spine? A Prospective Computerized Tomography–Based Analysis of 428 Screws
Nirmal D. Patil, Aditya Dahapute
International Journal of Spine Surgery Oct 2020, 7104; DOI: 10.14444/7104
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Keywords

  • pedicle
  • screw
  • thoracic
  • lumbar
  • spine
  • application
  • insertion
  • freehand
  • sagittal

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