title: Accuracy of using computed tomography to identify pedicle screw placement in cadaveric human lumbar spine.
abstract: METHODS
  Utility of using computed tomography to predict pedicle screw misplacement.
  
  
  OBJECTIVE
  This study defines the sensitivity and specificity of predicting pedicle screw placement by experienced clinicians using a CT scan image.
  
  
  BACKGROUND
  In clinical and research settings, the method most commonly used to evaluate pedicle screws placement has been computed tomography. However, no current literature describes the accuracy of this method of evaluating screw placement.
  
  
  METHODS
  Cobalt-chrome and titanium alloy pedicle screws of identical size were placed in six cadaveric human lumbar spine. Wide laminectomy was performed to allow complete visualization of the pedicles. Three consecutive lumbar levels were instrumented in each spine, giving 36 pedicle screw placements to identify. The instrumented spines were imaged, and four orthopaedic spine surgeons and a musculoskeletal radiologist were asked to read the images to identify the accuracy of screw placement within the pedicles.
  
  
  RESULTS
  The sensitivity rate of identifying a misplaced screw was 67 +/- 6% for cobalt-chrome screws compared with 86 +/- 5% for titanium screws (P < 0.005). The specificity rates of radiographic diagnosis of misplaced pedicle screws were 66 +/- 10% for cobalt-chrome screws and 88 +/- 8% for titanium screws (P < 0.005). Similarly, a statistically significant difference was found in the sensitivity rates of identifying screws placed correctly in the pedicle: 70 +/- 10% for cobalt-chrome screws versus 89 +/- 8% for titanium screws (P < 0.005). Overall accuracy rates were 68 +/- 7% for cobalt chrome screws versus 87 +/- 3% for titanium screws (P < 0.002).
  
  
  CONCLUSIONS
  Reliance on the computed tomography scan data alone in determining accuracy of pedicle screws can lead to inaccuracies in both clinical and research conditions.
authors.affiliation: Department of Orthopedic Surgery, University Hospitals of Cleveland and Case Western Reserve University, OH 44106, USA.
authors.forename: J U
authors.initials: JU
authors.lastname: Yoo
authors.forename: A
authors.initials: A
authors.lastname: Ghanayem
authors.forename: C
authors.initials: C
authors.lastname: Petersilge
authors.forename: J
authors.initials: J
authors.lastname: Lewin
mesh_terms: D016477:Artifacts; D001863:Bone Screws; D002102:Cadaver; D002857:Chromium; D003035:Cobalt; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013123:Spinal Fusion; D014025:Titanium; D014057:Tomography, X-Ray Computed / Q000592:standards*
chemical_list: D002857:Chromium; D003035:Cobalt; D014025:Titanium