Acta Neurochirurgica

, Volume 159, Issue 10, pp 2011–2017 | Cite as

Accuracy of 837 pedicle screw positions in degenerative lumbar spine with conventional open surgery evaluated by computed tomography

  • Ilkka Saarenpää
  • Timo Laine
  • Jussi Hirvonen
  • Saija Hurme
  • Esa Kotilainen
  • Jaakko Rinne
  • Katariina Korhonen
  • Janek Frantzén
Original Article - Spine
First Online:
Received:
Accepted:

Abstract

Background

The spatial and directional accuracy of the positioning of pedicle screws in the lumbosacral spine with conventional open surgery assessed by computed tomography (CT) has been published in several studies, systematic reviews and meta-analyses with a short-term follow-up. Inaccurate pedicle screw insertion may cause neurologic symptoms and weakens the construct.

Methods

The data of 147 patients operated on with transpedicular screw fixation based on anatomical landmarks, supported by fluoroscopy, by a senior neurosurgeon in our clinic between 2000 and 2010 were analyzed retrospectively. The accuracy of the pedicle screw position was assessed by using postoperative CT images and graded in 2-mm increments up to 6 mm by two independent surgeons and partly by an independent radiologist.

Results

A total of 837 lumbosacral pedicle screws were inserted in 147 randomly selected patients by a senior neurosurgeon. A mean accuracy of 85.7% of the screws being inside the pedicles was identified by the surgeon observers, with 3.3% being perforated 4 mm or more outside the pedicles. Postoperative neurologic symptoms were observed on the side corresponding to the breach in an average of 25.9% of patients with pedicle perforations, and 89.2% of the misplaced screws were either medially or inferiorly inserted.

Conclusions

Screw application reached a mean accuracy of 85.7% based on anatomical landmarks supported by fluoroscopy, warranting computer-assisted navigation for increased accuracy. Our results of 24 patients (16.3%) with the breached screws indicate that the direction of the breach may be more important than the absolute deviation in causing new neurologic symptoms.

Keywords

Spinal fusion Pedicle screw Transpedicular screw fixation Lumbar spine 
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Notes

Compliance with ethical standards

Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

Permission to carry out this retrospective study was performed without contacting the patients. Permission from the hospital administration for this registry-based study was obtained before the initiation of the study. The study material is collected from the patient records and radiologic images. The used instrumentation and bone graft materials are not investigational devices, since they all are CE marked.

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Copyright information

© Springer-Verlag GmbH Austria 2017

Authors and Affiliations

  1. 1.Division of Clinical Neurosciences, Department of NeurosurgeryTurku University HospitalTurkuFinland
  2. 2.Department of Clinical MedicineUniversity of TurkuTurkuFinland
  3. 3.ORTON Orthopaedic HospitalHelsinkiFinland
  4. 4.Department of RadiologyTurku University HospitalTurkuFinland
  5. 5.Department of BiostatisticsUniversity of TurkuTurkuFinland
  6. 6.Pargas Healthcare CenterPargasFinland

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