A new study published in The Spine Journal evaluates the accuracy of intraoperative fluoroscopy to place pedicle screws.
Researchers examined 198 consecutive patients who underwent transpedicular screw fixation, with a total of 1,218 screws analyzed. The pedicle screws were inserted in to the vertebral body with lateral fluoroscopy assistance only in 81 patients while 117 patients had screws inserted with the assistance of lateral fluoroscopy (Group A) and final positions of the screws were checked with anterioposterior fluoroscopy (Group B). The researchers found:
• 2.2 percent of the screws breached the pedicle
• 3.6 percent of the breached screws were in Group A
• 1.16 percent of the breached screws were in Group B
• Lateral violation in Group A was seen in 1.9 percent of the patients
• Medial violation was seen in 1.7 percent of Group A
• Lateral violation of the pedicle was seen in 0.87 percent of Group B
• Medial violation was seen in 0.29 percent of Group B
• Pedicle breach occurred in 21 patients and 15 underwent revision surgery to correct the misplacement
"We concluded that the intraoperative use of fluoroscopy, especially in the anterioposterior position, significantly decreases the risk of screw misplacement and the results are comparable with other advanced techniques," concluded the authors.
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