Accuracy of using computed tomography to identify pedicle screw placement in cadaveric human lumbar spine

Jung Yoo, Alexander Ghanayem, Cheryl Petersilge, Jonathan Lewin

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Study Design. Utility of using computed tomography to predict pedicle screw misplacement. Objective. This study defines the sensitivity and specificity of predicting pedicle screw placement by experienced clinicians using a CT scan image. Summary of Background Data. In clinical and research settings, the method most commonly used to evaluate pedicle screws placement has been computed tomography. However, no current literature describes the accuracy of this method of evaluating screw placement. Method. Cobalt-chrome and titanium alloy pedicle screws of identical size were placed in six cadaveric human lumbar spine. Wide laminectomy was performed to allow complete visualization of the pedicles. Three consecutive lumbar levels were instrumented in each spine, giving 36 pedicle screw placements to identify. The instrumented spines were imaged, and four orthopaedic spine surgeons and a musculoskeletal radiologists were asked to read the images to identify the accuracy of screw placement within the pedicles. Results. The sensitivity rate of identifying a misplaced screw was 67 ± 6% for cobalt-chrome screws compared with 86 ± 5% for titanium screws (P <0.005). The specificity rates of radiographic diagnosis of misplaced pedicle screws were 66± 10% for cobalt-chrome screws and 88 ± 8% for titanium screws (P <0.005). Similarly, a statistically significant difference was found in the sensitivity rates of identifying screws placed correctly in the pedicle: 70 ± 10% for cobalt- chrome screws versus 89 ± 8% for titanium screws (P <0.005). Overall accuracy rates were 68 ± 7% for cobalt chrome screws versus 87 ± 3% for titanium screws (P <0.002). Conclusion. Reliance on the computed tomography scan data alone in determining accuracy of pedicle screws can lead to inaccuracies in both clinical and research conditions.

Original languageEnglish (US)
Pages (from-to)2668-2671
Number of pages4
JournalSpine
Volume22
Issue number22
DOIs
StatePublished - Nov 15 1997

Fingerprint

Spine
Tomography
Cobalt
Titanium
Laminectomy
Pedicle Screws
Research
Sensitivity and Specificity

Keywords

  • Cobalt-chrome
  • Computed tomography scan
  • Pedicle screw
  • Titanium

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Accuracy of using computed tomography to identify pedicle screw placement in cadaveric human lumbar spine. / Yoo, Jung; Ghanayem, Alexander; Petersilge, Cheryl; Lewin, Jonathan.

In: Spine, Vol. 22, No. 22, 15.11.1997, p. 2668-2671.

Research output: Contribution to journalArticle

Yoo, Jung ; Ghanayem, Alexander ; Petersilge, Cheryl ; Lewin, Jonathan. / Accuracy of using computed tomography to identify pedicle screw placement in cadaveric human lumbar spine. In: Spine. 1997 ; Vol. 22, No. 22. pp. 2668-2671.
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abstract = "Study Design. Utility of using computed tomography to predict pedicle screw misplacement. Objective. This study defines the sensitivity and specificity of predicting pedicle screw placement by experienced clinicians using a CT scan image. Summary of Background Data. In clinical and research settings, the method most commonly used to evaluate pedicle screws placement has been computed tomography. However, no current literature describes the accuracy of this method of evaluating screw placement. Method. Cobalt-chrome and titanium alloy pedicle screws of identical size were placed in six cadaveric human lumbar spine. Wide laminectomy was performed to allow complete visualization of the pedicles. Three consecutive lumbar levels were instrumented in each spine, giving 36 pedicle screw placements to identify. The instrumented spines were imaged, and four orthopaedic spine surgeons and a musculoskeletal radiologists were asked to read the images to identify the accuracy of screw placement within the pedicles. Results. The sensitivity rate of identifying a misplaced screw was 67 ± 6{\%} for cobalt-chrome screws compared with 86 ± 5{\%} for titanium screws (P <0.005). The specificity rates of radiographic diagnosis of misplaced pedicle screws were 66± 10{\%} for cobalt-chrome screws and 88 ± 8{\%} for titanium screws (P <0.005). Similarly, a statistically significant difference was found in the sensitivity rates of identifying screws placed correctly in the pedicle: 70 ± 10{\%} for cobalt- chrome screws versus 89 ± 8{\%} for titanium screws (P <0.005). Overall accuracy rates were 68 ± 7{\%} for cobalt chrome screws versus 87 ± 3{\%} for titanium screws (P <0.002). Conclusion. Reliance on the computed tomography scan data alone in determining accuracy of pedicle screws can lead to inaccuracies in both clinical and research conditions.",
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