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Стратификации риска мальпозиции транспедикулярных винтов при «free-hand» технике имплантации в хирургии сколиоза
Стратификации риска мальпозиции транспедикулярных винтов при «free-hand» технике имплантации в хирургии сколиоза
Пимбурский И.П., Челпаченко О.Б., Яцык С.П., Жердев К.В., Бутенко А.С. Стратификации риска мальпозиции транспедикулярных винтов при «free-hand» технике имплантации в хирургии сколиоза. Педиатрия. Consilium Medicum. 2026;(1):77–82. DOI: 10.26442/26586630.2026.1.203579
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Аннотация
Обоснование. Задняя коррекция деформаций позвоночника у детей с применением полисегментарной фиксации транспедикулярными винтами (ТПВ) является «золотым стандартом» хирургического лечения сколиоза. Однако точность имплантации при «free-hand» технике варьирует, а риск мальпозиции зависит от анатомической сложности и параметров деформации, что формирует потребность в простом инструменте предоперационного планирования для стратификации риска.
Цель. Разработать инструмент предоперационного планирования на основе рентгенологических параметров деформации для прогнозирования риска мальпозиции ТПВ при «free-hand» технике.
Материалы и методы. Проведено одноцентровое ретроспективное исследование. Включены 45 пациентов, которым выполнена задняя коррекция деформации позвоночника с установкой ТПВ по «free-hand» технике, проанализировано 696 винтов. Женщины составили 73,3% (n=33), мужчины – 26,7% (n=12), медианный возраст – 14,0 [12,0; 16,0] года. По этиологии преобладал идиопатический сколиоз – 71,1% (n=32). Положение винтов оценивали по послеоперационной компьютерной томографии (КТ) с мультипланарными реконструкциями с регистрацией факта мальпозиции и направления перфорации (медиальной, латеральной, передней). По предоперационной КТ фиксировали фронтальный и сагиттальный наклоны, ротацию позвонка на уровне каждого винта. Прогностическую модель строили методом бинарной логистической регрессии с оценкой R2 Найджелкерка, дискриминационную способность оценивали при помощи ROC-анализа (площади под кривой – AUC) с определением cut-off по индексу Юдена.
Результаты. Медиана исходного угла Cobb составила 69° [61°; 93°], послеоперационно среднее значение – 28±12°, средняя коррекция – 59% (p<0,001). По данным КТ выявлено 148 мальпозиций (21,3% винтов). Частота мальпозиций статистически значимо возрастала при увеличении фронтального наклона и ротации (p<0,001). Установлено, что латеральные мальпозиции статистически значимо учащались при росте фронтального наклона (p<0,001), а медиальные – при увеличении ротации по сравнению с передними и латеральными (p<0,001). В бинарной логистической модели фронтальный наклон и ротация оказали статистически значимое влияние на вероятность мальпозиции, модель значимо отличалась от нулевой (p<0,001), а псевдо-R2 Найджелкерка составил 10,3%. Увеличение фронтального наклона на 1° повышало риск мальпозиции на 2,7% (отношение шансов 1,027, 95% доверительный интервал – ДИ 1,013–1,042), увеличение ротации на 1° – на 5,0% (отношение шансов 1,050, 95% ДИ 1,030–1,070). Площадь под кривой составила 0,682 (95% ДИ 0,631–0,733; p<0,001). Оптимальный порог вероятности P=0,212 обеспечивал чувствительность 70,5% и специфичность 62,0%, значения P≥0,212 соответствовали сочетанию фронтального наклона и ротации порядка 20° и более на уровне инструментирования.
Заключение. Риск мальпозиции ТПВ при «free-hand» технике статистически значимо связан с фронтальным наклоном и ротацией позвонка на уровне инструментации, при этом ротационный компонент оказывает более выраженное влияние. При сочетании фронтального наклона и ротации около 20° и более целесообразно рассматривать применение КТ-навигации или аддитивных технологий или изменения стратегии фиксации – использование крючковых систем или отказ от установки винта на данном уровне.
Ключевые слова: сколиоз, транспедикулярная фиксация, free-hand техника, мальпозиция, стратификация риска, позвоночник
Aim. To develop a preoperative planning tool based on radiographic deformity parameters to predict the risk of pedicle screw malposition with the «free-hand» technique.
