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Eur Spine J (2013) 22:495502 DOI 10.1007/s00586-012-2476-8
ORIGINAL ARTICLE
Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures: a prospective trial
Timo Michael Heintel Andreas Berglehner
Rainer Meffert
Received: 6 February 2012 / Revised: 16 July 2012 / Accepted: 2 August 2012 / Published online: 18 August 2012 Springer-Verlag 2012
AbstractPurpose The percutaneous insertion technique requires surgical skill and experience. However, there have been few clinical reports evaluating the accuracy of minimally invasive pedicle screw placement using the conventional uoroscopy method. The purpose of this study was to evaluate the accuracy of percutaneous pedicle screw placement in the treatment of thoracic and lumbar spine fractures using two-plane conventional uoroscopy. Methods A prospective clinical trial was performed. A total of 502 percutaneous pedicle screws in 111 patients, all inserted with the assistance of conventional uoroscopy, were evaluated. The safety and accuracy of pedicle screw placement were based on the evaluation of postoperative axial 3-mm slice computed tomography scans using the scoring system described by Zdichavsky et al. [Eur J Trauma 30:234240, 2004; Eur J Trauma 30:241247, 2004].
Results 427/502 pedicle screws (85 %) were classied as good and excellent concerning the best possible screw length and 494/502 (98 %) were found to have good or excellent position. One screw had to be revised due to medial position with a neurological decit.
Conclusions This study demonstrates the feasibility of placing percutaneous posterior thoracolumbar pedicle screws with the assistance of conventional uoroscopy. Minimally invasive transpedicular instrumentation is an accurate, reliable and safe method to treat a variety of spinal disorders, including thoracic and lumbar spine fractures.
Keywords Thoracolumbar spine fractures Pedicle
screw Percutaneous technique Minimally invasive spine
surgery Transpedicular instrumentation
Introduction
In the last two decades, there has been a clear trend in surgery to minimize the injury to normal tissues while abating the same or a better surgical outcome. The idea of percutaneous transpedicular instrumentation for thoracic and lumbar spine fractures has a long history. Percutaneous transpedicular instrumentation was rst performed and described by Magerl in 1977 [14]. It was brought into play for temporary external xation of spinal fractures and in case of infections [14, 15].
The advantage of percutaneous dorsal pedicle screw instrumentation appears to be obvious with respect to the approach. There...