A Powered Approach to Pedicle Screw Placement (AAOS Meeting 2014)
Using power tools to create pedicle tracts and place pedicle screws offers a safety profile equivalent to using manual tools—while shortening fluoroscopy times,” said David L. Skaggs, MD. Dr. Skaggs presented findings from his paper, “Safety and Efficacy of Power-Assisted Pedicle Tract Preparation and Pedicle Screw Placement,” yesterday.
“A survey conducted by the Scoliosis Research Society in 2011 found that spine surgeons have increased rates of overuse injuries compared to the general public,” Dr. Skaggs explained. “So I began to investigate the idea of using power tools to place pedicle screws.
Dr. Skaggs’ team retrospectively reviewed his patient records to find every complication related to pedicle screw placement. The study covered 442 cases and 6,412 pedicle screws. Overall, 159 patients (1,870 screws) underwent procedures using manual tools between January 2004 and June 2007, while 283 patients (4,542 screws) had their procedures conducted with power tools between January 2008 and August 2012. A screw was considered to have failed if the patient returned to the operating room for revision or removal of the screw. In addition, the research team reviewed operating and fluoroscopy times for each patient.
The incidence of injury associated with pedicle screw placement was 0.00 percent (0/1870) in the manual cohort and 0.02 percent (1/4542) in the power cohort. One screw in the power cohort caused a hemothorax. No neurologic or vascular injuries or any other complications were attributable to a pedicle screw in either group.
Fluoroscopy times in the power cohort were on average two-thirds of those of the manual cohort, although operating times were similar.
“There are four points I’d like to emphasize,” said Dr. Skaggs. “First, using a power drill requires less force, so it seems likely to be safer for the patient. Second, a drill at high speed can go through steel or hardened concrete. The preferred technique is to drill very slowly so you have better control. It’s my experience that a thin drill bit (2mm) turning at a slow speed offers better control and proprioception than using a rigid pedicle probe. Third, if you put the screw in under power, there’s less wobble, so the screw should have greater pull-out strength. Finally, this study covers one surgeon,” Dr. Skaggs admitted. “I’ve trained residents and fellows to use this technique. The next step will be for others to publish their findings so we can verify the efficacy of the procedure.”
Dr. Skaggs’ coauthors include: Derek A. Seehausen, BA; Lindsay Andras, MD; and Yashar Javidan, MD.
Details of the authors’ disclosure as submitted to the Orthopaedic Disclosure Program can be found in the Final Program; the most current disclosure information may be accessed electronically atwww.aaos.org/disclosure
2014 Annual Meeting News
Tuesday through Friday, March 11 – 14, 2014.
http://www.aaos.org/news/acadnews/2014/AAOS4_3_13.asp