Transpedicular screw fixation on the thoracolumbar spine

Area of Science:

• Spinal Surgery
• Orthopedic Surgery
• Neurosurgery

Background:

• Pedicular fixation is widely used for spinal fusions.
• It is a "blind technique" with risks of neural and vascular complications.
• Lack of uniform surgical management concepts exists.

Purpose of the Study:

• To evaluate and establish a uniformly accepted concept for surgical management in transpedicular fixation.
• To identify variations in pre-, intra-, and postoperative procedures.

Main Methods:

• A 17-question survey was sent to 31 experienced spine surgeons.
• Surgeons were asked about their techniques in transpedicular fixation.

Main Results:

• Significant variation in surgical approaches was observed, with only half of the answers showing consensus.
• Common practices include using conventional cushions, sharp dissection for access, and fluoroscopic guidance.
• Discrepancies exist in pedicle preparation, screw placement adjustments, and management of cerebrospinal fluid leaks or malpositions.

Conclusions:

• Despite frequent application of some concepts, there is no general agreement on optimal surgical handling in transpedicular fixation.
• A comparative evaluation of different techniques is lacking.
• Multicenter evaluation is necessary to establish unified methods and optimize postoperative results.