title: Accuracy of Percutaneous Pedicle Screw Insertion Technique with Conventional Dual Fluoroscopy Units and a Retrospective Comparative Study Based on Surgeon Experience.
abstract: Study Design Retrospective comparative study. Objective To evaluate the accuracy of percutaneous pedicle screw (PPS) placement and intraoperative imaging time using dual fluoroscopy units and their differences between surgeons with more versus less experience. Methods One hundred sixty-one patients who underwent lumbar fusion surgery were divided into two groups, A (n = 74) and B (n = 87), based on the performing surgeon's experience. The accuracy of PPS placement and radiation time for PPS insertion were compared. PPSs were inserted with classic technique under the assistance of dual fluoroscopy units placed in two planes. The breach definition of PPS misplacement was based on postoperative computed tomography (grade I: no breach; grade II: <2 mm; grade III: ≤2 to <4 mm). Results Of 658 PPSs, only 21 screws were misplaced. The breach rates of groups A and B were 3.3% (grade II: 3.4%, grade III: 0%) and 3.1% (grade II: 2.6%, grade III: 0.6%; p = 0.91). One patient in grade III misplacement had a transient symptom of leg numbness. Median radiation exposure time during PPS insertion was 25 seconds and 51 seconds, respectively (p < 0.01). Conclusions Without using an expensive imaging support system, the classic technique of PPS insertion using dual fluoroscopy units in the lumbar and sacral spine is fairly accurate and provides good clinical outcomes, even among surgeons lacking experience.
authors.affiliation: Department of Spinal Surgery, Fukuoka Wajiro Hospital, Fukuoka, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakahara
authors.affiliation: Department of Spinal Surgery, Shinkomonji Hospital, Fukuoka, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Yasuhara
authors.affiliation: Department of Spinal Surgery, Fukuoka Wajiro Hospital, Fukuoka, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Department of Spinal Surgery, Shinkomonji Hospital, Fukuoka, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Spinal Surgery, Shinkomonji Hospital, Fukuoka, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Kumamoto
authors.affiliation: Department of Spinal Surgery, Shinkomonji Hospital, Fukuoka, Japan.
authors.forename: Yasukazu
authors.initials: Y
authors.lastname: Hijikata
authors.affiliation: Department of Spinal Surgery, Shinkomonji Hospital, Fukuoka, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Kusumegi
authors.affiliation: Department of Spinal Surgery, Shinkomonji Hospital, Fukuoka, Japan.
authors.forename: Yushi
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Department of Spinal Surgery, Shinkomonji Hospital, Fukuoka, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Ogawa
authors.affiliation: Department of Spinal Surgery, Shinkomonji Hospital, Fukuoka, Japan.
authors.forename: Kenki
authors.initials: K
authors.lastname: Nishida
keywords: accuracy; dual fluoroscopy units; percutaneous pedicle screw; radiation exposure; surgeon experience