[A new kind of grade system for thoracic pedicle screw placement and its clinical purpose].
OBJECTIVE
To introduce a new kind of grade system for thoracic pedicle screws placement by performing postoperative computerized tomography (CT) scanning and discussion the clinical purpose.


METHODS
Four hundred and fifty thoracic pedicle screws were implanted in 64 patients with the assistance of fluoroscopy. Postoperative CT scanning was conducted to determine a grade for each screw: Part A, screw entirely contained within pedicle; Part B(1), violate lateral or upper pedicle but screw tip entirely contained within the vertebral body (VB); Part B(2), violate medial or inferior of pedicle; Part B(3), tip penetrated anterior or lateral VB; Part C, violate pedicle or VB and endangers spinal cord, nerve roots, or great vessels. Based on anatomical morphometry, thoracic vertebral were subdivided into upper (T(1 - 2)), middle (T(3 - 6)), and lower (T(7 - 12)) regions. The mean follow-up period was 25.8 months.


RESULTS
The postoperative CT scanning-documented grade were determined: Part A, 367 screws (81.6%); Part B, 78 (17.3%), B(1) 40 (8.1%); Part B(2), 23 (5.1%); Part B(3), 15 (3.4%); Part C, 5 (1.1%). There were not significant difference between upper and lower thoracic that the placement of pedicle screws in part B or C. In part C, 5 pedicle screws were all in the middle thoracic.


CONCLUSIONS
Postoperative CT scanning should be considered as a routine examination for evaluating thoracic pedicle screw placement.
Wu
Ye
Y
Institute of Orthopaedics, the 304 clinical department of the general hospital of People's Liberation Army, Beijing 100037, China.
Hou
Shu-xun
SX
Wu
Wun-wen
WW
Peng
Bao-jin
BJ
Wang
Hua-dong
HD
Wei
Xing
X
Shi
Ya-min
YM
D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods