Transpedicular Stabilization with Freehand Technique on the Thoracic Spine

Abstract

The use of pedicle screws has become popular during the past decade, first in applications involving the lumbar spine and subsequently in thoracic spine surgery. Pedicle screws also prevent the need to place instrumentation within the spinal canal-like sublaminar wiring or hooks which create the risk of neurological injury. Transpedicular stabilization (TS) has been shown to resist flexion and extension loads, as well as torsional loads better than other devices. Especially in spinal deformity surgery, the use of TS provides better correction and maintenance than system with hooks and wires. Disadvantages of pedicular screws are related to the misplacement of pedicle screws which can lead to disastrous complications such as vascular or neural injuries. Accurate and safe placement of screw within the pedicle is a crucial step during the surgery. There are many proven techniques used to insert pedicle screws, including fluoroscopic or radiographic guidance, stereotactic guidance system based on computed tomography, direct visualization of pedicle with the use of a laminotomy, and the freehand technique (without intraoperative image guidance). The freehand techniques use established surface landmarks and direct palpation of internal pedicle and vertebral structure. The objective of this chapter is to describe the freehand technique for transpedicular stabilization in the thoracic spine.