Are breech rates for pedicle screws higher in the upper thoracic spine?

被引：11
作者：
Privitera D.M. [1 ]
Matsumoto H. [2 ]
Gomez J.A. [3 ]
Roye Jr. D.P. [2 ,4 ]
Hyman J.E. [2 ,4 ]
Vitale M.G. [2 ,4 ]
机构：
[1] Department of Orthopaedic Surgery, State University of New York at Buffalo, Buffalo, NY 14214
[2] Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University, New York, NY 10032
[3] Department of Orthopaedic Surgery, Columbia University, PH11-Center, New York, NY 10032
[4] Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY 10032
来源：
Spine Deformity | 2013年 / 1卷 / 3期
关键词：
Computed tomography; Pediatric spinal deformity; Pedicle screw misplacement;
D O I：
10.1016/j.jspd.2013.04.002
中图分类号：
学科分类号：
摘要：
Study Design: A case-control study. Objectives: To evaluate pedicle screw placement in pediatric patients with various etiologies of scoliosis, and to identify predictors of misplacement. Summary of Background Data: Accuracy of placement of pedicle screws has not been well documented for posterior spinal instrumentation and fusion performed in the non-idiopathic population. Methods: A total of 54 patients (29 idiopathic, 16 neuromuscular, and 9 congenital/syndromic scoliosis), ages 5-19 years, were included. Computed tomography scans were obtained on patients postoperatively to assess screw position. Three pediatric orthopedic surgeons evaluated screw placement, and risk factors for misplacement were examined. Results: Of 1,042 pedicle screws, 8.3% were misplaced. Among all etiologies, screws placed at T1 (28.6%) and T2 (18.2%) had higher misplacement rates. T2 screws and curve correction greater than 75% had higher misplacement rates in congenital/syndromic patients; screws at T3, screws at upper end of construct, and proximal screws had significantly higher misplacement rates in neuromuscular patients; and no variables predicted misplacement in idiopathics. Screws placed at the most proximal end of the screw/rod construct also had a higher misplacement rate (14.1%) compared with all remaining levels (7.8%). Nonidiopathic patients had higher anterior misplacement compared with idiopathic. No screws were removed or revised, and no screw-related complications were observed. Conclusions: Pedicle screw instrumentation in the thoracolumbar spine was safe for pediatric patients. We found that pedicle screws placed at top levels are at higher risk for misplacement among all pediatric scoliosis patients. Nonidiopathic patients are at higher risk for anterior screw misplacement, and the predictive effect of vertebral level is more profound in nonidiopathic patients. Because of these findings, we routinely use fluoroscopic guidance for the placement of T1 and T2 screws, and screws at the proximal end of construct. © 2013 Scoliosis Research Society.
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页码：189 / 195
页数：6
相关论文
共 46 条
[1]  
King D., Internal fixation for lumbosacral fusion, J Bone Joint Surg Am, 30, pp. 560-565, (1948)
[2]  
Roy-Camille R., Saillant G., Mazel Ch., Plating of thoracic, thoracolumbar, and lumbar injuries with pedicle screw plates, Orthopedic Clinics of North America, 17, 1, pp. 147-159, (1986)
[3]  
Cotrel Y., Dubousset J., Guillaumat M., New universal instrumentation in spinal surgery, Clinical Orthopaedics and Related Research, 227, pp. 10-23, (1988)
[4]  
Gaines Jr. R.W., The use of pedicle-screwinternal fixation for the operative treatment of spinal disorders, J Bone Joint Surg Am, 82, pp. 1458-1476, (2000)
[5]  
Gertzbein S.D., Robbins S.E., Accuracy of pedicular screw placement in vivo, Spine, 15, 1, pp. 11-14, (1990)
[6]  
Kuntz C.T., Maher P.C., Levine N.B., Kurokawa R., Prospective evaluation of thoracic pedicle screw placement using fluoroscopic imaging, J Spinal Disord Tech, 17, pp. 206-214, (2004)
[7]  
Sjostrom L., Jacobsson O., Karlstrom G., Pech P., Rauschning W., CT analysis of pedicles and screw tracts after implant removal in thoracolumbar fractures, Journal of Spinal Disorders, 6, 3, pp. 225-231, (1993)
[8]  
Vaccaro A.R., Rizzolo S.J., Allardyce T.J., Et al., Placement of pedicle screws in the thoracic spine. Part I: Morphometric analysis of the thoracic vertebrae, J Bone Joint Surg Am, 77, pp. 1193-1199, (1995)
[9]  
Yamagata M., Kitahara H., Minami S., Et al., Mechanical stability of the pedicle screw fixation systems for the lumbar spine, Spine (Phila Pa 1976), 17, (1992)
[10]  
Zindrick M.R., Wiltse L.L., Widell E.H., A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine, Clinical Orthopaedics and Related Research, 203, pp. 99-112, (1986)
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