scholarly journals Thoracic pedicle screw fixation for spinal deformity

2003 ◽  
Vol 14 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Michael K. Rosner ◽  
David W. Polly ◽  
Timothy R. Kuklo ◽  
Stephen L. Ondra
Keyword(s):  
Spinal Deformity ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Thoracic Pedicle Screw ◽  
Transpedicular Screw ◽  
Thoracic Pedicle Screws ◽  
Spinal Deformity Surgery ◽  
Minimum Number ◽  
Transpedicular Screw Fixation

Techniques to improve segmental fixation have advanced the ability to correct complex spinal deformity. The purpose of instrumentation is to correct spinal deformity or to stabilize the spine to enhance the long-term biological fusion. The ultimate goal of spinal deformity surgery is the creation of a stable, balanced, pain-free spine centered over the pelvis in the coronal and sagittal planes. The minimum number of segments should be fused. These concepts remain challenging in the setting of deformity and instability. Successful results can be obtained if the surgeon understands the technology available, its capabilities, biological limitations, and the desired solution. The authors prefer to use thoracic pedicle screws when treating patients with spinal deformity because they provide greater corrective forces for realignment. This allows shorter-segment constructs and the possibility of true derotation in correction. In this article the authors focus on the use of thoracic transpedicular screw fixation in the management of complex spinal disorders and deformity.

scholarly journals Adjacent-segment disease after thoracic pedicle screw fixation

2018 ◽  
Vol 28 (3) ◽  
pp. 280-286 ◽  
Author(s):  
Nitin Agarwal ◽  
Robert F. Heary ◽  
Prateek Agarwal
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Spine Deformity ◽  
Fracture Stabilization ◽  
Thoracic Pedicle Screw

OBJECTIVEPedicle screw fixation is a technique widely used to treat conditions ranging from spine deformity to fracture stabilization. Pedicle screws have been used traditionally in the lumbar spine; however, they are now being used with increasing frequency in the thoracic spine as a more favorable alternative to hooks, wires, or cables. Although safety concerns, such as the incidence of adjacent-segment disease (ASD) after cervical and lumbar fusions, have been reported, such issues in the thoracic spine have yet to be addressed thoroughly. Here, the authors review the literature on ASD after thoracic pedicle screw fixation and report their own experience specifically involving the use of pedicle screws in the thoracic spine.METHODSSelect references from online databases, such as PubMed (provided by the US National Library of Medicine at the National Institutes of Health), were used to survey the literature concerning ASD after thoracic pedicle screw fixation. To include the authors’ experience at Rutgers New Jersey Medical School, a retrospective review of a prospectively maintained database was performed to determine the incidence of complications over a 13-year period in 123 consecutive adult patients who underwent thoracic pedicle screw fixation. Children, pregnant or lactating women, and prisoners were excluded from the review. By comparing preoperative and postoperative radiographic images, the occurrence of thoracic ASD and disease within the surgical construct was determined.RESULTSDefinitive radiographic fusion was detected in 115 (93.5%) patients. Seven incidences of instrumentation failure and 8 lucencies surrounding the screws were observed. One patient was observed to have ASD of the thoracic spine. The mean follow-up duration was 50 months.CONCLUSIONSThis long-term radiographic evaluation revealed the use of pedicle screws for thoracic fixation to be an effective stabilization modality. In particular, ASD seems to be less of a problem in the relatively immobile thoracic spine than in the more mobile cervical and lumbar spines.

scholarly journals Freehand thoracic pedicle screw technique using a uniform entry point and sagittal trajectory for all levels: preliminary clinical experience

2014 ◽  
Vol 21 (5) ◽  
pp. 778-784 ◽  
Author(s):  
Vernard S. Fennell ◽  
Sheri Palejwala ◽  
Jesse Skoch ◽  
David A. Stidd ◽  
Ali A. Baaj
Keyword(s):  
Pedicle Screw ◽  
Pedicle Screws ◽  
Transverse Process ◽  
Pedicle Screw Fixation ◽  
Entry Point ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Thoracic Pedicle Screw ◽  
Thoracic Pedicle Screws ◽  
Screw Diameter

