Yoga Raja Rampersaud1, Kwang-Soo Lee. 1. Division of Orthopaedic, University of Toronto, Toronto, Ontario, Canada. raja.rampersaud@uhn.on.ca
Abstract
STUDY DESIGN: Observational matched cohort study with computed tomography (CT) analysis of pedicle screw placement. OBJECTIVE: Assess the clinical accuracy of computer-assisted fluoroscopy for the placement of thoracolumbar pedicle screws through a mature posterolateral fusion mass. SUMMARY OF BACKGROUND DATA: Pedicle screw placement through an amorphous posterolateral fusion mass intuitively carries a higher risk of pedicle wall violation. METHODS: Postoperative CT scans of 102 pedicle screws placed through a mature posterolateral fusion mass (n = 10 [T10-T12]; n = 92 [L1-S1]) were independently assessed and compared with a matched control (nonobscured anatomy) group. All screws were placed before any decompression using the FluoroNav system. RESULTS: In the fusion mass group, overall 81.4% of screws were completely within the pedicle. Seven medial and 12 lateral pedicle breaches occurred. Relative to the total number of screws, pedicle breaches were graded II (<2 mm) in 13.5%, III (2-4 mm) in 2.9%, and IV (>4 mm) in 2.0% of screws. The number and direction of pedicle breaches were not significantly different when compared with the control group. There were no clinically significant screw misplacements in either group. CONCLUSIONS: The use of computer-assisted fluoroscopy is safe and effective for the placement of thoracolumbar (T10-S1) pedicle screws through a posterolateral fusion mass without performing laminoforaminotomies.
STUDY DESIGN: Observational matched cohort study with computed tomography (CT) analysis of pedicle screw placement. OBJECTIVE: Assess the clinical accuracy of computer-assisted fluoroscopy for the placement of thoracolumbar pedicle screws through a mature posterolateral fusion mass. SUMMARY OF BACKGROUND DATA: Pedicle screw placement through an amorphous posterolateral fusion mass intuitively carries a higher risk of pedicle wall violation. METHODS: Postoperative CT scans of 102 pedicle screws placed through a mature posterolateral fusion mass (n = 10 [T10-T12]; n = 92 [L1-S1]) were independently assessed and compared with a matched control (nonobscured anatomy) group. All screws were placed before any decompression using the FluoroNav system. RESULTS: In the fusion mass group, overall 81.4% of screws were completely within the pedicle. Seven medial and 12 lateral pedicle breaches occurred. Relative to the total number of screws, pedicle breaches were graded II (<2 mm) in 13.5%, III (2-4 mm) in 2.9%, and IV (>4 mm) in 2.0% of screws. The number and direction of pedicle breaches were not significantly different when compared with the control group. There were no clinically significant screw misplacements in either group. CONCLUSIONS: The use of computer-assisted fluoroscopy is safe and effective for the placement of thoracolumbar (T10-S1) pedicle screws through a posterolateral fusion mass without performing laminoforaminotomies.
Authors: Gang Li; Guohua Lv; Peter Passias; Michal Kozanek; Umesh S Metkar; Zhongjun Liu; Kirkham B Wood; Lubos Rehak; Youwen Deng Journal: Eur Spine J Date: 2010-03-17 Impact factor: 3.134
Authors: Stephen J Lewis; Ranganathan Arun; Andrew Bodrogi; David E Lebel; Sofia P Magana; Taylor E Dear; Chris Witiw Journal: Eur Spine J Date: 2013-06-07 Impact factor: 3.134
Authors: Ioannis D Gelalis; Nikolaos K Paschos; Emilios E Pakos; Angelos N Politis; Christina M Arnaoutoglou; Athanasios C Karageorgos; Avraam Ploumis; Theodoros A Xenakis Journal: Eur Spine J Date: 2011-09-07 Impact factor: 3.134