Pedicle screw accuracy in thoracolumbar fractures- is routine postoperative CT scan necessary?

Pedicle screw accuracy in thoracolumbar fractures- is routine postoperative CT scan necessary?

Abstract Background While several studies report on accuracy rates of pedicle screws, risk factors associated with inaccurate pedicle screw positioning in patients with thoracolumbar fractures are reported rarely. CT scan as a routine postoperative control is advocated by various authors, however it...

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Autores principales: R. Aigner, C. Bichlmaier, L. Oberkircher, T. Knauf, A. König, P. Lechler, S. Ruchholtz, M. Frink
Formato: article
Lenguaje:EN
Publicado: BMC 2021
Materias:
Screw misplacement
Risk factor
Computed tomography
Thoracolumbar fracture
Diseases of the musculoskeletal system
RC925-935
Acceso en línea:https://doaj.org/article/cd85329d070140be958f5b24ca8f5996
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spelling oai:doaj.org-article:cd85329d070140be958f5b24ca8f59962021-11-28T12:24:23ZPedicle screw accuracy in thoracolumbar fractures- is routine postoperative CT scan necessary?10.1186/s12891-021-04860-y1471-2474https://doaj.org/article/cd85329d070140be958f5b24ca8f59962021-11-01T00:00:00Zhttps://doi.org/10.1186/s12891-021-04860-yhttps://doaj.org/toc/1471-2474Abstract Background While several studies report on accuracy rates of pedicle screws, risk factors associated with inaccurate pedicle screw positioning in patients with thoracolumbar fractures are reported rarely. CT scan as a routine postoperative control is advocated by various authors, however its necessity remains unclear. Methods Two hundred forty-five patients were included in this retrospective study. Percutaneous dorsal instrumentation was most commonly performed (n = 201). Classification of Zdichavsky et al. and Rao et al. were used to classify screw misplacement and anterior perforation was further evaluated according to the extent of perforation (< 2 mm; > 2 mm). Multivariate analysis was performed to identify risk factors for misplacement of screws. Results One thousand sixty-eight pedicle screws were inserted in 245 patients. Misplacement was found in 51 screws (4.8%) in 42 patients (17.1%) according to the classification of Zdichavsky et al. and in 75 screws (7.0%) in 64 patients (26.1%) according to the classification of Rao et al.. An anterior perforation of the vertebral cortex was found in 56 screws (5.2%). Multivariate analysis showed fracture location in the upper thoracic (p = 0.048) and lumbar spine (p = 0.013) to be the only independent predictors for screw misplacement. In addition a significant correlation between pedicle diameter and the occurrence of screw malposition was found (p = 0.003). No consequences were drawn from postoperative routine CT in asymptomatic patients. Conclusion An overall low rate of screw misplacement was found with fracture location in the upper thoracic and lumbar spine being the only factors independently associated with the risk of screw misplacement. No consequences were drawn from postoperative routine CT in asymptomatic patients. Therefore its use has to be discussed critically.R. AignerC. BichlmaierL. OberkircherT. KnaufA. KönigP. LechlerS. RuchholtzM. FrinkBMCarticleScrew misplacementRisk factorComputed tomographyThoracolumbar fractureDiseases of the musculoskeletal systemRC925-935ENBMC Musculoskeletal Disorders, Vol 22, Iss 1, Pp 1-7 (2021)
institution DOAJ
collection DOAJ
language EN
topic Screw misplacement
Risk factor
Computed tomography
Thoracolumbar fracture
Diseases of the musculoskeletal system
RC925-935
spellingShingle Screw misplacement
Risk factor
Computed tomography
Thoracolumbar fracture
Diseases of the musculoskeletal system
RC925-935
R. Aigner
C. Bichlmaier
L. Oberkircher
T. Knauf
A. König
P. Lechler
S. Ruchholtz
M. Frink
Pedicle screw accuracy in thoracolumbar fractures- is routine postoperative CT scan necessary?
description Abstract Background While several studies report on accuracy rates of pedicle screws, risk factors associated with inaccurate pedicle screw positioning in patients with thoracolumbar fractures are reported rarely. CT scan as a routine postoperative control is advocated by various authors, however its necessity remains unclear. Methods Two hundred forty-five patients were included in this retrospective study. Percutaneous dorsal instrumentation was most commonly performed (n = 201). Classification of Zdichavsky et al. and Rao et al. were used to classify screw misplacement and anterior perforation was further evaluated according to the extent of perforation (< 2 mm; > 2 mm). Multivariate analysis was performed to identify risk factors for misplacement of screws. Results One thousand sixty-eight pedicle screws were inserted in 245 patients. Misplacement was found in 51 screws (4.8%) in 42 patients (17.1%) according to the classification of Zdichavsky et al. and in 75 screws (7.0%) in 64 patients (26.1%) according to the classification of Rao et al.. An anterior perforation of the vertebral cortex was found in 56 screws (5.2%). Multivariate analysis showed fracture location in the upper thoracic (p = 0.048) and lumbar spine (p = 0.013) to be the only independent predictors for screw misplacement. In addition a significant correlation between pedicle diameter and the occurrence of screw malposition was found (p = 0.003). No consequences were drawn from postoperative routine CT in asymptomatic patients. Conclusion An overall low rate of screw misplacement was found with fracture location in the upper thoracic and lumbar spine being the only factors independently associated with the risk of screw misplacement. No consequences were drawn from postoperative routine CT in asymptomatic patients. Therefore its use has to be discussed critically.
format article
author R. Aigner
C. Bichlmaier
L. Oberkircher
T. Knauf
A. König
P. Lechler
S. Ruchholtz
M. Frink
author_facet R. Aigner
C. Bichlmaier
L. Oberkircher
T. Knauf
A. König
P. Lechler
S. Ruchholtz
M. Frink
author_sort R. Aigner
title Pedicle screw accuracy in thoracolumbar fractures- is routine postoperative CT scan necessary?
title_short Pedicle screw accuracy in thoracolumbar fractures- is routine postoperative CT scan necessary?
title_full Pedicle screw accuracy in thoracolumbar fractures- is routine postoperative CT scan necessary?
title_fullStr Pedicle screw accuracy in thoracolumbar fractures- is routine postoperative CT scan necessary?
title_full_unstemmed Pedicle screw accuracy in thoracolumbar fractures- is routine postoperative CT scan necessary?
title_sort pedicle screw accuracy in thoracolumbar fractures- is routine postoperative ct scan necessary?
publisher BMC
publishDate 2021
url https://doaj.org/article/cd85329d070140be958f5b24ca8f5996
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