Abstract
Background: Fluoroscopic guidance to put pedicle screws helps to confirm the accuracy of the screw in place; however, it is always not mandatory Methods: In 79 patients, 531 pedicle screws were inserted during a period between July 2006 and November 2009. There were 218 pedicle screws in trauma, 138 in TB spine, 107 in Scoliosis, 26 in Scheuermann’s kyphosis, 18 in Spondylolysis / spondylolisthesis and 24 in tumors. In lumbar / sacral region total of 140 screws and in Dorsal region 391 screws were introduced. All screws were inserted free hand without fluoroscopic guidance. Accuracy of the placement was checked per operatively with pedicle probe by sounding technique. Before wound closure and whenever in doubt position of screws was checked under fluoroscope. Post operatively patients were subjected for CT scan to confirm the position of the screws. Seventeen patients with 107 screws were excluded from the study since they were not subjected for post-operative CT scan. The study consisted of 424 pedicle screws in 62 patients. Results: Out of 424 pedicle screws four screws (0.9%) were misplaced. Three patients complained of dysesthesia. Eleven screws (2.5%) were broken at last follow up of 12.6 months. The average surgical time for insertion of the screw without image intensifier is four minutes whereas with image intensifier was 7.5 minutes. Conclusion: Free hand insertion of pedicle screws is safe and time saving. DOI: http://dx.doi.org/10.3126/noaj.v2i1.8138 Nepal Orthopaedic Association Journal Vol.2(1) 2011: 35-42
Highlights
Pedicle screw fixation has become a gold standard for any spinal reconstructive or stabilization procedures and is the integral part of the armamentarium for any spine surgeons
Pedicle screw insertion is relatively safe and it is very effective in providing stability in all planes of the spinal movements
Most of the screws were applied in traumatic spines (n=218) followed by in spine affected by infection (n= 138), scoliosis (n = 107), Scheuermann’s Kyphosis (n = 26), spondylolisthesis / Spondylolysis (n= 18) and tumors (n= 24) (Chart 1)
Summary
Pedicle screw fixation has become a gold standard for any spinal reconstructive or stabilization procedures and is the integral part of the armamentarium for any spine surgeons. Its extension through three columns of the vertebrae improves load transfer across the spinal column by virtue of its load sharing capacity.[1] Pedicle screw insertion is relatively safe and it is very effective in providing stability in all planes of the spinal movements. Pedicle screws can be applied in any vertebra where the pedicle can accommodate the screws. Exhaustive studies are available on anatomy of human pedicles. Wide variations have been identified within common patterns and pedicular anatomy unique to cervical, thoracic, lumbar and sacral spine do exist. Fluoroscopic guidance to put pedicle screws helps to confirm the accuracy of the screw in place; it is always not mandatory
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