Materials and methods. A single-center retrospective study was performed. Forty-five patients who underwent posterior spinal deformity correction with «free-hand» pedicle screw insertion were included; a total of 696 screws were analyzed. Females accounted for 73.3% (n=33) and males for 26.7% (n=12), median age was 14.0 [12.0; 16.0] years. Idiopathic scoliosis predominated (71.1%, n=32). Screw position was assessed on postoperative CT with multiplanar reconstructions, recording malposition and breach direction (medial, lateral, anterior). Preoperatively, vertebral frontal tilt, sagittal tilt, and vertebral rotation were measured at each instrumented level. A predictive model was built using binary logistic regression with Nagelkerke’s R²; discriminative performance was evaluated by ROC analysis (AUC) and the optimal cut-off was determined using the Youden index.
Results. The median preoperative Cobb angle was 69° [61°; 93°]; the postoperative mean Cobb angle was 28±12°, corresponding to a 59% mean correction (p<0.001). CT identified 148 malpositions (21.3% of screws). Malposition rates increased significantly with increasing frontal tilt and vertebral rotation (p<0.001). Lateral malpositions were significantly more frequent with greater frontal tilt (p<0.001), whereas medial malpositions increased with higher rotation compared with anterior and lateral breaches (p<0.001). In the binary logistic model, both coronal tilt and rotation were significant predictors; the model differed from the null model (p<0.001) with a Nagelkerke pseudo-R² of 10.3%. Each 1° increase in coronal tilt increased the odds of malposition by 2.7% (OR 1.027; 95% CI 1.013–1.042), and each 1° increase in rotation increased the odds by 5.0% (OR 1.050, 95% CI 1.030–1.070). The AUC was 0.682 (95% CI 0.631–0.733; p<0.001). The optimal probability threshold was P=0.212, yielding 70.5% sensitivity and 62.0% specificity; P≥0.212 corresponded to a combination of coronal tilt and rotation of approximately 20° or more at the same instrumented level.
Conclusion. The risk of pedicle screw malposition with the «free-hand» technique is significantly associated with vertebral coronal tilt and rotation at the instrumented level, with rotation exerting a stronger effect. When coronal tilt and rotation are approximately 20° or greater, the use of CT-based navigation or additive manufacturing (3D-printing) technologies should be considered, as well as modification of the fixation strategy (e.g., use of hook constructs or omission of screw placement at that level) to improve the safety of pediatric scoliosis correction.
Keywords: scoliosis, pedicle screw fixation, free-hand technique, screw malposition, risk stratification, spine
Цель. Разработать инструмент предоперационного планирования на основе рентгенологических параметров деформации для прогнозирования риска мальпозиции ТПВ при «free-hand» технике.
Материалы и методы. Проведено одноцентровое ретроспективное исследование. Включены 45 пациентов, которым выполнена задняя коррекция деформации позвоночника с установкой ТПВ по «free-hand» технике, проанализировано 696 винтов. Женщины составили 73,3% (n=33), мужчины – 26,7% (n=12), медианный возраст – 14,0 [12,0; 16,0] года. По этиологии преобладал идиопатический сколиоз – 71,1% (n=32). Положение винтов оценивали по послеоперационной компьютерной томографии (КТ) с мультипланарными реконструкциями с регистрацией факта мальпозиции и направления перфорации (медиальной, латеральной, передней). По предоперационной КТ фиксировали фронтальный и сагиттальный наклоны, ротацию позвонка на уровне каждого винта. Прогностическую модель строили методом бинарной логистической регрессии с оценкой R2 Найджелкерка, дискриминационную способность оценивали при помощи ROC-анализа (площади под кривой – AUC) с определением cut-off по индексу Юдена.
Результаты. Медиана исходного угла Cobb составила 69° [61°; 93°], послеоперационно среднее значение – 28±12°, средняя коррекция – 59% (p<0,001). По данным КТ выявлено 148 мальпозиций (21,3% винтов). Частота мальпозиций статистически значимо возрастала при увеличении фронтального наклона и ротации (p<0,001). Установлено, что латеральные мальпозиции статистически значимо учащались при росте фронтального наклона (p<0,001), а медиальные – при увеличении ротации по сравнению с передними и латеральными (p<0,001). В бинарной логистической модели фронтальный наклон и ротация оказали статистически значимое влияние на вероятность мальпозиции, модель значимо отличалась от нулевой (p<0,001), а псевдо-R2 Найджелкерка составил 10,3%. Увеличение фронтального наклона на 1° повышало риск мальпозиции на 2,7% (отношение шансов 1,027, 95% доверительный интервал – ДИ 1,013–1,042), увеличение ротации на 1° – на 5,0% (отношение шансов 1,050, 95% ДИ 1,030–1,070). Площадь под кривой составила 0,682 (95% ДИ 0,631–0,733; p<0,001). Оптимальный порог вероятности P=0,212 обеспечивал чувствительность 70,5% и специфичность 62,0%, значения P≥0,212 соответствовали сочетанию фронтального наклона и ротации порядка 20° и более на уровне инструментирования.
