Appropriate insertion point for percutaneous pedicle screw placement in the lumbar spine using c-arm fluoroscopy: a cadaveric study

• Published in: BMC musculoskeletal disorders 2020-11, Vol.21 (1), p.750-750, Article 750
• Main Authors: Xu, Wei-Xing, Ding, Wei-Guo, Xu, Bin, Hu, Tian-Hong, Sheng, Hong-Feng, Zhu, Jia-Fu, Zhu, Xiao-Long
• Format: Article
• Language: English
• Subjects: Arm; C-arm X-ray fluoroscopy; Cadaver; Cadavers; Care and treatment; Facet joint; Fluoroscopy; Humans; Injuries; Insertion point; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - surgery; Methods; Musculoskeletal diseases; Orthopedic fixation devices; Pedicle projection; Pedicle Screws; Skull; Spinal diseases; Spinal Fusion; Spine (lumbar); Statistical analysis; Surgery; Vertebrae
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-020-03751-y

We studied the characteristics and regularity of appropriate insertion points for percutaneous pedicle screw placement in the lumbar spine using C-arm X-ray fluoroscopy. The purpose of this study was to improve the accuracy of percutaneous pedicle screw placement and reduce the incidence of superior-level facet joint violation. Six normal spinal specimens were included. Three different methods for placing percutaneous pedicle screws in the lumbar spine were applied, including the Roy-Camille method, Magerl method and Weinstein method. The relationships among the insertion point, pedicle projection and proximal facet joint on C-arm X-ray films were studied. The projection morphology of the vertebral pedicle in different segments of the lumbar spine was observed. The relationship between the outer edge of the pedicle projection and the outer edge of the cranial articular process was also studied. The distance between the insertion point and the facet joint (M1), the distance between the insertion point and outer edge of the cranial articular process (M2), and the distance between the insertion point and the projection center of the pedicle (M) were measured. In this study, we found that the projection shape of the vertebral pedicle differed across segments of the lumbar spine: the shape for L1-L3 was oval, and that for L4-L5 was round. The radiographic study showed that the outer edge of the cranial articular process was located on the lateral side of the outer edge of the pedicle projection and did not overlap with the pedicle projection. M for the Weinstein group was larger than that for the Roy-Camille group (P