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A New Perspective of Evaluation of the Relationship Between Spinal Pedicle Screw Malposition and Surgical Experience

Yıl 2024, Cilt: 41 Sayı: 1, 155 - 159, 29.03.2024

Halil Gök Olgun Bingöl

Öz

The computed tomography scans of patients who underwent posterior instrumentation for thoracolumbar vertebral fractures were retrospectively reviewed. The aim of this study is to present a single surgeon's experience in the placement of pedicular screws in the thoracic, lumbar, and sacral spine using the two-way fluoroscopy-assisted freehand technique. The directions of screw malposition were classified as anterior, medial, lateral, superior, and inferior; screws with malposition in more than one direction were recorded. Patients' neurological symptoms were recorded and their compatibility with the direction and amount of screw malposition was assessed. The effect of surgical experience on thoracic, lumbar, and sacral pedicle screw placement and the amount of screw experience required for correct pedicle screw placement were investigated. The study evaluated 1112 pedicle screws in 147 patients with thoracolumbar fractures. Screw malposition was found in 206 (18.52%) screws. Medial malposition was found to be statistically higher in the lumbar spine (p<0.001). A significant correlation was found between inferior malposition and neurological deficit (p=0.012). Thoracic and sacral pedicle screw malposition was statistically higher than lumbar (p<0.001). It was found that 386 pedicle screws were required for the learning curve in lumbar fractures (p=0.004). Surgical experience is an important factor in correct screw placement. It was found that 386 pedicle screws were required for the learning curve in the lumbar spine.

Anahtar Kelimeler

Thoraco-lumbo-sacral spine pedicular screw malposition learning curve

Kaynakça

  • Parker SL, McGirt MJ, Farber SH, Amin AG, Rick AM, Suk I, et al. Accuracy of free-hand pedicle screws in the thoracic and lumbar spine: Analysis of 6816 consecutive screws. Neurosurgery. 2011 Jan;68(1):170–178.
  • Kalfas IH, Kormos DW, Murphy MA, McKenzie RL, Barnett GH, Bell GR, et al. Application of frameless stereotaxy to pedicle screw fixation of the spine. J Neurosurg. 1995;83(4):641–647.
  • Perna F, Borghi R, Pilla F, Stefanini N, Mazzotti A, Chehrassan M. Pedicle screw insertion techniques: an update and review of the literature. Vol. 100, Musculoskeletal Surgery. Springer-Verlag Italia s.r.l.; 2016. p. 165–169.
  • 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. Vol. 29, SPINE.
  • Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976). 1990;15(1):11–14.
  • Gelalis ID, Paschos NK, Pakos EE, Politis AN, Arnaoutoglou CM, Karageorgos AC, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. European spine journal. 2012;21(2):247–255.
  • Castro WHM, Halm H, Jerosch J, Malms J, Steinbeck J, Blasius S. Accuracy of pedicle screw placement in lumbar vertebrae. Spine (Phila Pa 1976). 1996;21(11):1320–1324.
  • Schwarzenbach O, Berlemann U, Jost B, Visarius H, Arm E, Langlotz F, et al. Accuracy of computer-assisted pedicle screw placement: an in vivo computed tomography analysis. Spine (Phila Pa 1976). 1997;22(4):452–458.
  • Errani C, Vanel D, Gambarotti M, Alberghini M, Picci P, Faldini C. Vascular bone tumors: a proposal of a classification based on clinicopathological, radiographic and genetic features. Skeletal Radiol. 2012;41(12):1495–1507.
  • Schizas C, Schmit A, Schizas A, Becce F, Kulik G, Pierzchała K. Secular changes of spinal canal dimensions in western Switzerland: A narrowing epidemic? Spine (Phila Pa 1976). 2014;39(17):1339–1344.
  • Griffith JF, Huang J, Law SW, Xiao F, Leung JCS, Wang D, et al. Population reference range for developmental lumbar spinal canal size. Quant Imaging Med Surg. 2016;6(6):671–679.
  • Cho W, Cho SK, Wu C. The biomechanics of pedicle screw-based instrumentation. J Bone Joint Surg Br. 2010;92(8):1061–1065.
  • Belmont PJJ, Klemme WR, Dhawan A, Polly DWJ. In vivo accuracy of thoracic pedicle screws. Spine (Phila Pa 1976). 2001 Nov;26(21):2340–2346.
  • Aoude AA, Fortin M, Figueiredo R, Jarzem P, Ouellet J, Weber MH. Methods to determine pedicle screw placement accuracy in spine surgery: a systematic review. European Spine Journal. 2015;24(5):990–1004.
  • Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD. Free Hand Pedicle Screw Placement in the Thoracic Spine: Is it Safe. Spine (Phila Pa 1976). 2004;29(3):333–342.
  • Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res. 1986;NO. 203:7–17.
  • Robbins S, Gertzbein SD. Accuracy of Pedicle Screw Placement in vivo. J Orthop Trauma. 1989 Jun;3(2):161. Aoude AA, Fortin M, Figueiredo R, Jarzem P, Ouellet J, Weber MH. Methods to determine pedicle screw placement accuracy in spine surgery: a systematic review. European Spine Journal. 2015;24(5):990–1004.
  • Sarwahi V, Payares M, Wendolowski S, Gecelter R, Maguire K, Wang D, et al. Pedicle Screw Safety. Spine (Phila Pa 1976). 2017 Nov;42(22):E1305–1310.
  • Gaines RW. Current Concepts Review The Use of Pedicle-Screw Internal Fixation for the Operative Treatment of Spinal Disorders. J Bone Joint Surg Am. 2000 Oct;82(10):1458-1476.
  • Ghobrial GM, Williams KA, Arnold P, Fehlings M, Harrop JS. Iatrogenic neurologic deficit after lumbar spine surgery: A review. Clin Neurol Neurosurg. 2015;139:76–80.
  • Rauschning W. Computed tomography and cryomicrotomy of lumbar spine specimens: A new technique for multiplanar anatomic correlation. Vol. 8, Spine. 1983. p. 170–80.

