CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(01): 012-016
DOI: 10.1055/s-0043-1763523
Review Article

Accuracy and Safety of Fluoroscopy-Assisted Transpedicular Screw Insertion in Thoracolumbar Spine Surgery: Evaluation of 122 Screws

Imad-Eddine Sahri
1   Department of Neurosurgery, Mohammed V Military Hospital Rabat, Rabat, Morocco
Zakaria Chandid Tlemcani
1   Department of Neurosurgery, Mohammed V Military Hospital Rabat, Rabat, Morocco
1   Department of Neurosurgery, Mohammed V Military Hospital Rabat, Rabat, Morocco
El Asri Abad Cherif
1   Department of Neurosurgery, Mohammed V Military Hospital Rabat, Rabat, Morocco
Miloudi Gazzaz
1   Department of Neurosurgery, Mohammed V Military Hospital Rabat, Rabat, Morocco
› Author Affiliations


The objective of this study is to determine the accuracy and safety of trans-pedicular screws' insertion in the thoracolumbar spine using a fluoroscopy-assisted surgical technique. We retrospectively evaluated all patients who underwent a postoperative computed tomography scan to assess the location of the pedicular screws following thoracolumbar spinal surgery, at the Mohammed Vth Military Training Hospital-Rabat, from January 2020 to April 2022. We used Gertzbein's classification to grade pedicular cortex breaches. A screw penetration greater than 4 mm (grades D–E) was considered critical and one less than 4 mm was classified as noncritical (grades A–C). A total of 122 screws inserted in the T1 to L5 vertebrae were included from 25 patients. The average age was 46 years old. Pathologies included degenerative disorders (5 patients), tumors (8 patients), and trauma (12 patients). All screws were inserted using lateral and anteroposterior fluoroscopic guidance. A total of 11 transpedicular screws breaches were identified. The breaches incidence was significantly higher in thoracic pedicles (8 screws) than in lumbar pedicles (3 screws). Of these, three critical cases occurred in two patients and one of them required reintervention. The remaining eight exceedances were not critical and were closely monitored and followed up. Transpedicular screws fluoroscopy-assisted surgical fixation can be performed for the stabilization of the thoracolumbar spine with satisfactory safety and precision.

Publication History

Article published online:
27 March 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Lotfinia I, Sayahmelli S, Gavami M. Postoperative computed tomography assessment of pedicle screw placement accuracy. Turk Neurosurg 2010; 20 (04) 500-507
  • 2 Grauer JN, Vaccaro AR, Brusovanik G. et al. Evaluation of a novel pedicle probe for the placement of thoracic and lumbosacral pedicle screws. J Spinal Disord Tech 2004; 17 (06) 492-497
  • 3 Austin MS, Vaccaro AR, Brislin B, Nachwalter R, Hilibrand AS, Albert TJ. Image-guided spine surgery: a cadaver study comparing conventional open laminoforaminotomy and two image-guided techniques for pedicle screw placement in posterolateral fusion and nonfusion models. Spine 2002; 27 (22) 2503-2508
  • 4 Molliqaj G, Schatlo B, Alaid A. et al. Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery. Neurosurg Focus 2017; 42 (05) E14
  • 5 Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine 1990; 15 (01) 11-14
  • 6 Amato V, Giannachi L, Irace C, Corona C. Accuracy of pedicle screw placement in the lumbosacral spine using conventional technique: computed tomography postoperative assessment in 102 consecutive patients. J Neurosurg Spine 2010; 12 (03) 306-313
  • 7 Cooper C, Atkinson EJ, O'Fallon WM, Melton III LJ. Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985-1989. J Bone Miner Res 1992; 7 (02) 221-227
  • 8 Parker SL, McGirt MJ, Farber SH. et al. Accuracy of free-hand pedicle screws in the thoracic and lumbar spine: analysis of 6816 consecutive screws. Neurosurgery 2011; 68 (01) 170-178 , discussion 178
  • 9 Belmont Jr PJ, Klemme WR, Robinson M, Polly Jr DW. Accuracy of thoracic pedicle screws in patients with and without coronal plane spinal deformities. Spine 2002; 27 (14) 1558-1566