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Outcome-based classification for assessment of thoracic pedicular screw placement.

机译：基于结果的分类，用于评估胸椎椎弓根螺钉的位置。

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STUDY DESIGN: Prospective cohort study. OBJECTIVE: We propose a simple outcome-based classification for assessment of pedicle screw positions based on postoperative computed tomography scan. This bridges the gap between high rates of pedicle screw misplacement and minimal complications reported. SUMMARY OF BACKGROUND DATA: The main deterrent for the use of thoracic pedicular screws is the feared neurovascular complications due to screw "misplacements." The literature shows that only a small fraction of the misplaced screws actually causes any complication, and some misplacements can be acceptable both in terms of safety and their biomechanical strength. METHODS: Sixty patients with various spinal disorders were included in the study. The mean age was 29.6 years (range, 12-72 years). The patients were divided into 2 groups for assessment of pedicle screw placements using postoperative computed tomography scans: scoliosis group with 24 patients and the nonscoliosis group with 34 patients. Placements of screws were assessed using the outcome-based classification and the Rongming Xu criteria of screw placement. RESULTS: A total of 341 screws were assessed from 60 patients with various spinal disorders (scoliosis and nonscoliosis groups). Using the Rongming Xu criteria, the overall screw misplacement in scoliosis group was 50.72% (68 of 138) and that in nonscoliosis group was 45.45% (80 of 176 screws). Assessment of these screws using the outcome-based classification showed a high percentage of acceptable screw placements (type 1) - 89.85% (124 of 138 screws) in the scoliosis group and 86.93% (153 of 176 screws) in the nonscoliosis group. CONCLUSION: The literature shows consensus over high rates of pedicle screw misplacement, but low clinical complications, in the hands of the best of spine surgeons. The concept of acceptable screw placements and the outcome classification makes the pedicle screw assessment results correlate better with the clinical outcome.
机译：研究设计：前瞻性队列研究。目的：我们提出了一种基于结果的简单分类方法，用于基于术后计算机断层扫描的椎弓根螺钉位置评估。这弥合了椎弓根螺钉错位发生率高和报道的并发症少之间的差距。背景技术概述：使用胸椎椎弓根螺钉的主要威慑因素是由于螺钉“错位”而引起的令人担忧的神经血管并发症。文献表明，放错位置的螺钉中只有一小部分实际上会引起任何并发症，并且就安全性和它们的生物力学强度而言，某些放错位置都是可以接受的。方法：60名患有各种脊柱疾病的患者被纳入研究。平均年龄为29.6岁（范围为12-72岁）。使用术后计算机断层扫描将患者分为两组，以评估椎弓根螺钉的位置：脊柱侧弯组24例，非脊柱侧弯组34例。使用基于结果的分类和螺钉放置的徐荣明标准评估螺钉的放置。结果：从60名患有各种脊柱疾病（脊柱侧凸和非脊柱侧凸组）的患者中总共评估了341枚螺钉。使用徐荣明标准，脊柱侧弯组的整体螺钉错位率为50.72％（138个中的68个），而非脊柱侧凸组的整体螺钉错位为45.45％（176个螺钉中的80个）。使用基于结果的分类对这些螺钉进行评估显示，可接受的螺钉位置（类型1）的百分比很高-脊柱侧凸组为89.85％（138颗螺钉中的124颗），非脊柱侧凸组为86.93％（176颗螺钉中的153颗）。结论：文献显示，对于最好的脊柱外科医生来说，椎弓根螺钉错位发生率高但临床并发症少是共识。可接受的螺钉位置和结果分类的概念使椎弓根螺钉评估结果与临床结果更好地相关。

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