Asian Spine J.
2014 Jun;8(3):237-243. 10.4184/asj.2014.8.3.237.
Accuracy of Free Hand Pedicle Screw Installation in the Thoracic and Lumbar Spine by a Young Surgeon: An Analysis of the First Consecutive 306 Screws Using Computed Tomography
- Affiliations
-
- 1Department of Neurosurgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.
- 2Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. neurospine@snubh.org
- 3Department of Orthopaedic Surgery, Spine Service, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, USA.
- KMID: 2270341
- DOI: http://doi.org/10.4184/asj.2014.8.3.237
Abstract
- STUDY DESIGN: A retrospective cross-sectional study.
PURPOSE: The purpose of this study is to evaluate the accuracy and safety of free-hand pedicle screw insertion performed by a young surgeon.
OVERVIEW OF LITERATURE: Few articles exist regarding the safety of the free-hand technique without inspection by an experienced spine surgeon.
METHODS
The index surgeon has performed spinal surgery for 2 years by himself. He performed fluoroscopy-assisted pedicle screw installation for his first year. Since then, he has used the free-hand technique. We retrospectively reviewed the records of all consecutive patients undergoing pedicle screw installation using the free-hand technique without fluoroscopy in the thoracic or lumbar spine by the index surgeon. Incidence and extent of cortical breach by misplaced pedicle screw was determined by a review of postoperative computed tomography (CT) images.
RESULTS
A total of 36 patients received 306 free-hand placed pedicle screws in the thoracic or lumbar spine. A total of 12 screws (3.9%) were identified as breaching the pedicle in 9 patients. Upper thoracic spine was the most frequent location of screw breach (10.8%). Lateral breach (2.3%) was more frequent than any other direction. Screw breach on the right side (9 patients) was more common than that on the left side (3 patients) (p<0.01).
CONCLUSIONS
An analysis by CT scan shows that young spine surgeons who have trained under the supervision of an experienced surgeon can safely place free-hand pedicle screws with an acceptable breach rate through repetitive confirmatory steps.
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