Free-hand placement of high thoracic pedicle screws with the aid of fluoroscopy: evaluation of positioning by CT scans in a four-year consecutive series

• Published in: Arquivos de neuro-psiquiatria 2010-06, Vol.68 (3), p.390-395
• Main Authors: Braga, Bruno Perocco, de Morais, Josaphat Vilela, Vilela, Marcelo Duarte
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Bone Screws; Feasibility Studies; Female; Fluoroscopy; Follow-Up Studies; Humans; Joint Instability - surgery; Male; Middle Aged; Monitoring, Intraoperative - methods; NEUROSCIENCES; PSYCHIATRY; Spinal Diseases - diagnostic imaging; Spinal Diseases - surgery; Spinal Fusion - instrumentation; Spinal Fusion - methods; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - injuries; Thoracic Vertebrae - surgery; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0004-282X; 1678-4227; 1678-4227; 0004-282X
• DOI: 10.1590/S0004-282X2010000300012

To evaluate the feasibility, safety and accuracy of pedicle screw placement in the upper thoracic spine using the free-hand technique with the aid of fluoroscopy; to analyze the methods used to verify correct screw positioning intra and postoperatively. All patients with instability of the cervicothoracic or upper thoracic spine and at least one screw placed in the segment T1-T6 as part of a posterior construct entered the study. Only C-arm intraoperative fluoroscopy was used to guide screw placement. We obtained excellent positioning in 98.07% of the screws. CT scans precisely demonstrated pedicle wall and anterolateral body violations. There was no hardware failure, no neurological or vascular injury and no loss of alignment during the follow-up period. Pedicle screws can be safely placed in the upper thoracic spine when strict technical principles are followed. Only a CT scan can precisely demonstrate vertebral body and medial pedicle cortical violations.