Yıl 2024, Cilt: 41 Sayı: 1, 155 - 159, 29.03.2024

Halil Gök Olgun Bingöl

Öz

Kaynakça

  • Parker SL, McGirt MJ, Farber SH, Amin AG, Rick AM, Suk I, et al. Accuracy of free-hand pedicle screws in the thoracic and lumbar spine: Analysis of 6816 consecutive screws. Neurosurgery. 2011 Jan;68(1):170–178.
  • Kalfas IH, Kormos DW, Murphy MA, McKenzie RL, Barnett GH, Bell GR, et al. Application of frameless stereotaxy to pedicle screw fixation of the spine. J Neurosurg. 1995;83(4):641–647.
  • Perna F, Borghi R, Pilla F, Stefanini N, Mazzotti A, Chehrassan M. Pedicle screw insertion techniques: an update and review of the literature. Vol. 100, Musculoskeletal Surgery. Springer-Verlag Italia s.r.l.; 2016. p. 165–169.
  • 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. Vol. 29, SPINE.
  • Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976). 1990;15(1):11–14.
  • Gelalis ID, Paschos NK, Pakos EE, Politis AN, Arnaoutoglou CM, Karageorgos AC, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. European spine journal. 2012;21(2):247–255.
  • Castro WHM, Halm H, Jerosch J, Malms J, Steinbeck J, Blasius S. Accuracy of pedicle screw placement in lumbar vertebrae. Spine (Phila Pa 1976). 1996;21(11):1320–1324.
  • Schwarzenbach O, Berlemann U, Jost B, Visarius H, Arm E, Langlotz F, et al. Accuracy of computer-assisted pedicle screw placement: an in vivo computed tomography analysis. Spine (Phila Pa 1976). 1997;22(4):452–458.
  • Errani C, Vanel D, Gambarotti M, Alberghini M, Picci P, Faldini C. Vascular bone tumors: a proposal of a classification based on clinicopathological, radiographic and genetic features. Skeletal Radiol. 2012;41(12):1495–1507.
  • Schizas C, Schmit A, Schizas A, Becce F, Kulik G, Pierzchała K. Secular changes of spinal canal dimensions in western Switzerland: A narrowing epidemic? Spine (Phila Pa 1976). 2014;39(17):1339–1344.
  • Griffith JF, Huang J, Law SW, Xiao F, Leung JCS, Wang D, et al. Population reference range for developmental lumbar spinal canal size. Quant Imaging Med Surg. 2016;6(6):671–679.
  • Cho W, Cho SK, Wu C. The biomechanics of pedicle screw-based instrumentation. J Bone Joint Surg Br. 2010;92(8):1061–1065.
  • Belmont PJJ, Klemme WR, Dhawan A, Polly DWJ. In vivo accuracy of thoracic pedicle screws. Spine (Phila Pa 1976). 2001 Nov;26(21):2340–2346.
  • Aoude AA, Fortin M, Figueiredo R, Jarzem P, Ouellet J, Weber MH. Methods to determine pedicle screw placement accuracy in spine surgery: a systematic review. European Spine Journal. 2015;24(5):990–1004.
  • Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD. Free Hand Pedicle Screw Placement in the Thoracic Spine: Is it Safe. Spine (Phila Pa 1976). 2004;29(3):333–342.
  • Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res. 1986;NO. 203:7–17.
  • Robbins S, Gertzbein SD. Accuracy of Pedicle Screw Placement in vivo. J Orthop Trauma. 1989 Jun;3(2):161. Aoude AA, Fortin M, Figueiredo R, Jarzem P, Ouellet J, Weber MH. Methods to determine pedicle screw placement accuracy in spine surgery: a systematic review. European Spine Journal. 2015;24(5):990–1004.
  • Sarwahi V, Payares M, Wendolowski S, Gecelter R, Maguire K, Wang D, et al. Pedicle Screw Safety. Spine (Phila Pa 1976). 2017 Nov;42(22):E1305–1310.
  • Gaines RW. Current Concepts Review The Use of Pedicle-Screw Internal Fixation for the Operative Treatment of Spinal Disorders. J Bone Joint Surg Am. 2000 Oct;82(10):1458-1476.
  • Ghobrial GM, Williams KA, Arnold P, Fehlings M, Harrop JS. Iatrogenic neurologic deficit after lumbar spine surgery: A review. Clin Neurol Neurosurg. 2015;139:76–80.
  • Rauschning W. Computed tomography and cryomicrotomy of lumbar spine specimens: A new technique for multiplanar anatomic correlation. Vol. 8, Spine. 1983. p. 170–80.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Ortopedi
Bölüm Research Article
Yazarlar