Object Experience with freehand thoracic pedicle screw placement is well described in the literature. Published techniques rely on various starting points and trajectories for each level or segment of the thoracic spine. Furthermore, few studies provide specific guidance on sagittal and axial trajectories. The goal of this study was to propose a uniform entry point and sagittal trajectory for all thoracic levels during freehand pedicle screw placement and determine the accuracy of this technique. Methods The authors retrospectively reviewed postoperative CT scans of 33 consecutive patients who underwent open, freehand thoracic pedicle-screw fixation using a uniform entry point and sagittal trajectory for all levels. The same entry point for each level was defined as a point 3 mm caudal to the junction of the transverse process and the lateral margin of the superior articulating process, and the sagittal trajectory was always orthogonal to the dorsal curvature of the spine at that level. The medial angulation (axial trajectory) was approximately 30° at T-1 and T-2, and 20° from T-3 to T-12. Breach was defined as greater than 25% of the screw diameter residing outside of the pedicle or vertebral body. Results A total of 219 thoracic pedicle screws were placed with a 96% accuracy rate. There were no medial breaches and 9 minor lateral breaches (4.1%). None of the screws had to be repositioned postoperatively, and there were no neurovascular complications associated with the breaches. Conclusions It is feasible to place freehand thoracic pedicle screws using a uniform entry point and sagittal trajectory for all levels. The entry point does not have to be adjusted for each level as reported in existing studies, although this technique was not tested in severe scoliotic spines. While other techniques are effective and widely used, this particular method provides more specific parameters and may be easier to learn, teach, and adopt.

scholarly journals Clinical effect of a novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for thoracolumbar burst fractures

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Menghan Cai ◽  
Zhijun Xin ◽  
Weijun Kong ◽  
Qian Du ◽  
Wenjun Ji ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Vertebral Body ◽  
Bone Grafting ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Control Group ◽  
Observation Group ◽  
Thoracolumbar Burst Fractures ◽  
Transpedicular Screw ◽  
Transpedicular Screw Fixation

Abstract Background Short-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures (TBFs),but this technique has many problems. Therefore,the purpose of this article is to observe and evaluate the clinical efficacy of a novel transpedicular reducer that we designed for fractured vertebral body reduction and bone grafting in the treatment of TBFs. Methods From July 2018 to November 2020, 70 cases of TBFs were included. Thirty-five patients were treated with the novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation (observation group), and 35 patients were treated with short-segment transpedicular screw fixation (control group). Before the operation, after reduction, and 3 days, 3 months,and 12 months after the operation, the two groups were assessed, and compared with respect to the anterior and middle heights of the injured vertebrae, the ratios of the anterior and middle heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies (AVBHr and MVBHr, respectively), and the Cobb angle of the patients. We compared the pain VAS score and quality of life GQOL-74 score at the last follow-up. Finally,we evaluated the distribution of bone grafts and bone healing 12 months after the operation. Results The anterior height, middle height, AVBHr, MVBHr, and Cobb angle of the injured vertebral body in the observation after reduction, and 3 days, 3 months and 12 months post-operatively were compared with those of the injured vertebral body before operation. All of these parameters were improved, and the difference was statistically significant (p < 0.05). These parameters in the observation group at the above time points were significantly better than thoes in the control group at the corresponding time points (p < 0.05). The VAS scores at the last follow-up were significantly better than those of the control group (p < 0.05), but the GQOL-74 score differences were not statistically significant (p > 0.05). The observation group showed no obvious defects on CT at 12 months after the operation, and the bone healing was good. Conclusion The novel transpedicular reducer for reduction and bone grafting combined with pedicle screw fixation for TBFs has good clinical efficacy.

Rotational stability of thoracolumbar junction fixation systems

2021 ◽  
pp. 21-28
Author(s):  
A. A. Afaunov ◽  
K. K. Takhmazyan ◽  
M. L. Mukhanov ◽  
I. V. Basankin ◽  
M. Yu. Ageyev
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Thoracolumbar Spine ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Junction ◽  
Rotational Stability ◽  
Physiological Limits ◽  
Transpedicular Screw ◽  
Rotation Motion ◽  
Transpedicular Screw Fixation

Objective To compare the rotational stability of fusion constructs using bisegmental fixation of Th12-L2 vertebrae with anterior stabilization or pedicle screw fixation.Material and Methods The strength, rigidity and limit of elasticity in the “injured vertebral motion segments (VMS) – bisegmental anterior stabilization” system under dislocating rotational loads were estimated. The data obtained were compared with the similar characteristics of the “injured VMS – bisegmental 4-screw transpedicular metal construction” system and intact spine segments.Results Under rotational loads the limits of elasticity of injured spine segments of Th12-L2 with anterior stabilization and transpedicular screw fixation (TSF) is 45.5 and 41.7%, respectively, and the general strength is 66.4% and 80%, respectively, as compared with those intact VMS. Rigidity parameters of anterior-stabilized and pedicle screw fixated VMS with unstable damage of L1 are 60.2 and 93.9%, accordingly, in comparison with those intact VMS.Conclusion No significant differences were observed between bisegmental anterior stabilization and bisegmental pedicle screw fixation of thoracolumbar junction in terms of the key mechanical properties. When treating patients with unstable thoracolumbar spine injuries using bisegmental anterior stabilization or transpedicular fixation with 4-screw spinal system possible rotation motion amplitude of operated segments must not exceed 50% of maximum physiological limits.

