Skip to main content

Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures: a prospective trial



The percutaneous insertion technique requires surgical skill and experience. However, there have been few clinical reports evaluating the accuracy of minimally invasive pedicle screw placement using the conventional fluoroscopy method. The purpose of this study was to evaluate the accuracy of percutaneous pedicle screw placement in the treatment of thoracic and lumbar spine fractures using two-plane conventional fluoroscopy.


A prospective clinical trial was performed. A total of 502 percutaneous pedicle screws in 111 patients, all inserted with the assistance of conventional fluoroscopy, were evaluated. The safety and accuracy of pedicle screw placement were based on the evaluation of postoperative axial 3-mm slice computed tomography scans using the scoring system described by Zdichavsky et al. [Eur J Trauma 30:234–240, 2004; Eur J Trauma 30:241–247, 2004].


427/502 pedicle screws (85 %) were classified as good and excellent concerning the best possible screw length and 494/502 (98 %) were found to have good or excellent position. One screw had to be revised due to medial position with a neurological deficit.


This study demonstrates the feasibility of placing percutaneous posterior thoracolumbar pedicle screws with the assistance of conventional fluoroscopy. Minimally invasive transpedicular instrumentation is an accurate, reliable and safe method to treat a variety of spinal disorders, including thoracic and lumbar spine fractures.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11


  1. Bednar DA, Raducan V (1996) External spinal skeletal fixation in the management of back pain. Clin Orthop 322:131–145

    PubMed  Google Scholar 

  2. Belmont PJ, Klemme WR, Dhawan A, Polly DW Jr (2001) In vivo accuracy of thoracic pedicle screws. Spine 26:2340–2346

    PubMed  Article  Google Scholar 

  3. Blattert TR, Katscher S, Josten C (2011) Percutaneous techniques in the thoracic and lumbar spine. Unfallchirurg 114(1):17–25

    PubMed  Article  CAS  Google Scholar 

  4. Esses SI, Botsford DJ, Kostuik JP (1989) The role of external spinal skeletal fixation in the assessment of low-back disorders. Spine 14:594–601

    PubMed  Article  CAS  Google Scholar 

  5. Fan S, Hu Z, Zhao F, Zhao X, Huang Y, Fang X (2010) Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach. Eur Spine J 19(2):316–324

    PubMed  Article  Google Scholar 

  6. Fan SW, Hu ZJ, Fang XQ, Zhao FD, Huang Y, Yu HJ (2010) Comparison of paraspinal muscle injury in one-level lumbar posterior inter-body fusion: modified minimally invasive and traditional open approaches. Orthop Surg 2(3):194–200

    PubMed  Article  Google Scholar 

  7. Gertzbein SD, Robbins SE (1990) Accuracy of pedicular screw placement in vivo. Spine 15:11–14

    PubMed  Article  CAS  Google Scholar 

  8. Grass R, Biewener A, Dickopf A (2006) Perkutane dorsale versus offene Instrumentation bei Fraktu-ren des thorakolumbalen Über-gangs: Eine vergleichende prospective Untersuchung. Unfallchirurg 109:297–305

    PubMed  Article  CAS  Google Scholar 

  9. Hirano T, Hasegawa K, Takahashi HE, Uchiyama S, Hara T, Washio T, Sugiura T, Yokaichiya M, Ikeda M (1997) Structural characteristics of the pedicle and its role in screw stability. Spine 22:2504–2509

    PubMed  Article  CAS  Google Scholar 

  10. Holly LT, Schwender JD, Rouben DP, Foley KT (2006) Minimally invasive transforaminal lumbar interbody fusion: indications, technique and complications. Neurosurg Focus 20:1–5

    Article  Google Scholar 

  11. Jeanneret B, Jovanovic M, Magerl F (1994) Percutaneous diagnostic stabilization for low back pain: correlation with results after fusion operations. Clin Orthop 304:130–138

    PubMed  Google Scholar 

  12. Liljenqvist UR, Halm HF, Link TM (1997) Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine 22:2239–2245

    PubMed  Article  CAS  Google Scholar 

  13. Lyon DW, Hall DJ, Mulholland RC, Webb JK (1993) The role of external fixation as a predictor of fusion success. In: Ono K, Takemitsu Y, Yonenobu K (eds) Lumbar fusion and stabilization. Springer, Tokyo, pp 25–34

