title: Thoracic pedicle screw fixation in spinal deformities: are they really safe?
abstract: METHODS
  A retrospective study.
  
  
  OBJECTIVE
  To determine the safety of pedicle screw fixation in thoracic deformity correction.
  
  
  BACKGROUND
  Pedicle screw fixation enables enhanced correction of spinal deformities. However, the technique is still not widely applied for thoracic deformities for fear of neurologic complications.
  
  
  METHODS
  A total of 462 patients subjected to thoracic pedicle screw fixation for spinal deformities were analyzed after a minimum follow-up of 2 years. Etiologic diagnoses were idiopathic scoliosis in 330, congenital kyphoscoliosis in 68, kyphosis in 50, and others in 14. They were reviewed using the medical records and preoperative, intraoperative, and postoperative roentgenograms. Computed tomography was performed when screw position was questionable.
  
  
  RESULTS
  A total of 4604 thoracic pedicle screws were inserted (10.1 screws/patient). There were 67 screw malpositions (1.5%) in 48 patients (10.4%). The malpositions were inferior in 33, lateral in 18, superior in 12, and medial in 4. Screw-related neurologic complications occurred in four patients (0.8%); these comprised a transient paraparesis and three dural tears. Other complications comprised 11 intraoperative pedicle fractures, 35 screw loosenings, 9 postoperative infections, and 1 pneumothorax. There were no significant screw-related neurologic or visceral complications that adversely affected the long-term result. The deformity correction was 69.9% for idiopathic scoliosis and 60.7% for congenital scoliosis. The sagittal plane deformity correction was 47 degrees for kyphosis.
  
  
  CONCLUSIONS
  Thoracic pedicle screw fixation is a reliable method of treating spinal deformities, with an excellent deformity correction and a high margin of safety.
authors.affiliation: Seoul Spine Institute, Inje University Paik Hospital, Seoul, Korea. seilsuk@unitel.co.kr
authors.forename: S I
authors.initials: SI
authors.lastname: Suk
authors.forename: W J
authors.initials: WJ
authors.lastname: Kim
authors.forename: S M
authors.initials: SM
authors.lastname: Lee
authors.forename: J H
authors.initials: JH
authors.lastname: Kim
authors.forename: E R
authors.initials: ER
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004868:Equipment Failure; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects; D007738:Kyphosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation*; D013904:Thoracic Vertebrae / Q000601:surgery*