Заключение. Риск мальпозиции ТПВ при «free-hand» технике статистически значимо связан с фронтальным наклоном и ротацией позвонка на уровне инструментации, при этом ротационный компонент оказывает более выраженное влияние. При сочетании фронтального наклона и ротации около 20° и более целесообразно рассматривать применение КТ-навигации или аддитивных технологий или изменения стратегии фиксации – использование крючковых систем или отказ от установки винта на данном уровне.
Ключевые слова: сколиоз, транспедикулярная фиксация, free-hand техника, мальпозиция, стратификация риска, позвоночник
________________________________________________
Aim. To develop a preoperative planning tool based on radiographic deformity parameters to predict the risk of pedicle screw malposition with the «free-hand» technique.
Materials and methods. A single-center retrospective study was performed. Forty-five patients who underwent posterior spinal deformity correction with «free-hand» pedicle screw insertion were included; a total of 696 screws were analyzed. Females accounted for 73.3% (n=33) and males for 26.7% (n=12), median age was 14.0 [12.0; 16.0] years. Idiopathic scoliosis predominated (71.1%, n=32). Screw position was assessed on postoperative CT with multiplanar reconstructions, recording malposition and breach direction (medial, lateral, anterior). Preoperatively, vertebral frontal tilt, sagittal tilt, and vertebral rotation were measured at each instrumented level. A predictive model was built using binary logistic regression with Nagelkerke’s R²; discriminative performance was evaluated by ROC analysis (AUC) and the optimal cut-off was determined using the Youden index.
Results. The median preoperative Cobb angle was 69° [61°; 93°]; the postoperative mean Cobb angle was 28±12°, corresponding to a 59% mean correction (p<0.001). CT identified 148 malpositions (21.3% of screws). Malposition rates increased significantly with increasing frontal tilt and vertebral rotation (p<0.001). Lateral malpositions were significantly more frequent with greater frontal tilt (p<0.001), whereas medial malpositions increased with higher rotation compared with anterior and lateral breaches (p<0.001). In the binary logistic model, both coronal tilt and rotation were significant predictors; the model differed from the null model (p<0.001) with a Nagelkerke pseudo-R² of 10.3%. Each 1° increase in coronal tilt increased the odds of malposition by 2.7% (OR 1.027; 95% CI 1.013–1.042), and each 1° increase in rotation increased the odds by 5.0% (OR 1.050, 95% CI 1.030–1.070). The AUC was 0.682 (95% CI 0.631–0.733; p<0.001). The optimal probability threshold was P=0.212, yielding 70.5% sensitivity and 62.0% specificity; P≥0.212 corresponded to a combination of coronal tilt and rotation of approximately 20° or more at the same instrumented level.
Conclusion. The risk of pedicle screw malposition with the «free-hand» technique is significantly associated with vertebral coronal tilt and rotation at the instrumented level, with rotation exerting a stronger effect. When coronal tilt and rotation are approximately 20° or greater, the use of CT-based navigation or additive manufacturing (3D-printing) technologies should be considered, as well as modification of the fixation strategy (e.g., use of hook constructs or omission of screw placement at that level) to improve the safety of pediatric scoliosis correction.
