Accuracy of Screw Placement in Lumbar Transpedicular Fixation: A Comparative Study between Open and Percutaneous Techniques Using a Novel Classification Model

Background Data: In the late fifties of the last century, Boucher described posterior pedicle screw placement for the first time for treatment of a diversity of spinal pathologies. Currently, there are three methods for pedicle screw placement: the free hand, the fluoroscopy guided open and the perc...

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Autores principales:	Ahmad Elayouty, Sherif Morad, Ahmed Salem
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2017
Materias:	Percutaneous pedicle screw open pedicle screw fixation pedicle screw accuracy lumbar spine Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/a5054e7969d94597a9b79f1ee90d5498
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spelling	oai:doaj.org-article:a5054e7969d94597a9b79f1ee90d54982021-12-02T03:27:18ZAccuracy of Screw Placement in Lumbar Transpedicular Fixation: A Comparative Study between Open and Percutaneous Techniques Using a Novel Classification ModelDOI:10.21608/ESJ.2017.67572314-89502314-8969https://doaj.org/article/a5054e7969d94597a9b79f1ee90d54982017-07-01T00:00:00Zhttp://www.esj.journals.ekb.eg/article_6757.htmlhttps://doaj.org/toc/2314-8950https://doaj.org/toc/2314-8969Background Data: In the late fifties of the last century, Boucher described posterior pedicle screw placement for the first time for treatment of a diversity of spinal pathologies. Currently, there are three methods for pedicle screw placement: the free hand, the fluoroscopy guided open and the percutaneous techniques. Despite being reported safe and accurate, percutaneous pedicle screw insertion is still being investigated in comparison to the traditional open technique. Purpose: In this study, the authors are trying to find out if there was any superiority of one technique regarding accuracy of screw placement. Study Design: This is a retrospective comparative study designed to assess the accuracy of screw placement in the sagittal plane in patients who underwent lumbar transpedicular fixation by open versus percutaneous techniques. Patients and Methods: Patients were categorized into two groups: group A including patients who underwent open surgery and group B patients who underwent percutaneous fixation. Each screw was categorized according to the sagittal plane into one of the following classes: Class 0: with no cortical penetration at all, Class 1: with a single cortical penetration denoting accepted entry point and trajectory, Class 2: with 2 cortices penetration violating the lateral cortex of the pedicle and/or the vertebral body and Class 3: with 3 cortices penetration and a medially maldirected trajectory violating the roof and floor of the lateral recess. Results: The current study included 51 patients distributed as 28 patients (55 %) in group A and 23 patients (45 %) in group B. A total of 262 screws were investigated with 134 (51.15 %) screws in group A and 128 (48.85 %) screws in group B. Cross tabulation of raw data of different screw type distribution among the two patients’ groups preliminarily revealed a quite favorable screws position among group A patients with 94.77% of screws in class 1, 4.48% in class 2 and 0.75% of screws in class 3 compared to 81.25%, 12.5% and 6.25% respectively in group B of patients. However, statistical analysis using Chi Square test for individual screws’ groups related to specific pedicles failed to show any significant difference with each one of the pertinent P-values>0.05. On the other hand, comparison of maldirected screws (classes 2 and 3 collectively) between the two groups confirmed a statistically high significant difference in the number of maldirected screws per patient with a mean of 0.25 screw/patient in group A compared to 1.043 screw/patient in group B (P-value < 0.001). Conclusion: Percutaneous pedicle screw insertion technique is an accepted technique regarding screw accuracy when properly indicated having the advantages of being less traumatic and more cosmetic with its inherent complications and drawbacks including financial issues, more radiation exposure and longer operative time. (2017ESJ144)Ahmad Elayouty Sherif Morad Ahmed SalemEgyptian Spine AssociationarticlePercutaneous pedicle screwopen pedicle screw fixationpedicle screw accuracylumbar spineNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 23, Iss 1, Pp 36-42 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Percutaneous pedicle screw open pedicle screw fixation pedicle screw accuracy lumbar spine Neurology. Diseases of the nervous system RC346-429
