Freehand Juxtapedicular Screws Placed in the Apical Concavity of Adult Idiopathic Scoliosis Patients: Technique, Computed Tomography Confirmation, and Radiographic Results

Alexander J. Schupper, James D. Lin, Joseph A. Osorio, Nathan J. Lee, Jeremy M. Steinberger, Joseph M. Lombardi, Ronald A. Lehman, Lawrence G. Lenke

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: The purpose of this study is to highlight our technique for freehand placement of juxtapedicular screws along with intraoperative computed tomography (CT) and radiographic results. Methods: Consecutive patients with adult idiopathic scoliosis undergoing primary surgery by the senior author were identified. All type D (absent/slit like channel) pedicles were identified on preoperative CT. Three-dimensional visualization software was used to mea-sure screw angulation and purchase. Radiographs were measured by a fellowship trained spine surgeon. The freehand technique was used to place all screws in a juxtapedicular fash-ion without any fluoroscopic, radiographic, navigational or robotic assistance. Results: Seventy-three juxtapedicular screws were analyzed. The most common level was T7 (9 screws) on the left and T5 (12 screws) on the right. The average medial angulation was 20.7° (range, 7.1°–36.3°), lateral vertebral body purchase was 13.4 mm (range, 0–28.9 mm), and medial vertebral body purchase was 21.1 mm (range, 8.9–31.8 mm). More than half (53.4%) of the screws had bicortical purchase. Two screws were lateral on CT scan, defined by the screw axis lateral to the lateral vertebral body cortex. No screws were medial. There was a difference in medial angulation between screws with (n = 58) and without (n = 15) lateral body purchase (22.0 ± 4.9 vs. 15.5 ± 4.5, p < 0.001). Three of 73 screws were repo-sitioned after intraoperative CT. There were no neurovascular complications. The mean coronal cobb corrections for main thoracic and lumbar curves were 83.0% and 80.5%, re-spectively, at an average of 17.5 months postoperative. Conclusion: Freehand juxtapedicular screw placement is a safe technique for type D pedi-cles in adult idiopathic scoliosis patients.

Original languageEnglish
Pages (from-to)1116-1121
Number of pages6
JournalNeurospine
Volume19
Issue number4
DOIs
StatePublished - Dec 2022

Keywords

  • Extrapedicular screw placement
  • Juxtapedicular screw placement
  • Lumbar instrumenta-tion
  • Pedicle screw
  • Spine surgery
  • Thoracic instrumentation

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