The "slide technique": an improvement on the "funnel technique" for safe pedicle screw placement in the thoracic spine.
METHODS
Technical note.


OBJECTIVE
To report and describe a new free-hand technique for pedicle screw placement in the thoracic spine especially in severe deformities. Because of distortion of anatomic landmarks scoliosis, this free-hand placement technique based on pedicle access through the decancelled transverse process is a safe procedure.


METHODS
Transverse process is widely exposed and its posterior cortex is decorticated. The cancellous bone content of the transverse process is completely removed using a small curette. Bone wax is applied to avoid local bleeding and then the decancelled transverse process is inspected. The entry of the pedicle is then easily identified by the presence of remaining cancellous bone. A pedicular probe is then inserted and gently advanced. During pedicle probe insertion, the cortex of the anterior aspect of transverse process and the lateral margin of the pedicle act as a "slide" to permit safe insertion of the instrument.


RESULTS
In our experience, no patient required additional procedures for screw revision, and no neurologic deficit occurred stemming from malpositioning of pedicle screws. The key point of the "slide technique" is to use the cortex of the anterior aspect of transverse process and the lateral margin of the pedicle as a "slide" to permit correct probe positioning during pedicle probe insertion.


CONCLUSIONS
This technique is very close to the "funnel technique". The "funnel" and then the "slide" technique are mostly useful in complex spinal deformities as in neuromuscular patients. The "slide technique" is a safe, effective and cost-effective technique for pedicle screw placement in the thoracic spine especially in severe deformities.


METHODS
IV.
Department of Pediatric Orthopaedics, Université Pierre et Marie Curie Paris 6, Armand Trousseau Hospital, 26 avenue du Dr Arnold Netter, 75571, Paris Cedex 12, France, raphael.vialle@trs.aphp.fr.
Raphaël
R
Vialle
Reinhard
R
Zeller
Robert W
RW
Gaines
D000293:Adolescent; D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks; D001863:Bone Screws; D005260:Female; D006801:Humans; D008297:Male; D009468:Neuromuscular Diseases / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control*; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed