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Radiological and clinical outcome of screw placement in adolescent idiopathic scoliosis: evaluation with low-dose computed tomography.

Abul-Kasim, Kasim LU ; Ohlin, Acke LU ; Strömbeck, Anita; Maly, Pavel LU and Sundgren, Pia LU (2010) In European Spine Journal 19(1). p.96-104
Abstract
Posterior corrective surgery using "all pedicle screw construct" carries risk of neurovascular complications. The study aims were to assess the screw placement in patients with adolescent idiopathic scoliosis using CT with low-radiation dose, and to evaluate the clinical outcome in patients with misplaced pedicle screws. CTs of 49 consecutive patients (873 screws, 79% thoracic) were retrospectively evaluated by two independent radiologists. A new grading system was developed to distinguish between lateral, medial and anterior cortical perforations, endplate perforation and foraminal perforation. The grading system is based on whether the cortical violation is partial or total rather than on mm-basis. The overall rate of screw misplacement... (More)
Posterior corrective surgery using "all pedicle screw construct" carries risk of neurovascular complications. The study aims were to assess the screw placement in patients with adolescent idiopathic scoliosis using CT with low-radiation dose, and to evaluate the clinical outcome in patients with misplaced pedicle screws. CTs of 49 consecutive patients (873 screws, 79% thoracic) were retrospectively evaluated by two independent radiologists. A new grading system was developed to distinguish between lateral, medial and anterior cortical perforations, endplate perforation and foraminal perforation. The grading system is based on whether the cortical violation is partial or total rather than on mm-basis. The overall rate of screw misplacement was 17% (n = 149): 8% were laterally placed and 6.1% were medially placed. The rates of anterior cortical, endplate and foraminal perforation were 1.5, 0.9, and 0.5%, respectively. Lateral cortical perforation was more frequent in the thoracic spine (P = 0.005), whereas other types of misplacement including medial cortical perforation were more frequent on the left and the concave side of scoliotic curves (P = 0.002 and 0.003). No neurovascular complications were reported. The association between the occurrence of screw misplacement and the Cobb angle was statistically significant (P = 0.037). Misplacements exceeding half screw diameter should be classified as unacceptable. Low-dose CT implies exposing these young individuals to a significantly lower radiation dose than do other protocols used in daily clinical practice. We recommend using low-dose CT and the grading system proposed here in the postoperative assessment of screw placement. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Spine Journal
volume
19
issue
1
pages
96 - 104
publisher
Springer
external identifiers
  • wos:000273590100013
  • pmid:19888607
  • scopus:75049085475
ISSN
0940-6719
DOI
10.1007/s00586-009-1203-6
language
English
LU publication?
yes
id
d3c7d680-e9ef-4946-9996-ecbea08f1efc (old id 1512254)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19888607?dopt=Abstract
date added to LUP
2009-12-01 11:34:38
date last changed
2018-05-29 09:40:33
@article{d3c7d680-e9ef-4946-9996-ecbea08f1efc,
  abstract     = {Posterior corrective surgery using "all pedicle screw construct" carries risk of neurovascular complications. The study aims were to assess the screw placement in patients with adolescent idiopathic scoliosis using CT with low-radiation dose, and to evaluate the clinical outcome in patients with misplaced pedicle screws. CTs of 49 consecutive patients (873 screws, 79% thoracic) were retrospectively evaluated by two independent radiologists. A new grading system was developed to distinguish between lateral, medial and anterior cortical perforations, endplate perforation and foraminal perforation. The grading system is based on whether the cortical violation is partial or total rather than on mm-basis. The overall rate of screw misplacement was 17% (n = 149): 8% were laterally placed and 6.1% were medially placed. The rates of anterior cortical, endplate and foraminal perforation were 1.5, 0.9, and 0.5%, respectively. Lateral cortical perforation was more frequent in the thoracic spine (P = 0.005), whereas other types of misplacement including medial cortical perforation were more frequent on the left and the concave side of scoliotic curves (P = 0.002 and 0.003). No neurovascular complications were reported. The association between the occurrence of screw misplacement and the Cobb angle was statistically significant (P = 0.037). Misplacements exceeding half screw diameter should be classified as unacceptable. Low-dose CT implies exposing these young individuals to a significantly lower radiation dose than do other protocols used in daily clinical practice. We recommend using low-dose CT and the grading system proposed here in the postoperative assessment of screw placement.},
  author       = {Abul-Kasim, Kasim and Ohlin, Acke and Strömbeck, Anita and Maly, Pavel and Sundgren, Pia},
  issn         = {0940-6719},
  language     = {eng},
  number       = {1},
  pages        = {96--104},
  publisher    = {Springer},
  series       = {European Spine Journal},
  title        = {Radiological and clinical outcome of screw placement in adolescent idiopathic scoliosis: evaluation with low-dose computed tomography.},
  url          = {http://dx.doi.org/10.1007/s00586-009-1203-6},
  volume       = {19},
  year         = {2010},
}