1. 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 september 2012 1

2. 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).

3. 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,
- 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,
- 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,
- Liljenqvist U. R., Halm H. F. H., Link T. M. Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine, 1997, 22,
- 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,
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
- 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,

4. 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,
- 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,
- 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,
- Liljenqvist U. R., Halm H. F. H., Link T. M. Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine, 1997, 22,
- 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,
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
- 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,

5. Screw placement in thoracolumbar spine
Straight-forward & anatomic techniques

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

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

8. Technique of screw placement in thoracolumbar spine

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

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

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

12. Complications

13. Pedicle Screw Fixation in the Cervical Spine

14. 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 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.

15. 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.

16. Technique of Pedicle Screw Fixation in the Cervical Spine CII

17. Technique of Pedicle Screw Fixation in the Cervical Spine CII

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

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

20. 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.

21. 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

22. 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 22