Techniquesandaccuracyofthoracolumbarpediclescrewplacement

摘要： Pediclescrewinstrumentationhasbeenusedtostabilizethethoracolumbarspineforseveraldecades.Althoughpediclescrewswereoriginallyplacedviaafreehandtechnique,therehasbeenamovementinfavorofpediclescrewplacementwiththeaidofimaging.Suchassistivetechniquesincludefluoroscopyguidanceandstereotacticnavigation.Imaginghasthebenefitofincreasedvisualizationofapediclestrajectory,butcanresultinincreasedmorbidityassociatedwithradiationexposure,increasedtimeexpenditure,andpossibleworkflowinterruption.Manyinstitutionshavereportedhighaccuracieswitheachofthesethreecoretechniques.However,duetodifferingdefinitionsofaccuracyandvaryingradiographicanalyses,itisextremelydifficulttocomparestudiesside-by-sidetodeterminewhichtechniquesaresuperior.Fromtheliterature,itcanbeconcludedthatpediclesofvertebraewithinthemid-thoracicspineandvertebraethathavealteredmorphologyduetoscoliosisorotherdeformitiesarethemostdifficulttocannulate.Thus,spinesurgeonswouldbenefitthemostfromusingassistivetechnologiesinthesecircumstances.Allotherpediclesinthethoracolumbarspineshouldtheoreticallybecannulatedwitheaseviaafree-handtechnique,givenappropriatetrainingandexperience.Despitetheseglobalrecommendations,appropriatetechniquesmustbechosenatthesurgeonsdiscretion.Suchdeterminationsshouldbebasedonthesurgeonsexperienceandthespecificpathologythatwillbetreated. （共12頁）