Keywords: scoliosis, pedicle screw fixation, free-hand technique, screw malposition, risk stratification, spine
Полный текст
Список литературы
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25. Samdani AF, Ranade A, Sciubba DM, et al. Accuracy of free-hand placement of thoracic pedicle screws in adolescent idiopathic scoliosis: how much of a difference does surgeon experience make? Eur Spine J. 2010;19(1):91-5. DOI:10.1007/s00586-009-1183-6
2. Luo M, Li N, Shen M, Xia L. Pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis: A systematic review and meta-analysis with emphasis on complications and reoperations. Medicine (Baltimore). 2017;96(27):e7337. DOI:10.1097/MD.0000000000007337
3. Hicks JM, Singla A, Shen FH, Arlet V. Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976). 2010;35(11):E465-E70. DOI:10.1097/BRS.0b013e3181d1021a
4. Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976). 2007;32(3):E111-E20. DOI:10.1097/01.brs.0000254048.79024.8b
5. Aoude AA, Fortin M, Figueiredo R, et al. Methods to determine pedicle screw placement accuracy in spine surgery: a systematic review. Eur Spine J. 2015;24(5):990-1004. DOI:10.1007/s00586-015-3853-x
6. Sarwahi V, Wendolowski SF, Gecelter RC, et al. Are We Underestimating The Significance of Pedicle Screw Misplacement? Spine (Phila Pa 1976). 2016;41(9):E548-E55. DOI:10.1097/BRS.0000000000001318
7. Mac-Thiong JM, Parent S, Poitras B, et al. Neurological outcome and management of pedicle screws misplaced totally within the spinal canal. Spine (Phila Pa 1976). 2013;38(3):229-37. DOI:10.1097/BRS.0b013e31826980a9
8. Papin P, Arlet V, Marchesi D, et al. Unusual presentation of spinal cord compression related to misplaced pedicle screws in thoracic scoliosis. Eur Spine J. 1999;8(2):156-9. DOI:10.1007/s005860050147
9. Valič M, Žižek D, Špan M, et al. Malpositioned pedicle screw in spine deformity surgery endangering the aorta: report of two cases, review of literature, and proposed management algorithm. Spine Deform. 2020;8(4):809-17. DOI:10.1007/s43390-020-00094-5
10. Floccari LV, Larson AN, Crawford CH 3rd, et al. Which malpositioned pedicle screws should be revised? J Pediatr Orthop. 2018;38(2):110-5. DOI:10.1097/BPO.0000000000000753
11. Burger JA, Becker L, Li Z, et al. In idiopathic scoliosis distances of spinal cord to thoracic pedicle are within 2 mm in a large region of the thoracic apex. Sci Rep. 2024;14(1):14340. DOI:10.1038/s41598-024-64971-z
12. Wang S, Qiu Y, Liu W, et al. The potential risk of spinal cord injury from pedicle screw at the apex of adolescent idiopathic thoracic scoliosis: magnetic resonance imaging evaluation. BMC Musculoskelet Disord. 2015;16:310. DOI:10.1186/s12891-015-0766-0
13. Baldwin KD, Kadiyala M, Talwar D, et al. Does intraoperative CT navigation increase the accuracy of pedicle screw placement in pediatric spinal deformity surgery? A systematic review and meta-analysis. Spine Deform. 2022;10(1):19-29. DOI:10.1007/s43390-021-00385-5
14. Baky FJ, Milbrandt T, Echternacht S, et al. Intraoperative Computed Tomography-Guided Navigation for Pediatric Spine Patients Reduced Return to Operating Room for Screw Malposition Compared With Freehand/Fluoroscopic Techniques. Spine Deform. 2019;7(4):577-81. DOI:10.1016/j.jspd.2018.11.012
15. Cecchinato R, Berjano P, Zerbi A, et al. Pedicle screw insertion with patient-specific 3D-printed guides based on low-dose CT scan is more accurate than free-hand technique in spine deformity patients: a prospective, randomized clinical trial. Eur Spine J. 2019;28(7):1712-23. DOI:10.1007/s00586-019-05978-3
16. Lu C, Ma L, Wang X, et al. Comparison of 3D-printed Navigation Template-assisted Pedicle Screws versus Freehand Screws for Scoliosis in Children and Adolescents: A Systematic Review and Meta-analysis. J Neurol Surg A Cent Eur Neurosurg. 2023;84(2):188-97. DOI:10.1055/a-1938-0254
