• Peiqiang Su, Wentong Zhang, Yan Peng, Anjing Liang, Kaili Du, and Dongsheng Huang.
• Department of Orthopedics, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
• Eur Spine J. 2012 Jan 1;21(1):23-30.

ObjectiveTo determine the ideal entry point for individual pedicle screw in the surgical treatment of idiopathic scoliosis using computed tomographic (CT) three-dimensional (3D) reconstruction.MethodsTwenty patients with moderate or severe idiopathic scoliosis from two groups received surgical treatment using "Free Hand technique" and "Assisted Free Hand technique". Computed tomographic scanning with 3D reconstruction of the thoracic and lumbar spine was conducted to determine the entry point and to evaluate the placement accuracy.ResultsThe accuracy of placement was 88.2% in convexity and 84.5% in concavity for the "Free Hand" group, and 94.1% in convexity and 94% in concavity for the "Assisted Free Hand" group. Evidence showed that "Assisted Free Hand" group had higher accuracy when screws were placed in the thoracic spine (P = 0.02), while no obvious difference was seen in the lumbar spine placement (P = 0.47).ConclusionsWe conclude that in the surgical treatment of severe scoliosis, individual screw placement guided by entry points determined by CT reconstruction can result in improved accuracy and ease of the procedure.

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