Many surgeons use the freehand technique for pedicle screw placement, but how accurate is it in the thoracolumbosacral spine?
A study published in The Spine Journal examines pedicle screw placement in the thoracolumbosacral spine using the freehand technique with lateral fluoroscopy. The study includes 770 screws placed in 114 patients at T7 to S1. Here are five quick findings from the study:
• Three patients had wound infections
• One patient died
• 18 screws — 2.3 percent — had incorrect position
• L4 and L5 had the highest accuracy
• T9 had the highest inaccuracy rate
• Average inaccuracy rate was 10.5 percent for T7 to T9
• Average inaccuracy rate was 2.5 percent for T10 to L2
• Average inaccuracy rate was 0.9 percent for L3 to S1
• The difference between levels was statistically significant
• Only one screw needed revision
"The results of our study show that conventional methods for pedicle screw placement remain safe and accurate with best results obtained in the lumbosacral spine, followed by the thoracolumbar junction," said the study authors. "Nonetheless, results are less accurate in the mid thoracic spine."