Abstract
BackgroundPedicle screw instrumentation is used widely in lumbar spine for stabilization to enhance arthrodesis and has been accepted in the thoracic spine in recent years. The purpose of this study was to assess the value of postoperative 320 multi-slice computed tomography (MSCT) in assessment of pedicle screw placement in patients with spinal fixation with clinical and surgical correlation.ResultsA total of 340 pedicular screws were inserted to 70 cases. 286 (84.12%) were in, 54 screws (15.88%) were violated, and revision surgeries were required for 5 displaced screws. On axial, coronal reconstruction and three-dimensional (3D) reformatted CT images 36, 47, and 54 displaced screws were detected, respectively. Both sensitivity and specificity for 3D reformatted images were 100%. For axial image, they were 97.6% and 89.4%, respectively, compared with surgical findings in 5 revised screws.ConclusionMulti-slice CT scan is a valuable and valid postoperative assessment tool of accuracy of spinal pedicle screw placement.
Highlights
Pedicle screw instrumentation is used widely in lumbar spine for stabilization to enhance arthrodesis and has been accepted in the thoracic spine in recent years
Transpedicular screw procedure is accompanied with a prevalent series of complications comprising surgery at wrong-level, lesion of nerve root, dural tearing, injury to vascular structures, infections at surgical site, and screw displacement
During the period from January 2017 to June 2018, a cross-sectional study was carried out on 70 patients who were chosen by systemic random sampling technique and underwent spinal fusion surgery using pedicular screws in thoracic and/or lumbosacral spine to assess the value of postoperative 320 multi-slice computed tomography in the assessment of pedicle screw placement in patients with spinal fixation with clinical and surgical correlation
Summary
Pedicle screw instrumentation is used widely in lumbar spine for stabilization to enhance arthrodesis and has been accepted in the thoracic spine in recent years. The purpose of this study was to assess the value of postoperative 320 multi-slice computed tomography (MSCT) in assessment of pedicle screw placement in patients with spinal fixation with clinical and surgical correlation. Fixation of the spinal pedicles with screws is becoming a broadly used procedure of hardware spinal instrumentation. Though the advancement of surgical technique, instrumentation design, and the use of intraoperative fluoroscopy, puncture of pedicle cortex takes place threatening the nearby neurovascular or extra vertebral structures [1]. The probability of iatrogenic injury must be reduced as the pedicle is surrounded with vital anatomic structures: the dural sac locates medially, the nerve roots locate superiorly and inferiorly, and the vascular structures locate anterolaterally. Transpedicular screw procedure is accompanied with a prevalent series of complications comprising surgery at wrong-level, lesion of nerve root, dural tearing, injury to vascular structures, infections at surgical site, and screw displacement. Displacement of trans pedicular screw proportions fluctuating from 21.1% to 39.8% have been designated in the literatures [3, 4]
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