Accuracy of upper thoracic pedicle screw placement using three-dimensional image guidance

Area of Science:

• Neurosurgery
• Spinal Surgery
• Orthopedic Surgery

Background:

• Conventional pedicle screw malposition rates range from 6% to 41%.
• The upper thoracic spine (T1-T3) presents unique challenges for pedicle screw placement due to small pedicle size and limited fluoroscopic visualization.
• Malpositioned screws in this region can have severe consequences.

Purpose of the Study:

• To evaluate the accuracy and reliability of three-dimensional (3D) image guidance for pedicle screw placement in the T1-T3 vertebral levels.

Main Methods:

• Retrospective review of 34 patients undergoing cervicothoracic fusion with 150 pedicle screws placed using 3D image guidance.
• Postoperative thin-section computed tomography (CT) scans were used to assess screw accuracy.
• Pedicle breaches were graded based on the extent of cortical violation (Grade 1: 0-2 mm, Grade 2: 2-4 mm, Grade 3: >4 mm).

Main Results:

• 93.3% (140/150) of pedicle screws were accurately placed within the pedicle.
• All 10 pedicle violations were minor (Grade 1), with no associated complications.
• No complications occurred due to screw placement or the use of 3D image guidance.

Conclusions:

• Three-dimensional (3D) image guidance is an accurate and reliable method for pedicle screw placement in the technically demanding upper thoracic spine.
• This technology enhances surgical safety and precision in this region.
• Advantages include reduced radiation exposure for surgical staff.