Is in vivo manual palpation for thoracic pedicle screw instrumentation reliable?

Clinical article

Miriam L. Donohue Ph.D. 1 , Ross R. Moquin M.D. 2 , Amit Singla M.B.B.S., M.S. 1 , and Blair Calancie Ph.D. 1
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  • 1 Department of Neurosurgery, Upstate Medical University; and
  • 2 Empire State Neurosurgical Institute, Syracuse, New York
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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 ≥ 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.

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Contributor Notes

Address correspondence to: Blair Calancie, Ph.D., Neurosurgery, 750 E. Adams St., IHP #1213, Syracuse, NY 13210. email: calancib@upstate.edu.

Please include this information when citing this paper: published online February 21, 2014; DOI: 10.3171/2014.1.SPINE13197.

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