Safety and Efficacy of Power-Assisted Pedicle Tract Preparation and Screw Placement

Abstract

Study DesignRetrospective review of 1 surgeon's posterior spinal fusion cases. ObjectivesTo assess the safety and efficacy of using power tools versus using manual tools to create pedicle tracts and place pedicle screws. Summary of Background DataThis is the first study to report on the safety and efficacy of pedicle tract creation and pedicle screw placement using power tools. MethodsThe study included 442 cases and 6412 pedicle screws. The manual tool cohort included 159 cases (1,870 screws, January 1, 2004 to June 30, 2007). The power tool cohort included 283 cases (4,542 screws, January 1, 2008 to August 29, 2012). Patient charts and radiographs were reviewed. The researchers recorded the number of screws placed and their positions. Screws were classified as failed if the patient returned to surgery for revision or removal of the screw. Operating and fluoroscopy times were analyzed by cohort overall and for diagnosis-specific subsets. ResultsThe incidence of injury resulting from pedicle screw placement was 0.00% (0 of 1,870) with the manual method and 0.02% (1 of 4,542) with power (p = .5211). One screw, placed with power, was assumed to have caused a minor hemothorax, which was successfully treated with a chest tube. There were no neurologic or vascular injuries or other complications attributable to a pedicle screw in either group. Screws placed with power were removed or revised because of problems attributable to the pedicle screw one-sixth as often as those placed using manual tools: 2 of 1,410 (0.14%) versus 8 of 948 (0.84%) (p = .024). Fluoroscopy times in the power cohort were two-thirds as long as those in the manual cohort (p < .001). Operating times were not significantly different (p = .109). ConclusionsThe use of power tools to create pedicle tracts and place pedicle screws was associated with shorter fluoroscopy times and a lower revision rate compared with using manual tools. Both techniques posed similar low risks of injury to the patient.