Anterior Transpedicular Fixation of the Lower Thoracic and Lumbar Spine

Abstract

Currently, no anterior spinal implant provides a strong bone-screw interface because of the cancellous characteristics of the vertebral body. A more secure anchorage could be obtained by anterior transpedicular screw fixation. Four hundred transpedicular screws located between T7 and L5 were placed using the newly developed direction finder. Measurements were obtained directly from radiographs of the cadaveric specimens. In 10 cases (2.5%), the screws crossed the medial pedicle border, but never by more than 1.4 mm. A lateral protrusion was noted in another 41 screws (10%), with no protrusion greater than 2.2 mm. Encroachments beyond the superior or inferior border were not observed. The mean angle of the screws at each level measured between 7 and 19 in the transverse plane and between 2 and 4.5 in the sagittal plane. This technique should be reserved for vertebrae without significant arthritic changes. The rare screw with minimal infraction through the medial or lateral pedicle wall should not cause any vascular or neural compromise. The anterior transpedicular screw technique appeared relatively safe (88%) and encouraged the development of the new plate system for anterior spinal stabilization.