Accuracy Assessment of Freehand Pedicular Screw Placement

Background: The purpose of this prospective study was to determine the accuracy of pedicular screw insertion withoutthe use of fluoroscopy.Methods: This study was conducted on patients with spinal diseases in need of pedicular screw fixation and fusion.The included patients suffered from such conditions as vertebral fracture, spinal stenosis, kyphosis, tumor, and pelvicfractures and were managed with triangular osteosynthesis fixation. However, those with scoliosis deformity wereexcluded from the study. A total of 760 pedicular screws were inserted in C7 to S1 vertebrae without using fluoroscopy.The locations of the screws were assessed by means of computed tomography scan after the surgery. The data wereanalyzed in SPSS software (version 22) using the Chi-square test.Results: Out of 387 thoracic screws and 373 lumbar screws, 65 (16.8%) and 34 (9.1%) screws perforated the pediclewall or vertebral body, respectively. The most frequent locations of perforation in the thoracic and lumbar spine werethe anterior cortex of the vertebral body and medial wall of the pedicle, respectively. Except for the perforation of theanterior vertebral body (P=0.0001), there was no difference between the left and right sides or between thoracic andlumbar sites in terms of the preformation of the screw. No complication was observed due to screw perforation.Conclusion: Our findings revealed the unnecessity of using fluoroscopy in spine surgeries for the insertion of pediculatescrews. In this regard, the use of fluoroscopy for the placement of pedicular screw resulted in similar accuracy andcomplications, as compared to the free hand procedure.Level of evidence: I

Keywords:

Fluoroscopy , lumbar , Pedicular screw , Spine fixation , Thoracic