17. Singh A, Kotzur T, Peterson B, et al. Computer Assisted Navigation Does Not Improve Outcomes in Posterior Fusion for Adolescent Idiopathic Scoliosis. Global Spine J. 2025;15(4):1957-65. DOI:10.1177/21925682241274373
18. Pimburskiy IP, Domrachev IE, Chelpachenko OB, et al. Reducing implant-associated complications in scoliosis surgery by using o-arm navigation and additive technologies. Vestnik Rossiiskoi akademii medetsinskikh nauk = Annals of the Russian academy of medical sciences. 2025;80(2):146-54 (in Russian). DOI:10.15690/vramn18039
19. Chan CYW, Kwan MK. Safety of Pedicle Screws in Adolescent Idiopathic Scoliosis Surgery. Asian Spine J. 2017;11(6):998-1007. DOI:10.4184/asj.2017.11.6.998
20. Kwan MK, Chiu CK, Gani ASM, Wei CCY. Accuracy and Safety of Pedicle Screw Placement in Adolescent Idiopathic Scoliosis Patients: A Review of 2020 Screws Using Computed Tomography Assessment. Spine (Phila Pa 1976). 2017;42(5):326-35. DOI:10.1097/BRS.0000000000001738
21. Mulyadi R, Hutami WD, Suganda KD, et al. Risk of neurologic deficit in medially breached pedicle screws assessed by computed tomography: a systematic review. Asian Spine J. 2024;18(6):903-12. DOI:10.31616/asj.2024.0325
22. Librianto D, Saleh I, Fachrisal, et al. Breach Rate Analysis of Pedicle Screw Instrumentation Using Free-Hand Technique in the Surgical Correction Of Adolescent Idiopathic Scoliosis. J Orthop Case Rep. 2021;11(1):38-44. DOI:10.13107/jocr.2021.v11.i01.1956
23. Yamada T, Yamato Y, Hasegawa T, et al. Concave Side of Proximal Thoracic Zone Vulnerable to Pedicle Screw Perforation in Adolescent Idiopathic Scoliosis Surgery: Comparative Analysis of Pre- and Intraoperative Computed Tomography Navigation. J Clin Med. 2025;14(13):4729. DOI:10.3390/jcm14134729
24. Maalouly J, Sarkar M, Choi J. Retrospective study assessing the learning curve and the accuracy of minimally invasive robot-assisted pedicle screw placement during the first 41 robot-assisted spinal fusion surgeries. Mini-invasive Surg. 2021;5:35. DOI:10.20517/2574-1225.2021.57
25. Samdani AF, Ranade A, Sciubba DM, et al. Accuracy of free-hand placement of thoracic pedicle screws in adolescent idiopathic scoliosis: how much of a difference does surgeon experience make? Eur Spine J. 2010;19(1):91-5. DOI:10.1007/s00586-009-1183-6
2. Luo M, Li N, Shen M, Xia L. Pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis: A systematic review and meta-analysis with emphasis on complications and reoperations. Medicine (Baltimore). 2017;96(27):e7337. DOI:10.1097/MD.0000000000007337
3. Hicks JM, Singla A, Shen FH, Arlet V. Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976). 2010;35(11):E465-E70. DOI:10.1097/BRS.0b013e3181d1021a
4. Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976). 2007;32(3):E111-E20. DOI:10.1097/01.brs.0000254048.79024.8b
5. Aoude AA, Fortin M, Figueiredo R, et al. Methods to determine pedicle screw placement accuracy in spine surgery: a systematic review. Eur Spine J. 2015;24(5):990-1004. DOI:10.1007/s00586-015-3853-x
6. Sarwahi V, Wendolowski SF, Gecelter RC, et al. Are We Underestimating The Significance of Pedicle Screw Misplacement? Spine (Phila Pa 1976). 2016;41(9):E548-E55. DOI:10.1097/BRS.0000000000001318
7. Mac-Thiong JM, Parent S, Poitras B, et al. Neurological outcome and management of pedicle screws misplaced totally within the spinal canal. Spine (Phila Pa 1976). 2013;38(3):229-37. DOI:10.1097/BRS.0b013e31826980a9
8. Papin P, Arlet V, Marchesi D, et al. Unusual presentation of spinal cord compression related to misplaced pedicle screws in thoracic scoliosis. Eur Spine J. 1999;8(2):156-9. DOI:10.1007/s005860050147
9. Valič M, Žižek D, Špan M, et al. Malpositioned pedicle screw in spine deformity surgery endangering the aorta: report of two cases, review of literature, and proposed management algorithm. Spine Deform. 2020;8(4):809-17. DOI:10.1007/s43390-020-00094-5
10. Floccari LV, Larson AN, Crawford CH 3rd, et al. Which malpositioned pedicle screws should be revised? J Pediatr Orthop. 2018;38(2):110-5. DOI:10.1097/BPO.0000000000000753
