Aoude Ahmed, Ghadakzadeh Saber, Alhamzah Hamzah, Fortin Maryse, Jarzem Peter, Ouellet Jean A, Weber Michael H
McGill Scoliosis & Spine Centre, McGill University Health Centre, Montreal, Canada.
Asian Spine J. 2018 Feb;12(1):37-46. doi: 10.4184/asj.2018.12.1.37. Epub 2018 Feb 7.
This study was designed as a survey amongst Canadian spine surgeon to determine a scoring system to standardize pedicle screw placement assessment.
This study aimed to obtain and analyze the opinions of spine surgeons regarding the assessment of pedicle screw accuracy, with the goal of establishing clinical guidelines for interventions for malpositioned pedicle screws.
Accurate placement of pedicle screws is challenging, and misalignment can lead to various complications. To date, there is no recognized gold standard for assessing pedicle screw placement accuracy. The literature is lacking studies attempting to standardize pedicle screw placement accuracy assessment.
A survey of the clinical methods and imaging criteria that are used for assessing pedicle screw placement accuracy was designed and sent to orthopedic and neurosurgery spine surgeons from the Canadian Spine Society for their anonymous participation.
Thirty-five surgeons completed the questionnaire. The most commonly used modalities for assessing pedicle screw position postoperatively were plain X-rays (97%) and computed tomography (CT, 97%). In both symptomatic and asymptomatic patients, the most and least worrisome breaches were medial and anterior breaches, respectively. The majority of surgeons tended not to re-operate on asymptomatic breaches. More than 60% of surgeons would re-operate on patients with new-onset pain and a ≤4-mm medial or inferior breach in both thoracic and lumbar regions. If a patient experienced sensory loss and a breach on CT, in either the thoracic or lumbar levels, 90% and 70% of the surgeons would re-operate for a medial breach and an inferior breach, respectively.
Postoperative clinical presentation and imaging findings are crucial for interpreting aberrant pedicle screw placement. This study presents a preliminary scoring system for standardizing the classification of pedicle screws.
本研究设计为对加拿大脊柱外科医生进行一项调查，以确定一种评分系统来规范椎弓根螺钉置入评估。
本研究旨在获取并分析脊柱外科医生对椎弓根螺钉置入准确性评估的意见，目标是建立针对位置不当椎弓根螺钉干预的临床指南。
准确置入椎弓根螺钉具有挑战性，且位置不正可能导致各种并发症。迄今为止，尚无公认的评估椎弓根螺钉置入准确性的金标准。文献中缺乏试图规范椎弓根螺钉置入准确性评估的研究。
设计了一项关于用于评估椎弓根螺钉置入准确性的临床方法和影像标准的调查，并发送给加拿大脊柱协会的骨科和神经外科脊柱外科医生，邀请他们匿名参与。
35名外科医生完成了问卷。术后评估椎弓根螺钉位置最常用的方式是普通X线（97%）和计算机断层扫描（CT，97%）。在有症状和无症状患者中，最令人担忧和最不令人担忧的穿破情况分别是内侧穿破和前方穿破。大多数外科医生倾向于不对无症状穿破进行再次手术。超过60%的外科医生会对胸段和腰段出现新发疼痛且内侧或下方穿破≤4mm的患者进行再次手术。如果患者在胸段或腰段出现感觉丧失且CT显示有穿破，90%和70%的外科医生会分别因内侧穿破和下方穿破而进行再次手术。
术后临床表现和影像结果对于解读异常的椎弓根螺钉置入至关重要。本研究提出了一种用于规范椎弓根螺钉分类的初步评分系统。
