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Accuracy Analysis of Iliac Screw Using Freehand Technique in Spinal Surgery : Relation between Screw Breach and Revision Surgery

Journal of Korean Neurosurgical Society 2020년 63권 2호 p.210 ~ 217
이수범 ( Lee Su-Bum ) - University of Ulsan College of Medicine Asan Medical Center Department of Neurological Surgery

정상구 ( Jung Sang-Ku ) - University of Ulsan College of Medicine Gangneung Asan Hospital Department of Emergency Medicine
 ( Keshen Sam G. ) - Toronto Western Hospital University Health Network Division of Orthopaedic Surgery
 ( Lewis Stephen J. ) - Toronto Western Hospital University Health Network Division of Orthopaedic Surgery
박진훈 ( Park Jin-Hoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Neurological Surgery

Abstract


Objective: To analyze the accuracy of iliac screws using freehand technique performed by the same surgeon. We also analyzed how the breach of iliac screws was related to the clinical symptoms resulting in revision surgery.

Methods: From January 2009 to November 2015, 100 patients (193 iliac screws) were analyzed using postoperative computed tomography scans. The breaches were classified based on the superior, inferior, lateral, and medial iliac wall violation by the screw. According to the length of screw extrusion, the classification grades were as follows : grade 1, screw extrusion <1 cm; grade II, 1 cm ≤ screw extrusion <2 cm; grade III, 2 cm ≤ screw extrusion <3 cm; and grade IV, 3 cm ≤ screw extrusion. We also reviewed the revision surgery associated with iliac screw misplacement.

Results: Of the 193 inserted screws, 169 were correctly located and 24 were misplaced screws. There were eight grade I, six grade II, six grade III, and four grade IV screw breaches, and 11, 8, 2, and 3 screws violated the medial, lateral, superior, and inferior walls, respectively. Four revision surgeries were performed for the grade III or IV iliac screw breaches in the lateral or inferior direction with respect to its related symptoms.

Conclusion: In iliac screw placement, 12.4% breaches developed. Although most breaches were not problematic, symptomatic violations (2.1%) could result in revision surgery. Notably, the surgeon should keep in mind that lateral or inferior wall breaches longer than 2 cm can be risky and should be avoided.
Key Words: Sacropelvic fixation · Iliac screw · Breach · Accur

키워드

Sacropelvic fixation; Iliac screw; Breach; Accuracy; Freehand technique
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