11. Burger JA, Becker L, Li Z, et al. In idiopathic scoliosis distances of spinal cord to thoracic pedicle are within 2 mm in a large region of the thoracic apex. Sci Rep. 2024;14(1):14340. DOI:10.1038/s41598-024-64971-z
12. Wang S, Qiu Y, Liu W, et al. The potential risk of spinal cord injury from pedicle screw at the apex of adolescent idiopathic thoracic scoliosis: magnetic resonance imaging evaluation. BMC Musculoskelet Disord. 2015;16:310. DOI:10.1186/s12891-015-0766-0
13. Baldwin KD, Kadiyala M, Talwar D, et al. Does intraoperative CT navigation increase the accuracy of pedicle screw placement in pediatric spinal deformity surgery? A systematic review and meta-analysis. Spine Deform. 2022;10(1):19-29. DOI:10.1007/s43390-021-00385-5
14. Baky FJ, Milbrandt T, Echternacht S, et al. Intraoperative Computed Tomography-Guided Navigation for Pediatric Spine Patients Reduced Return to Operating Room for Screw Malposition Compared With Freehand/Fluoroscopic Techniques. Spine Deform. 2019;7(4):577-81. DOI:10.1016/j.jspd.2018.11.012
15. Cecchinato R, Berjano P, Zerbi A, et al. Pedicle screw insertion with patient-specific 3D-printed guides based on low-dose CT scan is more accurate than free-hand technique in spine deformity patients: a prospective, randomized clinical trial. Eur Spine J. 2019;28(7):1712-23. DOI:10.1007/s00586-019-05978-3
16. Lu C, Ma L, Wang X, et al. Comparison of 3D-printed Navigation Template-assisted Pedicle Screws versus Freehand Screws for Scoliosis in Children and Adolescents: A Systematic Review and Meta-analysis. J Neurol Surg A Cent Eur Neurosurg. 2023;84(2):188-97. DOI:10.1055/a-1938-0254
17. Singh A, Kotzur T, Peterson B, et al. Computer Assisted Navigation Does Not Improve Outcomes in Posterior Fusion for Adolescent Idiopathic Scoliosis. Global Spine J. 2025;15(4):1957-65. DOI:10.1177/21925682241274373
18. Пимбурский И.П., Домрачев И.Е., Челпаченко О.Б., и др. Снижение имплант-ассоциированных осложнений в хирургии сколиоза путем применения O-arm-навигации и аддитивных технологий. Вестник Российской академии медицинских наук. 2025;80(2):146-54 [Pimburskiy IP, Domrachev IE, Chelpachenko OB, et al. Reducing implant-associated complications in scoliosis surgery by using o-arm navigation and additive technologies. Vestnik Rossiiskoi akademii medetsinskikh nauk = Annals of the Russian academy of medical sciences. 2025;80(2):146-54 (in Russian]). DOI:10.15690/vramn18039
19. Chan CYW, Kwan MK. Safety of Pedicle Screws in Adolescent Idiopathic Scoliosis Surgery. Asian Spine J. 2017;11(6):998-1007. DOI:10.4184/asj.2017.11.6.998
20. Kwan MK, Chiu CK, Gani ASM, Wei CCY. Accuracy and Safety of Pedicle Screw Placement in Adolescent Idiopathic Scoliosis Patients: A Review of 2020 Screws Using Computed Tomography Assessment. Spine (Phila Pa 1976). 2017;42(5):326-35. DOI:10.1097/BRS.0000000000001738
21. Mulyadi R, Hutami WD, Suganda KD, et al. Risk of neurologic deficit in medially breached pedicle screws assessed by computed tomography: a systematic review. Asian Spine J. 2024;18(6):903-12. DOI:10.31616/asj.2024.0325
22. Librianto D, Saleh I, Fachrisal, et al. Breach Rate Analysis of Pedicle Screw Instrumentation Using Free-Hand Technique in the Surgical Correction Of Adolescent Idiopathic Scoliosis. J Orthop Case Rep. 2021;11(1):38-44. DOI:10.13107/jocr.2021.v11.i01.1956
23. Yamada T, Yamato Y, Hasegawa T, et al. Concave Side of Proximal Thoracic Zone Vulnerable to Pedicle Screw Perforation in Adolescent Idiopathic Scoliosis Surgery: Comparative Analysis of Pre- and Intraoperative Computed Tomography Navigation. J Clin Med. 2025;14(13):4729. DOI:10.3390/jcm14134729
24. Maalouly J, Sarkar M, Choi J. Retrospective study assessing the learning curve and the accuracy of minimally invasive robot-assisted pedicle screw placement during the first 41 robot-assisted spinal fusion surgeries. Mini-invasive Surg. 2021;5:35. DOI:10.20517/2574-1225.2021.57
