ACCURACY OF LUMBAR PEDICULAR SCREWS INSERTION AND CLINICAL CORRELATION OF PATIENTS UNDERGOING LUMBAR PEDICULAR FIXATION AT ZAGAZIG UNIVERSITY HOSPITAL

Abstract

Background: Pedicle screw instrumentation is generally utilized in the lumbar spine as a method for
adjustment to improve arthrodesis. Signs for pedicle screw instrumentation remember adjustment for the
setting of injury, deformation, tumors, diseases, degenerative conditions and recreation. Pedicle screw
instrumentation is widely used in the lumbar spine as a means of stabilization to enhance arthrodesis.
For accuracy, pedicle screw instrumentation may be guided by anatomic landmarks, preoperative
imaging, and intraoperative imaging tools such as plain radiography, fluoroscopy, and, more recently,
image-guided technology. This study aimed to improving accuracy of lumbar pedicular screws insertion
and clinical outcome of patients undergoing lumbar pedicular fixation. Patients and Methods: Site of
the investigation: Neurosurgery division at alexandria military emergency clinic and neurosurgery office
in Zagazig college. Kind of the investigation: accomplice study. Test size: expecting that participation
pace of patients for lumbar pedicular obsession is 3 patients for every month, the example size is 36. All
patients will be taken as a far reaching test. patients affirmed to have been undrwent transpedicular
lumbar obsession .All patients were taken as a comprehensive sample. Patients confirmed to have been
underwent transpedicular lumbar fixation. Results: In assessing 153 pedicle screws inserted in 36
patients. Out of 51 misplaced screws; lateral screw misplacement was observed in 28 screws (54.9 %)
and medial pedicle wall violation in 22 screws (43.1 %) and inferior misplacement in one patient. The
remaining 102 screws (67.55 %) were judged as correctly inserted. Of the 51 misplaced screws, 34
misplaced screws were classified as minor (cortical perforation ≤ 2 mm), 15 screws moderate (2–4 mm),
and 2 screws severe penetration (> 4 mm). Conclusion: Pedicle screw insertion carries risk of pedicular
wall violation even in experienced hands even though intraoperative fluoroscopy is used. However;
most violations are minimal with no clinical consequences and can be evaluated best by CT scan not
plain X-ray. Minor displacements don’t require corrections, while screws causing symptoms must be
redirected.