gms | German Medical Science

131. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

25.03. - 28.03.2014, Berlin

Intraoperative three-dimensional fluoroscopy after transpedicular positioning of Kirschner-wire versus conventional intraoperative biplanar fluoroscopic control: a retrospective study of 345 patients and 1880 pedicel screws

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  • Ghassan Kerry - Klinikum Nürnberg, Neurochirurgische Klinik, Nürnberg
  • Claus Ruedinger - Klinikum Nürnberg, Neurochirurgische Klinik, Nürnberg
  • Hans-Herbert Steiner - Klinikum Nürnberg, Neurochirurgische Klinik, Nürnberg

Deutsche Gesellschaft für Chirurgie. 131. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 25.-28.03.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14dgch245

doi: 10.3205/14dgch245, urn:nbn:de:0183-14dgch2459

Published: March 21, 2014

© 2014 Kerry et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Introduction: The aim of this study is to find out whether intraoperative three-dimensional imaging (3D) after transpedicular positioning of Kirschner wire (K-wire) in lumbar and thoracic posterior instrumentation procedures is of benefit to the patients and if this technique is accurately enough to make a postoperative screw position control via computer tomography (CT) dispensable, in comparison to the conventional intraoperative biplanar fluoroscopic control.

Material and methods: Lumbar and thoracic posterior instrumentation procedures conducted at our department between 2002 and 2012 were retrospectively reviewed. The patients were then divided into two groups: group A including patients who underwent intraoperative 3D scan after transpedicular positioning of the K-wire (Fgure 1 [Fig. 1]) and group B including patients who underwent only conventional intraoperative biplanar fluoroscopy. An early postoperative CT of the instrumented spinal section was done in all cases to assess the screw position. The rate of immediate intraoperative correction of the K-wires in cases of mal-positioning as well as the rate of postoperative screw revisions was measured. Radiation exposure, imaging quality, and financial aspects were discussed.

Results: In general, 345 patients (1880 screws) were reviewed and divided into two groups as aforementioned; group A with 225 patients (1218 screws) and group B with 120 patients (662 screws). One patient (0.44%) [one screw (0.082%)] of group A underwent postoperative screw correction while screw revisions were necessary in 14 patients (11.7%) [28 screws (4.2%)] of group B. Twenty-three patients (10.2%) [28 K-wires (2.3%)] of group A underwent intraoperative correction due to primary intraoperative detected K-wire mal-position. None of the intraoperative corrected K-wires resulted in a corresponding neurological deficit.

Conclusion: Three-dimensional imaging after transpedicular K-wire positioning leads to solid intraoperative identification of misplaced K-wires prior to screw placement and reduces screw revision rates compared with conventional fluoroscopic control. When no clinical deterioration emerges, a postoperative CT seems to be dispensable using this intraoperative 3D control method.