Thoracic pedicle screw insertion using a transpedicular drill guide: a preliminary study.

Insertion of thoracic pedicle screws can lead to major complications. This study reports the use of a transpedicular drill guide (TDG) for safe pedicle screw insertion in the thoracic spine. The conventional anatomic technique and the TDG were both used to drill pilot holes into the pedicles of four anatomic models of the thoracic spine. Ninety-nine percent of the 96 pilot holes drilled with the TDG were within 2 mm from the pedicle wall compared with 79% for the anatomic technique (P < 0.001). The TDG reduced the proportion and the extent of medial perforations. The TDG was easy to use and was superior to the conventional anatomic technique. It could be combined with fluoroscopy and pedicle palpation in certain clinical applications, especially for training surgeons, but only after confirming its accuracy in a cadaveric study.