Abstract
Objective:To determine outcome of freehand pedicle screw fixation for dorsal, lumbar and sacral fractures at a tertiary care centre in the developing world.Methods:A retrospective review was performed of 150 consecutive patients who underwent pedicle screw fixation from January 1, 2012 to 31st December 2017. A total of 751 pedicle screws were placed. Incidence and extent of cortical breach by misplaced pedicle screw was determined by review of intra-operative and post-operative radiographs and/or computed tomography.Results:Among the total 751 free hand placed pedicle screws, four screws (0.53%) were repositioned due to a misdirected trajectory towards the disc space. six screws (0.79%) were identified to have cause moderate breach while four screws (0.53%) cause severe breach. There was no occurrence of iatrogenic nerve root damage or violation of the spinal canal.Conclusion:Free hand pedicle screw placement based on external landmarks showed remarkable safety and accuracy in our center. The authors conclude that assiduous adherence to technique and preoperative planning is vital to success.
Highlights
Pedicle screw fixation with rod constructs has attained global acceptance for stable spine fixation.[1]
The study describes our step-by-step technique, which relies on a uniform entry point and sagittal trajectory for all levels
A retrospective review was performed of 150 consecutive patients who underwent pedicle screw fixation
Summary
Pedicle screw fixation with rod constructs has attained global acceptance for stable spine fixation.[1] A variety of techniques have been described in modern literature with free hand techniques having the unique advantage of being universally applicable, especially in the developing world with a dearth of equipment.[2] These free-hand techniques rely heavily on a surgeon’s experience and ability to locate the pedicle entry point with anatomical landmarks. Freehand pedicle screw placement in the lumbar spine has enjoyed wide acceptance but screw placement in the thoracic spine is more challenging due to the critical regional neurovascular anatomy and the narrow pedicular corridor mandating higher accuracy and precision.[3]. Freehand pedicle screw placement in the thoracic spine is considered both safe and effective and routinely performed by many spine surgeons.[6] based on each surgeon’ straining and individual preferences there is no one single or uniform technique and considerable variations exist among studies that may not provide reproducible parameters. The study describes our step-by-step technique, which relies on a uniform entry point and sagittal trajectory for all levels
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