Post-Operative Computed Tomography to Evaluate the Accuracy of Thoracic and Lumbosacral Spine Pedicular Screw Fixation

Abstract

Background: pedicular screw fixation is rapidly becoming a widely used method of spinal instrumentation. Despite improvement in design of instruments and surgical technique and the use of intra-operative fluoroscopy, pedicle cortical perforations occur endangering nearby neurovascular or extra vertebral structures.Objective: This is a prospective (consecutive cases study) designed for Evaluation of incidence of pedicle screw misplacement in our study sample, compare our results to what is published in literature.Patients and Method: This study involved 25 adult patients ( 10 males and 15 females ) their age ranged between ( 18 and 70 years) who underwent spinal surgery with pedicle screw fixation for different disorders of thoracic and lumbosacral spine with the aid of intraoperative fluoroscopy. Computed Tomography (CT) scan within one month was done for all patients to evaluate the accuracy of pedicle screw placement. Any new neurological symptoms was recorded and correlated with screw misplacement.Results: 122screws inserted in 25 patients with an overall accuracy of (90.16%), frank misplacement of (4.09% )and questionable penetration of ( 5.73%) , new neurological deficit was seen in (20%) among all misplaced screws and in one case (4%) out of the 25 cases.Conclusion: pedicle screw fixation surgery is a demanding procedure. Our incidence of screw misplacement is compatible with the lower published results in the literature. Not all patients with frank penetration of the pedicle cortical outlines developed complications.Keywords: Computed tomography, Pedicular Screw fixation, accuracy.