Where freehand screws are most often malpositioned in spinal deformity surgery: 5 key notes


A new study published in the Scoliosis Research Society's journal Spinal Deformity examines the levels most pedicle screws are malpositioned at for pediatric cases.

The researchers examined postoperative CTs for 85 patients who received 605 screws. The patients underwent spinal fusion using the freehand pedicle screw technique. There were 355 screws placed in patients without deformity and 250 screws placed in patients with deformity.


The researchers found:


1. The screws for pediatric deformity patients were more often malpositioned by 2 mm or more than those without deformity. Twenty-six percent of the deformity screws were misplaced compared with 19 percent of the non-deformity screws.


2. There wasn't a higher rate of screw malposition at the apical region for patients with deformity.


3. The highest severe screw malposition rates were between T3 and T8.


4. The pedicle breaches were more common in a medial direction — 74 percent — than the lateral direction — 26 percent.


5. Severe breaches at T3-T8 were more often directed lateral — 92 percent — than medial — 8 percent.


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