Browse > Article
http://dx.doi.org/10.3340/jkns.2018.0059

Can Right-Handed Surgeons Insert Upper Thoracic Pedicle Screws in much Comfortable Position? Right-Handedness Problem on the Left Side  

Akyoldas, Goktug (Department of Neurosurgery, Koc University)
Senturk, Salim (Department of Neurosurgery, Koc University)
Yaman, Onur (Department of Neurosurgery, Koc University)
Ozdemir, Nail (Department of Neurosurgery, Tepecik Education and Training Hospital)
Acaroglu, Emre (Department of Orthopedics, Memorial Hospital)
Publication Information
Journal of Korean Neurosurgical Society / v.61, no.5, 2018 , pp. 568-573 More about this Journal
Abstract
Objective : Thoracic pedicles have special and specific properties. In particular, upper thoracic pedicles are positioned in craniocaudal plane. Therefore, manipulation of thoracic pedicle screws on the left side is difficult for right-handed surgeons. We recommend a new position to insert thoracic pedicle screw that will be much comfortable for spine surgeons. Methods : We retrospectively reviewed 33 patients who underwent upper thoracic pedicle screw instrumentation. In 15 patients, a total of 110 thoracic pedicle screws were inserted to the upper thoracic spine (T1-6) with classical position (anesthesiologist and monitor were placed near to patient's head. Surgeons were standing classically near to patient's body while patients were lying in prone position). In 18 patients, a total of 88 thoracic pedicle screws were inserted to the upper thoracic spine with the new standing position-surgeons stand by the head of the patient and the anesthesia monitor laterally and under patient's belt level. All the operations performed by the same senior spine surgeons with the help of C-arm. Postoperative computed tomography scans were obtained to assess the screw placement. The screw malposition and pedicle wall violations were divided and evaluated separately. Cortical penetration were measured and graded at either : 1-2 mm penetration, 2-4 mm penetration and >4 mm penetration. Results : Total 198 screws were inserted with two different standing positions. Of 198 screws 110 were in the classical positioning group and 88 were in the new positioning group. Incorrect screw placement was found in 33 screws (16.6%). The difference between total screw malposition by both standing positions were found to be statistically significant (p=0.011). The difference between total pedicle wall violations by both standing positions were found to be statistically significant (p=0.003). Conclusion : Right-handedness is a problem during the upper thoracic pedicle screw placement on the left side. Changing the surgeon's position standing near to patient's head could provide a much comfortable position to orient the craniocaudal plane of the thoracic pedicles.
Keywords
Thoracic vertebrae; Pedicle screws; Right handed; Positioning;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD : Free hand pedicle screw placement in the thoracic spine: is it safe? Spine (Phila Pa 1976) 29 : 333-342; discussion 342, 2004   DOI
2 Kim YJ, Lenke LG : Thoracic pedicle screw placement: free-hand technique. Neurol India 53 : 512-519, 2005   DOI
3 Lee CS, Kim MJ, Ahn YJ, Kim YT, Jeong KI, Lee DH : Thoracic pedicle screw insertion in scoliosis using posteroanterior C-arm rotation method. J Spinal Disord Tech 20 : 66-71, 2007   DOI
4 Lehman RA Jr, Polly DW Jr, Kuklo TR, Cunningham B, Kirk KL, Belmont PJ Jr : Straight-forward versus anatomic trajectory technique of thoracic pedicle screw fixation: a biomechanical analysis. Spine (Phila Pa 1976) 28 : 2058-2065, 2003   DOI
5 Belmont PJ Jr, Klemme WR, Dhawan A, Polly DW Jr : In vivo accuracy of thoracic pedicle screws. Spine (Phila Pa 1976) 26 : 2340-2346, 2001   DOI
6 Costa F, Villa T, Anasetti F, Tomei M, Ortolina A, Cardia A, et al. : Primary stability of pedicle screws depends on the screw positioning and alignment. Spine J 13 : 1934-1939, 2013   DOI
7 Di Silvestre M, Parisini P, Lolli F, Bakaloudis G : Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976) 32 : 1655-1661, 2007   DOI
8 Fisher CG, Sahajpal V, Keynan O, Boyd M, Graeb D, Bailey C, et al. : Accuracy and safety of pedicle screw fixation in thoracic spine trauma. J Neurosurg Spine 5 : 520-526, 2006   DOI
9 Gertzbein SD, Robbins SE : Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976) 15 : 11-14, 1990   DOI
10 Lien SB, Liou NH, Wu SS : Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine. Eur Spine J 16 : 1215-1222, 2007   DOI
11 Liljenqvist U, Hackenberg L, Link T, Halm H : Pullout strength of pedicle screws versus pedicle and laminar hooks in the thoracic spine. Acta Orthop Belg 67 : 157-163, 2001
12 Liljenqvist UR, Halm HF, Link TM : Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine (Phila Pa 1976) 22 : 2239-2245, 1997   DOI
13 Minor ME, Morrissey NJ, Peress R, Carroccio A, Ellozy S, Agarwal G, et al. : Endovascular treatment of an iatrogenic thoracic aortic injury after spinal instrumentation: case report. J Vasc Surg 39 : 893-896, 2004   DOI
14 Suk SI, Kim WJ, Lee SM, Kim JH, Chung ER : Thoracic pedicle screw fixation in spinal deformities: are they really safe? Spine (Phila Pa 1976) 26 : 2049-2057, 2001   DOI
15 Guzey FK, Emel E, Hakan Seyithanoglu M, Serdar Bas N, Ozkan N, Sel B, et al. : Accuracy of pedicle screw placement for upper and middle thoracic pathologies without coronal plane spinal deformity using conventional methods. J Spinal Disord Tech 19 : 436-441, 2006   DOI
16 Hackenberg L, Link T, Liljenqvist U : Axial and tangential fixation strength of pedicle screws versus hooks in the thoracic spine in relation to bone mineral density. Spine (Phila Pa 1976) 27 : 937-942, 2002   DOI
17 Heini P, Scholl E, Wyler D, Eggli S : Fatal cardiac tamponade associated with posterior spinal instrumentation. A case report. Spine (Phila Pa 1976) 23 : 2226-2230, 1998   DOI
18 Vaccaro AR, Rizzolo SJ, Balderston RA, Allardyce TJ, Garfin SR, Dolinskas C, et al. : Placement of pedicle screws in the thoracic spine. Part II: an anatomical and radiographic assessment. J Bone Joint Surg Am 77 : 1200-1206, 1995   DOI
19 Wang VY, Chin CT, Lu DC, Smith JS, Chou D : Free-hand thoracic pedicle screws placed by neurosurgery residents: a CT analysis. Eur Spine J 19 : 821-827, 2010   DOI
20 Yaman O, Acaroglu E : Role of surgeon handedness in transpedicular screw insertion. Acta Orthop Traumatol Turc 48 : 479-482, 2014   DOI