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Accuracy of thoracic pedicle screw placement in scoliosis using the ideal pedicle entry point during the freehand technique

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Abstract

Previously, we described the ideal pedicle entry point (IPEP) for the thoracic spine at the base of the superior facet at the junction of the lateral one third and medial two thirds with the freehand technique on cadavers. Here we measured the accuracy of thoracic pedicle screw placement (Chung et al. Int Orthop 2008) on post-operative computed tomography (CT) scans in 43 scoliosis patients who underwent operation with the freehand technique taking the same entry point. Of the 854 inserted screws, 268 (31.3%) were displaced; 88 (10.3%) and 180 (21.0%) screws were displaced medially and laterally, respectively. With regard to the safe zone, 795 screws were within the safe zone representing an accuracy rate of 93%; 448 and 406 thoracic screws inserted in adolescent idiopathic and neuromuscular scoliosis showed an accuracy of 89.9 and 94%, respectively (p = 0.6475). The accuracy rate of screws inserted in the upper, middle and lower thoracic pedicles were 94.2, 91.6 and 93.7%, respectively (p = 0.2411). The results indicate that IPEP should be considered by surgeons during thoracic pedicle screw instrumentation.

Résumé

Le point d’entrée idéal des vis pediculaires (IPEP) au niveau thoracique se situe au niveau de la facette articulaire supérieure à la jonction du tiers latéral, 2/3 médial. Nous avons mesuré l’efficacité de cette technique « à main levée » par des scanners post-opératoires sur 43 scolioses chez 43 patients opérés. 268 (31,3%) des 854 vis mises en place n’étaient pas à un niveau parfait. 88 (10,3%) et 180 (21,0%) étaient soit trop médianes soit trop latérales. Néanmoins, si l’on considère la zone de sécurité, 795 vis soit 93% étaient en zone de sécurité. 448 et 446 vis thoraciques insérées lors d’une scoliose idiopathique ou neuromusculaire de l’adolescent étaient en zone saine dans respectivement 89,9% et 94% (p = 0,6475). Le taux de précision des vis insérées à la partie supérieure ou médiane ou inférieure du pédicule thoracique était respectivement de 94,2%, 91,6% et 93,7% (p = 0,2411). Résultats : cette étude montre que la technique de mise en place des vis pediculaires à « main levée » peut être considérée comme une technique efficace au niveau thoracique.

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Authors and Affiliations

  1. Department of Orthopedics, Scoliosis Research Institute, Korea University Guro Hospital, Seoul, Republic of Korea

    Hitesh Modi, Seung Woo Suh & Jae-Hyuk Yang

  2. Department of Orthopedics, Rare Disease Institute, Korea University Guro Hospital, Seoul, Republic of Korea

    Hae-Ryong Song

  3. Department Of Orthopaedics, Korea University Guro Hospital, #80, Guro Dong, Gurogu, Seoul, 152 703, South Korea

    Seung Woo Suh

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  1. Hitesh Modi
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  2. Seung Woo Suh
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  3. Hae-Ryong Song
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  4. Jae-Hyuk Yang
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Correspondence to Seung Woo Suh.

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Modi, H., Suh, S.W., Song, HR. et al. Accuracy of thoracic pedicle screw placement in scoliosis using the ideal pedicle entry point during the freehand technique. International Orthopaedics (SICOT) 33, 469–475 (2009). https://doi.org/10.1007/s00264-008-0535-x

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  • DOI: https://doi.org/10.1007/s00264-008-0535-x

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