Comparison of Accuracy of Percutaneous Placement of Thoracolumbar Pedicle Screws with Open Method

Abstract

Background: A common complication in insertion of pedicle screws by percutaneous or standard open technique is misplacement of screws which can occur through any wall of the pedicle and damage adjacent structures. Objective: The purpose of our study is to compare the accuracy of screw placement through either technique, carried out in our setup in traumatic thoracolumbar spine fractures. Study Design: Descriptive correctional study. Settings: Department of Neurosurgery, SMBB Institute of Trauma, Dow University of Health Sciences, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Pakistan. Duration: July 2018 and December 2021. Methods: Data of all patients with traumatic single level thoracolumbar fractures undergoing pedicle screw fixation either by percutaneous or open technique with or without decompression between July 2018 and December 2021 was retrieved from hospital records. The study reviewed patient demographics, neurological grading using the ASIA impairment scale, operative notes, and post-operative CT scans. The accuracy of screw placement was evaluated based on axial, coronal, and sagittal images using the Gertzbein-Robbins grading system. Information was collected on a pre-designed proforma and SPSS version 26 was used for the data analysis. Results: Total of 260 screws were placed in 65 patients, out of which 88 were placed by percutaneous and 172 by open technique. Although there was a higher incidence of pedicle breach in percutaneous technique(n=10) as compared to open technique(n=10), statistical analysis showed no significant difference (p-value>0.05) between the two techniques. Conclusion: Although there is a higher incidence of malposition in pedicle screw placement by percutaneous technique, but the statistical difference in accuracy of screw placement between the two groups is not significant. Also, no relation was found between the rates of misplacement for lumbar and thoracic screws or distribution of the direction of pedicle breach among the groups.