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Kwan MK, Chiu CK, Chan CYW, Zamani R, Hansen-Algenstaedt N. The use of fluoroscopic guided percutaneous pedicle screws in the upper thoracic spine (T1-T6): Is it safe? J Orthop Surg (Hong Kong) 2018; 25:2309499017722438. [PMID: 28748740 DOI: 10.1177/2309499017722438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE This study analysed the accuracy and safety of the fluoroscopic guided percutaneous screws in the upper thoracic vertebrae (T1-T6). METHODS Computed tomography scans from 74 patients were retrospectively evaluated between January 2008 and December 2012. Pedicle perforations were classified by two types of grading systems. For medial, lateral, superior and inferior perforations: grade 0 - no violation; grade 1 - <2 mm; grade 2 - 2-4 mm and grade 3 - >4 mm. For anterior perforations: grade 0 - no violation; grade 1 - <4 mm; grade 2 - 4-6 mm and grade 3 - >6 mm. RESULTS There were 35 (47.3%) male and 39 (52.7%) female patients with a total 260 thoracic pedicle screws (T1-T6) analysed. There were 32 screw perforations which account to a perforation rate of 12.3% (11.2% grade 1, 0.7% grade 2 and 0.4% grade 3). None led to pedicle screw-related complications. The perforation rate was highest at T1 (33.3%, all grade 1 perforations), followed by T6 (14.5%) and T4 (14.0%). CONCLUSION Fluoroscopic guided percutaneous pedicle screws of the upper thoracic spine (T1-T6) are technically more demanding and carry potential risks of serious complications. Extra precautions need to be taken when fluoroscopic guided percutaneous pedicle screws are placed at T1 and T2 levels, due to high medial pedicular angulation and obstruction of lateral fluoroscopic images by the shoulder girdle and at T4-T6 levels, due to smaller pedicular width.
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Affiliation(s)
- Mun Keong Kwan
- 1 Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- 1 Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- 1 Department of Orthopaedic Surgery (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia
| | - Reza Zamani
- 2 Department of Spine Surgery, Orthocentrum Hamburg, Parkklinik Manhagen, Hansastrasse, Hamburg, Germany
| | - Nils Hansen-Algenstaedt
- 2 Department of Spine Surgery, Orthocentrum Hamburg, Parkklinik Manhagen, Hansastrasse, Hamburg, Germany.,3 Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Chiu CK, Chan CYW, Kwan MK. The accuracy and safety of fluoroscopic-guided percutaneous pedicle screws in the thoracic and lumbosacral spine in the Asian population: A CT scan analysis of 1002 screws. J Orthop Surg (Hong Kong) 2018; 25:2309499017713938. [PMID: 28705124 DOI: 10.1177/2309499017713938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study investigates the safety and accuracy of percutaneous pedicle screws placed using fluoroscopic guidance in the thoracolumbosacral spine among Asian patients. METHODS Computerized tomography scans of 128 patients who had surgery using fluoroscopic-guided percutaneous pedicle screws were selected. Medial, lateral, superior, and inferior screw perforations were classified into grade 0 (no violation), grade 1 (<2 mm perforation), grade 2 (2-4 mm perforation), and grade 3(>4 mm perforation). Anterior perforations were classified into grade 0 (no violation), grade 1 (<4 mm perforation), grade 2 (4-6 mm perforation), and grade 3(>6 mm perforation). Grade 2 and grade 3 perforation were considered as "critical" perforation. RESULTS In total, 1002 percutaneous pedicle screws from 128 patients were analyzed. The mean age was 52.7 ± 16.6. There were 70 male patients and 58 female patients. The total perforation rate was 11.3% (113) with 8.4% (84) grade 1, 2.6% (26) grade 2, and 0.3% (3) grade 3 perforations. The overall "critical" perforation rate was 2.9% (29 screws) and no complications were noted. The highest perforation rates were at T4 (21.6%), T2 (19.4%), and T6 (19.2%). CONCLUSION The total perforation rate of 11.3% with the total "critical" perforation rate of 2.9% (2.6% grade 2 and 0.3% grade 3 perforations). The highest perforation rates were found over the upper to mid-thoracic region. Fluoroscopic-guided percutaneous pedicle screws insertion among Asians has the safety and accuracy comparable to the current reported percutaneous pedicle screws and open pedicle screws techniques.