25. Samdani AF, Ranade A, Sciubba DM, et al. Accuracy of free-hand placement of thoracic pedicle screws in adolescent idiopathic scoliosis: how much of a difference does surgeon experience make? Eur Spine J. 2010;19(1):91-5. DOI:10.1007/s00586-009-1183-6
________________________________________________
2. Luo M, Li N, Shen M, Xia L. Pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis: A systematic review and meta-analysis with emphasis on complications and reoperations. Medicine (Baltimore). 2017;96(27):e7337. DOI:10.1097/MD.0000000000007337
3. Hicks JM, Singla A, Shen FH, Arlet V. Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976). 2010;35(11):E465-E70. DOI:10.1097/BRS.0b013e3181d1021a
4. Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976). 2007;32(3):E111-E20. DOI:10.1097/01.brs.0000254048.79024.8b
5. Aoude AA, Fortin M, Figueiredo R, et al. Methods to determine pedicle screw placement accuracy in spine surgery: a systematic review. Eur Spine J. 2015;24(5):990-1004. DOI:10.1007/s00586-015-3853-x
6. Sarwahi V, Wendolowski SF, Gecelter RC, et al. Are We Underestimating The Significance of Pedicle Screw Misplacement? Spine (Phila Pa 1976). 2016;41(9):E548-E55. DOI:10.1097/BRS.0000000000001318
7. Mac-Thiong JM, Parent S, Poitras B, et al. Neurological outcome and management of pedicle screws misplaced totally within the spinal canal. Spine (Phila Pa 1976). 2013;38(3):229-37. DOI:10.1097/BRS.0b013e31826980a9
8. Papin P, Arlet V, Marchesi D, et al. Unusual presentation of spinal cord compression related to misplaced pedicle screws in thoracic scoliosis. Eur Spine J. 1999;8(2):156-9. DOI:10.1007/s005860050147
9. Valič M, Žižek D, Špan M, et al. Malpositioned pedicle screw in spine deformity surgery endangering the aorta: report of two cases, review of literature, and proposed management algorithm. Spine Deform. 2020;8(4):809-17. DOI:10.1007/s43390-020-00094-5
10. Floccari LV, Larson AN, Crawford CH 3rd, et al. Which malpositioned pedicle screws should be revised? J Pediatr Orthop. 2018;38(2):110-5. DOI:10.1097/BPO.0000000000000753
11. Burger JA, Becker L, Li Z, et al. In idiopathic scoliosis distances of spinal cord to thoracic pedicle are within 2 mm in a large region of the thoracic apex. Sci Rep. 2024;14(1):14340. DOI:10.1038/s41598-024-64971-z
12. Wang S, Qiu Y, Liu W, et al. The potential risk of spinal cord injury from pedicle screw at the apex of adolescent idiopathic thoracic scoliosis: magnetic resonance imaging evaluation. BMC Musculoskelet Disord. 2015;16:310. DOI:10.1186/s12891-015-0766-0
13. Baldwin KD, Kadiyala M, Talwar D, et al. Does intraoperative CT navigation increase the accuracy of pedicle screw placement in pediatric spinal deformity surgery? A systematic review and meta-analysis. Spine Deform. 2022;10(1):19-29. DOI:10.1007/s43390-021-00385-5
14. Baky FJ, Milbrandt T, Echternacht S, et al. Intraoperative Computed Tomography-Guided Navigation for Pediatric Spine Patients Reduced Return to Operating Room for Screw Malposition Compared With Freehand/Fluoroscopic Techniques. Spine Deform. 2019;7(4):577-81. DOI:10.1016/j.jspd.2018.11.012
15. Cecchinato R, Berjano P, Zerbi A, et al. Pedicle screw insertion with patient-specific 3D-printed guides based on low-dose CT scan is more accurate than free-hand technique in spine deformity patients: a prospective, randomized clinical trial. Eur Spine J. 2019;28(7):1712-23. DOI:10.1007/s00586-019-05978-3
16. Lu C, Ma L, Wang X, et al. Comparison of 3D-printed Navigation Template-assisted Pedicle Screws versus Freehand Screws for Scoliosis in Children and Adolescents: A Systematic Review and Meta-analysis. J Neurol Surg A Cent Eur Neurosurg. 2023;84(2):188-97. DOI:10.1055/a-1938-0254
17. Singh A, Kotzur T, Peterson B, et al. Computer Assisted Navigation Does Not Improve Outcomes in Posterior Fusion for Adolescent Idiopathic Scoliosis. Global Spine J. 2025;15(4):1957-65. DOI:10.1177/21925682241274373
