Evaluation Of The Accuracy Of Percutaneous Pedicle Screw Placement By CT And Its Clinical Efficacy

Objective: This study was conducted to evaluate the accuracy ofpercutaneous pedicle screw placement, and to discuss the its clinical efficacy.Methods one: From March2010to June2013, a total of140cases sufferingfrom degenerative diseases and thoracolumbar fractures were retrospectivelyanalysised. The mean age was45.1(21-74) years. Posterior pedicle screwfixation was performed in all patients. A total of596pedicle screws wereused.264pedicle screws were placed percutaneously, and332were placedopenly. Postoperative CT scan and related software measurement wereperformed postoperatively. A simple rating system Mobbs—Raley was usedto assess the accuracy of screw placement. Grade0: pedicle screws wereentirely within the cortex; Grade1: pedicle screw threaded through the wall of<2mm;2: the penetration of the pedicle wall was>2mm, but no nervedamagement; Grade3: penetration and accompanied complications. Location,number and distance of the pedicle screw perforation were recorded.Methods two:Patients suffering from single thoracolumbar fracture withoutnerver injury or spinal canal decompression were selected from above. GroupA (23patients): single stage fracture treated with four nails placedpercutaneously. Group B (26patients): fracture treated with four nails placedopenly. Incision length, operative time, blood loss, postoperative drainage andhospital stay were compared. VAS score was compared postoperatively. Group C (28patients): lumbar disc herniation treated with percutaneouspedicle screw placement in non-symptomatic side and decompression andscrew placement under channel Quadrant vacuum and in symptomatic side.Group D (30patients): treatment with single stage open PLIF technique.Operative time, blood loss, hospital stay ODI and VAS scores werecompared.Results one: Postoperative CT scan showed52pedicle screws perforatedcortex, the overall bad rate of pedicle screws was8.7%;31screws pierced inopen setting group, including Grade1:21screws, Grade2:9screws andGrade3:1screw.264screws placed in percutaneous group, and21screwspierced, including including Grade1:15screws, Grade2:6screws. Accuracyof pedicle screw placement in percutaneous group was higher than that og theopen group (92.0%VS90.7%), no significant was detected.Results two:When compared Group A with Group B, incision length was7.5±0.9cm in Group A, and12.7±1.3cm in Group B(P＜0.01); operative timewas90.9±12.1min in Group A, and123.6±16.6min in Group B (P＜0.01);blood loss was60.6±21.8ml in Group A, and342.7±60.2ml in Group B (P＜0.01); postoperative drainage was16.3±4.6ml in Group A, and124.2±21.8ml in Group B (P＜0.01); hospital stay was15.3±2.7d in Group A, and18.0±2.9d in Group B (P＜0.01); When compared Group C with Group D,operative time was129.00±15.53min in Group C, and134.00±16.26min inGroup D (P＜0.01); hospital stay was12.54±1.57d in Group C, and18.25±2.26d in Group D (P＜0.01); blood loss was198.43±24.37ml inGroup C, and481.33±85.89ml in Group D (P＜0.01); ODI score was9.64±2.88in Group C, and16.33±2.95in Group D (P.＜0.01); VAS scorescore was1.34±0.80in Group C, and3.13±1.81in Group D (P＜0.01). No complication was detected in Group C, and a cace of incision necrosiscomblined with low-grade infection was investigated in Group D.Conclusion: The accuracy of percutaneous pedicle screw placement iscomparable to open surgery, but there is no significant difference. In theclinical application, the use of minimally invasive percutaneous pedicle screwwas significantly better than traditional open surgery in terms of clinicalefficacy, with a small incision, less blood loss, shorter hospital stay, tissueinjury, postoperative pain and quick recovery. Percutaneous pedicle screw issuitable for a variety of spinal disorders. It is a basic operation of minimallyinvasive spine surgery, and when combined with other posterior open surgery,it can achieve therapeutic purposes of posterior surgery, reducing theposterior tissue damage.