Tomographic Evaluation Of The Placement Of Pedicle Screws Used In Deformities Of The Thoracic And Lumbar Spine Based On The "free Hand" Technique [avaliação Tomográfica Do Posicionamento De Parafusos Pediculares Em Deformidades Na Coluna Torácica E Lombar Introduzidos Com Base Na Técnica "free Hand]

Objective: To evaluate the placement of pedicle screws in the vertebrae of the thoracic and lumbar spine in patients with scoliosis using the"free hand" technique. Methods: Evaluation of CT scans of 284 pedicle screws in 15 patients (seven men and eight women) aged between 12 and 39 years (mean 16.7 years) with scoliosis. The screws were inserted from T2 to S1 for the following conditions: two congenital scoliosis and 13 neuromuscular, to evaluate the placement of screws in relation to the walls of pedicles. Results: Regarding the cortical pedicle screws, 244 (86%) were positioned between the cortical or just touching it. Lateral cortical lesion was seen in 16 screws and medial cortex lesion in 13 screws, being greater the number of violations in the thoracic vertebrae. Conclusion: The use of pedicle screw instrumentation in thoracic and lumbar vertebrae for scoliosis proved safe and effective when applied to different levels with the "free hand" technique. In the thoracic vertebrae, the pedicular cortical violations were more frequent, but did not impair the stability of fixation and did not injure the neural, vascular and visceral structures.104321324Youkilis, A.S., Quint, D.J., Mcgillicuddy, J.E., Papadoupoulos, S.M., Stereotactic navigation for placement of pedicle screws in the thoracic spine (2001) Neurosurgery, 48 (4), pp. 771-778Kim, Y.J., Lenke, L.G., Thoracic pedicle screw placement: Free-hand technique (2005) Neurology India, 53 (4), pp. 512-519Grauer, J.N., Vaccaro, A.R., Brusovanik, G., Girardi, F.P., Silveri, C.P., Cammisa, F.P., Evaluation of a novel pedicle probe for the placement of thoracic and lumbosacral pedicle screws (2004) J Spinal Disord Tech, 17 (6), pp. 492-497Kim, Y.J., Lenke, L.G., Cheh, G., Riew, K.D., Evaluation of pedicle screw placement in the deformed spine using intraoperative plain radiographs: A comparison with computerized tomography (2005) Spine, 30 (18), pp. 2084-2088. , DOI 10.1097/01.brs.0000178818.92105.ecKim, Y.J., Lenke, L.G., Bridwell, K.H., Cho, Y.S., Riew, K.D., Free Hand Pedicle Screw Placement in the Thoracic Spine: Is it Safe (2004) Spine, 29 (3), pp. 333-342. , DOI 10.1097/01.BRS.0000109983.12113.9BDefino, H.L.A., Filho, J.M., Morphometric study of the pedicle of thoracic and lumbar vertebrae (1999) Revista Brasileira de Ortopedia, 34 (2), pp. 97-108De Marco, F.A., Risso Neto, M.I., Cavali, P.T.M., Sussi, M.A., Pasqualini, W., Landim, E., Avaliaçãodo posicionamento de parafusos pediculares na coluna torácica e lombar introduzidos com base em referenciais anatômicos e radioscópicos (2008) Coluna/Columna, 7 (1), pp. 1-7Rodrigues, L.M.R., Nicolau, J.R., Puertas, E.B., Wajchenberg, M., Avaliação tomográfica dos parafusos pediculares torácicos nas escolioses idiopáticas (2008) Coluna/Columna, 7 (2), pp. 139-142Ul Haque, M., Shufflebarger, H.L., O'Brien, M., Macagno, A., Radiation exposure during pedicle screw placement in adolescent idiopathic scoliosis: Is fluoroscopy safe? (2006) Spine, 31 (21), pp. 2516-2520. , DOI 10.1097/01.brs.0000238675.91612.2f, PII 0000763220061001000019Schwarzenbach, O., Berlemann, U., Jost, B., Visarius, H., Arm, E., Langlotz, F., Nolte, L.-P., Ozdoba, C., Accuracy of computer-assisted pedicle screw placement: An in vivo computed tomography analysis (1997) Spine, 22 (4), pp. 452-458. , DOI 10.1097/00007632-199702150-00020Roy-Camille, R., Saillant, G., Mazel, C., Internal fixation of the lumbar spine with pedicle screw plating (1986) Clin Orthop Relat Res, (203), pp. 1-7Castro, W.H.M., Halm, H., Jerosch, J., Malms, J., Steinbeck, J., Blasius, S., Accuracy of pedicle screw placement in lumbar vertebrae (1996) Spine, 21 (11), pp. 1320-1324. , DOI 10.1097/00007632-199606010-00008Hamill, C.L., Lenke, L.G., Bridwell, K.H., Chapman, M.P., Blanke, K., Baldus, C., The use of pedicle screw fixation to improve correction in the lumbar spine of patients with idiopathic scoliosis: Is it warranted? (1996) Spine, 21 (10), pp. 1241-1249. , DOI 10.1097/00007632-199605150-00020Amiot, L.-P., Lang, K., Putzier, M., Zippel, H., Labelle, H., Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar, and sacral spine (2000) Spine, 25 (5), pp. 606-614. , DOI 10.1097/00007632-200003010-0001