, Volume 102, Issue 1, pp 47–55 | Cite as

Pedicle screw fixation in thoracolumbar and lumbar spine assisted by lateral fluoroscopic imaging: a study to evaluate the accuracy of screw placement

  • S. P. Mohanty
  • S. N. Bhat
  • M. Pai Kanhangad
  • G. S. Gosal
Original Article



The purpose of this study was to evaluate the accuracy of pedicle screw placement, its advantages, and limitations in posterior instrumentation of thoracolumbar and lumbar burst fractures assisted only by lateral fluoroscopic imaging.

Materials and methods

Pre- and postoperative computerized tomographic (CT) scans of 117 patients with thoracolumbar and lumbar burst fractures, who underwent posterior instrumentation with pedicle screw fixation, were prospectively analyzed. Accuracy of screw placement, reconstruction of the vertebral height, and correction of the kyphotic angle were studied. Position of the pedicle screws were determined, and cortical breach was graded on the postoperative axial CT scans. Percentage of vertebral height reconstruction and kyphotic angle correction were calculated from the postoperative midsagittal CT scans.


Four hundred and sixty-eight pedicle screws in 234 motion segments were included in this study. 427 screws were centrally placed with an accuracy rate of 91.24%. Out of the 41 (8.76%) screws that breached the pedicle wall, 32 (6.84%) screws had violated the medial wall, while 9 (1.92%) screws breached the lateral wall. There were no “air-ball” screws. No screw penetrated the anterior wall. Postoperatively, none of the patients deteriorated neurologically, and no screw required revision. Postoperatively, there was significant restoration of vertebral height and correction of kyphosis (P < 0.05).


Pedicle fixation performed on a Relton-Hall frame is relatively simple and, when performed carefully using only lateral fluoroscopic imaging, has a lower potential for complications due to cortical breach.


Spinal injury Burst fractures Pedicle screws Computed tomography 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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 Declaration of Helsinki and its later amendments or comparable ethical standards. Institutional ethical clearance was obtained before starting the study.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.


