• Mario Di Silvestre, Patrizio Parisini, Francesco Lolli, and Georgios Bakaloudis.
• Spine Surgery Department, Istituti Ortopedici Rizzoli, Bologna, Italy. mario.disilvestre@ior.it
• Spine. 2007 Jul 1; 32 (15): 1655-61.

Study DesignA retrospective study.ObjectiveTo analyze complications with thoracic pedicle screws in scoliosis treatment at our Department over a 3-year period (1999-2001).Summary Of Background DataThe use of pedicle screws remains controversial for thoracic scoliosis for fear of complications.MethodsA total of 115 consecutive patients who underwent posterior fusion using 1035 transpedicular thoracic screws were reviewed. All patients presented a main thoracic scoliosis with a mean Cobb angle of 75.4 degrees (range, 60 degrees -105 degrees ). For thoracic screw placement, a mini-laminotomy technique was used, inserting a spatula inside the vertebral canal to palpate the borders of the pedicle. Postoperative CT scan was used in 25 patients (21.7%) to study a total of 311 screws, when the screw position was questionable.ResultsAn independent spine surgeon retrospectively reviewed medical records and radiographs of the patients, at a mean follow-up of 4 years. There were 18 screws misplaced (1.7%) in a total of 13 patients (11.3%). Screw malposition was symptomatic only in 1 patient (pleural effusion and fever) and asymptomatic in the other 12 cases (10.4%). Other complications included intraoperative pedicle fractures in 15 patients (13%), dural tears (without neurologic complications) in 14 cases (12.1%), and superficial wound infections in 2 (1.7%). Another operation for screw removal was performed in 5 patients (4.3%), due to pleural effusion (in 1 case), asymptomatic late lateral loosening of a malpositioned screw (in 1), and the possible future risks related the intrathoracic screw position despite the lack of any symptoms (in 3). Two cases (1.7%) were retreated due to wound infection, without removing instrumentation. There was no loss of correction at follow-up.ConclusionsThe thoracic pedicle screw placement in scoliosis patients requires utmost caution. The mini-laminotomy technique was beneficial in increasing safety of the procedure with an acceptable incidence of complications.

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