Accuracy Assessment of Freehand Pedicular Screw Placement



Bahonar Hospital, School of Medicine, Kerman University of Medcal Science, Kerman, Iran


Background: The purpose of this prospective study was to determine the accuracy of pedicular screw insertion without
the use of fluoroscopy.
Methods: This study was conducted on patients with spinal diseases in need of pedicular screw fixation and fusion.
The included patients suffered from such conditions as vertebral fracture, spinal stenosis, kyphosis, tumor, and pelvic
fractures and were managed with triangular osteosynthesis fixation. However, those with scoliosis deformity were
excluded from the study. A total of 760 pedicular screws were inserted in C7 to S1 vertebrae without using fluoroscopy.
The locations of the screws were assessed by means of computed tomography scan after the surgery. The data were
analyzed in SPSS software (version 22) using the Chi-square test.
Results: Out of 387 thoracic screws and 373 lumbar screws, 65 (16.8%) and 34 (9.1%) screws perforated the pedicle
wall or vertebral body, respectively. The most frequent locations of perforation in the thoracic and lumbar spine were
the anterior cortex of the vertebral body and medial wall of the pedicle, respectively. Except for the perforation of the
anterior vertebral body (P=0.0001), there was no difference between the left and right sides or between thoracic and
lumbar sites in terms of the preformation of the screw. No complication was observed due to screw perforation.
Conclusion: Our findings revealed the unnecessity of using fluoroscopy in spine surgeries for the insertion of pediculate
screws. In this regard, the use of fluoroscopy for the placement of pedicular screw resulted in similar accuracy and
complications, as compared to the free hand procedure.
Level of evidence: I