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A retrospective analysis of pedicle screw accuracy in minimally invasive lumbar spinal surgery
EANS Academy. McLarnon M. 09/26/19; 275977; EP02066
Michael McLarnon
Michael McLarnon

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Abstract
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Background: Pedicle screw surgery is virtually synonymous with spinal operations due to the prevalence of spinal fusion within the sub-specialty. Therefore optimising surgical technique for screw placement is highly important. In this study, a novel percutaneous technique for pedicle screw placement was used. We hope to observe competitive levels of accuracy coupled with low rates of revision. In addition, the use of intraoperative fluoroscopy shows less radiation exposure compared to other navigation techniques. Two grading systems are implemented, highlighting both absolute accuracy and clinical significance of screw placement.
Methods: Retrospective review of post-operative CT/MRI images of patients operated on between February 2015 and December 2018 who underwent either TLIF or PLIF approach for back and/or radicular symptoms secondary to degenerative spinal disease. Pedicle screws were then graded for accuracy of placement. Period of Follow up 34 months. Screws were analyzed in axial, sagittal and coronal planes and graded by two systems: Gertzbein and Heary.
Results: 107 patients were reviewed with mean age 53 years (range 20-76 years). 95 TLIF for degenerative disease (1 secondary to spinal malignancy), and 12 PLIF. Fusion level ranged from T9 to S1 with L5/S1 level being commonest. 22 patients were excluded due to lack of postoperative imaging. Of the 358 screws graded, 350 were completely contained in the pedicle (0mm displacement). Of the remaining 8, 1 screw misplacement had clinical significance and required revision (>4mm, inferomedial).
Conclusion: Data in the literature has suggested that screw accuracy using conventional techniques was around 92% with a revision rate of 8%. We have demonstrated 98% accuracy in screw placement using this novel technique with a revision rate of < 1 %.
With the grading system implemented, we were able to define both absolute extent of breach and it´s clinical significance.
Background: Pedicle screw surgery is virtually synonymous with spinal operations due to the prevalence of spinal fusion within the sub-specialty. Therefore optimising surgical technique for screw placement is highly important. In this study, a novel percutaneous technique for pedicle screw placement was used. We hope to observe competitive levels of accuracy coupled with low rates of revision. In addition, the use of intraoperative fluoroscopy shows less radiation exposure compared to other navigation techniques. Two grading systems are implemented, highlighting both absolute accuracy and clinical significance of screw placement.
Methods: Retrospective review of post-operative CT/MRI images of patients operated on between February 2015 and December 2018 who underwent either TLIF or PLIF approach for back and/or radicular symptoms secondary to degenerative spinal disease. Pedicle screws were then graded for accuracy of placement. Period of Follow up 34 months. Screws were analyzed in axial, sagittal and coronal planes and graded by two systems: Gertzbein and Heary.
Results: 107 patients were reviewed with mean age 53 years (range 20-76 years). 95 TLIF for degenerative disease (1 secondary to spinal malignancy), and 12 PLIF. Fusion level ranged from T9 to S1 with L5/S1 level being commonest. 22 patients were excluded due to lack of postoperative imaging. Of the 358 screws graded, 350 were completely contained in the pedicle (0mm displacement). Of the remaining 8, 1 screw misplacement had clinical significance and required revision (>4mm, inferomedial).
Conclusion: Data in the literature has suggested that screw accuracy using conventional techniques was around 92% with a revision rate of 8%. We have demonstrated 98% accuracy in screw placement using this novel technique with a revision rate of < 1 %.
With the grading system implemented, we were able to define both absolute extent of breach and it´s clinical significance.
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