Artikel
First experience with pedicle screw placement in the thoracic and lumbar spine using a novel cannulated polyaxial screw system
Erste Erfahrungen bei Pedikelinstrumentierung der thorakalen und lumbalen Wirbelsäule mit einem neuartigen kanülierten polyaxialen Schraubensystem
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Autoren
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L. Weise
- Neurochirurgische Klinik und Poliklinik, Charité, Campus Benjamin Franklin, Berlin
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O. Suess
- Neurochirurgische Klinik und Poliklinik, Charité, Campus Benjamin Franklin, Berlin
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M. Brock
- Neurochirurgische Klinik und Poliklinik, Charité, Campus Benjamin Franklin, Berlin
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T. Kombos
- Neurochirurgische Klinik und Poliklinik, Charité, Campus Benjamin Franklin, Berlin
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: Dorsal instrumentation with the use of pedicular screws is an established treatment for various diseases such as degenerative instability, trauma, tumor and scoliosis. The precise placement of the pedicle screws remains challenging, especially for thoracic pedicles with its small diameters. Complications due to misplacement of pedicle screws comprise neurogical lesions as well as instability. Misplacement rates with conventional screw systems are reported to be up to 40% and up to 11% under neuronavigation. The objective of this prospective study is to assess the accuracy of thoracic and lumbar pedicle screw placement with the use of a novel wire guided cannulated polyaxial screw system.
Methods: The cannulated screw system (XIA Precision®, Stryker) was used in 21 consecutive patients (14 female, 7 male, mean age 69y). The procedures were performed between May and November 2005 with a mean follow-up period of 3 months. Ninety-six pedicle screws (64 lumbar, 32 thoracic) were placed under fluorsoscopic guidance. The underlying diseases were tumor (n=4), trauma (n=9) and degenerative (n=8). Patients were evaluated before and after surgery in terms of pain level and neurological condition. Post-operative control of screw positioning was obtained by CT scan. Misplacement was defined as in previous studies as a pedicular cortex perforation of at least 2mm.
Results: In 84 out of 96 (87,5%) pedicle screws no cortical perforation was observed. In 7 cases questionable pedicular cortex perforation, 4 cases of 2-4mm and one case of 5 mm misplacement was shown. Only one screw had to be revised due to radicular pain. In the remaining cases no neurological deficit, radicular pain or instability was observed.
Conclusions: The use of this cannulated screw system for the placement of pedicle screws in the thoracic and lumbar spine is safe and accurate. The advantages of this technique include easy handling without a time consuming setup. Further control of stability of this cannulated screw system versus the conventional massive screw system with a longer follow-up should be performed.
