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Placement of percutaneous thoracic pedicle screws using neuronavigation

BACKGROUND: Percutaneous thoracic pedicle screw fixation is challenging because of the complexity of the spinal anatomy and obscuration of normal surgical landmarks by soft tissue. We report a novel percutaneous technique in which intraoperative Iso-C C-arm navigation was used to treat complex thoracic spinal fractures. METHODS: Between March and September 2007, percutaneous thoracic pedicle screw fixation was performed with the assistance of intraoperative Iso-C C-arm fluoroscopy in six patients (two males, four females; mean age=33 years, range=16-61 years) with unstable thoracic fractures. The accuracy of pedicle screw placement was assessed by postoperative computed tomography and graded according to the method of Youkilis et al. RESULTS: Five patients had unstable acute traumatic fractures and one had an osteoporotic burst fracture. Altogether, 19 spinal segments (range=2-4/patient) were fixated using 37 pedicle screws. Pedicle screw misplacement was grade II in 16% and grade III in 3%. None of the patients had neurologic consequences due to screw misplacement, and none required conversion to an open procedure or revision of hardware. There was one wound infection. CONCLUSION: Percutaneous thoracic pedicle screw fixation with intraoperative neuronavigation for the stabilization of complex spinal fractures is feasible and associated with acceptable rates of accuracy and morbidity

Keywords : Adolescent,Adult,Bone Screws,diagnostic imaging,Feasibility Studies,Female,Fluoroscopy,Humans,instrumentation,Intraoperative Period,Male,methods,Middle Aged,Morbidity,Neuronavigation,Spinal Fractures,Spinal Fusion,surgery,Thoracic Vertebrae,Tomography,X-Ray Computed,Young Adult,, Percutaneous,Thoracic,Pedicle,Screws, butrans patch

Date of Publication : 2010 Dec

Authors : Kakarla UK;Little AS;Chang SW;Sonntag VK;Theodore N;

Organisation : Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA

Journal of Publication : World Neurosurg

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/21492627

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