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Accuracy of cannulated pedicle screw versus conventional pedicle screw for extra-pedicular screw placement in dysplastic pedicles without cancellous channel in adolescent idiopathic scoliosis: a computerized tomography (CT) analysis

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Abstract

Purpose

This study aimed at studying the accuracy and safety of extra-pedicular screw insertion for dysplastic pedicles in AIS comparing cannulated screw system versus conventional screw system.

Methods

104 AIS patients with 1524 pedicle screws were evaluated using CT scan. 302 screws were inserted in dysplastic pedicles using fluoroscopic guidance technique. 155 screws were inserted using a cannulated system (Group 1), whereas 147 screws were inserted using standard screws (Group 2). The pedicle perforations were assessed using a classification by Rao et al.; G0: no violation; G1: <2 mm perforation; G2: 2–4 mm perforation; and G3: >4 mm perforation). For anterior perforations, the pedicle perforations were assessed using a modified grading system (Grade 0: no violation, Grade 1: less than 4 mm perforation; Grade 2: 4 mm to 6 mm perforation; and Grade 3: more than 6 mm perforation).

Results

The perforation rate in Group 1 was 4.5% and in Group 2 was 15.6% (p = 0.001). Most of the perforations were anterior perforations (53.3%). The anterior perforation rate in Group 1 was 1.9% compared to 8.8% in Group 2 (p = 0.009). Group 1 has a medial perforation rate of 1.3% compared to Group 2, 6.1% (p = 0.031). The rate of critical pedicle perforation in Group 1 was 2.6% and in Group 2 was 6.8% (p = 0.102). In Group 1, there were no critical medial perforation but there was one G2 lateral perforation, one G2 superior perforation and two G3 anterior perforations. In Group 2, there were three G2 medial perforations, one G2 lateral perforation, one G2 anterior perforation and five G3 anterior perforations.

Conclusion

Usage of cannulated screw system significantly increases the accuracy of pedicle screw insertion in dysplastic pedicles in AIS.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia

    Chee Kean Lee, Chris Yin Wei Chan, Siti Mariam Abd Gani & Mun Keong Kwan

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  1. Chee Kean Lee
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  2. Chris Yin Wei Chan
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  3. Siti Mariam Abd Gani
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  4. Mun Keong Kwan
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Correspondence to Chris Yin Wei Chan.

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Lee, C.K., Chan, C.Y.W., Gani, S.M.A. et al. Accuracy of cannulated pedicle screw versus conventional pedicle screw for extra-pedicular screw placement in dysplastic pedicles without cancellous channel in adolescent idiopathic scoliosis: a computerized tomography (CT) analysis. Eur Spine J 26, 2951–2960 (2017). https://doi.org/10.1007/s00586-017-5266-5

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  • DOI: https://doi.org/10.1007/s00586-017-5266-5

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