Assessment of pedicle screw malposition rates in thoracolumbosacral spine: results of postoperative computed tomography in 100 patients

Year 2018, Volume: 43 Issue: 4, 816 - 820, 29.12.2018

Özcan Aslanbaş Kadir Oktay , Kerem Mazhar Özsoy , Nuri Eralp Çetinalp Metin Tuna

https://doi.org/10.17826/cumj.376307

Cited By: 1

Abstract

Purpose: The purpose of this retrospective study was to evaluate the screw malpositions of patients who underwent transpedicular screw application in various elective and emergency conditions.

Material and Methods: 100 patients who underwent transpedicular screw application with various spinal pathologies between January 2012 and September 2016 were included in this retrospective study. Anteroposterior and lateral X-rays and thin section spinal computed tomography scans were performed within 72 hours after the operation. The data including age, gender, operation levels, number of screws placed, preoperative and postoperative neurological conditions, complications, number of screw malpositions and revision surgeries of the patients were gathered.

Results: A total of 692 transpedicular screws were applied to 100 cases. 610 (88.15%) of the 692 transpedicular screws placed were evaluated as normal. 82 screws (11.85%) were evaluated as malpositions and 5 of them were revised. According to Gertzbein classification; 20 screws were grade 1, 44 screws were grade 2 and 18 screws were grade 3. 4 patients had anterior perforation, 39 patients had medial perforation, 38 patients had lateral perforation and 1 patient had inferior perforation. There was a dominancy of thoracal levels in screw malpositions.

Conclusion: Thin section CT scans taken postoperatively was found to be the gold standard for detecting screw malpositions. We identified that malpositions were most frequently seen as medial pedicle wall perforations in the thoracal region due to anatomical structure of the pedicles.

Keywords

Transpedicular screw, malposition, spinal instrumentation

Torakolumbosakral omurgada pedikül vidası malpozisyon oranlarının değerlendirilmesi: 100 hastanın postoperatif bilgisayarlı tomografi sonuçları

Abstract

Amaç: Çalışmamızda elektif ve acil şartlarda çeşitli tanılarla opere olarak transpediküler vida uygulanan hastaların, vida pozisyonlarının retrospektif olarak incelenerek vida malpozisyonlarının değerlendirilmesi amaçlandı.

Gereç ve Yöntem: Ocak 2012 ile Eylül 2016 tarihleri arasında çeşitli spinal patolojilerle transpediküler vida uygulanan 100 hasta retrospektif olarak incelendi. Operasyon sonrası 72 saat içinde anteroposterior ve lateral direk grafi ve ince kesit spinal bilgisayarlı tomografi görüntülemeleri yapıldı. Hastaların yaş, cinsiyet, operasyon seviyeleri, yerleştirilen vida sayıları, preoperatif ve postoperatif nörolojik durumları, komplikasyonlar, vida malpozisyon sayıları ve revizyon ameliyatlarını içeren verileri toplandı.

Bulgular: 100 olguya toplam 692 transpediküler vida uygulandı. Yerleştirilen 692 transpediküler vidanın 610'u (%88.15) normal olarak değerlendirildi. 82 vida (%11.85) malpozisyon olarak değerlendirildi ve 5'i revize edildi. Gertzbein sınıflamasına göre; 20 vida derece 1, 44 vida derece 2 ve 18 vida derece 3 olarak değerlendirildi. 4 hastada anterior perforasyon, 39 hastada medial perforasyon, 38 hastada lateral perforasyon, 1 hastada inferior perforasyon vardı. Vida malpozisyonlarının torakal seviyelerde daha çok görüldüğü saptandı.

Sonuç: Ameliyat sonrası alınan ince kesitli bilgisayarlı tomografi taramaları vida malpozisyonlarının belirlenmesinde altın standart olarak kabul edilmektedir. Malpozisyonların pediküllerin anatomik yapısına bağlı olarak en sık torakal bölgede medial pedikül duvarı perforasyonları şeklinde olduğunu tespit ettik.

