Pedicle screw fixation in thoracolumbar and lumbar spine assisted by lateral fluoroscopic imaging: a study to evaluate the accuracy of screw placement

Background: The purpose of this study was to evaluate the accuracy of pedicle screw placement, its advantages, and limitations in posterior instrumentation of thoracolumbar and lumbar burst fractures assisted only by lateral fluoroscopic imaging. Materials and methods: Pre- and postoperative computerized tomographic (CT) scans of 117 patients with thoracolumbar and lumbar burst fractures, who underwent posterior instrumentation with pedicle screw fixation, were prospectively analyzed. Accuracy of screw placement, reconstruction of the vertebral height, and correction of the kyphotic angle were studied. Position of the pedicle screws were determined, and cortical breach was graded on the postoperative axial CT scans. Percentage of vertebral height reconstruction and kyphotic angle correction were calculated from the postoperative midsagittal CT scans. Results: Four hundred and sixty-eight pedicle screws in 234 motion segments were included in this study. 427 screws were centrally placed with an accuracy rate of 91.24%. Out of the 41 (8.76%) screws that breached the pedicle wall, 32 (6.84%) screws had violated the medial wall, while 9 (1.92%) screws breached the lateral wall. There were no “air-ball” screws. No screw penetrated the anterior wall. Postoperatively, none of the patients deteriorated neurologically, and no screw required revision. Postoperatively, there was significant restoration of vertebral height and correction of kyphosis (P < 0.05). Conclusion: Pedicle fixation performed on a Relton-Hall frame is relatively simple and, when performed carefully using only lateral fluoroscopic imaging, has a lower potential for complications due to cortical breach.