Halil Gök 0000-0002-7002-4118

Olgun Bingöl 0000-0003-1720-1709

Yayımlanma Tarihi 29 Mart 2024
Gönderilme Tarihi 8 Şubat 2024
Kabul Tarihi 26 Şubat 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 41 Sayı: 1

Kaynak Göster

APA Gök, H., & Bingöl, O. (2024). A New Perspective of Evaluation of the Relationship Between Spinal Pedicle Screw Malposition and Surgical Experience. Journal of Experimental and Clinical Medicine, 41(1), 155-159.
AMA Gök H, Bingöl O. A New Perspective of Evaluation of the Relationship Between Spinal Pedicle Screw Malposition and Surgical Experience. J. Exp. Clin. Med. Mart 2024;41(1):155-159.
Chicago Gök, Halil, ve Olgun Bingöl. “A New Perspective of Evaluation of the Relationship Between Spinal Pedicle Screw Malposition and Surgical Experience”. Journal of Experimental and Clinical Medicine 41, sy. 1 (Mart 2024): 155-59.
EndNote Gök H, Bingöl O (01 Mart 2024) A New Perspective of Evaluation of the Relationship Between Spinal Pedicle Screw Malposition and Surgical Experience. Journal of Experimental and Clinical Medicine 41 1 155–159.
IEEE H. Gök ve O. Bingöl, “A New Perspective of Evaluation of the Relationship Between Spinal Pedicle Screw Malposition and Surgical Experience”, J. Exp. Clin. Med., c. 41, sy. 1, ss. 155–159, 2024.
ISNAD Gök, Halil - Bingöl, Olgun. “A New Perspective of Evaluation of the Relationship Between Spinal Pedicle Screw Malposition and Surgical Experience”. Journal of Experimental and Clinical Medicine 41/1 (Mart 2024), 155-159.
JAMA Gök H, Bingöl O. A New Perspective of Evaluation of the Relationship Between Spinal Pedicle Screw Malposition and Surgical Experience. J. Exp. Clin. Med. 2024;41:155–159.
MLA Gök, Halil ve Olgun Bingöl. “A New Perspective of Evaluation of the Relationship Between Spinal Pedicle Screw Malposition and Surgical Experience”. Journal of Experimental and Clinical Medicine, c. 41, sy. 1, 2024, ss. 155-9.
Vancouver Gök H, Bingöl O. A New Perspective of Evaluation of the Relationship Between Spinal Pedicle Screw Malposition and Surgical Experience. J. Exp. Clin. Med. 2024;41(1):155-9.
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