[Computerized tomography monitoring of the position of pedicle screws in scoliosis surgery].
With the increasing use of pedicle screws in instrumented spine surgery the neurological risk must be evaluated critically. Studies, which evaluated the accuracy of pedicle screw placement in scoliosis surgery, have not been published up to date to our knowledge. In 25 consecutive patients with idiopathic scoliosis, who underwent posterior instrumented curve correction and stabilization, the accuracy of pedicle screw placement was evaluated using axial computed tomography. There was a total of 178 screws between T5 and L4. The preoperative Cobb angle of the curve averaged 60.7 degrees, the mean rotation of the instrumented vertebrae was 19.1 degrees according to Perdriolle. 145 pedicle screws (81.5%) were placed correctly within the pedicles, of which 4 screws (4.5%) penetrated the anterior aspect of the vertebral body with a mean of 0.9 mm. 22 screws (12.4%) showed lateral penetration of the pedicle with a mean of 1.9 mm, of which one screw was placed completely lateral of the pedicle. 8 screws (4.5%) penetrated the medial wall of the pedicle by 1.3 mm on average. One screw each penetrated the cranial and caudal border of the pedicle. Statistical analysis did not reveal any significant relationships between pedicle screw misplacement and grade of vertebral rotation or site of instrumentation. Neurological complications were not noted in any of the cases. In our mind the risk of pedicle screw threaded curve correction and fusion in scoliosis surgery in the hands of an experienced spine surgeon is calculated acceptably low.
Halm
H
H
Klinik und Poliklinik für Allgemeine Orthopädie, Westfälische Wilhelms-Universität Münster.
Liljeqvist
U
U
Link
T
T
Jerosch
J
J
Winkelmann
W
W
D001863:Bone Screws / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D018570:Risk Assessment; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation; D013127:Spinal Nerves / Q000293:injuries; D014057:Tomography, X-Ray Computed