Image-guided thoracic pedicle screw placement: a technical study in cadavers and preliminary clinical experience

Thoracic pedicle screw fixation is effective and reliable in providing short-segment stabilization. Although the procedure is becoming more widely used, accurate insertion of the screws is difficult due to the small dimensions of thoracic pedicles, and the associated risk is high due to the proximity of the spinal cord. In previous studies authors have shown the accuracy of image-guided lumbar pedicle screw placement, but there have been no reported investigations into the accuracy of image-guided thoracic pedicle screw placement. The authors report their experience with such an investigation.

To evaluate the accuracy of image-guided thoracic pedicle screw placement in vitro and in vivo, thoracic pedicle screws were placed with an image-guidance system in five human cadavers and 10 patients. In cadavers, the accuracy of screw placement was assessed by postoperative computerized tomography and visual inspection and in patients by postoperative imaging studies. Of the 120 pedicle screws placed in five cadavers pedicle violation occurred in 23 cases (19.2%); there was one pedicle violation (4.2%) in each of the last two cadavers. Of the 45 pedicle screws placed in 10 patients, pedicle violations occurred in three (6.7%).

In comparison with historical controls, the accuracy of thoracic pedicle screw placement is improved with the use of an image-guidance system. It allows the surgeon to visualize the thoracic pedicle and the surrounding structures that are normally out of the surgical field of view. The surgeon, however, must be aware of the limitations of an image-guidance system and have a sound basic knowledge of spinal anatomy to avoid causing serious complications.