Accuracy of Pedicle Screw Placement in Patients with Marfan Syndrome

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2017 Mar 23

PMID 28327138

Citations 5

Authors

Jun Qiao

Feng Zhu

Leilei Xu

Zhen Liu

Xu Sun

Bangping Qian

Qing Jiang

Zezhang Zhu

Yong Qiu

Affiliations

Soon will be listed here.

Abstract

Background: There is no study concerning safety and accuracy of pedicle screw placement in Marfan syndrome. The objective of this study is to investigate accuracy and safety of pedicle screw placement in scoliosis associated with Marfan syndrome.

Methods: CT scanning was performed to analyze accuracy of pedicle screw placement. Pedicle perforations were classified as medial, lateral or anterior and categorized to four grades: ≤ 2 mm as Grade 1, 2.1-4.0 mm as Grade 2, 4.1-6.0 mm as Grade 3, ≥6.1 mm as Grade 4. Fully contained screws or with medial wall perforation ≤ 2 mm or with lateral wall perforation ≤ 6 mm and without injury of visceral organs were considered acceptable, otherwise were unacceptable.

Results: 976 pedicle screws were placed, 713 screws (73.1%) were fully contained within the cortical boundaries of the pedicle. 924 (94.7%) screws were considered as acceptable, and 52 (5.3%) as unacceptable. The perforation rate was higher using free-hand technique than O-arm navigation technique (30.8% VS. 11.4%, P < 0.05), higher in lumbar region than in thoracic region (34.1% VS. 22.3%, P < 0.05) and higher in concave side than in convex side (33.5% VS. 21.9%, P < 0.05). No injury of visceral organs especially aorta erosion was noted in the series. 7 cases of dural tear caused by misplaced screws occurred, and 4 cases developed cerebro-spinal fluid leak. Drainage and pressure dressings were applied for these patients, and no infection was observed. Leg pain was observed in 7 cases, and 2 cases simultaneously complained of leg weakness. Revision surgery was conducted to remove the misplaced screws for these 2 patients. Conservative treatment was applied for the 5 patients without leg weakness. Symptoms of leg weakness and pain resolved in all patients.

Conclusion: Placement of pedicle screw in Marfan syndrome is accuracy and safe. O-arm navigation was an effective modality to ensure the safety and accuracy of screw placement. Special attention should be paid when screws were placed at the lumber spine and the concave side of spine deformity to avoid the higher rate of complications.

Citing Articles

Using a 3D Navigation Template to Increase the Accuracy of Thoracic Pedicle Screws in Patients with Scoliosis.

Jiang C, Shi Y, Sun Y, Cai M, Wu H, Hu L Bioengineering (Basel). 2023; 10(7).

PMID: 37508783 PMC: 10376895. DOI: 10.3390/bioengineering10070756.

Improved Accuracy and Safety of Pedicle Screw Placement by Using a Probe with an Electrical Conductivity-Measuring Device during Severe Syndromic and Neuromuscular Scoliosis Spine Surgery.

Yurube T, Kanda Y, Ito M, Takeoka Y, Suzuki T, Uno K J Clin Med. 2022; 11(2).

PMID: 35054113 PMC: 8778992. DOI: 10.3390/jcm11020419.

Sublaminar fixation versus hooks and pedicle screws in scoliosis surgery for Marfan syndrome.

Rava A, Dema E, Palmisani M, Palmisani R, Cervellati S, Girardo M J Craniovertebr Junction Spine. 2020; 11(1):26-30.

PMID: 32549709 PMC: 7274359. DOI: 10.4103/jcvjs.JCVJS_12_20.

Correction of Scoliosis with Large Thoracic Curves in Marfan Syndrome: Does the High-Density Pedicle Screw Construct Contribute to Better Surgical Outcomes.

Jiang D, Liu Z, Yan H, Li J, Tseng C, Yuan Y Med Sci Monit. 2019; 25:9658-9665.

PMID: 31846451 PMC: 6929550. DOI: 10.12659/MSM.918829.

Surgical treatment of spinal deformities in Marfan syndrome: Long-term follow-up results using different instrumentations.

Palmisani M, Dema E, Rava A, Palmisani R, Girardo M, Cervellati S J Craniovertebr Junction Spine. 2019; 10(3):172-178.

PMID: 31772430 PMC: 6868540. DOI: 10.4103/jcvjs.JCVJS_68_19.

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