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CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(01): 012-016
DOI: 10.1055/s-0043-1763523
Review Article

Accuracy and Safety of Fluoroscopy-Assisted Transpedicular Screw Insertion in Thoracolumbar Spine Surgery: Evaluation of 122 Screws

Imad-Eddine Sahri
1   Department of Neurosurgery, Mohammed V Military Hospital Rabat, Rabat, Morocco
,
Zakaria Chandid Tlemcani
1   Department of Neurosurgery, Mohammed V Military Hospital Rabat, Rabat, Morocco
,
Sofia El Akroud 
1   Department of Neurosurgery, Mohammed V Military Hospital Rabat, Rabat, Morocco
,
El Asri Abad Cherif
1   Department of Neurosurgery, Mohammed V Military Hospital Rabat, Rabat, Morocco
,
Miloudi Gazzaz
1   Department of Neurosurgery, Mohammed V Military Hospital Rabat, Rabat, Morocco
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Abstract

The objective of this study is to determine the accuracy and safety of trans-pedicular screws' insertion in the thoracolumbar spine using a fluoroscopy-assisted surgical technique. We retrospectively evaluated all patients who underwent a postoperative computed tomography scan to assess the location of the pedicular screws following thoracolumbar spinal surgery, at the Mohammed Vth Military Training Hospital-Rabat, from January 2020 to April 2022. We used Gertzbein's classification to grade pedicular cortex breaches. A screw penetration greater than 4 mm (grades D–E) was considered critical and one less than 4 mm was classified as noncritical (grades A–C). A total of 122 screws inserted in the T1 to L5 vertebrae were included from 25 patients. The average age was 46 years old. Pathologies included degenerative disorders (5 patients), tumors (8 patients), and trauma (12 patients). All screws were inserted using lateral and anteroposterior fluoroscopic guidance. A total of 11 transpedicular screws breaches were identified. The breaches incidence was significantly higher in thoracic pedicles (8 screws) than in lumbar pedicles (3 screws). Of these, three critical cases occurred in two patients and one of them required reintervention. The remaining eight exceedances were not critical and were closely monitored and followed up. Transpedicular screws fluoroscopy-assisted surgical fixation can be performed for the stabilization of the thoracolumbar spine with satisfactory safety and precision.

Keywords

transpedicular screw insertion - thoracolumbar spine - fluoroscopy - accuracy - safety


Publication History

Article published online:
27 March 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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