title: Image guided percutaneous trans-pedicular screw fixation of the thoracic spine. A clinical evaluation.
abstract: OBJECTIVE
  We report our preliminary experience with a minimally invasive image guided percutaneous trans-pedicular fixation technique of the thoracic spine in patients with significant co-morbidity. This study aims to demonstrate the feasibility and efficacy of the presented operative technique as well as to detect potential drawbacks.
  
  
  METHODS
  A navigated percutaneous application of trans-pedicular screws was performed in 14 patients with radiological validated instability of the thoracic spine and significant medical co-morbidity. Due to poor bone quality, vertebroplasty of the affected levels had to be performed in nine patients. The levels involved were (T9-12) in ten patients, the middle (T5-8) in two patients and the upper thoracic (T1-4) segments in two others. VAS scores for local back pain were used to assess clinical outcome.
  
  
  RESULTS
  A total of 56 screws were inserted. There was no additional morbidity associated with the procedure. Post-operative CT scans and plain X-rays were obtained in all patients. In 2 (3.5%) medial penetration of the pedicle border occurred without neurological sequelae for the patient. Reduction of VAS scores regarding back pain during the first post-operative week was noted. Follow up ranged between 6 months and 12 months.
  
  
  CONCLUSIONS
  Navigated percutaneous trans-pedicular fixation of the thoracic spine is feasible and can be performed safely in patients where open surgery is of significant risk. Pre-operative planning is essential in order to avoid intra-operative complications with the instrumentation system.
authors.affiliation: Department of Neurosurgery, University of Freiburg, Freiburg im Breisgau, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hubbe
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kogias
authors.forename: Vassilios I
authors.initials: VI
authors.lastname: Vougioukas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D007796:Laminectomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010014:Osteolysis / Q000150:complications / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome