J Korean Neurosurg Soc.  2012 Jan;51(1):66-70. 10.3340/jkns.2012.51.1.66.

Free Hand Pedicle Screw Placement in the Thoracic Spine without Any Radiographic Guidance : Technical Note, a Cadaveric Study

• Hyun SJ
• Kim YJ
• Cheh G
• Yoon SH
• Rhim SC

• KMID: 2190479
• DOI: http://doi.org/10.3340/jkns.2012.51.1.66

Abstract

Thoracic pedicle screw fixation techniques are still controversial for thoracic deformities because of possible complications including neurologic deficit. Methods to aid the surgeon in appropriate screw placement have included the use of intraoperative fluoroscopy and/or radiography as well as image-guided techniques. We describe our technique for free hand pedicle screw placement in the thoracic spine without any radiographic guidance and present the results of pedicle screw placement analyzed by computed tomographic scan in two human cadavers. This free hand technique of thoracic pedicle screw placement performed in a step-wise, consistent, and compulsive manner is an accurate, reliable, and safe method of insertion to treat a variety of spinal disorders, including spinal deformity.

Keyword

Pedicle screw placement; Thoracic spine; Surgical anatomy; Free hand technique; Surgical technique; Cadaveric study

MeSH Terms

Cadaver
Congenital Abnormalities
Fluoroscopy
Hand
Humans
Neurologic Manifestations
Spine

Figure

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  Fig. 1 Complete exposure and facetectomy : the posterior elements of the spine to the edge of the transverse processes are exposed bilaterally. The inferior facets are removed with a straight osteotome (down to T10) or rongeur (below T10). There is a trend towards a more medial and cephalad (proximal) starting point on the posterior elements as one proceeds to the apical midthoracic region (T7-T9).

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  Fig. 2 Gearshift is advanced from the desired starting point toward the center of the isthmic part. Inner pedicle palpation and length measurement.

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  Fig. 3 The harmonious position of the screws are exposed.

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  Fig. 4 All transpedicular screws inserted into the thoracic spine are evaluated by C-arm, naked eye examination.

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  Fig. 5 Accuracy evaluation using computed tomographic (CT) scans. Definition of acceptable screws : axis of the pedicle screw between the medial and lateral pedicle walls (A and B). CT scan demonstrates the medial (C) and lateral (D) cortical breach. E : Arrow indicates the medially violated screw by naked eye examination.

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