Evaluation of a novel pedicle probe for the placement of thoracic and lumbosacral pedicle screws
Evaluation of a novel pedicle probe for the placement of thoracic and lumbosacral pedicle screws
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DOI：
10.1097/01.bsd.0000112046.36255.58
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发表时间：
2004-12-01
影响因子：
--
通讯作者：
Scuderi, GJ
中科院分区：
文献类型：
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作者：
Grauer, JN;Vaccaro, AR;Scuderi, GJ
背景：椎弓根螺钉内固定在腰椎中很常见，在胸椎中也越来越被接受。椎弓根通常用变速探头或刮匙插入管子。SafePath(Mekanika，Boca Raton，FL)是一种可供选择的椎弓根探头，用于椎弓根插管。目的：与常用的椎弓根插管技术相比，本研究的目的是评价该装置的准确性。方法：对4具新鲜冷冻的胸椎和腰椎标本进行研究。每具身体一侧的椎弓根都被插入了SafePath装置。对侧椎弓根用变速探头或3-0颈椎刮匙置入。通过X线摄片、CT扫描和解剖直接观察来评价椎弓根探头放置的准确性。结果：128个椎弓根中有51个(40%)在直接观察中被破坏。变速探头和刮宫的结果没有显著差异；22例中有2例(9%)，45例胸椎中有14例(33%)。在使用SafePath装置时，22例腰椎侵犯中有0例(0%)，45例胸部侵犯中有34例(76%)。SafePath在腰椎的表现明显更好，在胸椎的表现明显更差。X线片和CT对椎弓根脱位的判断准确率分别为88%和85%。结论：本体外研究结果提示SafePath装置可替代传统的腰椎椎弓根插管技术。然而，胸椎的情况正好相反，在胸椎，SafePath的表现明显低于传统技术。
Background: Pedicle screw instrumentation is common in the lumbar spine and is gaining acceptance in the thoracic spine. The pedicle is generally cannulated with a gearshift probe or curette. SafePath (Mekanika, Boca Raton, FL) is an alternative pedicle probe designed for pedicle cannulation. This is a blunt-tipped, nonaggressive drill that seeks the cancellous portion of the pedicle.Objective: The objective of this study was to evaluate the accuracy of this device in comparison with techniques commonly used for pedicle cannulation.Methods: Four osteoligamentous fresh-frozen thoracic to sacral cadaveric spines were studied. The pedicles of one side of each cadaver were cannulated with the SafePath device. The contralateral pedicles were cannulated with either a gearshift probe or a 3-0 cervical curette. The accuracy of pedicle probe placement was evaluated by radiography, computed tomography (CT) scan, and direct observation via dissection.Results: By direct observation, 51 of 128 pedicles were violated (40%). There were not significant differences between the results obtained with the gearshift probe or curette; there were 2 of 22 lumbosacral violations (9%) and 14 of 45 thoracic violations (33%). With the SafePath device, there were 0 of 22 lumbosacral violations (0%) and 34 of 45 thoracic violations (76%). SafePath performed significantly better in the lumbar spine and significantly worse in the thoracic spine. The accuracy for determining pedicle violation was 88% for radiography and 85% for CT.Conclusions: The results of this in vitro study suggest that the SafePath device may represent an alternative to traditional pedicle cannulation techniques in the lumbosacral spine. However, the opposite is true in the thoracic spine, where SafePath performed significantly worse than traditional techniques.