The Novel Pedicle Screw Scoring System: The HEY Score

Objective: The novel pedicle screw scoring system is a mean of assessing accuracy pedicle screw insertion and validation spinal pathologies, degenerative, tumor, and trauma. It provides the surgeon with a means of assessing the accuracy of pedicle screw insertion. This will enable the measurement of competency and surgical skill, monitor a learning curve, and provide a tool for new pedicle screw technologies.

Method: We conducted a retrospective study of 102 patients. A total of 410. It is based on three measurements: ideal angle (A) angle of perpendicular line passing through the center of the vertebra body and spinous process), ideal width (W), and ideal length (L) of the pedicle. Pre- and postoperative computed tomography and magnetic resonance imaging were used to measure the parameters.

Angle (A)
1 point	within 5 degrees of the ideal angle
2 points	within 5 to 10 degrees of the ideal angle
3 points	more than 10 degrees of the ideal angle
Width (W)
1 point	within 1 mm of the ideal width
2 points	within 2 mm of the ideal width
3 points	more than 3 mm of the ideal width
Length (L)
1 point	within 5 mm of the idea length
2 points	within 5 to 10 mm of the ideal length
3 points	more than10 mm of the ideal length

Any screw breeches were also recorded (medial, lateral, or anterior). We proposed that the higher the HEY score (e.g., 9: A3.W3.L3) the more likely is to breach (revision/complications). Whereas the lower scoring, better screws (e.g., 3: A1.W1.L1). A detailed validation of this technique has been submitted as a separate study.

Conclusion: It is a novel and unique system. By measuring three parameters of the pedicle, an overall accuracy score can be assigned to each screw. Such a scoring system can be used to compare different techniques, monitor training and learning curves, and assess overall competency.