  1. 1.
    Steffee AD, Biscup RS, Sitkowskj DJ (1986) Segmental spine plates with pedicle screw fixation a new internal fixation device for disorders of the lumbar and thoracolumbar spine. Clin Orthop Relat Res 203:45–53Google Scholar
  2. 2.
    Roy-Camille R, Saillant G, Berteaux D, Salgado V (1976) Osteosynthesis of thoraco-lumbar spine fractures with metal plates screwed through the vertebral pedicles. Reconstr Surg Traumatol 15:2–16PubMedGoogle Scholar
  3. 3.
    Gertzbein SD, Robbins SE (1990) Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976) 15:11–14CrossRefGoogle Scholar
  4. 4.
    Yahiro MA (1994) Comprehensive literature review: pedicle screw fixation devices. Spine 19(20):2274S–2278SCrossRefPubMedGoogle Scholar
  5. 5.
    Puvanesarajah V, Liauw JA, Lo SF, Lina IA, Witham TF (2014) Techniques and accuracy of thoracolumbar pedicle screw placement. World J Orthop 5(2):112CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Kalfas IH, Kormos DW, Murphy MA et al (1995) Application of frameless stereotaxy to pedicle fixation of the spine. J Neurosurg 83:641–647CrossRefPubMedGoogle Scholar
  7. 7.
    Amiot LP, Lang K, Zippel H, Labelle H (1998) Comparative accuracy between conventional and computer-assisted pedicle screw installation. Presented at the annual meeting of the international society for the study of the lumbar spine, Brussels, BelgiumGoogle Scholar
  8. 8.
    Merloz P, Tonetti J, Pittet L et al (1998) Pedicle screw placement using image guided techniques. Clin Orthop 354:39–48CrossRefGoogle Scholar
  9. 9.
    Schwarzenbach O, Berleman U, Jost B et al (1997) Accuracy of computer-assisted pedicle screw placement. An in vivo computed tomography analysis. Spine 22:452–458CrossRefPubMedGoogle Scholar
  10. 10.
    Laine T, Schlenzka D, Mäkitalo K et al (1997) Improved accuracy of pedicle screw insertion with computer-assisted surgery. Spine 22:1254–1258CrossRefPubMedGoogle Scholar
  11. 11.
    Maynard FM et al (1997) International standards for neurological and functional classification of spinal cord injury. Spinal Cord 35:266–274CrossRefPubMedGoogle Scholar
  12. 12.
    Cobb JR (1948) Outline for the study of scoliosis. In: Edwards JW (ed) Instructional course lectures, vol 5. The American Academy of Orthopedic Surgeons, Ann Arbor, pp 261–275Google Scholar
  13. 13.
    Mumford J, Weinstein JN, Spratt KF, Goel VK (1993) Thoracolumbar burst fractures: the clinical efficacy and outcome of non-operative management. Spine 18:955–970CrossRefPubMedGoogle Scholar
  14. 14.
    Hashimoto T, Kaneda K, Abumi K (1988) Relationship between traumatic spinal canal stenosis and neurologic deficits in thoracolumbar burst fractures. Spine 13:1268–1272CrossRefPubMedGoogle Scholar
  15. 15.
    Olsewski JM, Simmons EH, Kallen FC, Mendel FC, Severin CM, Berens DL (1990) Morphometry of the lumbar spine: anatomical perspectives related to transpedicular fixation. J Bone Joint Surg 72(4):541–549CrossRefPubMedGoogle Scholar
  16. 16.
    Gaines RW (2000) The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg Am 82-A:1458–1476CrossRefPubMedGoogle Scholar
  17. 17.
    Krag MH, Weaver DL, Beynnon BD, Haugh LD (1988) Morphometry of the thoracic and lumbar spine related to transpedicular screw placement for surgical spinal fixation. Spine (Phila Pa 1976) 13:27–32CrossRefGoogle Scholar
  18. 18.
    Zou D, Yoo JU, Edwards WT, Donovan DM, Chang KW, Bayley JC, Fredrickson BE, Yuan HA (1993) Mechanics of anatomic reduction of thoracolumbar burst fractures| comparison of distraction versus distraction plus lordosis, in the anatomic reduction of the thoracolumbar burst fracture. Spine 18(2):195–203CrossRefPubMedGoogle Scholar
  19. 19.
    Harrington RM, Budorick T, Hoyt J, Anderson PA, Tencer AF (1993) Biomechanics of indirect reduction of bone retropulsed into the spinal canal in vertebral fracture. Spine 18(6):692–699CrossRefPubMedGoogle Scholar
  20. 20.
    Mohanty SP, Bhat SN, Ishwara-Keerthi C (2011) The effect of posterior instrumentation of the spine on canal dimensions and neurological recovery in thoracolumbar and lumbar burst fractures. Musculoskelet Surg 95(2):101–106CrossRefPubMedGoogle Scholar
  21. 21.
    Odgers CJ, Vaccaro AR, Pollack ME, Cotler JM (1996) Accuracy of pedicle screw placement with the assistance of lateral plain radiography. J Spinal Disord 9(4):334–338CrossRefPubMedGoogle Scholar
  22. 22.
    Castro WH, Halm H, Jerosch J, Malms J, Steinbeck J, Blasius S (1996) Accuracy of pedicle screw placement in lumbar vertebrae. Spine 21:1320–1324CrossRefPubMedGoogle Scholar
  23. 23.
    Weinstein JN, Spratt KF, Spengler D, Brick C (1998) Spinal pedicle fixation: reality and validity of roentgenogram – based assessment and surgical factors on successful screw placement. Spine 13:1012–1016CrossRefGoogle Scholar

Copyright information

© Istituto Ortopedico Rizzoli 2017

Authors and Affiliations

  1. 1.Orthopaedics Unit-3, Division of Spine and Hip, Kasturba Medical CollegeManipal UniversityManipalIndia
  2. 2.Orthopaedics Unit-3, Kasturba Medical CollegeManipal UniversityManipalIndia
  3. 3.Department of Orthopaedics Kasturba Medical CollegeManipal UniversityManipalIndia

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