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Affiliation(s)
- Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Accuracy and safety of fluoroscopic guided percutaneous pedicle screws in thoracic and lumbosacral spine: a review of 2000 screws. Spine (Phila Pa 1976) 2015; 40:E954-63. [PMID: 25929207 DOI: 10.1097/brs.0000000000000958] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To investigate the accuracy and safety of percutaneous pedicle screws placed using fluoroscopic guidance in the thoracic and lumbosacral spine. SUMMARY OF BACKGROUND DATA Several studies had examined the accuracy and safety of percutaneous pedicle screws but provided large variations in their results with small number of patients or few number of pedicle screws evaluated. METHODS Computerized tomography of patients who had surgery with fluoroscopic guided percutaneous pedicle screws were chosen from 2 centers: (1) European patients from University Medical Center Hamburg-Eppendorf, Germany and (2) Asian patients from University Malaya Medical Centre, Malaysia. Screw perforations were classified into Grade 0, Grade 1 (<2 mm), Grade 2 (2-4 mm), and Grade 3 (>4 mm). RESULTS In total, 2000 percutaneous pedicle screws from 273 patients were analyzed: 1290 screws from 183 European patients and 710 screws from 90 Asian patients. The mean age was 59.1 ± 15.6. There were 140 male patients and 133 female patients. The total perforation rate was 9.4% with 151 (7.5%) Grade 1, 31 (1.6%) Grade 2, and 5 (0.3%) Grade 3 perforations. The total perforation rates among Europeans were 9.4% and among Asians were 9.3%. There was no difference between the 2 groups (P > 0.05). There were 3 distinct peaks in perforation rates (trimodal distribution) at T1, midthoracic region (T4-T7), and lumbosacral junction (L5 and S1). The highest perforation rates were at T1 (33.3%), S1 (19.4%), and T4 (18.6%). CONCLUSION Implantation of percutaneous pedicle screws insertion using fluoroscopic guidance is safe and has the accuracy comparable to open techniques of pedicle screws insertion. LEVEL OF EVIDENCE 4.
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Kwan MK, Chiu CK, Chan CYW, Zamani R, Hansen-Algenstaedt N. A comparison of feasibility and safety of percutaneous fluoroscopic guided thoracic pedicle screws between Europeans and Asians: is there any difference? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015. [PMID: 26223743 DOI: 10.1007/s00586-015-4150-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To directly compare the safety of fluoroscopic guided percutaneous thoracic pedicle screw placement between Caucasians and Asians. METHODS This was a retrospective computerized tomography (CT) evaluation study of 880 fluoroscopic guided percutaneous pedicle screws. 440 screws were inserted in 73 European patients and 440 screws were inserted in 75 Asian patients. Screw perforations were classified into Grade 0: no violation; Grade 1: <2 mm perforation; Grade 2: 2-4 mm perforation; and Grade 3: >4 mm perforation. For anterior perforations, the pedicle perforations were classified into Grade 0: no violation, Grade 1: <4 mm perforation; Grade 2: 4-6 mm perforation; and Grade 3: >6 mm perforation. RESULTS The inter-rater reliability was adequate with a kappa value of 0.83. The mean age of the study group was 58.3 ± 15.6 years. The indications for surgery were tumor (70.3 %), infection (18.2 %), trauma (6.8 %), osteoporotic fracture (2.7 %) and degenerative diseases (2.0 %). The overall screw perforation rate was 9.7 %, in Europeans 9.1 % and in Asians 10.2 % (p > 0.05). Grade 1 perforation rate was 8.4 %, Grade 2 was 1.2 % and Grade 3 was 0.1 % with no difference in the grade of perforations between Europeans and Asians (p > 0.05). The perforation rate was the highest in T1 (33.3 %), followed by T6 (14.5 %) and T4 (14.0 %). Majority of perforations occurred medially (43.5 %), followed by laterally (25.9 %), and anteriorly (23.5 %). There was no statistical significant difference (p > 0.05) in the perforation rates between right-sided pedicle screws and left-sided pedicle screws (R: 10.0 %, L: 9.3 %). CONCLUSIONS There were no statistical significant differences in the overall perforation rates, grades of perforations, direction of perforations for implantation of percutaneous thoracic pedicle screws insertion using fluoroscopic guidance between Europeans and Asians. The safety profile for this technique was comparable to the current reported perforation rates for conventional open pedicle screw technique.