spellingShingle	Percutaneous pedicle screw open pedicle screw fixation pedicle screw accuracy lumbar spine Neurology. Diseases of the nervous system RC346-429 Ahmad Elayouty Sherif Morad Ahmed Salem Accuracy of Screw Placement in Lumbar Transpedicular Fixation: A Comparative Study between Open and Percutaneous Techniques Using a Novel Classification Model
description	Background Data: In the late fifties of the last century, Boucher described posterior pedicle screw placement for the first time for treatment of a diversity of spinal pathologies. Currently, there are three methods for pedicle screw placement: the free hand, the fluoroscopy guided open and the percutaneous techniques. Despite being reported safe and accurate, percutaneous pedicle screw insertion is still being investigated in comparison to the traditional open technique. Purpose: In this study, the authors are trying to find out if there was any superiority of one technique regarding accuracy of screw placement. Study Design: This is a retrospective comparative study designed to assess the accuracy of screw placement in the sagittal plane in patients who underwent lumbar transpedicular fixation by open versus percutaneous techniques. Patients and Methods: Patients were categorized into two groups: group A including patients who underwent open surgery and group B patients who underwent percutaneous fixation. Each screw was categorized according to the sagittal plane into one of the following classes: Class 0: with no cortical penetration at all, Class 1: with a single cortical penetration denoting accepted entry point and trajectory, Class 2: with 2 cortices penetration violating the lateral cortex of the pedicle and/or the vertebral body and Class 3: with 3 cortices penetration and a medially maldirected trajectory violating the roof and floor of the lateral recess. Results: The current study included 51 patients distributed as 28 patients (55 %) in group A and 23 patients (45 %) in group B. A total of 262 screws were investigated with 134 (51.15 %) screws in group A and 128 (48.85 %) screws in group B. Cross tabulation of raw data of different screw type distribution among the two patients’ groups preliminarily revealed a quite favorable screws position among group A patients with 94.77% of screws in class 1, 4.48% in class 2 and 0.75% of screws in class 3 compared to 81.25%, 12.5% and 6.25% respectively in group B of patients. However, statistical analysis using Chi Square test for individual screws’ groups related to specific pedicles failed to show any significant difference with each one of the pertinent P-values>0.05. On the other hand, comparison of maldirected screws (classes 2 and 3 collectively) between the two groups confirmed a statistically high significant difference in the number of maldirected screws per patient with a mean of 0.25 screw/patient in group A compared to 1.043 screw/patient in group B (P-value < 0.001). Conclusion: Percutaneous pedicle screw insertion technique is an accepted technique regarding screw accuracy when properly indicated having the advantages of being less traumatic and more cosmetic with its inherent complications and drawbacks including financial issues, more radiation exposure and longer operative time. (2017ESJ144)
format	article
author	Ahmad Elayouty Sherif Morad Ahmed Salem
author_facet	Ahmad Elayouty Sherif Morad Ahmed Salem
author_sort	Ahmad Elayouty
title	Accuracy of Screw Placement in Lumbar Transpedicular Fixation: A Comparative Study between Open and Percutaneous Techniques Using a Novel Classification Model
title_short	Accuracy of Screw Placement in Lumbar Transpedicular Fixation: A Comparative Study between Open and Percutaneous Techniques Using a Novel Classification Model
title_full	Accuracy of Screw Placement in Lumbar Transpedicular Fixation: A Comparative Study between Open and Percutaneous Techniques Using a Novel Classification Model
title_fullStr	Accuracy of Screw Placement in Lumbar Transpedicular Fixation: A Comparative Study between Open and Percutaneous Techniques Using a Novel Classification Model
title_full_unstemmed	Accuracy of Screw Placement in Lumbar Transpedicular Fixation: A Comparative Study between Open and Percutaneous Techniques Using a Novel Classification Model
title_sort	accuracy of screw placement in lumbar transpedicular fixation: a comparative study between open and percutaneous techniques using a novel classification model
publisher	Egyptian Spine Association
publishDate	2017
url	https://doaj.org/article/a5054e7969d94597a9b79f1ee90d5498
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Accuracy of Screw Placement in Lumbar Transpedicular Fixation: A Comparative Study between Open and Percutaneous Techniques Using a Novel Classification Model

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