title: The awl-staple versus guidewire method for placing vertebral screws in thoracoscopic anterior spinal fusion and instrumentation for adolescent idiopathic scoliosis.
abstract: METHODS
  A retrospective chart and radiograph review in a consecutive series of patients at a single institution.
  
  
  OBJECTIVE
  To compare 2 methods of placing vertebral body screws in thoracoscopic anterior spinal fusion and instrumentation with respect to radiographic, clinical, and perioperative variables.
  
  
  BACKGROUND
  Placing vertebral body screws in thoracoscopic anterior spinal fusion and instrumentation for adolescent idiopathic scoliosis can be performed using 2 methods: the awl/staple technique and the guidewire method. There are no current studies that have compared both of these techniques.
  
  
  METHODS
  Two groups of patients were analyzed depending on the method of screw placement: The AS group (n=15) used the awl/staple method and the GW group (n=27) used the guidewire method. Surgical times and estimated blood loss were obtained from the medical record. Fluoroscopy times were obtained from the radiology technician. Preoperative posteroanterior standing, bending, and immediate postoperative radiographs were examined to determine the primary curve magnitude, postoperative curve correction, curve flexibility, and the Lenke classification.
  
  
  RESULTS
  The AS group had significantly less fluoroscopy times (156.6+/-71.4 vs. 328.4+/-171.6 s) and operative times (416.1+/-65.4 vs. 505.6+/-61.8 min) compared with the GW group (P<0.05). When calculating the duration per fusion level, the AS group was also shorter for fluoroscopy times (27.1+/-13.2 vs. 49.3+/-24.5 s/level) (P<0.05) and surgical times (72.0+/-15.2 vs. 76.9+/-9.8 min/level) (P=0.10). There was a trend toward a lower incidence of screw plow or pullout (0.0% vs. 14.8%) for the AS group (P=0.157).
  
  
  CONCLUSIONS
  The awl/staple technique is the preferred technique for placing vertebral body screws when performing thoracoscopic anterior spinal fusion/instrumentation because it has shorter fluoroscopy times, surgical times, and a lower incidence of screw plow/pullout than the traditional guidewire method.
authors.affiliation: Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, University of Texas at Southwestern Medical Center, Dallas, TX 75219, USA.
authors.forename: Sundeep
authors.initials: S
authors.lastname: Agrawal
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sucato
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D005260:Female; D006801:Humans; D008297:Male; D019990:Perioperative Care; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013906:Thoracoscopy / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome