Evaluation of a Transpedicular Drill Guide for Pedicle Screw Placement in the Thoracic Spine

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2003 Jun 5

PMID 12783286

Citations 12

Authors

Jean-Marc Mac-Thiong

Hubert Labelle

Marcel Rooze

Veronique Feipel

Carl-Eric Aubin

Affiliations

Soon will be listed here.

Abstract

Insertion of pedicle screws in the thoracic spine is technically difficult and may lead to major complications. Although many computer-assisted systems have been developed to optimize pedicle screw insertion, these systems are expensive, not user-friendly and involve significant radiation from pre-operative computed tomographic (CT) scan imaging. This study describes and evaluates a transpedicular drill guide (TDG) designed to assist in the proper placement of pedicle screws in the thoracic spine. Pilot holes were made manually using the TDG in the thoracic spine (T1-T11) of three human cadavers before inserting 4.5-mm-diameter screws. CT scans followed by visual inspection of the spines were performed to evaluate the position of the screws. Five of 66 screws (7.6%) violated the pedicle wall: two (3.0%) medially and three (4.5%) laterally. The medial and lateral perforations were within 1 mm and 2 mm of the pedicle wall, respectively. The medial perforations were not at risk of causing neurological complications. No screw penetrated the superior or inferior pedicle wall. The TDG is easy to use and can decrease the incidence of misplaced thoracic pedicle screws. The TDG could be used as a complement to fluoroscopy in certain applications, especially for training surgeons.

Citing Articles

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Dennler C, Jaberg L, Spirig J, Agten C, Gotschi T, Furnstahl P J Orthop Surg Res. 2020; 15(1):174.

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References

Foley K, Simon D, Rampersaud Y . Virtual fluoroscopy: computer-assisted fluoroscopic navigation. Spine (Phila Pa 1976). 2001; 26(4):347-51. DOI: 10.1097/00007632-200102150-00009. View

Ebraheim N, Jabaly G, Xu R, Yeasting R . Anatomic relations of the thoracic pedicle to the adjacent neural structures. Spine (Phila Pa 1976). 1997; 22(14):1553-6; discussion 1557. DOI: 10.1097/00007632-199707150-00002. View

SUK S, Lee C, Kim W, Chung Y, Park Y . Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine (Phila Pa 1976). 1995; 20(12):1399-405. View

Youkilis A, Quint D, McGillicuddy J, Papadopoulos S . Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery. 2001; 48(4):771-8; discussion 778-9. DOI: 10.1097/00006123-200104000-00015. View

Roy-Camille R, Saillant G, Mazel C . Plating of thoracic, thoracolumbar, and lumbar injuries with pedicle screw plates. Orthop Clin North Am. 1986; 17(1):147-59. View

Liljenqvist U, Allkemper T, Hackenberg L, Link T, Steinbeck J, Halm H . Analysis of vertebral morphology in idiopathic scoliosis with use of magnetic resonance imaging and multiplanar reconstruction. J Bone Joint Surg Am. 2002; 84(3):359-68. DOI: 10.2106/00004623-200203000-00005. View

Bolger C, Wigfield C . Image-guided surgery: applications to the cervical and thoracic spine and a review of the first 120 procedures. J Neurosurg. 2000; 92(2 Suppl):175-80. DOI: 10.3171/spi.2000.92.2.0175. View

Weinstein J, Spratt K, Spengler D, Brick C, Reid S . Spinal pedicle fixation: reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement. Spine (Phila Pa 1976). 1988; 13(9):1012-8. DOI: 10.1097/00007632-198809000-00008. View

Xu R, Ebraheim N, Shepherd M, Yeasting R . Thoracic pedicle screw placement guided by computed tomographic measurements. J Spinal Disord. 1999; 12(3):222-6. View

10.

Parent S, Labelle H, Skalli W, Latimer B, De Guise J . Morphometric analysis of anatomic scoliotic specimens. Spine (Phila Pa 1976). 2002; 27(21):2305-11. DOI: 10.1097/00007632-200211010-00002. View

11.

Reynolds Jr A, Roberts P, Pollay M, Stratemeier P . Quantitative anatomy of the thoracolumbar epidural space. Neurosurgery. 1985; 17(6):905-7. DOI: 10.1227/00006123-198512000-00006. View

12.

Liljenqvist U, Halm H, Link T . Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine (Phila Pa 1976). 1997; 22(19):2239-45. DOI: 10.1097/00007632-199710010-00008. View

13.

Papin P, Arlet V, Marchesi D, Rosenblatt B, Aebi M . Unusual presentation of spinal cord compression related to misplaced pedicle screws in thoracic scoliosis. Eur Spine J. 1999; 8(2):156-9. PMC: 3611145. DOI: 10.1007/s005860050147. View

14.

Zindrick M, Wiltse L, Doornik A, Widell E, Knight G, Patwardhan A . Analysis of the morphometric characteristics of the thoracic and lumbar pedicles. Spine (Phila Pa 1976). 1987; 12(2):160-6. DOI: 10.1097/00007632-198703000-00012. View

15.

Nolte L, Slomczykowski M, Berlemann U, Strauss M, Hofstetter R, Schlenzka D . A new approach to computer-aided spine surgery: fluoroscopy-based surgical navigation. Eur Spine J. 2000; 9 Suppl 1:S78-88. PMC: 3611449. DOI: 10.1007/pl00010026. View

16.

Van Sint Jan S, Rooze M . The thenar muscles. New findings. Surg Radiol Anat. 1992; 14(4):325-9. DOI: 10.1007/BF01794759. View

17.

Ebraheim N, Xu R, Ahmad M, Yeasting R . Projection of the thoracic pedicle and its morphometric analysis. Spine (Phila Pa 1976). 1997; 22(3):233-8. DOI: 10.1097/00007632-199702010-00001. View

18.

Ugur H, Attar A, Uz A, Tekdemir I, Egemen N, Genc Y . Thoracic pedicle: surgical anatomic evaluation and relations. J Spinal Disord. 2001; 14(1):39-45. DOI: 10.1097/00002517-200102000-00007. View

19.

Belmont Jr P, Klemme W, Dhawan A, Polly Jr D . In vivo accuracy of thoracic pedicle screws. Spine (Phila Pa 1976). 2001; 26(21):2340-6. DOI: 10.1097/00007632-200111010-00010. View

20.

Liljenqvist U, Hackenberg L, Link T, Halm H . Pullout strength of pedicle screws versus pedicle and laminar hooks in the thoracic spine. Acta Orthop Belg. 2001; 67(2):157-63. View