Transmuscle ultrasonography in the placement of thoracolumbar pedicle screws: A cadaveric study.

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Transmuscle ultrasonography in the placement of thoracolumbar pedicle screws: A cadaveric study.

World Neurosurg. 2018 Apr 17;:

Authors: Xie CL, Huang QS, Wu L, Xu L, Dou HC, Wang XY, Lin ZK

Abstract
BACKGROUND: Transpedicular screws fixation has a biomechanical advantage of improving fusion rates. In the posterior thoracolumbar immobilization, a large number of screws cause perforation to pedicle or vertebra body. Techniques as radiograph and CT were used to minimize this complication. However, ultrasound in detecting the pedicle breach during the placement of the screw in unknown. Our goal is to evaluate the sensitivity of ultrasound for detecting the breaches.
METHODS: A B-type transducer was used for scanning 216 Titanium pins inserted into the cadaveric pedicle. 180 pins were intentionally misplaced, including 90 pins breached the lateral wall of the pedicle and 90 pins pierced the anterior wall of the vertebral body. The ultrasonic images were reviewed by three examiners who blinded to both the procedure and corresponding CT-findings. The perforation length of pins was measured by three radiologists through CT images.
RESULTS: The CT data was divided into two groups. Group 1 (perforation length: 0-2mm),the sensitivity of ultrasound for detecting the lateral wall breach and the anterior wall was 80.95% and 76.42%, in Group 2 (perforation length: 2-4mm) was 94.79% and 91.93% respectively. The overall sensitivity of the lateral wall and the anterior wall was 89.63% and 86.30%. The sensitivity of ultrasound to detect the lateral wall was higher than the anterior wall, and Group 2 was more easy to be detected than Group 1 both in lateral or anterior perforation.
CONCLUSIONS: This study showed that ultrasound could be applied to detect perforation of 4mm or less. Using of ultrasound may improve patient safety.

PMID: 29678714 [PubMed - as supplied by publisher]

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