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Affiliation(s)
- Mun Keong Kwan
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University Malaya, 50603, Kuala Lumpur, Malaysia
| | - Reza Zamani
- Orthocentrum Hamburg, Department of Spine Surgery, Parkklinik Manhagen, Hansastrasse, Hamburg, Germany
| | - Nils Hansen-Algenstaedt
- Orthocentrum Hamburg, Department of Spine Surgery, Parkklinik Manhagen, Hansastrasse, Hamburg, Germany.,Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Gonzalvo A, Fitt G, Liew S, de la Harpe D, Vrodos N, McDonald M, Rogers MA, Wilde PH. Correlation between pedicle size and the rate of pedicle screw misplacement in the treatment of thoracic fractures: Can we predict how difficult the task will be? Br J Neurosurg 2015; 29:508-12. [DOI: 10.3109/02688697.2015.1019414] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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La Barbera L, Galbusera F, Villa T, Costa F, Wilke HJ. ASTM F1717 standard for the preclinical evaluation of posterior spinal fixators: Can we improve it? Proc Inst Mech Eng H 2014; 228:1014-26. [DOI: 10.1177/0954411914554244] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Preclinical evaluation of spinal implants is a necessary step to ensure their reliability and safety before implantation. The American Society for Testing and Materials reapproved F1717 standard for the assessment of mechanical properties of posterior spinal fixators, which simulates a vertebrectomy model and recommends mimicking vertebral bodies using polyethylene blocks. This set-up should represent the clinical use, but available data in the literature are few. Anatomical parameters depending on the spinal level were compared to published data or measurements on biplanar stereoradiography on 13 patients. Other mechanical variables, describing implant design were considered, and all parameters were investigated using a numerical parametric finite element model. Stress values were calculated by considering either the combination of the average values for each parameter or their worst-case combination depending on the spinal level. The standard set-up represents quite well the anatomy of an instrumented average thoracolumbar segment. The stress on the pedicular screw is significantly influenced by the lever arm of the applied load, the unsupported screw length, the position of the centre of rotation of the functional spine unit and the pedicular inclination with respect to the sagittal plane. The worst-case combination of parameters demonstrates that devices implanted below T5 could potentially undergo higher stresses than those described in the standard suggestions (maximum increase of 22.2% at L1). We propose to revise F1717 in order to describe the anatomical worst case condition we found at L1 level: this will guarantee higher safety of the implant for a wider population of patients.
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Affiliation(s)
- Luigi La Barbera
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering ‘Giulio Natta’, Politecnico di Milano, Milano, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | | | - Tomaso Villa
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering ‘Giulio Natta’, Politecnico di Milano, Milano, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Francesco Costa
- Department of Neurosurgery, Humanitas Clinical and Research Center, Milano, Italy
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre of Musculoskeletal Research Ulm (ZMFU), Ulm University, Ulm, Germany
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Morales-Avalos R, Leyva-Villegas J, Sánchez-Mejorada G, Cárdenas-Serna M, Vílchez-Cavazos F, De León ÁMP, Elizondo-Riojas G, Martínez-García J, De La Garza-Castro O, Elizondo-Omaña R, Guzmán-López S. Age- and gender-related variations in morphometric characteristics of thoracic spine pedicle. Clin Anat 2013; 27:441-50. [DOI: 10.1002/ca.22359] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 11/11/2013] [Accepted: 11/15/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Rodolfo Morales-Avalos
- Department of Human Anatomy; Faculty of Medicine, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Jorge Leyva-Villegas
- Department of Human Anatomy; Faculty of Medicine, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Gabriela Sánchez-Mejorada
- Laboratory of Physical Anthropology, Department of Human Anatomy; Faculty of Medicine, Universidad Nacional Autónoma de México, D.F; México
| | - Marcela Cárdenas-Serna
- Department of Human Anatomy; Faculty of Medicine, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Félix Vílchez-Cavazos
- Orthopedics and Traumatology Service; University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Ángel Martínez-Ponce De León
- Neurosurgery Service; University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Guillermo Elizondo-Riojas
- Department of Radiology; University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Jorge Martínez-García
- Department of Radiology; University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Oscar De La Garza-Castro
- Department of Human Anatomy; Faculty of Medicine, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Rodrigo Elizondo-Omaña
- Department of Human Anatomy; Faculty of Medicine, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
| | - Santos Guzmán-López
- Department of Human Anatomy; Faculty of Medicine, Universidad Autónoma de Nuevo León; Monterrey Nuevo León México
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