1. Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized commercial reproduction of this slide is prohibited Supplemental PowerPoint Slides Accuracy and Safety of Fluoroscopic Guided Percutaneous Pedicle Screws in Thoracic and Lumbosacral Spine: A Review of 2000 screws Nils Hansen-Algenstaedt, MD, PhD, 1.Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 2.Orthocentrum Hamburg, Department of Spine Surgery, Parkklinik Manhagen, Hansastrasse, Hamburg, Germany. Chee Kidd Chiu, MBBS, MSOrth, Department of Orthopaedic Surgery (NOCERAL), University Malaya, Kuala Lumpur, Malaysia. Chris Yin Wei Chan, MD, MSOrth, Department of Orthopaedic Surgery (NOCERAL), University Malaya, Kuala Lumpur, Malaysia. Chee Kean Lee, MBBS, MSOrth, Department of Orthopaedic Surgery (NOCERAL), University Malaya, Kuala Lumpur, Malaysia. Christian Schaefer, MD, 1.Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 2.Department of Spine Surgery, Rheumaklinik Bad Bramstedt, Oskar Alexander Strasse, Bad Bramstedt, Germany. Mun Keong Kwan, MBBS, MSOrth, Department of Orthopaedic Surgery (NOCERAL), University Malaya, Kuala Lumpur, Malaysia.

2. Key Points The objective of this study is to investigate the accuracy and safety of percutaneous pedicle screws placed using fluoroscopic guidance in the thoracic and lumbosacral spine. There were three distinct peaks in perforation rates (trimodal distribution) at T1, midthoracic region (T4-T7) and lumbosacral junction (L5 & S1). The highest perforation rate were at T1 (33.3), S1 (19.4%) and T4 (18.6%). We recommend that extra precautions need to be taken when percutaneous pedicle screws are placed in these three regions. Despite a total perforation rate of 9.4%, majority of the perforations were only grade 1 (7.5%). The perforation rate for grade 2 was 1.6% and for grade 3 was only 0.3%. Implantation of percutaneous pedicle screws insertion using fluoroscopic guidance is safe and has the accuracy comparable to the conventional open method.

3. Perforation rates distribution according to vertebral levels showing trimodal peaks at T1, T4-T7 and L5 & S1.

4. Total number of percutaneous pedicle screws, screws with perforations and the perforation rate between Europeans and Asians.