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Advances in Medicine
Volume 2016, Article ID 4296294, 7 pages
http://dx.doi.org/10.1155/2016/4296294
Research Article

Control of Pedicle Screw Placement with an Electrical Conductivity Measurement Device: Initial Evaluation in the Thoracic and Lumbar Spine

1DRK Kliniken Berlin Westend, Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Berlin, Germany
2Department of Neurosurgery, Charité University Hospital, Berlin, Germany
3Vivantes Klinikum am Friedrichshain, Neurochirurgische Klinik, Berlin, Germany

Received 7 April 2016; Accepted 16 August 2016

Academic Editor: Hassan Serhan

Copyright © 2016 Olaf Suess and Markus Schomacher. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Aim. Transpedicular screw fixation is widely used in spinal surgery. But the insertion of pedicle screws can sometimes be challenging because of the variability in pedicle size and the proximity of nerve roots. Methods. We detected intraoperatively the sensitivity for iatrogenic pedicel perforation with a hand-held electronic conductivity measurement device (ECD) that measures electrical conductivity of tissue-medium surrounding the instrument tip. ECD was used to guide the placement of 84 pedicle screws in 15 patients undergoing surgery for tumor or degenerative spinal disease at various spinal levels from T8 to L5. Additionally a CT-scan controlled screw positioning postoperatively. Results. The placement was “correct” (no mediocaudal pedicle wall penetration) for 78 of 84 (92,8%) screws, “suboptimal but acceptable” (0–2 mm penetration) for 4 of 84 (4,8%) screws, and “misplaced” (penetration > 2 mm) for 2 of 84 (2,4%) screws. Conclusion. Although this study was not designed to compare electronic conductivity technique to other guidance methods, such as fluoroscopy or navigation, a convincing “proof of concept” for ECD use in spinal instrumentation could be demonstrated. Advantages include easy handling without time-consuming setup and reduced X-ray exposure. However, further investigations are necessary to evaluate i.a. the economic aspects for this single-use developed instrument.