Keywords

Transpediküler vida, malpozisyon, spinal enstrumantasyon

References

• Lotfinia I, Sayahmelli S, Gavami M. Postoperative computed tomography assessment of pedicle screw placement accuracy. Turk Neurosurg. 2010;20:500-7.
• Motiei-Langroudi R, Sadeghian H. Assessment of pedicle screw placement accuracy in thoracolumbosacral spine using freehand technique aided by lateral fluoroscopy: results of postoperative computed tomography in 114 patients. Spine J. 2015;15:700-4.
• Van de Kelft E, Costa F, Van der Planken D, Schils F. A prospective multicenter registry on the accuracy of pedicle screw placement in the thoracic, lumbar, and sacral levels with the use of the O-arm imaging system and StealthStation Navigation. Spine (Phila Pa 1976). 2012;37:E1580-7.
• Castro WH, Halm H, Jerosch J, Malms J, Steinback J, Blasius S. Accuracy of pedicle screw placement in lumbar vertebrae. Spine (Phila Pa 1976). 1996;21:1320-4.
• Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976). 1990;15:11-4.
• Güven O, Yalçin S, Karahan M, Sevinç TT. Postoperative evaluation of transpedicular screws with computed tomography. Orthop Rev. 1994;23:511-6.
• Laine T, Lund T, Ylikoski M, Lohlikoski J, Schlenzka D. Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients. Eur Spine J. 2000;9:235-40.
• Kosay C, Akcali O, Berk RH, Erbil G, Alici E. A new method for detecting pedicular wall perforation during pedicle screw insertion. Spine (Phila Pa 1976). 2001;26:1477-81.
• Schwarzenbach O, Berleman U, Jost B, Visarius H, Arm E, Langlotz F, Nolte LP, Ozdoba C. Accuracy of computer-assisted pedicle screw placement. An in vivo computed tomography analysis. Spine (Phila Pa 1976). 1997;22:452-8.
• Verma R, Krishan S, Haendlmayer K, Mohsen A. Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws. Eur Spine J. 2010;19:370-5.
• Gelalis ID, Paschos NK, Pakos EE, Politis AN, Arnaoutoglou CM, Karageorgos AC, Ploumis A, Xenakis TA. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J 2012;21:247-55.
• Meng XT, Guan XF, Zhang HL, He SS. Computer navigation versus fluoroscopy-guided navigation for thoracic pedicle screw placement: a meta-analysis. Neurosurg Rev. 2016;39:385-91.
• Noriega DC, Hernández-Ramajo R, Rodríguez-Monsalve Milano F, Sanchez-Lite I, Toribio B, Ardura F, Torres R, Corredera R, Kruger A. Risk-benefit analysis of navigation techniques for vertebral transpedicular instrumentation: a prospective study. Spine J. 2017;17:70-5.
• Tormenti MJ, Kostov DB, Gardner PA, Kanter AS, Spiro RM, Okonkwo DO. Intraoperative computed tomography image-guided navigation for posterior thoracolumbar spinal instrumentation in spinal deformity surgery. Neurosurg Focus. 2010;28:E11.
• Laine T, Makitalo K, Schlenzka D, Tallroth K, Poussa M, Alho A. Accuracy of pedicle screw insertion: a prospective CT study in 30 low back patients. Eur Spine J. 1997;6:402-5.
• Learch TJ, Massie JB, Pathria MN, Ahlgren BA, Garfin SR. Assessment of pedicle screw placement utilizing conventional radiography and computed tomography: a proposed systematic approach to improve accuracy of interpretation. Spine (Phila Pa 1976). 2004;29:767-73.
• Kalfas IH, Kormos DW, Murphy MA, McKenzie RL, Barnett GH, Bell GR, Steiner CP, Triamble MB, Weisenberger JP. Application of frameless stereotaxy to pedicle fixation of the spine. J Neurosurg. 1995;83:641-7.