Syed Aamir Shah, Hammad Mehtab, Rayif Rashid Kanth, Faizullah Khan, Muhammad Nawaz, Sheema Atif


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ABSTRACT

Aim: To assess the accuracy of inserting a pedicle screw percutaneously to fix thoracic and lumbar spinal fractures by minimally invasive procedures.

Study design: Prospective observational study.

Place and duration: This study was conducted at , Pakistan Institute of Medical Sciences Islamabad, Pakistan  from March 2020 to March 2021.

Methodology: A total of 50 patients were evaluated, who had suffered from spinal injuries in the form of thoracic and lumbar spine fractures and were admitted for spinal surgery. Extensive CT scans were ordered for these patients and on the basis of these scans, the clinicians authorized and assessed the positioning for the percutaneous pedicle screw. However, in cases where the scans were not enough to visualize the exact placement of the pedicle cortex, an approach known as the cortical encroachment was applied. In cases where the need for the screw to be inserted laid outside the boundaries of the pedicle cortex the clinicians utilized a method known as the frank penetration. If placement for this screw was located outside the boundaries of the pedicle these boundaries were categorized in three types. Minor: if the displacement was less than 3 millimeters, moderate: where the placement lay between 3 to 6 millimeters and severe: where the placement was greater than 6 millimeters.

Results: At total of 380 screws were fitted percutaneously in 50 patients. A total of 281(74%) of these screws were fitted inside the pedicle, 53 screws (14%) were placed in such a way that they encroached the pedicle and 46 (12%) of the cases showed that the screws penetrated the pedicle. Minor screw penetration was in 32 (8.47%) cases, moderate penetration in 10 (2.58 %) and severe penetration in 3 (0.7%) cases. Among one of severe screw penetration post-operative neurological symptoms were noted.

Conclusion: Our study concludes that most of the pedicle positioning of screws were ideally placed, while in few cases there were Encroachment and perforation

Keywords: Thoracic spine, lumber spine, spinal injury, pedicel screw



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