Comparison Between Gearshift And Drill Techniques For Pedicle Screw Placement By Resident Surgeons

Area of Science:

• Spine Surgery
• Orthopedic Surgery
• Surgical Techniques

Background:

• Pedicle screw placement is crucial for spinal stability.
• Suboptimal screw trajectories risk neurological and vascular injury.
• Accurate screw placement is paramount in thoracolumbar spine surgery.

Purpose of the Study:

• To evaluate the accuracy of pedicle screw placement by resident surgeons.
• To compare the gearshift and drill techniques for pedicle screw insertion.

Main Methods:

• Cadaveric comparison study involving six resident surgeons.
• Freehand pedicle screw placement in the thoracolumbar spine (T1-S1) using gearshift and drill techniques.
• CT scan analysis by blinded observers to record violations and critical perforations (>2mm breach).

Main Results:

• 51.5% of 200 pedicles had violations; lateral breaches were most common (65%).
• No significant difference in overall violations between gearshift (49.5%) and drill (50.5%) techniques.
• Higher violation rates observed in mid-thoracic vertebrae (T3-T6).

Conclusions:

• Both gearshift and drill techniques demonstrate similar risks of pedicle breach when used by resident surgeons.
• Current techniques may require refinement to improve accuracy in pedicle screw placement.