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Erschienen in:
12.12.2017 | Original Article
Accuracy of thoracic pedicle screw placement in adolescent patients with severe spinal deformities: a retrospective study comparing drill guide template with free-hand technique
Erschienen in: European Spine Journal | Ausgabe 2/2018
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Purpose
Patients with severe spinal deformities often have small pedicle diameters, and pedicle dimensions vary between segments and individuals. Free-hand pedicle screw placement can be inaccurate. Individualized drill guide templates may be used, but the accuracy of pedicle screw placement in severe scoliosis remains unknown. The accuracy of drill guide templates and free-hand technique for the treatment of adolescent patients with severe idiopathic scoliosis are compared in this study.
Methods
This study included 37 adolescent patients (mean age 16.4 ± 1.3 years) with severe idiopathic scoliosis treated surgically at a single spine center between January 2014 and June 2017. Spinal deformities were corrected using posterior pedicle screw fixation. Patients in group I were treated with rapid prototype drill guide template technique (20 patients; 396 screws) and patients in group II were treated with free-hand technique (17 patients; 312 screws). Outcomes that included operative time, correction rate, and the incidence and distribution of screw misplacement were evaluated.
Results
Operative time in group I was 283 ± 22.7 min compared to 285 ± 25.8 min in group II (p = 0.89). The scoliosis correction rate was 55.0% in group I and 52.9% in group II (p = 0.33). Based on both axial and sagittal reconstruction images, the accuracy rate of pedicle screw placement was 96.7% in group I and 86.9% in group II (p = 0.000).
Conclusion
The drill guide template technique has potential to offer more accurate and thus safer placement of pedicle screws than free-hand technique in the treatment of severe scoliosis in adolescents.