Skip to main content

Advertisement

SpringerLink
Log in

A five-step remedial screw placement method to treat severe spinal deformity with free-hand transpedicular screw placement

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Severe spinal deformity is a complex morphological deformation that occurs and develops in three-dimensional space combined with abnormal development and morphology of anatomical structures, which presents great difficulties in the process of transpedicular screw placement. This study tried to explore the methods of transpedicular screw placement in surgical correction of severe spinal deformities.

Methods

Surgical corrections through posterior approach were performed in all the 76 cases (mean age 20.4 years). The averaging preoperative Cobb’s angle of scoliosis was 108.2° ± 33.6° (range 100°–170°). Among these patients, 34 cases were combined with kyphosis; the average Cobb’s angle of kyphosis was 77.3° (range 63°–160°). During operation, the screw tract was first established with the regular free-hand pedicle screw placement method. When this failed, in order to adjust the screw trajectory, a five-step remedial method was performed in the following order: (1) the“funnel” method; (2) exploring the pedicle exterior edge through the costotransverse joint; (3) exploring the superior and inferior edges of pedicle through the nerve root canal; (4) the vertebral plate fenestration; and (5) hemilaminectomy.

Results

Among all 1,472 screws planned to be placed for the patients, 1,210 (82.2 %) were successfully placed after using the regular method, and 262 (17.8 %) failed in this stage. After applying the five-step remedial method, 256 of the failed 262 screws were successfully placed. Among them, 176 screws (68.8 %) were successfully placed after Step 1, 44 (17.2 %) after Step 2, 21 (8.2 %) after Step 3, 12 (4.7 %) after Step 4, and 3 (1.2 %) after Step 5. In only six, pedicles screws could not be placed eventually. No nerve or blood vessel damages occurred in all cases. All final screw positions were validated by CT.

Conclusion

The five-step remedial method proved to be an effective supplementary method for transpedicular screw placement to treat patients with severe spinal deformities. The key points include a detailed preoperative plan, a meticulous hand drilling sensation, and an experienced probing technique for screw tract.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kim YJ, Lenke LG, Bridwell KH et al (2004) Free hand pedicle screw placement in the thoracic spine: is it safe? Spine 29:333–342

    Article  PubMed  Google Scholar 

  2. Senaran H, Shah SA, Gabos PG et al (2008) Difficult Thoracic Pedicle Screw Placement in Adolescent Idiopathic Scoliosis. J Spinal Disord Tech 21:187–191

    Article  PubMed  Google Scholar 

  3. Lehman RA, Lenke LG, Keeler KA et al (2008) Operative treatment of adolescent idiopathic scoliosis with posterior pedicle screw-only constructs minimum three-year follow-up of one hundred fourteen cases. Spine 33:1598–1604

    Article  PubMed  Google Scholar 

  4. Kim YJ, Lenke LG, Cho SK et al (2004) Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine 29:2040–2048

    Article  PubMed  Google Scholar 

  5. Lee CS, Kim MJ, Ahn YJ et al (2007) Thoracic pedicle screw insertion in scoliosis using posteroanterior C-arm rotation method. J Spinal Disord Tech 20:66–71

    Article  PubMed  Google Scholar 

  6. Zindrick MR, Knight GW, Sartori MJ et al (2000) Pedicle morphology of the immature thoracolumbar spine. Spine 25:2726–2735

    Article  PubMed  CAS  Google Scholar 

  7. Suk SI, Kim WJ, Lee SM et al (2001) Thoracic pedicle screw in spinal deformities: are they really safe. Spine 26:2049–2057

    Article  PubMed  CAS  Google Scholar 

  8. Parent S, Labelle H, Skalli W et al (2004) Thoracic pedicle morphometry in vertebrae from scoliotic spines. Spine 29:239–248

    Article  PubMed  Google Scholar 

  9. Xie JM, Wang YS, Zhang Y et al (2007) Operative skill of lower cervical transpedicle screw. Orthop J China 15:745–748

    Google Scholar 

  10. Yossi S, Michael AM, Yoram A et al (2005) Accuracy and safety of thoracic pedicle screw placement in spinal deformities. J Spinal Disord Tech 18:522–526

    Article  Google Scholar 

  11. Feyza KG, Erhan EM, Hakan S et al (2006) Accuracy of pedicle screw placement for upper and middle thoracic pathologies without coronal plane spinal deformity using conventional methods. J Spinal Disord Tech 19:436–441

    Article  Google Scholar 

  12. Girardi FR, Cammisa FP Jr, Sandhu HS et al (1999) The placement of lumbar pedicle screws using computerized stereotactic guidance. J Bone Joint Surg Br 81:825–829

    Article  PubMed  CAS  Google Scholar 

  13. Lenke LG, Watanabe K (2006) When to avoid pedicle screw fixation (abstract). In: The 41st Annual Meeting of the Scoliosis Research Society Pre-Course, Monterey, CA, 13 Sept 2006

  14. Watanabe K, Lenke LG, Matsumoto M et al (2010) A novel pedicle channel classification describing osseous anatomy: how many thoracic scoliotic pedicles have cancellous channels? Spine 35:1836–1842

    Article  PubMed  Google Scholar 

  15. Klane KW, Richard O, Andrew TM et al (2006) Pullout strength of thoracic pedicle screw instrumentation: comparison of the transpedicular and extrapedicular techniques. Spine 31:355–358

    Article  Google Scholar 

  16. Xie JM, Wang YS, Zhao Z et al (2011) The safe placement of upper and middle thoracic pedicle screws in pediatric deformity. J Spinal Disord Tech 24(1):55–59

    Article  PubMed  Google Scholar 

  17. Liljenqvist UR, Allkemper T, Hackenberg L et al (2002) Analysis of vertebral morphology in idiopathic scoliosis with use of magnetic resonance imaging and multiplanar reconstruction. J Bone Joint Surg Am 84-A:359–368

    PubMed  Google Scholar 

  18. Vaccaro AR, Rizzolo SJ, Balderston RA et al (1995) Placement of pedicle screws in the thoracic spine. Part II: an anatomical and radiographic assessment. J Bone Joint Surg Am 77:1200–1206

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, education institution, or other charitable or nonprofit organization with which the author are affiliated or associated.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, 374# Dianmian Road, Kunming, 650101, Yunnan, People’s Republic of China

    Jing-Ming Xie, Zhi Zhao, Ying-Song Wang, Ying Zhang, Tao Li & Ni Bi

  2. Department of Orthopaedics, The Affiliated Hospital of Guiyang Medical College, Guiyang, 550001, Guizhou, People’s Republic of China

    Hua Yang

Authors
  1. Jing-Ming Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhi Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hua Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ying-Song Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ying Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tao Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ni Bi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jing-Ming Xie.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Xie, JM., Zhao, Z., Yang, H. et al. A five-step remedial screw placement method to treat severe spinal deformity with free-hand transpedicular screw placement. Eur Spine J 22, 417–424 (2013). https://doi.org/10.1007/s00586-012-2546-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-012-2546-y

Keywords

Search

Navigation