Detection of Common Anatomical Landmarks and Vertical Trajectories for Freehand Pedicle Screw Placement

• Published in: Orthopaedic surgery Vol. 15; no. 6; pp. 1541 - 1548
• Main Authors: Wang, Shunmin, Zhang, Weihang, Sun, Jingchuan, Wang, Yuan, Fan, Jianping, Yu, Yaping, Zhao, Feng, Gao, Jie, Shi, Jiangang, Guo, Yongfei
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.06.2023; John Wiley & Sons, Inc; Wiley
• Subjects: Accuracy; Adolescent idiopathic scoliosis (AIS); Back surgery; Clinical; Fractures; Freehand technique; Intraoperative detection; Medical imaging; Pedicle screws; Preoperative planning; Scoliosis; Spinal cord; Adolescent idiopathic scoliosis (AIS); Freehand technique; Pedicle screws; Intraoperative detection; Preoperative planning
• ISSN: 1757-7853; 1757-7861
• DOI: 10.1111/os.13729

Objective It is clinically important for pedicle screws to be placed quickly and accurately. Misplacement of pedicle screws results in various complications. However, the incidence of complications varies greatly due to the different professional titles of physicians and surgical experience. Therefore, physicians must minimize pedicle screw dislocation. This study aims to compare the three nail placement methods in this study, and explore which method is the best for determining the anatomical landmarks and vertical trajectories. Methods This study involved 70 patients with moderate idiopathic scoliosis who had undergone deformity correction surgery between 2018 and 2021. Two spine surgeons used three techniques (preoperative computed tomography scan [CTS], visual inspection‐X‐freehand [XFH], and intraoperative detection [ID] of anatomical landmarks) to locate pedicle screws. The techniques used include visual inspection for 287 screws in 21 patients, preoperative planning for 346 screws in 26 patients, and intraoperative probing for 309 screws in 23 patients. Observers assessed screw conditions based on intraoperative CT scans (Grade A, B, C, D). Results There were no significant differences between the three groups in terms of age, sex, and degree of deformity. We found that 68.64% of screws in the XFH group, 67.63% in the CTS group, and 77.99% in the ID group were placed within the pedicle margins (grade A). On the other hand, 6.27% of screws in the XFH group, 4.33% in the CTS group, and 6.15% in the ID group were considered misplaced (grades C and D). The results show that the total amount of upper thoracic pedicle screws was fewer, meanwhile their placement accuracy was lower. The three methods used in this study had similar accuracy in intermediate physicians (P > 0.05). Compared with intermediate physicians, the placement accuracy of three techniques in senior physicians was higher. The intraoperative detection group was better than the other two groups in the good rate and accuracy of nail placement (P < 0.05). Conclusion Intraoperative common anatomical landmarks and vertical trajectories were beneficial to patients with moderate idiopathic scoliosis undergoing surgery. It is an optimal method for clinical application. There are tens of thousands of patients with spinal deformities in our hospital. There is no universal standard and method of nail placement. This method of screw placement is a summary of the clinical experience of senior physicians, especially the laminae depression and vertical trajectory are very useful, and it is hoped that it will bring convenience to the growth of the future spinal surgery screw placement. 3D model: A: transversally probe into the injection location and the isthmic lamina or joint plane (inferior, inferior, medial, lateral, inferior, posterior lamina). B: Probe the needle point laterally and maintain a vertical trajectory. C: Maintain a vertical trajectory with the aid of a right Angle instrument (white right Angle).