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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, 14 (5) 722-730; 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, Belgium)
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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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    Figure 1

    Intraoperative image showing the side and end-on view of placement of the right angled retractor.

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    Figure 2

    Intraoperative image showing the outline of the lamina of the cephalad vertebrae and the vertebrae for screw insertion. A rectangular box is the outline for the base of the right-angled retractor. This must be placed on the surface of adjacent lamina on the contralateral side. The long limb of the retractor then guides the sagittal angulation of the screw.

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    Figure 3

    The 3 zones of the exit of the screws.

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    Figure 4

    Case of neglected old D3 vertebral body fracture treated with posterior spinal fusion and instrumentation from D1 to D5. Image shows the 3D MPR mode of Horos with cuts.

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    Figure 5

    L4-L5 transforaminal lumbar interbody fusion performed for a case of degenerative disc disease. The computed tomography scan shows the reconstructed postoperative images with the screw in zone A. The postoperative radiograph of the same patient is represented in Figure 7.

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    Figure 6

    A sagittal cut along the axis of the screw showing a grade 1 breach of the superior pedicle wall.

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    Figure 7

    (A) L2-L3 spondylodiscitis. (B) Interlaminar line and a line drawn perpendicular to the interlaminar line passing through the base of the superior articular facet simulating the base of the right angle). (C) Final postoperative x-ray.

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International Journal of Spine Surgery
Vol. 14, Issue 5
1 Oct 2020
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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, 14 (5) 722-730; 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, 14 (5) 722-730; DOI: 10.14444/7104
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  • Comparison of Stand-Alone Anterior Lumbar Interbody Fusion, 360° Anterior Lumbar Interbody Fusion, and Arthroplasty for Recurrent Lumbar Disc Herniation: Focus on Nerve Decompression and Painful Spinal Instability Resolution
  • Recovery Trajectories After Lumbar Fusion Stratified by Baseline Patient-Reported Outcomes Measurement Information System Physical Function Disability Levels
  • Association Between Nonsteroidal Anti-inflammatory Drugs Use and Surgical Outcomes Following Posterior Lumbar Fusion: A Medical Claims Database Analysis
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Keywords

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

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