Article
Extrapedicular screw fixation for traumatic, degenerative and neoplastic instability of the thoracic spine
Die extrapedikuläre Technik bei der Versorgung traumatischer, degenerativer und neoplatischer Instabilitäten der Brustwirbelsäule
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Published: | May 4, 2005 |
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Outline
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Objective
The proximity of thoracic pedicles to the spinal cord and neurovascular structures minimizes the margin of error for screw misplacement. The aim of this study was to evaluate the feasibility and efficacy of extrapedicular (intercostovertebral) screw fixation of the thoracic spine in routine clinical practice.
Methods
Parapedicular screw fixation of the thoracic spine was performed in 41 patients with traumatic, degenerative and neoplastic instability. A total of 328 screws were inserted. Postoperative computerized tomographic images were obtained in all cases and the position of each screw in respect to the pedicle rib unit, the spinal canal and the vertebral body was analyzed according to a proposed grading system. In addition medial angulation was calculated for each instrumented level.
Results
There was no additional morbidity associated with parapedicular screw insertion. A single screw penetrated the spinal canal without causing neurological deficit and was revised. The rest of the inserted screws were placed within the pedicle rib unit and vertebral body without breaching of neural foramina, pleura and vascular structures. Angulation varied significantly depending on the intsrumented level.
Conclusions
Cervicothoracic, thoracic and thoracolumbar instabilities can be adequately and safely treated using parapedicular screw fixation under fluoroscopic imaging. The use of computer-aided navigation may be beneficial, but is not deemed to be mandatory.