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Screw perforation features in 129 consecutive patients performed computer-guided cervical pedicle screw insertion

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Abstract

Study design

A cross-sectional study of the data retrospectively collected by chart review.

Objectives

This study aimed to clarify screw perforation features in 129 consecutive patients treated with computer-assisted cervical pedicle screw (CPS) insertion and to determine important considerations for computer-assisted CPS insertion.

Summary of background data

CPS fixation has been criticized for the potential risk of serious injury to neurovascular structures. To avoid such serious risks, computed tomography (CT)-based navigation has been used during CPS insertion, but screw perforation can occur even with the use of a navigation system.

Methods

The records of 129 consecutive patients who underwent cervical (C2–C7) pedicle screw insertion using a CT-based navigation system from September 1997 to August 2013 were reviewed. Postoperative CT images were used to evaluate the accuracy of screw placement. The screw insertion status was classified as grade 1 (no perforation), indicating that the screw was accurately inserted in pedicle; grade 2 (minor perforation), indicating perforation of less than 50 % of the screw diameter; and grade 3 (major perforation), indicating perforation of 50 % or more of the screw diameter. We analyzed the direction and rate of screw perforation according to the vertebral level.

Results

The rate of grade 3 pedicle screw perforations was 6.7 % (39/579), whereas the combined rate of grades 2 and 3 perforations was 20.0 % (116/579). No clinically significant complications, such as vertebral artery injury, spinal cord injury, or nerve root injury, were caused by the screw perforations. Of the screws showing grade 3 perforation, 30.8 % screws were medially perforated and 69.2 % screws were laterally perforated. Of the screws showing grades 2 and 3 perforation, 21.6 % screws were medially perforated and 78.4 % screws were laterally perforated. Furthermore, we evaluated screw perforation rates according to the vertebral level. Grade 3 pedicle screw perforation occurred in 6.1 % of C2 screws; 7.5 % of C3 screws; 13.0 % of C4 screws; 6.5 % of C5 screws; 3.2 % of C6 screws; and 4.0 % of C7 screws. Grades 2 and 3 pedicle screw perforations occurred in 12.1 % of C2 screws, 22.6 % of C3 screws, 31.5 % of C4 screws, 22.2 % of C5 screws, 14.4 % of C6 screws, and 12.1 % of C7 screws. C3–5 screw perforation rate was significantly higher than C6–7 (p = 0.0024).

Conclusions

Careful insertion of pedicle screws is necessary, especially at C3 to C5, even when using a CT-based navigation system. Pedicle screws tend to be laterally perforated.

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Conflict of interest

None of the authors of this manuscript received any type of support, benefits, or funding from a commercial party related directly or indirectly to the subject of this article.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Yodakubo Hospital, 2857 Furumachi, Nagawamachi, Chiisagatagun, Nagano, 386-0603, Japan

    Masashi Uehara

  2. Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto-City, Nagano, 390-8621, Japan

    Jun Takahashi, Shota Ikegami, Keijiro Mukaiyama, Shugo Kuraishi, Masayuki Shimizu, Toshimasa Futatsugi & Hiroyuki Kato

  3. Department of Orthopaedic Surgery, Ina Central Hospital, 1313-1 Koshirokubo, Ina-City, Nagano, 396-8555, Japan

    Nobuhide Ogihara

  4. Department of Orthopaedic Surgery, Shinonoi General Hospital, 666-1 Shinonoiai, Nagano-City, Nagano, 388-8004, Japan

    Hiroyuki Hashidate

  5. Department of Orthopaedic Surgery, Marunouchi Hospital, 1-7-45 Nagisa, Matsumoto-City, Nagano, 390-8621, Japan

    Hiroki Hirabayashi

Authors
  1. Masashi Uehara
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  2. Jun Takahashi
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  3. Shota Ikegami
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  4. Keijiro Mukaiyama
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  5. Shugo Kuraishi
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  6. Masayuki Shimizu
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  7. Toshimasa Futatsugi
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  8. Nobuhide Ogihara
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  9. Hiroyuki Hashidate
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  10. Hiroki Hirabayashi
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  11. Hiroyuki Kato
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Corresponding author

Correspondence to Jun Takahashi.

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Uehara, M., Takahashi, J., Ikegami, S. et al. Screw perforation features in 129 consecutive patients performed computer-guided cervical pedicle screw insertion. Eur Spine J 23, 2189–2195 (2014). https://doi.org/10.1007/s00586-014-3502-9

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  • DOI: https://doi.org/10.1007/s00586-014-3502-9

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