18. Pimburskiy IP, Domrachev IE, Chelpachenko OB, et al. Reducing implant-associated complications in scoliosis surgery by using o-arm navigation and additive technologies. Vestnik Rossiiskoi akademii medetsinskikh nauk = Annals of the Russian academy of medical sciences. 2025;80(2):146-54 (in Russian). DOI:10.15690/vramn18039
19. Chan CYW, Kwan MK. Safety of Pedicle Screws in Adolescent Idiopathic Scoliosis Surgery. Asian Spine J. 2017;11(6):998-1007. DOI:10.4184/asj.2017.11.6.998
20. Kwan MK, Chiu CK, Gani ASM, Wei CCY. Accuracy and Safety of Pedicle Screw Placement in Adolescent Idiopathic Scoliosis Patients: A Review of 2020 Screws Using Computed Tomography Assessment. Spine (Phila Pa 1976). 2017;42(5):326-35. DOI:10.1097/BRS.0000000000001738
21. Mulyadi R, Hutami WD, Suganda KD, et al. Risk of neurologic deficit in medially breached pedicle screws assessed by computed tomography: a systematic review. Asian Spine J. 2024;18(6):903-12. DOI:10.31616/asj.2024.0325
22. Librianto D, Saleh I, Fachrisal, et al. Breach Rate Analysis of Pedicle Screw Instrumentation Using Free-Hand Technique in the Surgical Correction Of Adolescent Idiopathic Scoliosis. J Orthop Case Rep. 2021;11(1):38-44. DOI:10.13107/jocr.2021.v11.i01.1956
23. Yamada T, Yamato Y, Hasegawa T, et al. Concave Side of Proximal Thoracic Zone Vulnerable to Pedicle Screw Perforation in Adolescent Idiopathic Scoliosis Surgery: Comparative Analysis of Pre- and Intraoperative Computed Tomography Navigation. J Clin Med. 2025;14(13):4729. DOI:10.3390/jcm14134729
24. Maalouly J, Sarkar M, Choi J. Retrospective study assessing the learning curve and the accuracy of minimally invasive robot-assisted pedicle screw placement during the first 41 robot-assisted spinal fusion surgeries. Mini-invasive Surg. 2021;5:35. DOI:10.20517/2574-1225.2021.57
25. Samdani AF, Ranade A, Sciubba DM, et al. Accuracy of free-hand placement of thoracic pedicle screws in adolescent idiopathic scoliosis: how much of a difference does surgeon experience make? Eur Spine J. 2010;19(1):91-5. DOI:10.1007/s00586-009-1183-6
Авторы
И.П. Пимбурский*1, О.Б. Челпаченко1,2, C.П. Яцык3, К.В. Жердев1,4, А.С. Бутенко1
1ФГАУ «Национальный медицинский исследовательский центр здоровья детей» Минздрава России, Москва, Российская Федерация
2ГБУЗ «Научно-исследовательский институт неотложной детской хирургии и травматологии – Клиника доктора Рошаля» Департамента здравоохранения г. Москвы, Москва, Российская Федерация
3ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Российская Федерация
4ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Российская Федерация
*bdfyltvbljd@yandex.ru
1National Medical Research Center for Children’s Health, Moscow, Russian Federation
2Research Institute of Emergency Pediatric Surgery and Traumatology – Doctor Roshal Clinic, Moscow, Russian Federation
3Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
4Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
*bdfyltvbljd@yandex.ru
1ФГАУ «Национальный медицинский исследовательский центр здоровья детей» Минздрава России, Москва, Российская Федерация
2ГБУЗ «Научно-исследовательский институт неотложной детской хирургии и травматологии – Клиника доктора Рошаля» Департамента здравоохранения г. Москвы, Москва, Российская Федерация
3ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Российская Федерация
4ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Российская Федерация
*bdfyltvbljd@yandex.ru
________________________________________________
1National Medical Research Center for Children’s Health, Moscow, Russian Federation
2Research Institute of Emergency Pediatric Surgery and Traumatology – Doctor Roshal Clinic, Moscow, Russian Federation
3Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
4Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
*bdfyltvbljd@yandex.ru
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