Accuracy and Safety of Pedicle Screw Placement in Adolescent Idiopathic Scoliosis Patients
Autor: | Chee Kidd Chiu, Siti Mariam Abd Gani, Mun Keong Kwan, Chris Chan Yin Wei |
---|---|
Rok vydání: | 2017 |
Předmět: |
musculoskeletal diseases
medicine.medical_specialty Adolescent medicine.medical_treatment Perforation (oil well) Scoliosis Iliac crest Thoracic Vertebrae 03 medical and health sciences 0302 clinical medicine Pedicle Screws medicine.artery medicine Humans Orthopedics and Sports Medicine 030212 general & internal medicine Esophagus Aorta business.industry equipment and supplies musculoskeletal system medicine.disease Surgery Spinal Fusion surgical procedures operative medicine.anatomical_structure Radicular pain Spinal fusion Thoracic vertebrae Neurology (clinical) Radiology Safety Tomography X-Ray Computed business 030217 neurology & neurosurgery |
Zdroj: | Spine. 42:326-335 |
ISSN: | 1528-1159 0362-2436 |
Popis: | Study design Retrospective review of CT scan. Objective To investigate the accuracy and safety of pedicle screws placed in adolescent idiopathic scoliosis (AIS) patients. Summary of background data The reported pedicle screws perforation rates for corrective AIS surgery vary widely from 1.2% to 65.0%. Knowledge regarding the safety of pedicle screws in scoliosis surgery is very important in preventing complications. Methods This study investigates the accuracy and safety of pedicle screws placed in 140 AIS patients. CT scans were used to assess the perforations that were classified according to Rao et al (2002): grade 0, grade 1 ( 4 mm). Anterior perforations were classified into grade 0, grade 1 ( 6 mm). Grade 2 and 3 (excluding lateral grade 2 and 3 perforation over thoracic vertebrae) were considered as critical perforations. Results A total of 2020 pedicle screws from 140 patients were analyzed. The overall total perforation rate was 20.3% (410 screws) with 8.2% (166 screws) grade 1, 2.9% (58 screws) grade 2 and 9.2% (186 screws) grade 3 perforations. Majority of the perforations was because of lateral perforation occurring over the thoracic region, as a result of application of extrapedicular screws at this region. When the lateral perforations of the thoracic region were excluded, the perforation rate was 6.4% (129 screws), grade 2, 1.4% (28 screws) and grade 3, 0.8% (16 screws). There were only two symptomatic left medial grade 2 perforations: one screw at T12 presented with postoperative iliac crest numbness and another screw at L2 presented with radicular pain that subsided with conservative treatment. There were six anterior perforations abutting the right lung, four anterior perforations abutting the aorta, two anterior perforations abutting the esophagus, and one abutting the trachea was noted. Conclusion Pedicle screws insertion in AIS has a total perforation rate of 20.3%. After exclusion of lateral thoracic perforations, the overall perforation rate was 8.6% with a critical perforation rate of 2.2% (44/2020). The rate of symptomatic screw perforation leading to radicular symptoms was 0.1%. There was no spinal cord, aortic, esophageal, or lung injuries caused by malpositioned screws in this study. Level of evidence 4. |
Databáze: | OpenAIRE |
Externí odkaz: |