Placement of Thoracic Pedicle Screws

JBJS Essential Surgical Techniques, 2016 · DOI: 10.2106/JBJS.ST.N.00114 · Published: March 9, 2016

Simple Explanation

Thoracic pedicle screws are favored due to their superior biomechanics and are used in treating conditions like scoliosis, spinal deformity, trauma, tumors, and infections. The procedure necessitates precision to avoid spinal cord or visceral injury, which could lead to severe complications like paralysis or death. Surgeons can use freehand, fluoroscopy-guided, or 3-D image-guided methods, choosing the technique they find safest and most reliable.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Not specified

Key Findings

1
The straightforward technique, which parallels the superior end plate, offers the best insertional torque.
2
The anatomic trajectory, bisecting the pedicle's sagittal axis, provides the largest available bone channel.
3
Intraoperative 3-D imaging is the most reliable technique to confirm screw placement accuracy, although it exposes patients to the most radiation.

Research Summary

Thoracic pedicle screws are widely used for various spinal pathologies due to their superior biomechanics, but precise placement is crucial to avoid severe complications. Two basic screw trajectories exist: the straightforward technique and the anatomic trajectory, each with distinct advantages. Various techniques exist for screw placement, including freehand, fluoroscopy-guided, and 3-D image-guided methods, each with its own advantages and disadvantages.

Practical Implications

Surgical Planning

Preoperative planning involving plain radiographs and computed tomography scans is essential for accurate screw placement.

Technique Selection

Surgeons should select the screw placement technique (freehand, fluoroscopy-guided, or 3D image-guided) that they find safe and reliable.

Postoperative Care

With good thoracic screw placement, rehabilitation typically is accelerated because a stable spinal construct is achieved, allowing most patients to walk without external mobilization.

Study Limitations

1
Malposition can result in spinal cord or visceral injury with potential catastrophic consequences.
2
Accuracy of placement is a debated topic.
3
Computed tomography carries a substantial radiation burden to the patient.

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