Is in vivo manual palpation for thoracic pedicle screw instrumentation reliable?
Is in vivo manual palpation for thoracic pedicle screw instrumentation reliable?
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DOI：
10.3171/2014.1.spine13197
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发表时间：
2014-05-01
影响因子：
2.8
通讯作者：
Calancie, Blair
中科院分区：
文献类型：
--
作者：
Donohue, Miriam L.;Moquin, Ross R.;Calancie, Blair
物体。以前关于人工触诊放置胸椎椎弓根螺钉的准确性的报道仅限于身体研究。这项新研究的作者评估了在活体成人胸椎手术中，手动触诊检测胸椎手术中内侧和外侧椎弓根断裂的准确性。徒手创建椎弓根轨迹，并使用球头探头手动触诊。术后对所有植入的胸椎和L-1椎弓根螺钉的位置和椎弓根侧壁进行CT扫描。对525个椎弓根椎弓根/螺钉置入物进行了比较。有21个椎弓根有内侧断裂，直径为2 mm，外科医生正确地识别出这些椎弓根轨迹中只有4个有内侧断裂。外科医生正确地确定了128个椎弓根中有17个有明显的侧向断裂(=2 mm)。102枚螺钉在任何方向(内侧、外侧或孔)都没有可测量到的断裂。外科医生正确地识别了98%的理想位置的螺丝钉。在这项胸椎椎弓根螺钉放置的实时研究中，人工触诊检测内侧或外侧骨折的准确率低得令人不安。这些发现与最近身体对触诊准确性的评估一致，并表明在脊柱内固定手术中放置胸椎椎弓根螺钉时，迫切需要更可靠的替代方法来评估椎弓根的完整性。
Object. Previous reports on the accuracy of manual palpation for thoracic pedicle screw placement have been restricted to cadaveric studies. Authors of the present novel study assessed the accuracy of manual palpation for the detection of medial and lateral pedicle breaches during thoracic spine surgery in living adult humans.Methods. Pedicle tracks were created freehand and manually palpated using a ball-tipped probe. Postoperative CT scans of all implanted thoracic and L-1 screws were evaluated with respect to screw position and the pedicle wall.Results. Five hundred twenty-five pedicle track/screw placements were compared. There were 21 pedicles with medial breaches measuring >= 2 mm The surgeon correctly identified only 4 of these pedicle tracks as having a medial breach. The surgeon correctly identified 17 of 128 pedicles with a significant (>= 2 mm) lateral breach. One hundred two screw placements had no measurable breach in any direction (medial, lateral, or foraminal). The surgeon correctly identified 98% of these ideally placed screws.Conclusions. In this real-time study of thoracic pedicle screw placement, the accuracy of manual palpation for detecting medial or lateral breaches that were a >= 2 mm was disturbingly low. These findings are consistent with those in recent cadaveric evaluations of palpation accuracy and point to the critical need for more reliable alternative methods to assess pedicle integrity during the placement of thoracic pedicle screws for spine instrumentation surgery.