Independent assessment of a new pedicle probe and its ability to detect pedicle breach: a cadaveric study

Laboratory investigation

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  • 1 Departments of Orthopaedic Surgery and
  • 3 Radiology, Loma Linda University Medical Center, and
  • 2 School of Medicine, Loma Linda University, Loma Linda, California
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Object

The authors undertook an independent, non–industry funded cadaveric study to evaluate the efficacy of a pedicle-probing device, which uses impedance measurement to warn of impending and actual pedicle screw breach.

Methods

A previously validated fresh-frozen cadaver model (saline-soaked spine) was used. Individuals at 3 levels of training (attending spine surgeon, orthopedic surgery resident, and medical student) used a cannulated pedicle-probing device to cannulate each of the levels between T-2 and S-1. Each pedicle was cannulated freehand using 2 approaches: 1) a standard trajectory through the middle of the pedicle, and 2) a medial trajectory aimed to breach the medial wall of the pedicle. A 16-slice helical CT scanner was used. The images were interpreted and analyzed by 2 orthopedic spine surgeons and a neuroradiologist.

Results

The sensitivity of the pedicle probe to detect impending breach or breach of 4 mm or less was 90.06%. The sensitivity in detecting medial wall breach was 95.8%. The positive predictive value was 87.1%. The device detected medial breach more often than lateral breach.

Conclusions

This study showed that this pedicle-probing device could reasonably be used to detect impending breach and actual breach of 4 mm or less. Medial breach was detected better than lateral breach. Use of the pedicle probe may improve patient safety.

Abbreviation used in this paper:PPV = positive predictive value.

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Contributor Notes

Address correspondence to: Olumide A. Danisa, M.D., 11406 Loma Linda Dr., Ste. 218, Loma Linda, CA 92354. email: ODanisa@llu.edu.

Please include this information when citing this paper: published online August 29, 2014; DOI: 10.3171/2014.6.SPINE131028.

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