Avila Mauricio J, Baaj Ali A
Neurological Surgery, Weill Cornell Medical College.
Neurological Surgery, NewYork-Presbyterian/Weill Cornell Medical College.
Cureus. 2016 Feb 19;8(2):e501. doi: 10.7759/cureus.501.
Pedicle screw fixation in the thoracic spine presents certain challenges due to the critical regional neurovascular anatomy as well as the narrow pedicular corridor that typically exists. With increased awareness of the dangers of intraoperative radiation, the ability to place pedicle screws with anatomic landmarks alone is paramount. In this study, we reviewed the literature from 1990 to 2015 for studies that included freehand pedicle screw placement in the thoracic spine with special emphasis on entry points and the trajectories of the screws. We excluded studies that used fluoroscopy guidance, navigation techniques, cadaveric and biomechanical articles, case reports, and experimental studies on animals. The search retrieved 40 articles, and after careful selection, seven articles were analyzed. Over 8,000 screws were placed in the different studies. The mean accuracy for placement of the thoracic screws was 93.3%. However, there is little consensus between studies in entry points, sagittal, and axial trajectories of the screws. We complete this review by presenting our step-by-step technique for the placement of freehand pedicle screws in the thoracic spine.
由于胸椎区域关键的神经血管解剖结构以及通常存在的狭窄椎弓根通道，胸椎椎弓根螺钉固定存在一定挑战。随着对术中辐射危害的认识不断提高，仅依靠解剖标志放置椎弓根螺钉的能力至关重要。在本研究中，我们回顾了1990年至2015年的文献，查找了包括徒手在胸椎置入椎弓根螺钉的研究，特别关注进针点和螺钉的轨迹。我们排除了使用透视引导、导航技术、尸体和生物力学方面的文章、病例报告以及动物实验研究。检索到40篇文章，经过仔细筛选，分析了7篇文章。在不同研究中共置入了8000余枚螺钉。胸椎螺钉置入的平均准确率为93.3%。然而，各研究在螺钉的进针点、矢状面和轴向轨迹方面几乎没有达成共识。我们通过介绍徒手在胸椎置入椎弓根螺钉的分步技术来完成本综述。
