Clinical accuracy of cervical pedicle screw insertion using lateral fluoroscopy: a radiographic analysis of the learning curve

Abstract

Cervical pedicle screw is thought to be the most stable instrumentation for reconstructive surgery of the cervical spine. However, because of the unresolved and inherent risk of neurovascular injuries due to screw perforation, it remains not widespread nowadays despite the excellent biomechanical property. Fifty-two consecutive cases having undergone spinal reconstruction using cervical pedicle screw were investigated. There were 24 females and 28 males. The mean follow-up period was 53 months. Those patients were stratified into three groups according to the period of screw insertion. A total of 280 screws were inserted. Ninety-two screws in 19 cases, 100 screws in 18 cases and 88 screws in 15 cases were inserted in the earlier, the middle and the later periods, respectively. Clinical results including complications were recorded in all cases. Screw perforations were evaluated in both plain X-ray and CT. Screw perforations occurred in 11 (12.0%), 7 (7.0%) and 1 (1.1%) screws in each period. There were no complications, such as infection, neurological deterioration and neurovascular injury directly related to screw insertion. The learning curve showed a significant improvement especially in the later period. However, the perforation rates in both the earlier and middle periods must not be underestimated. Surgeons with less experience must insert cervical pedicle screws with the assistance of a senior surgeon to avoid lethal complications.

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Acknowledgments

No funds were received in support of this work. No benefits in any form have been or will be received from any commercial party related directly or indirectly to the subject of this manuscript. The devices used in the current study, i.e. the CPS system and the Axon system, have not been approved by the Food and Drug Administration in the United States.

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Correspondence to Hisashi Yoshimoto.

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Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Yoshimoto, H., Sato, S., Hyakumachi, T. et al. Clinical accuracy of cervical pedicle screw insertion using lateral fluoroscopy: a radiographic analysis of the learning curve. Eur Spine J 18, 1326–1334 (2009). https://doi.org/10.1007/s00586-009-1109-3

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Keywords

  • Cervical spine
  • Pedicle screw
  • Accuracy
  • Screw perforation
  • Learning curve