The influence of anatomy (normal versus scoliosis) on the free-hand placement of pedicle screws: Is misplacement more frequent in patients with anatomical deformity?

摘要

>Study design: Retrospective prognostic study.>Objective: To evaluate whether patients with anatomical deformity due to scoliosis have a higher frequency of inaccurate pedicle screw insertion and related complications using the free-hand technique compared with those whose normal anatomy had been impacted by trauma.>Methods: Consecutively treated trauma patients with otherwise normal anatomy (48 patients instrumented with 291 screws, group A) and scoliosis patients (24 patients instrumented with 287 screws, group B) were evaluated. Screw position on CT was evaluated using the classification by Gertzbein and Robbins with modification by Karagoz Guzey. (See web appendix at for complete classification description.) Images were examined by two fellows and one junior staff member none of whom participated in patient management. Screw position was determined by consensus.>Results: In group A, five (1.7%) out of 289 screws were severely misplaced and 26 (9%) screws caused either medial (3.8%) or lateral (5.2%) cortical breeches. The other 258 (89.3%) screws were fully contained within the cortical boundaries of the pedicle. In group B, seven (2.8%) out of 256 screws were severely misplaced. Thirty-three (13%) screws caused cortical breeches, either medial (9%), lateral (2%), or anterior (2%), and 216 (84.3%) screws were fully contained within the cortical boundaries of the pedicle and the vertebra. Neurological complications were reported in one patient with scoliosis. No vascular complications were reported in either group.>Conclusions: The percentage of incorrectly placed screws was similar in both groups, trauma and deformity patients. The presence of vertebral anatomical changes related to adult scoliosis was not associated with an increase in the screw-related neurological or vascular complications. rules="all" class="rendered small default_table">>Methods evaluation and class of evidence (CoE)> valign="top" align="left" colspan="2" rowspan="1">>Methodological principle:> valign="top" align="left" colspan="2" rowspan="1">Study design:> valign="top" align="left" rowspan="1" colspan="1"> Prospective cohort valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Retrospective cohort valign="top" align="center" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1"> Case control valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Case series valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" colspan="2" rowspan="1">Methods> valign="top" align="left" rowspan="1" colspan="1"> Patients at similar point in course of treatment valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1"> Follow-up ≥85% valign="top" align="center" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1"> Similarity of treatment protocols for patient groups valign="top" align="center" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1"> Patients followed for long enough for outcomes to occur valign="top" align="center" rowspan="1" colspan="1">•> valign="top" align="left" rowspan="1" colspan="1"> Control for extraneous risk factors valign="top" align="left" rowspan="1" colspan="1">> valign="top" align="left" rowspan="1" colspan="1">>Evidence class: valign="top" align="center" rowspan="1" colspan="1">>IIIThe definiton of the different classes of evidence is available on page 73.