• Xu Li, Wenzhi Zhang, Rui Zhang, Xifu Shang, Chen Deng, Lei Kong, and Jintao Han.
• Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Hefei, China.
• World Neurosurg. 2018 Oct 1; 118: 81-85.

ObjectiveWe sought to describe a novel modified guidewire technique used in the placement of percutaneous pedicle screws (PPSs), which enables safe and precise control of the depth of screw placement and prevents excessive advancement of the guidewire with low radiation exposure. PPSs have been widely used and have many advantages. However, inadvertent advancement of the guidewire may damage peripheral tissue or viscera, and repeated confirmation of the depth of screw and guidewire leads to extensive radiation exposure.MethodsA modified guidewire with markers was used intraoperatively. The reading of the mark on the guidewire increased as the PPS advanced into the pedicle. The depth of the screw in the pedicle was calculated as the mark reading after each screw was rotated into the pedicle minus the initial mark reading. After all pedicle screws were placed, the positions of the screws were checked by C-arm or G-arm fluoroscopy.ResultsThe modified guidewire was applied in 41 thoracic-lumbar fracture patients. The depths of the percutaneous screws were precisely controlled as planned. There were no inadvertent breaches of the anterior cortices of the vertebrae. No patients reported neurologic symptoms, and there was no screw misplacement detected. Surgeons had no radiation exposure, and patients were only exposed once to the radiation.ConclusionsThe modified guidewire with markers is an effective device to precisely control the depth of PPSs and prevent complications of the guidewire in the placement of pedicle screws.Copyright © 2018 Elsevier Inc. All rights reserved.

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