Lumbosacral pedicle screw placement using a fluoroscopic pedicle axis view and a cannulated tapping device
Autor: | Takashi Hirai, Renpei Mastumoto, Tsuyoshi Kato, Atsushi Okawa, Kenichi Shinomiya, Tsuyoshi Yamada, Hiroyuki Inose, Mitsuhiro Enomoto, Satoshi Sumiya, Shigenori Kawabata, Toshitaka Yoshii |
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Jazyk: | angličtina |
Předmět: |
Adult
Male musculoskeletal diseases medicine.medical_specialty Sacrum Catheters Cannulated tapping medicine.medical_treatment Perforation (oil well) Lumbar vertebrae Pedicle screw placement Radiography Interventional Young Adult Pedicle Screws medicine Technical Note Fluoroscopy Humans Pedicle axis view Orthopedics and Sports Medicine Pedicle screw Accuracy Aged Retrospective Studies Aged 80 and over Lumbar Vertebrae medicine.diagnostic_test business.industry Middle Aged musculoskeletal system equipment and supplies Surgery medicine.anatomical_structure Spinal Fusion surgical procedures operative Spinal fusion Orthopedic surgery Female Risk factor business Lumbosacral joint |
Zdroj: | Journal of Orthopaedic Surgery and Research |
ISSN: | 1749-799X |
DOI: | 10.1186/s13018-015-0225-5 |
Popis: | Background Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. However, the misplacement of pedicle screws can lead to disastrous complications. Inaccurate pedicle screw placement is relatively common even when placement is performed under fluoroscopic control. In order to improve the accuracy of the screw placement, we applied a technique using guide wires and a cannulated tapping device with the assistance of a fluoroscopic pedicle axis view. Methods From 2006 to 2011, 854 pedicle screws were placed in 176 patients in lumbosacral spinal fusion surgeries. The accuracy of screw placement was evaluated using postoperative reconstructed computed tomography images. Screw misplacement was classified as minor (cortical perforation 6 mm). Using logistic regression analysis, we also investigated the potential risk factors associated with screw misplacement. Results Pedicle screw misplacement was observed in 37 screws (4.3 %) in 34 patients. In the sub-classification analysis, 28 screws (3.3 %) were determined to be minor perforations, 7 screws (0.8 %) were considered to be moderate perforations, and 2 screws (0.2 %) was judged to be a severe perforation (cortical perforation >6 mm). None of the 28 screws that were considered to be minor perforations were associated with any significant symptoms in the patients. However, 2 of the 9 screws that were determined to be moderate or severe perforations caused neurological symptoms (1 of which required revision). No significant differences were observed in the incidence of screw misplacement among the vertebral levels. Significant risk factors for screw misplacement were obesity and degenerative scoliosis. The odds ratios of these significant risk factors were 3.593 (95 % confidence interval (CI), 1.061–12.175) for obesity and 8.893 for degenerative scoliosis (95 % CI, 1.200–76.220). Conclusions A modified fluoroscopic technique using a pedicle axis view and a cannulated tapping instrument can achieve safe and accurate pedicle screw placement. In addition, obesity and degenerative scoliosis were identified as significant risk factors for screw misplacement. |
Databáze: | OpenAIRE |
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