Placement of Thoracic Pedicle Screws

JBJS Essential Surgical Techniques
David W PollyKristen E Jones

Abstract

Thoracic pedicle screws have become the spinal anchor of choice because of the superior biomechanics of this technique. It is widely used for the treatment of scoliosis, spinal deformity (such as kyphosis), trauma, tumors, infection, and other pathologies. The technique demands precision as malposition can result in spinal cord or visceral injury with potential catastrophic consequences (death or paralysis). There have been many published articles looking at the anatomy and the anatomic variation in various populations according to race, age, deformity, etc. Lenke and others have developed start point guidelines that seem to have reasonable validity. There are two basic screw trajectories:The straightforward technique.The anatomic trajectory. The straightforward technique parallels the superior end plate of the instrumented vertebra. It has the best insertional torque. The anatomic trajectory bisects the sagittal axis of the pedicle, typically 15° cranial to caudal, and has the largest available bone channel. The accuracy of placement is a debated topic. There are several meta-analyses and systematic reviews that address this question. However, there are a variety of definitions of acceptable compared with optimal placement. Th...Continue Reading

References

Oct 27, 2001·Spine·P J BelmontD W Polly
Jul 29, 2004·Journal of Spinal Disorders & Techniques·Ronald A LehmanJoseph R Orchowski
Mar 28, 2006·Neurology India·Yongjung J Kim, Lawrence G Lenke
Aug 16, 2012·Journal of Pediatric Orthopedics·A Noelle LarsonJonathan N Sembrano
Nov 26, 2013·The Spine Journal : Official Journal of the North American Spine Society·Ronald A LehmanHaines Paik
Jun 25, 2014·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Marinus de KleuverChristopher Shaffrey

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Citations

Nov 21, 2016·Musculoskeletal Surgery·F PernaM Chehrassan
Nov 16, 2017·Biomedical Engineering Online·Farhad AzimifarFarhad Tabatabai Ghomsheh

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