title: Safe and accurate placement of thoracic and thoracolumbar percutaneous pedicle screws without image-navigation.
abstract: BACKGROUND
  Percutaneous pedicle screw placement is now commonly used to treat spinal instability. It is imperative, especially at thoracic levels, to avoid damage to adjacent neurovascular structures. Although more technically demanding when compared with the lumbar spine, we believe that the percutaneous placement of thoracic pedicle screws can be performed safely without image-navigation.
  
  
  OBJECTIVE
  The purpose was to evaluate the safety of percutaneous pedicle screw placement in the thoracic and thoracolumbar spine without image-navigation.
  
  
  METHODS
  A retrospective study at a single institution.
  
  
  METHODS
  Patients over the age of 18 years who presented with degenerative disease, trauma or tumor that required surgical stabilization.
  
  
  METHODS
  Our outcomes included postoperative plain film X-rays and computerized tomography (CT).
  
  
  METHODS
  We performed a retrospective study of patients who underwent percutaneous pedicle screw placement without image-navigation between T2 and L2.
  
  
  RESULTS
  Between 2005 and 2011, a total of 507 pedicle screws were placed in 120 patients. The indications included trauma (17%), tumor (8%), and degenerative conditions (75%). The mean age was 61.3 years (range: 20-81 years). Fifty-seven percent were male, and 43% were female. The mean blood loss was 297 ± 40 ml. All patients underwent postoperative anterior-posterior and lateral films that showed safe placement of pedicle screws. Moreover, 57% of patients underwent postoperative CT imaging. There was 1 (0.4%) medial breach and 13 (5%) lateral breaches of the pedicle screw patients who underwent CT imaging as read by an independent neuroradiologist. None of the breaches resulted in adverse neurological sequelae either immediately after or at most recent follow-up.
  
  
  CONCLUSIONS
  Thoracic and thoracolumbar percutaneous pedicle screw placement can be performed safely and accurately without image-navigation.
authors.affiliation: Department of Neurosurgery, Ohio State University, Columbus, Ohio, USA.
authors.forename: Shahid M
authors.initials: SM
authors.lastname: Nimjee
authors.affiliation: Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Isaac O
authors.initials: IO
authors.lastname: Karikari
authors.affiliation: Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Carolyn A Hardin
authors.affiliation: Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Ohio State University, Columbus, Ohio, USA.
authors.forename: Ciaran J
authors.initials: CJ
authors.lastname: Powers
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Brown
authors.affiliation: Department of Surgery, Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Isaacs
keywords: Pedicle screw; percutaneous; thoracic spine