Accuracy of fluoroscopically-assisted pedicle screw placement: analysis of 1,218 screws in 198 patients

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dc.contributor.authorKöktekir, Ender
dc.contributor.authorCeylan, Davut
dc.contributor.authorTatarlı, Necati
dc.contributor.authorKarabağlı, Hakan
dc.contributor.authorRecber, Fahri
dc.contributor.authorAkdemir, Gökhan
dc.date.accessioned2020-03-26T18:49:17Z
dc.date.available2020-03-26T18:49:17Z
dc.date.issued2014
dc.departmentSelçuk Üniversitesien_US
dc.description.abstractBACKGROUND CONTEXT: We retrospectively analyzed a total of 1,218 pedicle screws for accuracy, with postoperative computed tomography (CT), in 198 patients who were operated on between March 2004 and September 2012. PURPOSE: To determine the incidence of screw misplacement in patients who received a transpedicular screw fixation, with intraoperative fluoroscopy in the lateral and lateral with anteroposterior (AP) positions. The results are compared between the two groups. STUDY DESIGN: Retrospective comparative study of accuracy of pedicle screw placement in thoracic and lumbar spine. PATIENT SAMPLE: The sample consists of 198 consecutive patients who underwent transpedicular screw fixation. OUTCOME MEASURES: Accuracy of screw placement was evaluated by postoperative CT scan. Misplacement was defined in cases where more than 25% of the screw size was residing outside the pedicle. METHODS: The indications for hardware placement, radiologic studies, patient demographics, and reoperation rates were recorded. Five hundred twenty-eight screws (Group A, n = 81) were inserted into the vertebral body with the assistance of lateral fluoroscopy only, whereas 690 screws (Group B, n = 117) were inserted with the assistance of lateral fluoroscopy, and the final positions of the screws were checked with AP fluoroscopy. RESULTS: A total of 1,218 screws were analyzed, with 962 screws placed at the lumbosacral region and 256 screws at the thoracic region. According to the postoperative CT scan, 27 screws (2.2%) were identified as breaching the pedicle. Nineteen of them (3.6%) were in Group A, whereas 8 (1.16%) were in Group B. The rate of pedicle breaches was significantly different between Group A and B (p5.0052). In Group A, the lateral violation of the pedicle was seen in 10 screws (1.9%), whereas medial violation was seen in 9 screws (1.7%). In Group B, the lateral violation of the pedicle was seen in six screws (0.87%), whereas medial violation was seen in two screws (0.29%). The medial and lateral penetration of screws were significantly different between Groups A and B (p = .05). A pedicle breach occurred in 21 patients, and 15 of them underwent a revision surgery to correct the misplaced screw. Of these patients, 11 (13.6%) were in Group A, and 4 (3.4%) were in Group B (p = .0335). CONCLUSIONS: In this study, we evaluated and clarified the diagnostic value of intraoperative fluoroscopy in both the lateral and AP imaging that have not yet been evaluated in any comparative study. We concluded that the intraoperative use of fluoroscopy, especially in the AP position, significantly decreases the risk of screw misplacement and the results are comparable with other advanced techniques. (C) 2014 Elsevier Inc. All rights reserved.en_US
dc.identifier.doi10.1016/j.spinee.2014.03.044en_US
dc.identifier.endpage1708en_US
dc.identifier.issn1529-9430en_US
dc.identifier.issn1878-1632en_US
dc.identifier.issue8en_US
dc.identifier.pmid24704680en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.startpage1702en_US
dc.identifier.urihttps://dx.doi.org/10.1016/j.spinee.2014.03.044
dc.identifier.urihttps://hdl.handle.net/20.500.12395/30575
dc.identifier.volume14en_US
dc.identifier.wosWOS:000341304300042en_US
dc.identifier.wosqualityQ1en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherELSEVIER SCIENCE INCen_US
dc.relation.ispartofSPINE JOURNALen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/closedAccessen_US
dc.selcuk20240510_oaigen_US
dc.subjectAccuracyen_US
dc.subjectMisplacementen_US
dc.subjectPedicle screwen_US
dc.subjectFluoroscopyen_US
dc.subjectSpinal stabilizationen_US
dc.subjectIntraoperative imagingen_US
dc.titleAccuracy of fluoroscopically-assisted pedicle screw placement: analysis of 1,218 screws in 198 patientsen_US
dc.typeArticleen_US

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