    Chapter  Google Scholar 

  14. Magerl F (1980) Verletzungen der Burst- und Lendenwirbelsäule. Langenbecks Arch Chir 352:428–433

    Article  Google Scholar 

  15. Magerl F (1984) Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop 189:125–141

    PubMed  Google Scholar 

  16. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3(4):184–201

    PubMed  Article  CAS  Google Scholar 

  17. Nakashima H, Sato K, Ando T, Inoh H, Nakamura H (2009) Comparison of the percutaneous screw placement precision of isocentric C-arm 3-dimensional fluoroscopy-navigated pedicle screw implantation and conventional fluoroscopy method with minimally invasive surgery. J Spinal Disord Tech 22(7):468–472

    PubMed  Article  Google Scholar 

  18. Olerud S, Sjöström L, Karlström G, Hamberg M (1986) Spontaneous effect of increased stability of the lower lumbar spine in cases of severe chronic back pain: the answer of an external transpeduncular fixation test. Clin Orthop 203:67–74

    PubMed  Google Scholar 

  19. Park Y, Ha JW (2007) Comparison of one level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach. Spine 32:537–543

    PubMed  Article  Google Scholar 

  20. Polly DW Jr, Potter BK, Kuklo T, Young S, Johnson C, Klemme WR (2004) Volumetric spinal canal intrusion: a comparison between thoracic pedicle screws and thoracic hooks. Spine 29(1):63–69

    PubMed  Article  Google Scholar 

  21. Prokop A, Löhlein F, Chmielnicki M, Volbracht J (2009) Minimally invasive percutaneous instrumentation for spine fractures. Unfallchirurg 112:621–628

    PubMed  Article  CAS  Google Scholar 

  22. Rodriguez-Vela J, Lobo-Escolar A, Joven-Aliaga E, Herrera A, Vicente J, Sunen E, Loste A, Tabuenca A (2009) Perioperative and short-term advantages of mini-open approach for lumbar spinal fusion. Eur Spine J 18(8):1194–1201

    PubMed  Article  CAS  Google Scholar 

  23. Soini J, Seitsalo S (1993) The external fixation test of the lumbar spine: 30 complications in 25 of 100 consecutive patients. Acta Orthop Scand 64:147–149

    PubMed  Article  CAS  Google Scholar 

  24. Tiusanen H, Seitsalo S, Östermann K, Soini J (1996) The role of external transpedicular fixation in anterior interbody lumbar fusion. J Spinal Disord 9:433–438

    PubMed  Article  CAS  Google Scholar 

  25. Weinstein JN, Rydevik BL, Rausching WR (1992) Anatomical and technical considerations of pedicle screw fixation. Clin Orthop 284:34–46

    PubMed  Google Scholar 

  26. Youkilis AS, Quint DJ, McGillicuddy JE, Papadopoulos SM (2001) Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery 48:771–779

    PubMed  CAS  Google Scholar 

  27. Zdichavsky M, Blauth M, Knop C, Graessner M, Herrmann H, Krettek C, Bastian L (2004) Accuracy of pedicle screw placement in thoracic spine fractures. Part I: inter- and intra-observer reliability of the scoring system. Eur J Trauma 30:234–240

    Article  Google Scholar 

  28. Zdichavsky M, Blauth M, Knop C, Lotz J, Krettek C, Bastian L (2004) Accuracy of pedicle screw placement in thoracic spine fractures. Part II: a retrospective analysis of 278 pedicle screws using computed tomographic scans. Eur J Trauma 30:241–247

    Article  Google Scholar 

  29. Zindrick MR, Wiltse LL, Widell EH, Thomas JC, Holland WR, Field BT, Spencer CW (1986) A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine. Clin Orthop Relat Res 203:99–112

    PubMed  Google Scholar 

Download references

Conflict of interest


Author information

Authors and Affiliations


Corresponding author

Correspondence to Timo Michael Heintel.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Heintel, T.M., Berglehner, A. & Meffert, R. Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures: a prospective trial. Eur Spine J 22, 495–502 (2013).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Thoracolumbar spine fractures
  • Pedicle screw
  • Percutaneous technique
  • Minimally invasive spine surgery
  • Transpedicular instrumentation