scholarly journals Clinical effect of a new type of transpedicular reducer for fracture reduction via pedicle and bone grafting combined with pedicle screw fixation for thoracolumbar burst fractures

2021 ◽  
Author(s):  
Menghan Cai ◽  
Zhijun Xin ◽  
Weijun Kong ◽  
Qian Du ◽  
Wenjun Ji ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Bone Grafting ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Fracture Reduction ◽  
Control Group ◽  
Thoracolumbar Burst Fractures ◽  
Transpedicular Screw ◽  
New Type ◽  
Transpedicular Screw Fixation

Abstract Background: Short-segment transpedicular screw fixation is a common method for the treatment of thoracolumbar burst fractures (TBFs),but this technique has many problems.Therefore,the purpose of this article is to observe and evaluate the clinical efficacy of a new type of transpedicular reducer that we designed for fractured vertebral body reduction and bone grafting in the treatment of TBFs.Methods:From July 2018 to November 2020, 70 cases of TBFs were included. 35 cases were treated with the new transpedicular reducer for fracture reduction via pedicle and bone grafting combined with pedicle screw fixation (observation group), 35 cases were treated with short-segment transpedicular screw fixation (control group).Before operation, after application of the transpedicular reducer(not needed in the control group),3 days after operation, 3 months after operation, 6 months after operation, and 12 months after operation, the two groups were recorded and compared respectively: the anterior and middle heights of the injured vertebrae, the ratios of the anterior and middle heights of the injured vertebral body to the respective heights of the adjacent uninjured vertebral bodies (AVBHr and MVBHr, respectively), and the Cobb angle of patients.And we compared the pain VAS score and quality of life GQOL-74 score at the last follow-up.At last,we evaluated the distribution of bone grafts and bone healing 12 months after the operation.Results:All 70 cases were followed up for at least 12 months.The observation group's anterior and middle heights of the injured vertebral, AVBHr and MVBHr were higher than those of the control group at 3 days,3 months,6 months and 12 months after operation, the cobb angle was smaller than that in control group, the pain VAS score and the quality of life GQOL-74 score at the last follow-up were better than those of the control group, and these difference were statistically significant (P <0.05). The observation group showed no obvious defects on CT at 12 months after operation, and the bone healing was good. Conclusion: The new type of transpedicular reducer for fracture reduction via pedicle and bone grafting combined with pedicle screw fixation for TBFs has a good clinical efficacy.

Technique of thoracic pedicle screw fixation for trauma

2004 ◽  
Vol 7 (1) ◽  
pp. 22-30 ◽  
Author(s):  
Roger Hartl ◽  
Nicholas Theodore ◽  
Curtis A Dickman ◽  
Volker K.H Sonntag
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Thoracic Pedicle Screw

scholarly journals The evaluation of long-term screw pull-out rates following posterior thoracolumbar fusion surgery with short and thin pedicle screws

2019 ◽  
pp. 178-182
Author(s):  
Umit Kocaman ◽  
Hakan Yilmaz
Keyword(s):  
Pedicle Screws ◽  
Fusion Surgery ◽  
Pull Out ◽  
Transpedicular Screw ◽  
Thoracic Pedicle Screws ◽  
Pedicle Length ◽  
Neurocentral Junction ◽  
Male Patients ◽  
Lumbar Pedicle

Background. The aim of this study was to evaluate screw pull-out rates after fusion operations with short and thin pedicle screws.Methods. A total of 200 posterior lumbar and thoracolumbar fusion operations performed at our clinic with short and thin pedicle screws (5.5x35 mm) were retrospectively evaluated. The patients were assessed with computed tomography postoperatively on the day of surgery and at the 6th month. Single groove retraction of the transpedicular screw was evaluated as pull-out. The results were evaluated by the 'number of pull-out cases / total number of cases' and also the 'total number of pull-out screws / total number of screws used' ratios. Results. There were 112 (56%) female and 88 (44%) male patients with a mean age of 58 years. The total number of screws used in the 200 cases was 1188. There were 88 (7.4%) thoracic pedicle screws, 1056 (88.9%) lumbar pedicle screws and 44 (3.7%) sacral pedicle screws used. No pull-out was found in the control CTs taken postoperatively. Left side T11 and T12 pull-out was observed in one case and left L4 pull-out was observed in another case in the control CTs taken at the postoperative 6th month. Pull-out was observed in 2 (1%) of the 200 cases and 3 (0.25%) of the 1188 screws.Conclusions. All the short and thin pedicle screws used had passed the pedicle length and neurocentral junction. The use of a 5.5x35 mm screws in fusion operations is less invasive than using longer and thicker screws while the pull-out rates may be similar.

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