Journal of Korean Neurosurgical Society

  • 제61권5호
  • /
  • Pages.568-573
  • /
  • 2018
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지
DOI QR코드

DOI QR Code

Can Right-Handed Surgeons Insert Upper Thoracic Pedicle Screws in much Comfortable Position? Right-Handedness Problem on the Left Side

  • 투고 : 2018.03.13
  • 심사 : 2018.05.15
  • 발행 : 2018.09.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : Thoracic pedicles have special and specific properties. In particular, upper thoracic pedicles are positioned in craniocaudal plane. Therefore, manipulation of thoracic pedicle screws on the left side is difficult for right-handed surgeons. We recommend a new position to insert thoracic pedicle screw that will be much comfortable for spine surgeons. Methods : We retrospectively reviewed 33 patients who underwent upper thoracic pedicle screw instrumentation. In 15 patients, a total of 110 thoracic pedicle screws were inserted to the upper thoracic spine (T1-6) with classical position (anesthesiologist and monitor were placed near to patient's head. Surgeons were standing classically near to patient's body while patients were lying in prone position). In 18 patients, a total of 88 thoracic pedicle screws were inserted to the upper thoracic spine with the new standing position-surgeons stand by the head of the patient and the anesthesia monitor laterally and under patient's belt level. All the operations performed by the same senior spine surgeons with the help of C-arm. Postoperative computed tomography scans were obtained to assess the screw placement. The screw malposition and pedicle wall violations were divided and evaluated separately. Cortical penetration were measured and graded at either : 1-2 mm penetration, 2-4 mm penetration and >4 mm penetration. Results : Total 198 screws were inserted with two different standing positions. Of 198 screws 110 were in the classical positioning group and 88 were in the new positioning group. Incorrect screw placement was found in 33 screws (16.6%). The difference between total screw malposition by both standing positions were found to be statistically significant (p=0.011). The difference between total pedicle wall violations by both standing positions were found to be statistically significant (p=0.003). Conclusion : Right-handedness is a problem during the upper thoracic pedicle screw placement on the left side. Changing the surgeon's position standing near to patient's head could provide a much comfortable position to orient the craniocaudal plane of the thoracic pedicles.

키워드

참고문헌

  1. Belmont PJ Jr, Klemme WR, Dhawan A, Polly DW Jr : In vivo accuracy of thoracic pedicle screws. Spine (Phila Pa 1976) 26 : 2340-2346, 2001 https://doi.org/10.1097/00007632-200111010-00010
  2. Costa F, Villa T, Anasetti F, Tomei M, Ortolina A, Cardia A, et al. : Primary stability of pedicle screws depends on the screw positioning and alignment. Spine J 13 : 1934-1939, 2013 https://doi.org/10.1016/j.spinee.2013.03.046
  3. Di Silvestre M, Parisini P, Lolli F, Bakaloudis G : Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976) 32 : 1655-1661, 2007 https://doi.org/10.1097/BRS.0b013e318074d604
  4. Fisher CG, Sahajpal V, Keynan O, Boyd M, Graeb D, Bailey C, et al. : Accuracy and safety of pedicle screw fixation in thoracic spine trauma. J Neurosurg Spine 5 : 520-526, 2006 https://doi.org/10.3171/spi.2006.5.6.520
  5. Gertzbein SD, Robbins SE : Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976) 15 : 11-14, 1990 https://doi.org/10.1097/00007632-199001000-00004
  6. Guzey FK, Emel E, Hakan Seyithanoglu M, Serdar Bas N, Ozkan N, Sel B, et al. : Accuracy of pedicle screw placement for upper and middle thoracic pathologies without coronal plane spinal deformity using conventional methods. J Spinal Disord Tech 19 : 436-441, 2006 https://doi.org/10.1097/00024720-200608000-00011
  7. Hackenberg L, Link T, Liljenqvist U : Axial and tangential fixation strength of pedicle screws versus hooks in the thoracic spine in relation to bone mineral density. Spine (Phila Pa 1976) 27 : 937-942, 2002 https://doi.org/10.1097/00007632-200205010-00010
  8. Heini P, Scholl E, Wyler D, Eggli S : Fatal cardiac tamponade associated with posterior spinal instrumentation. A case report. Spine (Phila Pa 1976) 23 : 2226-2230, 1998 https://doi.org/10.1097/00007632-199810150-00017
  9. Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD : Free hand pedicle screw placement in the thoracic spine: is it safe? Spine (Phila Pa 1976) 29 : 333-342; discussion 342, 2004 https://doi.org/10.1097/01.BRS.0000109983.12113.9B
  10. Kim YJ, Lenke LG : Thoracic pedicle screw placement: free-hand technique. Neurol India 53 : 512-519, 2005 https://doi.org/10.4103/0028-3886.22622
  11. Lee CS, Kim MJ, Ahn YJ, Kim YT, Jeong KI, Lee DH : Thoracic pedicle screw insertion in scoliosis using posteroanterior C-arm rotation method. J Spinal Disord Tech 20 : 66-71, 2007 https://doi.org/10.1097/01.bsd.0000211248.75200.3f
  12. Lehman RA Jr, Polly DW Jr, Kuklo TR, Cunningham B, Kirk KL, Belmont PJ Jr : Straight-forward versus anatomic trajectory technique of thoracic pedicle screw fixation: a biomechanical analysis. Spine (Phila Pa 1976) 28 : 2058-2065, 2003 https://doi.org/10.1097/01.BRS.0000087743.57439.4F
  13. Lien SB, Liou NH, Wu SS : Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine. Eur Spine J 16 : 1215-1222, 2007 https://doi.org/10.1007/s00586-006-0245-2
  14. Liljenqvist U, Hackenberg L, Link T, Halm H : Pullout strength of pedicle screws versus pedicle and laminar hooks in the thoracic spine. Acta Orthop Belg 67 : 157-163, 2001
  15. Liljenqvist UR, Halm HF, Link TM : Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine (Phila Pa 1976) 22 : 2239-2245, 1997 https://doi.org/10.1097/00007632-199710010-00008
  16. Minor ME, Morrissey NJ, Peress R, Carroccio A, Ellozy S, Agarwal G, et al. : Endovascular treatment of an iatrogenic thoracic aortic injury after spinal instrumentation: case report. J Vasc Surg 39 : 893-896, 2004 https://doi.org/10.1016/j.jvs.2003.10.056
  17. Suk SI, Kim WJ, Lee SM, Kim JH, Chung ER : Thoracic pedicle screw fixation in spinal deformities: are they really safe? Spine (Phila Pa 1976) 26 : 2049-2057, 2001 https://doi.org/10.1097/00007632-200109150-00022
  18. Vaccaro AR, Rizzolo SJ, Balderston RA, Allardyce TJ, Garfin SR, Dolinskas C, et al. : Placement of pedicle screws in the thoracic spine. Part II: an anatomical and radiographic assessment. J Bone Joint Surg Am 77 : 1200-1206, 1995 https://doi.org/10.2106/00004623-199508000-00009
  19. Wang VY, Chin CT, Lu DC, Smith JS, Chou D : Free-hand thoracic pedicle screws placed by neurosurgery residents: a CT analysis. Eur Spine J 19 : 821-827, 2010 https://doi.org/10.1007/s00586-010-1293-1
  20. Yaman O, Acaroglu E : Role of surgeon handedness in transpedicular screw insertion. Acta Orthop Traumatol Turc 48 : 479-482, 2014 https://doi.org/10.3944/AOTT.2014.13.0046