title: Comparison of computerized tomography and direct visualization in thoracic pedicle screw placement.
abstract: OBJECTIVE
  To validate computerized tomography (CT) scanning as a tool to assess the accuracy of thoracic pedicle screw placement, the authors compared its accuracy with that of direct visualization in instrumented cadaveric spine specimens.
  
  
  METHODS
  A grading scale was devised to score the placement of the pedicle screw. The grades ranged from 0 to 3 depending on the extent to which the pedicle had been violated. One hundred fifty-five pedicles were fitted with instrumentation in eight cadaveric spines. A single observer graded the appearance of the screw based on CT scans (3-mm axial sections with 1-mm overlap) and direct visualization of the specimen. The authors arrived at a Kappa value of 0.51, which suggested only moderate agreement between the two measurement techniques. Whereas CT had a positive predictive value of 95%, it had a negative predictive value of 62%.
  
  
  CONCLUSIONS
  The authors thus conclude that although CT scanning is the most valid tool to assess the accuracy of thoracic pedicle screw placement, it tends to overestimate the number of misplaced screws.
authors.affiliation: Department of Neurosurgery, University of Utah, Salt Lake City 84132, USA.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Rao
authors.forename: Darrel S
authors.initials: DS
authors.lastname: Brodke
authors.forename: Matthew
authors.initials: M
authors.lastname: Rondina
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Dailey
mesh_terms: D000328:Adult; D001863:Bone Screws; D006801:Humans; D012680:Sensitivity and Specificity; D013123:Spinal Fusion / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed