Accuracy of Freehand Versus Modified Funnel Technique for Pedicle Screw Insertion in the Thoracic Spine.

AIM: To describe a new pedicle screw insertion technique, a modification of the funnel technique, and to compare this technique with conventional freehand screw insertion regarding their accuracy and complications in the thoracic spine. MATERIAL AND METHODS: Three hundred forty-three patients who underwent a posterior spinal fusion with different etiologies were retrospectively analyzed. In 84 patients, pedicle screws were placed using the freehand technique, and in 259 patients, the modified funnel technique was used. Screw malposition was evaluated in the immediate and final follow-up in anteroposterior and lateral spinal radiographs by two independent observers. The rates of incorrect pedicle screws and complications, surgical duration, and estimated blood loss were compared between the groups. RESULTS: A total of 6141 pedicle screws (1468 in the freehand group, 4673 in the modified funnel group) were evaluated. The rate of incorrect pedicle screws was higher in the freehand group (12.0% vs. 4.6%, p=0.001). The surgical time was shorter in the modified funnel group (190.9 ± 57.0 vs. 174.1 ± 47.6 min; p=0.017). The estimated blood loss was similar between the groups (1391.50 ± 570.01 vs. 1264.13 ± 602.29 mL; p=0.053). There were 82 intraoperative pedicle fractures but no neurologic complications in either group. CONCLUSION: The modified funnel technique provides more accurate pedicle screw insertion in the thoracic spine in the presence of dysplastic pedicles in conjunction with axial rotation compared with the freehand technique. Furthermore, surgical time may be reduced without increasing blood loss.

Management and results of early-onset scoliosis with dual magnetically controlled growing rods: Additional preliminary results of spinal fusion surgery.

OBJECTIVES: The aim of this study was to evaluate the clinical and radiographic outcomes and complications of dual magnetically controlled growing rods (MCGRs) in the treatment of early-onset scoliosis (EOS) and to investigate the results of patients with definitive spinal fusion following MCGR. PATIENTS AND METHODS: A total of 15 patients (7 males, 8 females; mean age: 8.7±1.7 years; range, 6 to 10 years) with EOS who underwent dual MCGR and were prospectively followed between February 2013 and March 2019 were included in this retrospective study. The Cobb angle, thoracic kyphosis, and the length of the spine between T1-T12 and T1-S1 were measured on preoperative, postoperative, and follow-up radiographs. The 24-Item Early-Onset Scoliosis Questionnaire (EOSQ-24) was used to assess the functional outcomes before and after the operation. All complications during the treatment were recorded. RESULTS: The mean follow-up was 27.8±10.4 (range, 12 to 60) months. The mean curve correction immediately after the index surgery and latest follow-up was 47.6% and 42.4%, respectively (p>0.05). At the last follow-up, there were no significant changes in mean Cobb and kyphosis angles. The mean T1-T12 length increase was 26.2±7.1 (range, 16 to 40) mm, while the mean T1-S1 length increase was 43.3±15.0 (range, 24 to 70) mm. Complications developed in four (26.6%) of 15 patients. Definitive spinal fusion surgery was performed in seven patients. Total mean Cobb angle difference between the final follow-up and fusion surgery was 9.3° (p=0.016) and kyphosis angle difference was -2.1° (p=0.349). After fusion surgery, total lengthening in T1-T12 and T1-S1 distance was 10.5 mm (p=0.036) and 15.0 mm (p=0.022), respectively. A significant increase in all subdomain scores of the EOSQ-24 (p<0.05), except for financial impact, was recorded in all patients. CONCLUSION: Dual MCGR technique is an effective, reliable, and robust treatment alternative for primary EOS. However, surgeons should be aware of the relatively high rate of complications. In addition, residual deformity can be corrected successfully with definitive surgery.