Accuracy and safety of pedicle screw fixation in thoracic spine trauma

被引:57
作者
Fisher, Charles G.
Sahajpal, Vic
Keynan, Ory
Boyd, Michael
Graeb, Douglas
Bailey, Christopher
Panagiotopoulos, Kostas
Dvorak, Marcel F.
机构
[1] Univ British Columbia, Dept Orthopaed, Spine Div, Vancouver, BC V5Z 1M9, Canada
[2] Univ British Columbia, Dept Surg, Div Neurosurg, Vancouver, BC V6T 1W5, Canada
[3] Vancouver Hosp & Hlth Sci Ctr, Combined Neurosurg & Orthopaed Spine Program, Vancouver, BC V5Z 1M9, Canada
[4] Tel Aviv Univ, Sackler Fac Med, Tel Aviv Sourasky Med Ctr, Dept Orthopaed Surg B, IL-69978 Tel Aviv, Israel
[5] Vancouver Gen Hosp, Dept Radiol, Vancouver, BC V5Z 1M9, Canada
关键词
trauma; pedicle screw fixation; thoracic spine;
D O I
10.3171/spi.2006.5.6.520
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Object. The authors evaluated the accuracy of placement and safety of pedicle screws in the treatment of unstable thoracic spine fractures. Methods. Patients with unstable fractures between T-1 and T-10, which had been treated with pedicle screw (PS) placement by one of five spine surgeons at a referral center were included in a prospective cohort study. Postoperative computed tomography scans were obtained using 3-mm axial cuts with sagittal reconstructions. Three independent reviewers (C.B., V.S., and D.G.) assessed PS position using a validated grading scale. Comparison of failure rates among cases grouped by selected baseline variables were performed using Pearson chi-square tests. Independent peri- and postoperative surveillance for local and general complications was performed to assess safety. Twenty-three patients with unstable thoracic fractures treated with 201 thoracic PSs were analyzed. Only PSs located between T-1 and T-12 were studied, with the majority of screws placed between T-5 and T-10. Of the 201 thoracic PSs, 133 (66.2%) were fully contained within the pedicle wall. The remaining 68 screws (33.8%) violated the pedicle wall. Of these, 36 (52.9%) were lateral, 27 (39.7%) were medial, and five (7.4%) were anterior perforations. No superior, inferior, anteromedial, or anterolateral perforations were found. When local anatomy and the clinical safety of screws were considered, 98.5% (198 of 201) of the screws were probably in an acceptable position. No baseline variables influenced the incidence of perforations. There were no adverse neurological, vascular, or visceral injuries detected intraoperatively or postoperatively. Conclusions. In the vast majority of cases, PSs can be placed in an acceptable and safe position by fellowship-trained spine surgeons when treating unstable thoracic spine fractures. However, an unacceptable screw position can occur.
引用
收藏
页码:520 / 526
页数:7
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