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C-Arm Oblique View-Assisted Screw Placement Method for Extremely Small Lumbar Pedicles in Thoracolumbar Vertebral
Chunliang Guo1, Tao Ding2, Jianqing Zheng1
1Department of Orthopedics, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, China.
Objective:
This study aims to introduce an innovative technique for placing pedicle screws in patients with extremely small lumbar pedicles using an oblique view from a C-arm x-ray machine, achieving a comparable gripping force to conventional implanting for the treatment of thoracolumbar vertebral fractures.
Methods:
A retrospective analysis was conducted on 11 patients with extremely small lumbar pedicles and thoracolumbar vertebral body fractures. The height of the vertebral body and Cobb angle were measured on computed tomography radiographs, and comparisons were made between pre- and postoperative values. Scores from the visual analog scale, Oswestry Disability Index, and Short Form-36 were recorded to evaluate the surgical outcomes.
Results:
All patients successfully underwent the surgery without intraoperative complications such as pedicle collapse, cerebrospinal fluid leakage, or nerve damage. The height of the anterior margin of the vertebral body and the compression rate of the anterior margin of the injured vertebrae showed significant improvement, as did the Cobb angle, with statistically significant differences (P < 0.05). The patients' visual analog scale, Oswestry Disability Index, and Short Form-36 scores were all significantly reduced compared to preoperative levels (P < 0.05). All cases demonstrated excellent reconstruction and maintenance of spinal stability, with the longest follow-up reaching 2 years postoperatively. No issues such as screw loosening or extraction were observed during this period.
Conclusions:
The C-arm x-ray machine oblique radiograph-assisted external pedicle implanting approach offers a simple, accurate, and safe alternative for internal fixation surgery in patients with extremely small lumbar pedicles, without the need for an O-arm navigation system.
Clinical Relevance:
This retrospective cohort study confirms that the technique is a highly effective modality for managing thoracolumbar vertebral fractures with extremely narrow lumbar pedicles, reliably restoring and maintaining spinal stability, and thus offering a novel therapeutic option for clinicians.
