Abstract
We sought to compare the safety and accuracy of a new free-hand pedicle screw placement technique to that of the conventional technique. One hundred fifty-three consecutive adult patients with simple fracture in the thoracic or/and lumbar spine were alternately assigned to either the new free-hand or the conventional group. In the new free-hand technique group, preoperative computerized tomography (CT) images were used to calculate the targeted medial-lateral angle of each pedicle trajectory and the pedicle screw was inserted perpendicular to the correspond-ing supraspinal ligament. In the conventional technique group, the medial-lateral and cranial-caudal angle of each pedicle trajectory was determined by intraoperatively under fluoroscopic guidance. The accuracy rate of pedicle screw placement, the time of intraoperative fluoroscopy, the operating time and the amount of blood loss during operation were respectively compared. All screws were analyzed by using intraoperative radiographs, intraoperative triggered electromyography (EMG) monitoring data, postoperative CT data and clinical outcomes. The accuracy rate of pedicle screw placement in the new free-hand technique group and the conventional technique group was 96.3% and 94.2% (P < 0.05), respectively. The intraoperative fluoroscopy time of the new technique group was less than that of the conventional technique group (5.37 seconds vs. 8.79 seconds, P < 0.05). However, there was no statistical difference in the operating time and the amount of blood loss during operation (P > 0.05). Pedicle screw placement with the free-hand technique which keeps the screw perpendicular to the supraspinal ligament is an accurate, reliable and safe technique to treat simple fracture in the thoracic or lumbar spine.
Highlights
Pedicle screw is widely used in the treatment of degenerative, traumatic and developmental conditions of the spine as it achieves excellent biomechanical荭These authors contributed to this work
In the conventional technique group, 76 patients with vertebral fractures at T1 to L4 received 312 pedicle screws placed in the thoracic or lumbar spine
Many clinical studies reported a low incidence of neurological injury associated with misplaced screws, there was evidence that small cortical breaches can impact on the biomechanical strength of a construct[2,11,23,24]
Summary
Pedicle screw is widely used in the treatment of degenerative, traumatic and developmental conditions of the spine as it achieves excellent biomechanical荭These authors contributed to this work. A number of computerized tomography (CT) and fluoroscopybased navigation systems have been developed with demonstrated ability to increase screw accuracy, decrease radiation exposure and reduce operative times[10,11]. These systems have not seen widespread adoption as they require time-consuming planning and invasive fixation of a reference arm, and they are unable to compensate for positional changes and are expensive capital investments[11,12,13,14,15,16,17,18]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
