title: Minimally invasive screw fixation of fractures in the thoracic spine: CT-controlled pre-surgical guidewire implantation in routine clinical practice.
abstract: OBJECTIVE
  To evaluate the feasibility and accuracy of minimally invasive, transpedicular screw placement in cervicothoracic fractures with the help of computed tomography (CT)-controlled guidewires.
  
  
  METHODS
  Two hundred and ninety-three guidewires were inserted in 35 patients (42.9±21.2 years) under CT fluoroscopy (286 thoracic, seven cervical). There were 28 traumatic cases, three pathological fractures, three fractures due to infectious infiltrations, and one osteoporotic fracture. In 151 pedicles, screw placement was performed in the CT room. CT images were reviewed regarding accuracy and cortical violations using the popular 2 mm increment deviation classification of Gertzbein and Robbins.
  
  
  RESULTS
  Guidewire implantation resulted in only 28 cortical contacts. Minor encroachments of the pedicle wall by inserted screws occurred in 39.1% (59 of 151) and in 23.8% if taking unavoidable encroachments into account (30 of 59). Pedicular isthmus width correlated to cortical guidewire contacts (r=-0.449; p=0.077) and pedicle violations (all graded "A") by the inserted screws (r=-0.581; p=0.049). Total procedural duration was 138.6±44.2 minutes, representing 14.5±11.6 minutes for each pedicle, while showing a significant correlation against higher vertebral levels (r=-0.849; p=0.0002) and the occurrence of pedicle violations (r=-0.641; p=0.027).
  
  
  CONCLUSIONS
  The treatment of vertebral fractures with a guidewire-based pedicle screw insertion technique under CT imaging results in very high accuracy and a low complication rate.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. Electronic address: sebastian.fischer@kgu.de.
authors.forename: S
authors.initials: S
authors.lastname: Fischer
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: T J
authors.initials: TJ
authors.lastname: Vogl
authors.affiliation: Dr. Mohr and Colleagues, Carl-Ulrich Street 2, 63263 Neu-Isenburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Kresing
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Marzi
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Zangos
authors.affiliation: Radiology Munich, Burgstraße 7, 80331 Munich, Germany.
authors.forename: M G
authors.initials: MG
authors.lastname: Mack
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Eichler
mesh_terms: D000328:Adult; D001863:Bone Screws; D005240:Feasibility Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D015203:Reproducibility of Results; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods*