The use of fluoroscopic guided percutaneous pedicle screws in the upper thoracic spine (T1-T6)
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The use of fluoroscopic guided percutaneous pedicle screws in the upper thoracic spine (T1-T6) : Is it safe? / Kwan, Mun Keong; Chiu, Chee Kidd; Chan, Chris Yin Wei; Zamani, Reza; Hansen-Algenstaedt, Nils.
In: J ORTHOP SURG-HONG K, Vol. 25, No. 2, 28.07.2017, p. 2309499017722438.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - The use of fluoroscopic guided percutaneous pedicle screws in the upper thoracic spine (T1-T6)
T2 - Is it safe?
AU - Kwan, Mun Keong
AU - Chiu, Chee Kidd
AU - Chan, Chris Yin Wei
AU - Zamani, Reza
AU - Hansen-Algenstaedt, Nils
PY - 2017/7/28
Y1 - 2017/7/28
N2 - PURPOSE: This study analysed the accuracy and safety of the fluoroscopic guided percutaneous screws in the upper thoracic vertebrae (T1-T6).METHODS: Computed tomography scans from 74 patients were retrospectively evaluated between January 2008 and December 2012. Pedicle perforations were classified by two types of grading systems. For medial, lateral, superior and inferior perforations: grade 0 - no violation; grade 1 - <2 mm; grade 2 - 2-4 mm and grade 3 - >4 mm. For anterior perforations: grade 0 - no violation; grade 1 - <4 mm; grade 2 - 4-6 mm and grade 3 - >6 mm.RESULTS: There were 35 (47.3%) male and 39 (52.7%) female patients with a total 260 thoracic pedicle screws (T1-T6) analysed. There were 32 screw perforations which account to a perforation rate of 12.3% (11.2% grade 1, 0.7% grade 2 and 0.4% grade 3). None led to pedicle screw-related complications. The perforation rate was highest at T1 (33.3%, all grade 1 perforations), followed by T6 (14.5%) and T4 (14.0%).CONCLUSION: Fluoroscopic guided percutaneous pedicle screws of the upper thoracic spine (T1-T6) are technically more demanding and carry potential risks of serious complications. Extra precautions need to be taken when fluoroscopic guided percutaneous pedicle screws are placed at T1 and T2 levels, due to high medial pedicular angulation and obstruction of lateral fluoroscopic images by the shoulder girdle and at T4-T6 levels, due to smaller pedicular width.
AB - PURPOSE: This study analysed the accuracy and safety of the fluoroscopic guided percutaneous screws in the upper thoracic vertebrae (T1-T6).METHODS: Computed tomography scans from 74 patients were retrospectively evaluated between January 2008 and December 2012. Pedicle perforations were classified by two types of grading systems. For medial, lateral, superior and inferior perforations: grade 0 - no violation; grade 1 - <2 mm; grade 2 - 2-4 mm and grade 3 - >4 mm. For anterior perforations: grade 0 - no violation; grade 1 - <4 mm; grade 2 - 4-6 mm and grade 3 - >6 mm.RESULTS: There were 35 (47.3%) male and 39 (52.7%) female patients with a total 260 thoracic pedicle screws (T1-T6) analysed. There were 32 screw perforations which account to a perforation rate of 12.3% (11.2% grade 1, 0.7% grade 2 and 0.4% grade 3). None led to pedicle screw-related complications. The perforation rate was highest at T1 (33.3%, all grade 1 perforations), followed by T6 (14.5%) and T4 (14.0%).CONCLUSION: Fluoroscopic guided percutaneous pedicle screws of the upper thoracic spine (T1-T6) are technically more demanding and carry potential risks of serious complications. Extra precautions need to be taken when fluoroscopic guided percutaneous pedicle screws are placed at T1 and T2 levels, due to high medial pedicular angulation and obstruction of lateral fluoroscopic images by the shoulder girdle and at T4-T6 levels, due to smaller pedicular width.
KW - Journal Article
U2 - 10.1177/2309499017722438
DO - 10.1177/2309499017722438
M3 - SCORING: Journal article
C2 - 28748740
VL - 25
SP - 2309499017722438
JO - J ORTHOP SURG-HONG K
JF - J ORTHOP SURG-HONG K
SN - 1022-5536
IS - 2
ER -
