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Accuracy of Free Hand Pedicle Screw Installation in the Thoracic and Lumbar Spine by a Young Surgeon: An Analysis of the First Consecutive 306 Screws Using Computed Tomography
Asian Spine Journal ; : 237-243, 2014.
Article in English | WPRIM | ID: wpr-217656
ABSTRACT
STUDY

DESIGN:

A retrospective cross-sectional study.

PURPOSE:

The purpose of this study is to evaluate the accuracy and safety of free-hand pedicle screw insertion performed by a young surgeon. OVERVIEW OF LITERATURE Few articles exist regarding the safety of the free-hand technique without inspection by an experienced spine surgeon.

METHODS:

The index surgeon has performed spinal surgery for 2 years by himself. He performed fluoroscopy-assisted pedicle screw installation for his first year. Since then, he has used the free-hand technique. We retrospectively reviewed the records of all consecutive patients undergoing pedicle screw installation using the free-hand technique without fluoroscopy in the thoracic or lumbar spine by the index surgeon. Incidence and extent of cortical breach by misplaced pedicle screw was determined by a review of postoperative computed tomography (CT) images.

RESULTS:

A total of 36 patients received 306 free-hand placed pedicle screws in the thoracic or lumbar spine. A total of 12 screws (3.9%) were identified as breaching the pedicle in 9 patients. Upper thoracic spine was the most frequent location of screw breach (10.8%). Lateral breach (2.3%) was more frequent than any other direction. Screw breach on the right side (9 patients) was more common than that on the left side (3 patients) (p<0.01).

CONCLUSIONS:

An analysis by CT scan shows that young spine surgeons who have trained under the supervision of an experienced surgeon can safely place free-hand pedicle screws with an acceptable breach rate through repetitive confirmatory steps.
Subject(s)

Full text: Available Index: WPRIM (Western Pacific) Main subject: Organization and Administration / Spine / Fluoroscopy / Tomography, X-Ray Computed / Incidence / Cross-Sectional Studies / Retrospective Studies / Hand Type of study: Incidence study / Observational study / Prevalence study / Prognostic study / Risk factors Limits: Humans Language: English Journal: Asian Spine Journal Year: 2014 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Organization and Administration / Spine / Fluoroscopy / Tomography, X-Ray Computed / Incidence / Cross-Sectional Studies / Retrospective Studies / Hand Type of study: Incidence study / Observational study / Prevalence study / Prognostic study / Risk factors Limits: Humans Language: English Journal: Asian Spine Journal Year: 2014 Type: Article