Russian Research Institute for Traumatology and Orthopedics named after R.R.Vreden North-West Medical University named after I.I.Mechnikov Transpedicular fixation – Specific of screw insertion on different levels Dmitry Ptashnikov prof., head of spinal surgery & oncology department, head of orthopedic department Dear chairman, dear colleagues. AO Spine Principles Course – Treatment of Trauma Injures of the Spine. Moscow, Russia 19-20 september 2012 1

Brief History The first descriptions of the use of bone screws to obtain internal spinal fixation at the time of fusion were by Tourney in 1943 and King in 1944. Boucher in 1959 was the first to use pedicle screws. Roy-Camille was the first to use pedicle screws connected to a dorsal plate (Cin Orthop 203:7-17, 1986). The first system using both screws and hooks connecting them with rods or plates (i.e universal spinal instrumentation) was introduced by Cotrel and Dubousset (Clin Orthop 227:10-23, 1988).

The effectiveness of pedicular fixation of the spine - Boos N., Webb J. K. Pedicle screw fixation in spinal disorders : A European view. Eur. Spine J., 1997, 6, 2-18. - Butler T. E., Asher M. A., Jayaraman G., Nunley P. D.,Robinson R. G. The strength and stiffness of thoracic implant anchors in osteoporotic spines. Spine, 1994, 19, 1956-1962. - Coe J. D., Warden K. E., Herzig M. A., McAfee P. C. Influence of bone mineral density on the fixation of thoracolumbar implants. Spine, 1990, 15, 903-907. - Dvorak M., MacDonald S., Gurr K. R., Bailey S. I., Haddad R. G. An anatomic, radiographic, and biomechanical assessment of extrapedicular screw fixation in the thoracic spine. Spine, 1993, 18, 1689-1694. - Liljenqvist U. R., Halm H. F. H., Link T. M. Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine, 1997, 22, 2239-2245. - Skinner R., Maybee J., Transfeldt E., Venter R., Chalmers W. Experimental pullout testing and comparison of variables in transpedicular screw fixation. A biomechanical study. Spine, 1990, 15, 195-201. U. LILJENQVIST, L. HACKENBERG, T. LINK, H. HALM. PULLOUT STRENGTH OF PEDICLE SCREWS VERSUS PEDICLE AND LAMINAR HOOKSIN THE THORACIC SPINE. Acta Orthopædica Belgica, Vol. 67 - 2 - 2001 - Hackenberg L. Link T. Liljenqvist U. Axial and tangential fixation strength of pedicle screws versus hooks in the thoracic spine in relation to bone mineral density. Spine, 2002, 27, 937-42.

The effectiveness of pedicular fixation of the spine - Boos N., Webb J. K. Pedicle screw fixation in spinal disorders : A European view. Eur. Spine J., 1997, 6, 2-18. pedicle screws offer a significantly higher axial, tangential and pullout strength compared to both laminar and pedicle hooks in the spine; pedicle screws might permit a better curve correction especially in rigid curves; relationship between pedicle & screw diameter allow a safe pedicle screw placement. - Butler T. E., Asher M. A., Jayaraman G., Nunley P. D.,Robinson R. G. The strength and stiffness of thoracic implant anchors in osteoporotic spines. Spine, 1994, 19, 1956-1962. - Coe J. D., Warden K. E., Herzig M. A., McAfee P. C. Influence of bone mineral density on the fixation of thoracolumbar implants. Spine, 1990, 15, 903-907. - Dvorak M., MacDonald S., Gurr K. R., Bailey S. I., Haddad R. G. An anatomic, radiographic, and biomechanical assessment of extrapedicular screw fixation in the thoracic spine. Spine, 1993, 18, 1689-1694. - Liljenqvist U. R., Halm H. F. H., Link T. M. Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine, 1997, 22, 2239-2245. - Skinner R., Maybee J., Transfeldt E., Venter R., Chalmers W. Experimental pullout testing and comparison of variables in transpedicular screw fixation. A biomechanical study. Spine, 1990, 15, 195-201. U. LILJENQVIST, L. HACKENBERG, T. LINK, H. HALM. PULLOUT STRENGTH OF PEDICLE SCREWS VERSUS PEDICLE AND LAMINAR HOOKSIN THE THORACIC SPINE. Acta Orthopædica Belgica, Vol. 67 - 2 - 2001 - Hackenberg L. Link T. Liljenqvist U. Axial and tangential fixation strength of pedicle screws versus hooks in the thoracic spine in relation to bone mineral density. Spine, 2002, 27, 937-42.

Screw placement in thoracolumbar spine Straight-forward & anatomic techniques

Technique of screw placement in thoracic spine Straight-forward Funnel In-Out-In

Technique of screw placement in lumbar spine Roy-Camille vs. Weinstein

Technique of screw placement in thoracolumbar spine

Comparative characteristics of the effectiveness of various techniques of pedicle screw placement

Comparative characteristics of the effectiveness of various techniques of pedicle screw placement ………

Comparative characteristics of the effectiveness of various techniques of pedicle screw placement

Complications

Pedicle Screw Fixation in the Cervical Spine

Brief History Pedicle screw fixation of the cervical spine was pioneered in 1964 by Leconte, who inserted screws into the C2. Leconte’s work was followed by that of Saillant and Bleynia in 1979. Pedicle screw fixation was not used in the lower cervical spine until 1995. Abumi and colleagues, followed by Jeanneret and colleagues, were the first to introduce screws into the pedicles in the lower cervical spine to treat fractures and dislocations.

Pedicle Screw Fixation in the Cervical Spine NOTE: CT preoperatively. Pedicle screw should not be used if pedicle width is <3,5mm. Available screw diameters are 3.5, 4.0, and 4.5 mm, and lengths are 20, 22, 24, and 28 mm.

Technique of Pedicle Screw Fixation in the Cervical Spine CII

Technique of Pedicle Screw Fixation in the Cervical Spine CII

Technique of Pedicle Screw Fixation in the Cervical Spine CIII-CVII

Technique of Pedicle Screw Fixation in the Cervical Spine CIII-CVII

57 (9.2%) demonstrated screw exposure (<50% of the screw outside the pedicle). 24 (3.9%) demonstrated pedicle perforation (>50% of the screw outside the pedicle). One case in which a probe penetrated a vertebral artery without further complication and one case with transient radiculopathy.

CONCLUSION pedicle screws is the safe & effective method fixation in different levels of the spine; pedicle screws might permit a better curve correction especially a derotation of spine & sagittal balanсe restoration then other instrumentations. 21

North-West Medical University named after I.I.Mechnikov Russian Research Institute for Traumatology and Orthopedics named after R.R.Vreden North-West Medical University named after I.I.Mechnikov drptashnikov@yandex.ru 22