PMID- 27807776
OWN - NLM
STAT- MEDLINE
DCOM- 20180525
LR  - 20181202
IS  - 1432-0932 (Electronic)
IS  - 0940-6719 (Linking)
VI  - 26
IP  - 11
DP  - 2017 Nov
TI  - Screw perforation rates in 359 consecutive patients receiving computer-guided 
      pedicle screw insertion along the cervical to lumbar spine.
PG  - 2858-2864
LID - 10.1007/s00586-016-4843-3 [doi]
AB  - PURPOSE: Pedicle screw (PS) insertion has been criticized for its risk of serious 
      injury to neurovascular structures. Although computed tomography (CT)-based 
      navigation has been developed to avoid such complications, perforation remains an 
      issue, even with the aid of additional guidance. We clarify screw perforation 
      rate and direction in 359 consecutive patients treated using CT-based PS 
      insertion and present important considerations for more accurate screw placement. 
      METHODS: The medical records of 359 consecutive patients who underwent PS 
      insertion involving C2-L5 using a CT-based navigation system were reviewed. 
      Postoperative CT images were analyzed to evaluate the accuracy of screw 
      placement. We investigated both rate and direction of screw perforation according 
      to vertebral level. RESULTS: Of the 3413 PS that were inserted, 6.9% were judged 
      as Grade 2 or 3 perforations. The combined rate of these perforations was 5.0% 
      for C2, 11.4% for C3-5, 7.0% for C6-7, 10.4% for T1-4, 8.8% for T5-8, 4.5% for 
      T9-12, and 3.8% for L1-5. We also analyzed the odds ratio (OR) for screw 
      perforation in vertebrae accounting for the effects of age and disease. 
      Multivariate analysis identified that PS insertions at C3-5 (OR 2.9, 95% CI 
      1.6-5.1; p < 0.001), T1-4 (OR 2.7, 95% CI 1.6-4.7; p < 0.001), and T5-8 (OR 2.3; 
      95% CI 1.4-3.8; p = 0.001) were significantly associated with Grade 2 or 3 screw 
      perforation as compared with that of L1-5. CONCLUSIONS: Even with CT-based 
      navigation, careful insertion of PS is needed in the middle cervical spine 
      because of a significantly higher perforation rate as compared with the lumbar 
      region.
FAU - Uehara, Masashi
AU  - Uehara M
AD  - Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 
      Asahi, Matsumoto-City, Nagano, 390-8621, Japan.
FAU - Takahashi, Jun
AU  - Takahashi J
AD  - Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 
      Asahi, Matsumoto-City, Nagano, 390-8621, Japan. jtaka@shinshu-u.ac.jp.
FAU - Ikegami, Shota
AU  - Ikegami S
AD  - Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 
      Asahi, Matsumoto-City, Nagano, 390-8621, Japan.
FAU - Kuraishi, Shugo
AU  - Kuraishi S
AD  - Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 
      Asahi, Matsumoto-City, Nagano, 390-8621, Japan.
FAU - Futatsugi, Toshimasa
AU  - Futatsugi T
AD  - Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 
      Asahi, Matsumoto-City, Nagano, 390-8621, Japan.
FAU - Kato, Hiroyuki
AU  - Kato H
AD  - Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 
      Asahi, Matsumoto-City, Nagano, 390-8621, Japan.
LA  - eng
PT  - Journal Article
DEP - 20161102
PL  - Germany
TA  - Eur Spine J
JT  - European spine journal : official publication of the European Spine Society, the 
      European Spinal Deformity Society, and the European Section of the Cervical Spine 
      Research Society
JID - 9301980
SB  - IM
MH  - Cervical Vertebrae/*surgery
MH  - Humans
MH  - Lumbar Vertebrae/*surgery
MH  - *Pedicle Screws
MH  - Postoperative Complications
MH  - Retrospective Studies
MH  - *Spinal Fusion/adverse effects/methods/statistics & numerical data
MH  - *Surgery, Computer-Assisted/adverse effects/methods/statistics & numerical data
MH  - Tomography, X-Ray Computed
OTO - NOTNLM
OT  - CT-based navigation system
OT  - Pedicle screw
OT  - Perforation rate
OT  - Vertebral level
OT  - Whole spine
EDAT- 2016/11/04 06:00
MHDA- 2018/05/26 06:00
CRDT- 2016/11/04 06:00
PHST- 2016/03/26 00:00 [received]
PHST- 2016/10/23 00:00 [accepted]
PHST- 2016/09/23 00:00 [revised]
PHST- 2016/11/04 06:00 [pubmed]
PHST- 2018/05/26 06:00 [medline]
PHST- 2016/11/04 06:00 [entrez]
AID - 10.1007/s00586-016-4843-3 [pii]
AID - 10.1007/s00586-016-4843-3 [doi]
PST - ppublish
SO  - Eur Spine J. 2017 Nov;26(11):2858-2864. doi: 10.1007/s00586-016-4843-3. Epub 2016 
      Nov 2.