Can Right-Handed Surgeons Insert Upper Thoracic Pedicle Screws in much Comfortable Position? Right-Handedness Problem on the Left Side

OBJECTIVE: Thoracic pedicles have special and specific properties. In particular, upper thoracic pedicles are positioned in craniocaudal plane. Therefore, manipulation of thoracic pedicle screws on the left side is difficult for right-handed surgeons. We recommend a new position to insert thoracic pedicle screw that will be much comfortable for spine surgeons. METHODS: We retrospectively reviewed 33 patients who underwent upper thoracic pedicle screw instrumentation. In 15 patients, a total of 110 thoracic pedicle screws were inserted to the upper thoracic spine (T1–6) with classical position (anesthesiologist and monitor were placed near to patient’s head. Surgeons were standing classically near to patient’s body while patients were lying in prone position). In 18 patients, a total of 88 thoracic pedicle screws were inserted to the upper thoracic spine with the new standing position-surgeons stand by the head of the patient and the anesthesia monitor laterally and under patient’s belt level. All the operations performed by the same senior spine surgeons with the help of C-arm. Postoperative computed tomography scans were obtained to assess the screw placement. The screw malposition and pedicle wall violations were divided and evaluated separately. Cortical penetration were measured and graded at either : 1–2 mm penetration, 2–4 mm penetration and >4 mm penetration. RESULTS: Total 198 screws were inserted with two different standing positions. Of 198 screws 110 were in the classical positioning group and 88 were in the new positioning group. Incorrect screw placement was found in 33 screws (16.6%). The difference between total screw malposition by both standing positions were found to be statistically significant (p=0.011). The difference between total pedicle wall violations by both standing positions were found to be statistically significant (p=0.003). CONCLUSION: Right-handedness is a problem during the upper thoracic pedicle screw placement on the left side. Changing the surgeon’s position standing near to patient’s head could provide a much comfortable position to orient the craniocaudal plane of the thoracic pedicles.

Can Right-Handed Surgeons Insert Upper Thoracic Pedicle Screws in much Comfortable Position? Right-Handedness Problem on the Left Side

OBJECTIVE: Thoracic pedicles have special and specific properties. In particular, upper thoracic pedicles are positioned in craniocaudal plane. Therefore, manipulation of thoracic pedicle screws on the left side is difficult for right-handed surgeons. We recommend a new position to insert thoracic pedicle screw that will be much comfortable for spine surgeons.METHODS: We retrospectively reviewed 33 patients who underwent upper thoracic pedicle screw instrumentation. In 15 patients, a total of 110 thoracic pedicle screws were inserted to the upper thoracic spine (T1–6) with classical position (anesthesiologist and monitor were placed near to patient’s head. Surgeons were standing classically near to patient’s body while patients were lying in prone position). In 18 patients, a total of 88 thoracic pedicle screws were inserted to the upper thoracic spine with the new standing position-surgeons stand by the head of the patient and the anesthesia monitor laterally and under patient’s belt level. All the operations performed by the same senior spine surgeons with the help of C-arm. Postoperative computed tomography scans were obtained to assess the screw placement. The screw malposition and pedicle wall violations were divided and evaluated separately. Cortical penetration were measured and graded at either : 1–2 mm penetration, 2–4 mm penetration and >4 mm penetration.RESULTS: Total 198 screws were inserted with two different standing positions. Of 198 screws 110 were in the classical positioning group and 88 were in the new positioning group. Incorrect screw placement was found in 33 screws (16.6%). The difference between total screw malposition by both standing positions were found to be statistically significant (p=0.011). The difference between total pedicle wall violations by both standing positions were found to be statistically significant (p=0.003).CONCLUSION: Right-handedness is a problem during the upper thoracic pedicle screw placement on the left side. Changing the surgeon’s position standing near to patient’s head could provide a much comfortable position to orient the craniocaudal plane of the thoracic pedicles.

Primary sacral hydatid cyst causing cutaneous fistula

Echinococcus granulosus and Echinococcus multilocularis are the causes of hydatid disease and the main characteristic is endemic. Generally, it affects the liver and lungs. Spinal hydatidosis accounts for less than 1% of the cases. Vertebral hydatidosis is usually silent and a slowly progressive disease with a long latent period. Another rare form is the primary sacral hydatid cyst. Generally, patients suffer from back pain and neural compression symptoms. A 43-year woman was admitted with left leg pain and a fluid leakage from a cutaneous fistula on the left hip. It was diagnosed on MRI as a bilateral cystic lesion which eroded the first sacral wing, extending to the paravertebral region and left intervertebral foramen. We present a case with fluid leakage from cutaneous fistula