Is Free Hand Technique for Pedicle Screw Insertion Safe in Setup Lacking Advance Navigation System?
Journal Title: Journal of Pakistan Orthopaedic Association - Year 2021, Vol 33, Issue 01
Abstract
Objective: To determine the safety of pedicle screw fixation of the spine by free hand technique in terms of screw malposition and screw related post operative complications. Methods: This descriptive study was conducted in Orthopedic department Lady Reading Hospital Peshawar Pakistan from 23rd April 2017 to 23rd March 2020. Patients of either gender and age operated with pedicle screw fixation of the spine by free hand technique using universal entry point were included. Post operative radiographs of the spine were utilized for screw position. Patients with malposition radiographic screws and those with screw related post operative complications were screened with CT scan of the spine. CT based position of the pedicle screw was classified as per Zhang classification as type 0 (good), type 1 (Acceptable), type 2 (Unacceptable) and type 3 (Grievous). Revision surgery was performed for symptomatic pedicle screws and type 2 and type 3 malposition screws. Results: The total number of patients enrolled in our study were 96. Mean age was 34.20±9 years (range 10 to 70 years). Male patients were 45 (46.9%) and female 51 (53.1%). Total number of screws were 717 with maximum number of screws (n=425, 59.27%) in lumbar spine followed by thoracic spine (n=250, 34.87%) and sacral spine (n=42, 5.86%). Radiologically 684 (95.40%) screws were within the pedicles and patients were without any symptoms while 33 (4.6%) screws were malposition. CT scan classified 29 (4.0%) malposition screws as type 1 but the patients were asymptomatic. Only 3 (0.4%) screws in two patients were symptomatic type 2 and revision was done. No screw related vascular or visceral complication was reported. Conclusion: Free hand technique of pedicle screw fixation using universal entry point is a safe and reliable method in the absence of advance navigation system. Thorough knowledge of the spine, anatomy of the vertebrae and surgeon’s experience are however mandatory for safe placement of pedicle screw with free hand technique.
Authors and Affiliations
Waqar Hassan1, Shams Ur Rahman 2, Mehmood Ul Hassan 3, Naeemullah4, Wali Mohammad Khan5, Syed Imran Bukhari6
Keywords
Related Articles
- EP ID EP694718
- DOI -
- Views 206
- Downloads 0
Proximal Fibular Osteotomy: Pain Relief of Medial Compartment Knee Osteoarthritis.
Objective: This study was carried out to compare the mean pain score in patients of medial compartmental osteoarthritis of knee before and after proximal fibular osteotomy (PFO). Methodology: This single group quasi e...
Clubfoot – Today
The incidence of club foot is 4 to 6 per 1000 births and majority of the babies with club foot are born in the developing countries. 1Multiple factors are responsible for this deformity. The vascularity and the accessory...
Functional Out Come of Dynamic Hip Screw Fixation in Intertrochanteric Fracture
The objective of the study was to assess the functional outcome of intertrochanteric fracture fixed with dynamic hip screw by looking at the time of union, rate of infection, range of hip motion & limb shortening. Met...
A Comparative Study of McKenzie Back Program and Conventional Physiotherapy in Relieving Backache due to Lumbar Disc Prolapse.
Objective: To compare McKenzie back program and conventional physiotherapy in reducing pain and functional disability in patients with backache due to lumbar disc prolapse. Methods: This randomized controlled trial wa...
Custom-Made Antibiotic Cement-Coated Nails for The Treatment of Infected Nonunion in Femur
Evaluation of antibiotic cement impregnated nailing in the management of infected non-union of femur. Methods: The prospective study was made on 19 cases of infected non-union of femur from 2014 to 2015 Evaluation of...