Accuracy of Inserting a Pedicle Screw Percutaneously to Fix Thoracic and Lumbar Spinal Fractures by Minimally Invasive Procedures: A Prospective Observational Study
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
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