Accuracy of Percutaneous Pedicle Screw Placement Using Modified Single Anterior-Posterior Fluoroscopy with the C-Arm for the Treatment of Traumatic Thoracic and Lumbar Fractures.

Abstract

We aimed to assess percutaneous pedicle screw (PPS) placement accuracy, fluoroscopy shot number, and operation time using a modified single anterior-posterior (AP) fluoroscopy with a C-arm in treating traumatic thoracic and lumbar vertebral fractures. In total, 164 patients with single-level traumatic thoracic or lumbar fracture who underwent 6 PPS placements between April 2018 and September 2020 were divided into 2 groups. Conventional AP combined lateral fluoroscopy was used in Group A, whereas modified single AP fluoroscopy was used in Group B. The accuracy of the PPS placement, number of fluoroscopy shots, and operation time were compared. All patients underwent computed tomography 2-4 days after surgery to evaluate screw position. Pedicle breach was divided into 4 grades based on postoperative computed tomography. Our study included 984 implanted pedicle screws, of which 36 (3.7%) were malpositioned. The breach rate was 3.5% (grade 1, 3.1%; grade 2, 0.4%) in Group A and 3.7% (grade 1, 3.0%; grade 2, 0.8%) in Group B. The median number of fluoroscopy shots during PPS placement was 21.9 in Group A and 8.4 in Group B. The median operation time was 76.07 ± 6.86 minutes in Group A and 55.78 ± 7.21 minutes in Group B. The PPS placement method using modified single AP fluoroscopy for treating traumatic thoracic and lumbar spine fractures was fairly accurate and reduced the number of fluoroscopy shots and operation time. This technique requires only a C-arm for assistance and can be easily mastered by spinal surgeons across hospitals of various levels.