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Can Postoperative Radiographs Accurately Identify Screw Misplacements?

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Abstract

Study Design

Retrospective case series.

Objective

The objective of this study was to determine the safety of postoperative radiographs to assess screw placement.

Summary of Background Data

Previously defined criteria are frequently employed to determine pedicle screw placement on intraoperative supine radiographs. Postoperatively, radiographs are typically used as a precursor to identify screws of concern, and a computed tomographic (CT) is typically ordered to confirm screw safety.

Methods

First, available postoperative PA and lateral radiographs were reviewed by 6 independently blinded observers. Screw misplacement was assessed using previously defined criteria. A musculoskeletal radiologist assessed all CT scans for screw placement. Pedicle screw position was classified either as acceptable or misplaced. Misplacements were subclassified as medial, lateral, or anterior.

Results

One hundred four patients with scoliosis or kyphosis underwent posterior spinal fusion and had postoperative CT scan available were included. In total, 2,034 thoracic and lumbar screws were evaluated. On CT scan, 1,772 screws were found to be acceptable, 142 were laterally misplaced, 30 medially, and 90 anteriorly. Of the 30 medially placed screws, 80% to 87% screws were believed to be in positions other than medial, with a median of 73% (63% to 92%) of these screws presumed to be in normal position. Similarly, of the 142 screws placed laterally, 49% to 81% screws were identified in positions other than lateral, with a median of 77% (59% to 96%) of these screws felt to be in normal position. Of the 90 anteriorly misplaced screws, 16% to 87% screws were identified in positions other than anterior, with 72% (20% to 98%) identified as normal. The criteria produced a median 52% sensitivity, 70% specificity, and 68% accuracy across the 6 observers.

Conclusion

Radiograph is a poor diagnostic modality for observing screw position.

Level of Evidence

Level IV.

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Authors and Affiliations

  1. Department of Pediatric Orthopaedics, Cohen Children’s Medical Center, Northwell Health System, New Hyde Park, NY, USA

    Vishal Sarwahi MD, Terry Amaral MD, Stephen Wendolowski BS & Rachel Gecelter BS

  2. Department of Orthopaedic Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, 6th Floor, Bronx, NY, 10467, USA

    Saankritya Ayan MD

  3. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Yungtai Lo PhD

  4. Department of Radiology, Montefiore Medical Center, Bronx, NY, USA

    Beverly Thornhill MD

Authors
  1. Vishal Sarwahi MD
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  2. Saankritya Ayan MD
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  3. Terry Amaral MD
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  4. Stephen Wendolowski BS
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  5. Rachel Gecelter BS
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  6. Yungtai Lo PhD
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  7. Beverly Thornhill MD
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Corresponding author

Correspondence to Vishal Sarwahi MD.

Additional information

Author disclosures

VS (reports other from Medtronic, other from Precision Spine, other from Precision Spine, outside the submitted work); SA (none); TA (none), SW (none); RG (none); YL (none); BT (none).

No funding was secured for this study.

The authors wish to acknowledge Gordon Sims and Lana Nirenstein for their contribution and effort towards the completion of this study.

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Sarwahi, V., Ayan, S., Amaral, T. et al. Can Postoperative Radiographs Accurately Identify Screw Misplacements?. Spine Deform 5, 109–116 (2017). https://doi.org/10.1016/j.jspd.2016.10.007

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  • DOI: https://doi.org/10.1016/j.jspd.2016.10.007

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