Medknow Publications on behalf of the Neurological Society of India
Abstract
Pedicle screws are widely used for instrumentation of the thoracolumbar
spine. The anatomic studies performed in the last two decades,
detailing the complex morphometry and three-dimensional anatomy of the
thoracolumbar pedicles, have enabled the emergence of the so-called
"free-hand" technique of pedicle screw placement based exclusively on
anatomical parameters. However, in the thoracic spine, the benefits of
pedicle screws have been tempered by its potential risks, such as,
spinal canal violation, pedicle fracture, nerve root compression, and
vascular lesions. Furthermore, the narrow and inconsistent shape of the
thoracic pedicles, especially in spinal deformity, makes their
placement technically challenging. In this article, the authors make a
critical appraisal of current "state-of-art" of "free-hand" technique
of pedicle instrumentation, analyzing its anatomical basis, surgical
technique, present indications and limitations as well as the role of
adjuvant image-guided and neurophysiological monitoring methods
