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BMC Musculoskeletal Disorders

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Open Access 01-12-2017 | Research article

Does a deep seated L5 vertebra position with respect to the iliac crests affect the accuracy of percutaneous pedicle screw placement at lumbosacral junction?

Authors: Jing Guo, Lianjin Guo, Juzhou Gao, Qinjie Ling, Zhixun Yin, Erxing He

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

Abstract

Background

Significant prominence of iliac crests with a deep seated L5 vertebra can potentially interfere with the screw trajectory when placing percutaneous pedicle screws (PPS) at the lumbosacral segment. The objective of this study was to investigate the influence of L5 position in relation to the iliac crests on the accuracy of percutaneous placement of lumbosacral pedicle screws.

Methods

From Oct 2012 to Sep 2014, 54 patients who underwent PPS placement at L5-S1 segment were recruited. Patients were divided into 2 groups: the L5-Seated Group (L5-S Group, n = 34) including patients with intercrest lines passing through the L4 vertebra or L4/5 intervertebral disc; whereas the L5-Non-Seated Group (L5-NS Group, n = 20) including patients with intercrest lines passing through the L5 vertebra. Postoperative computerized tomography was obtained in all patients, and PPS accuracy was evaluated by grading pedicle breach (Grade 0, no breach; Grade 1, ≤2mm; Grade 2, >2mm without neurological compromise; Grade 3, with complications). Screw convergence angle (SCA), defined as the angle subtended by the screw axis and vertebral midline, was also recorded.

Results

In the L5-S Group, 82.4% (56/68) screws were measured as Grade 0 at L5, and 66.2% (45/68) were Grade 0 at S1; meanwhile, in the L5-NS Group, 77.5% (31/40) and 75.0% (30/40) screws were Grade 0 at L5 and S1, respectively. Misplacement rate was numerically higher at S1 in the L5-S Group (P > 0.05). There were significantly more medial pedicle violations at S1 in the L5-S Group as compared to the L5-NS Group (25.0% vs 7.5%, P = 0.024). No statistical difference was found in L5 SCA between the 2 groups (L5-S Group 23.7° ± 7.4° vs L5-NS Group 23.4° ± 10.6°, P = 0.945); however, S1 SCA was significantly smaller in the L5-S Group (14.7° ± 5.8°) when compared with the L5-NS Group (20.8° ± 5.2°) (P = 0.036).

Conclusions

A deep seated L5 vertebra with respect to the iliac crests might compromise the accuracy of PPS placement at S1 vertebra. Severe iliac prominence may interfere with the screw trajectory and limit the medial angulation of pedicle screw for percutaneous S1 fixation.

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Title: Does a deep seated L5 vertebra position with respect to the iliac crests affect the accuracy of percutaneous pedicle screw placement at lumbosacral junction?
Authors: Jing Guo
Lianjin Guo
Juzhou Gao
Qinjie Ling
Zhixun Yin
Erxing He
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-017-1537-x

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Does a deep seated L5 vertebra position with respect to the iliac crests affect the accuracy of percutaneous pedicle screw placement at lumbosacral junction?

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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