Fluoroscopically assisted pedicle screw fixation for thoracic and thoracolumbar injuries: technique and short-term complications.
METHODS
Retrospective review of charts and fluoroscopic, radiographic, and computed tomography images for 252 screws (41 patients).


OBJECTIVE
To describe a fluoroscopically assisted technique of thoracic pedicle screw insertion and to determine the technique's safety, short-term complications, and accuracy.


BACKGROUND
Pedicle screw instrumentation is safe and effective for lumbar spine stabilization, but evidence of its accuracy and complications in the thoracic spine is lacking.


METHODS
Between 1997 and 2000, 41 consecutive patients with unstable cervicothoracic, thoracic, and thoracolumbar spine injuries were admitted to a regional, level 1 trauma center. These patients underwent posterior spine arthrodesis and pedicle screw instrumentation placed intraoperative multiplanar fluoroscopic imaging. Pedicle screw placement accuracy was determined by review of postoperative computed tomography scans. Instrumentation failure prevalence was determined by review of fluoroscopic images, postoperative radiographs, and computed tomography scans. Neurologic, infectious, vascular, and gastrointestinal complications were determined by review of operative reports, hospital records, and clinic notes.


RESULTS
Of the 126 (50%) thoracic screws (22 patients) with postoperative computed tomography scans, 16 (12.7%) penetrated the pedicle cortex (4 [2.4%] medially and 13 [10.3%] laterally) and 7 (5.6%) penetrated the vertebral body. There were four surgical complications: one instrumentation failure (broken rod, no loss of correction), one deep infection, and two superficial infections. The infections resolved with irrigation, debridement, and intravenous antibiotics. During the 6- to 24-month follow-up period, there were no neurologic, vascular, or gastrointestinal complications.


CONCLUSIONS
Cervicothoracic, thoracic, and thoracolumbar spine injuries can be managed safely and effectively with thoracic pedicle screws inserted under multiplanar fluoroscopic imaging.
Carbone
John J
JJ
Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA.
Tortolani
P Justin
PJ
Quartararo
Louis G
LG
D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws / Q000009:adverse effects; D002574:Cervical Vertebrae / Q000601:surgery; D002648:Child; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D013124:Spinal Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome