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Characteristics of pedicle screw misplacement using freehand technique in degenerative scoliosis surgery

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to estimate the accuracy of pedicle screw (PS) placement in degenerative scoliosis surgery, characterize a patient population with PS misplacement, and analyze the association between misplaced PS vector and lumbar coronal curve.

Methods

In this study, 122 patients (average age 68.6 years), who underwent corrective and decompression surgery, were selected retrospectively. PS accuracy was evaluated in the thoracic to lumbar spine. We identified characteristics of misplacement in each patient. Screw positions were categorized into grade A, entirely in the pedicle; grade B, < 2 mm breach; grade C, 2–4 mm breach; and grade D, > 4 mm breach using postoperative computed tomography.

Results

The mean preoperative lumbar coronal curve was 32.3 ± 18.4°, and the number of fused vertebrae was 8.9 ± 2.8. A total of 2032 PS were categorized as follows: grade A, 1897 PS (93.3%); grade B, 67 (3.3%); grade C, 26 (1.3%); and grade D, 43 (2.1%). One PS (grade D), inserted at T5, needed surgery for removal due to neurological deficit. The misplacement group (grades C and D) had a significantly stronger lumbar coronal curve and apical vertebral rotation than the accuracy group (grades A and B). Misplaced PS vector (direction and degree) was significantly correlated with inserted vertebral rotation. Grade D misplacement was distributed mainly around the transitional vertebra of the lumbar curve.

Conclusions

The accuracy of PS insertion in the thoracic to lumbar spine was high in DS surgery, but the need for care was highlighted in the transitional vertebra.

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References

  1. Debnath UK, Mehdian SMH, Webb JK (2011) Spinal deformity correction in Duchenne muscular dystrophy (DMD): comparing the outcome of two instrumentation techniques. Asian Spine J 5(1):43–50

    Article  PubMed  PubMed Central  Google Scholar 

  2. Jutte PC, Castelein RM (2002) Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations. Eur Spine J 11(6):594–598

    Article  CAS  PubMed  Google Scholar 

  3. Kotani Y, Abumi K, Ito M, Takahata M, Sudo H, Ohshima S et al (2007) Accuracy analysis of pedicle screw placement in posterior scoliosis surgery: comparison between conventional fluoroscopic and computer-assisted technique. Spine 32(14):1543–1550

    Article  PubMed  Google Scholar 

  4. Laudato PA, Pierzchala K, Schizas C (2018) Pedicle screw insertion accuracy using O-Arm, robotic guidance, or freehand technique. Spine 43(6):E373–E378

    Article  PubMed  Google Scholar 

  5. Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD (2004) Free hand pedicle screw placement in the thoracic spine: is it safe? Spine 29(3):333–342

    Article  PubMed  Google Scholar 

  6. Samdani AF, Ranade A, Sciubba DM, Cahill PJ, Antonacci MD, Clements DH et al (2010) Accuracy of free-hand placement of thoracic pedicle screws in adolescent idiopathic scoliosis: how much of a difference does surgeon experience make? Eur Spine J 19(1):91–95

    Article  PubMed  Google Scholar 

  7. Wang VY, Chin CT, Lu DC, Smith JS, Chou D (2010) Free-hand thoracic pedicle screws placed by neurosurgery residents: a CT analysis. Eur Spine J 19(5):821–827

    Article  PubMed  PubMed Central  Google Scholar 

  8. Parker SL, McGirt MJ, Farber SH, Amin AG, Rick AM, Suk I et al (2011) Accuracy of free-hand pedicle screws in the thoracic and lumbar spine: analysis of 6816 consecutive screws. Neurosurgery 68(1):170–178

    Article  PubMed  Google Scholar 

  9. Miekisiak G, Kornas P, Lekan M, Dacko W, Latka D, Kaczmarczyk J (2015) Accuracy of the free-hand placement of pedicle screws in the lumbosacral spine using a universal entry point. J Spinal Disord Tech 28(4):E194–E198

    Article  PubMed  Google Scholar 

  10. Etemadifar M, Jamalaldini M (2017) Evaluating accuracy of free-hand pedicle screw insertion in adolescent idiopathic scoliosis using postoperative multi-slice computed tomography scan. Adv Biomed Res 6(1):19

    Article  PubMed  PubMed Central  Google Scholar 

  11. Aizawa T, Kokubun S, Ozawa H, Kusakabe T, Tanaka Y, Hoshikawa T et al (2016) Increasing incidence of degenerative spinal diseases in Japan during 25 years: the registration system of spinal surgery in Tohoku university spine society. Tohoku J Exp Med 238(2):153–163

    Article  PubMed  Google Scholar 

  12. Silva FE, Lenke LG (2010) Adult degenerative scoliosis: Evaluation and management. Neurosurg Focus 28(3):1–10

    Article  Google Scholar 

  13. Rampersaud YR, Pik JHT, Salonen D, Farooq S (2005) Clinical accuracy of fluoroscopic computer-assisted pedicle screw fixation: a CT analysis. Spine 30(7):183–190

    Article  Google Scholar 

  14. Hicks JM, Singla A, Shen FH, Arlet V (2010) Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine 35(11):465–470

    Article  Google Scholar 

  15. Belmont PJ, Klemme WR, Robinson M, Polly DW (2002) Accuracy of thoracic pedicle screws in patients with and without coronal plane spinal deformities. Spine 27(14):1558–1566

    Article  PubMed  Google Scholar 

  16. Faro FD, Marks MC, Pawelek J, Newton PO (2004) Evaluation of a functional position for lateral radiograph acquisition in adolescent idiopathic scoliosis. Spine 29(20):2284–2289

    Article  PubMed  Google Scholar 

  17. Perisinakis K, Theocharopoulos N, Damilakis J, Katonis P, Papadokostakis G, Hadjipavlou A et al (2004) Estimation of patient dose and associated radiogenic risks from fluoroscopically guided pedicle screw insertion. Spine 29(14):1555–1560

    Article  PubMed  Google Scholar 

  18. Weinstein MA, McCabe JP, Cammisa J (2000) Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord 13(5):422–426

    Article  CAS  PubMed  Google Scholar 

  19. Boachie-adjei O, Girardi FP, Bansal M, Rawlins BA (2000) Safety and efficacy of pedicle screw placement for adult spinal deformity with a pedicle-probing conventional anatomic technique. Clin Spine Surg 13(6):496–500

    CAS  Google Scholar 

  20. Yamada S, Won DJ, Yamada SM (2004) Pathophysiology of tethered cord syndrome: correlation with symptomatology. Neurosurg Focus 16(2):1–5

    Article  Google Scholar 

  21. Sarwahi V, Wendolowski SF, Gecelter RC, Amaral T, Lo Y, Wollowick AL et al (2016) Are we underestimating the significance of pedicle screw misplacement? Spine 41(9):E548–E555

    Article  PubMed  Google Scholar 

  22. Zhu F, Sun X, Qiao J, Ding Y, Zhang B, Qiu Y (2014) Misplacement pattern of pedicle screws in pediatric patients with spinal deformity a computed tomography Study. J Spinal Disord Tech 27(8):431–435

    Article  PubMed  Google Scholar 

  23. Harimaya K, Lenke LG, Son-Hing JP, Bridwell KH, Schwend RM, Luhmann SJ et al (2011) Safety and accuracy of pedicle screws and constructs placed in infantile and juvenile patients. Spine 36(20):1645–1651

    Article  PubMed  Google Scholar 

  24. Chan CYW, Kwan MK (2018) Zonal differences in risk and pattern of pedicle screw perforations in adolescent idiopathic scoliosis (AIS): a computerized tomography (CT) review of 1986 screws. Eur Spine J 27(2):340–349

    Article  CAS  PubMed  Google Scholar 

  25. Makino T, Kaito T, Fujiwara H, Yonenobu K (2012) Analysis of lumbar pedicle morphology in degenerative spines using multiplanar reconstruction computed tomography: what can be the reliable index for optimal pedicle screw diameter? Eur Spine J 21(8):1516–1521

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bydon M, Xu R, Amin AG, Macki M, Kaloostian P, Sciubb DM et al (2014) Safety and efficacy of pedicle screw placement using intraoperative computed tomography: consecutive series of 1148 pedicle screws. J Neurosurg Spine 21(3):320–328

    Article  PubMed  Google Scholar 

  27. Takata Y, Sakai T, Higashino K, Matsuura T, Suzue N, Hamada D et al (2015) State of the art: Intraoperative neuromonitoring in spinal deformity surgery. J Med Investig 62(3):103–108

    Article  Google Scholar 

  28. Cui G, Wang Y, Kao TH, Zhang Y, Liu Z, Liu B et al (2012) Application of intraoperative computed tomography with or without navigation system in surgical correction of spinal deformity: a preliminary result of 59 consecutive human cases. Spine 37(10):891–900

    Article  PubMed  Google Scholar 

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Funding

Funding sources of Yu Yamato and Shin Oe: Medtronic Sofamor Danek Inc., Japan Medical Dynamic Marketing Inc., and Meitoku Medical Institution Jyuzen Memorial Hospital.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan

    Tomohiro Yamada, Tomohiko Hasegawa, Yu Yamato, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Shin Oe, Yuki Mihara, Hiroki Ushirozako, Koichiro Ide, Yuh Watanabe, Keiichi Nakai, Kenta Kurosu & Yukihiro Matsuyama

  2. Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan

    Yu Yamato & Shin Oe

Authors
  1. Tomohiro Yamada
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  2. Tomohiko Hasegawa
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  3. Yu Yamato
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  4. Go Yoshida
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  5. Tomohiro Banno
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  6. Hideyuki Arima
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  7. Shin Oe
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  8. Yuki Mihara
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  9. Hiroki Ushirozako
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  10. Koichiro Ide
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  11. Yuh Watanabe
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  12. Keiichi Nakai
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  13. Kenta Kurosu
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  14. Yukihiro Matsuyama
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Contributions

TY wrote and prepared the manuscript, and all of the authors participated in the study design. All authors have read, reviewed, and approved the article.

Corresponding author

Correspondence to Tomohiro Yamada.

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Conflict of interest

Tomohiro Yamada, Tomohiko Hasegawa, Go Yoshida, Tatsuya Yasuda, Hideyuki Arima, Tomohiro Banno, Hiroki Ushirozako, Koichiro Ide, Yuh Watanabe, Keichi Nakai and Yukihiro Matsuyama have nothing to disclose. Yu Yamato and Shin Oe work at a donation-endowed laboratory in the Division of Geriatric Musculoskeletal Health.

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Yamada, T., Hasegawa, T., Yamato, Y. et al. Characteristics of pedicle screw misplacement using freehand technique in degenerative scoliosis surgery. Arch Orthop Trauma Surg 143, 1861–1867 (2023). https://doi.org/10.1007/s00402-022-04380-x

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  • DOI: https://doi.org/10.1007/s00402-022-04380-x

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