Comparative analysis of the effectiveness of the combined method of inserting pedicle screws with the free-hand technique in patients with idiopathic scoliosis

Abstract

Objective. To analyze intraoperative data and results of treatment of patients with idiopathic scoliosis with two options of the open insertion of pedicle screws using the free-hand technique.Material and Methods. The data of 457 patients aged 16–35 years who underwent surgical treatment for idiopathic scoliosis by one surgeon were analyzed. In 236 patients (Group I), the screws were placed manually, and in 221 (Group II) – using power tool. The preparation of the canal for pedicle screws in both groups was performed using the free-hand technique. The correct position of the screws wasassessed intraoperatively using an image intensifier and neurophysiological monitoring. The duration of surgery and X-ray monitoring, blood loss, and the presence of intra- and postoperative complications were assessed.Results. In Group I, 4243 screws were inserted, and in Group II – 3978. The correct position of pedicle screws was recorded in 89.1 % of cases in Group I, and in 89.6 % of cases in Goup II. In Group I, the incorrect position of anchor elements was detected in 10.9 % of cases, and in Group II – in 10.4 % of cases. The number of screws re-positioned intraoperatively corresponded to the number of incorrectly positioned screws. There was a statistically significant difference in the volume of intraoperative blood loss and duration of surgery betweenpatients of both groups (p < 0.05).Conclusion. The development and active introduction of high-tech methods of surgical treatment of spinal deformities increase the number of interventions performed annually. The proposed combined method of surgical treatment seems to be optimal because manual formation of the canal reduces the risk of intraoperative complications, and the use of power tool during screw placement shortens duration of surgery and reduces blood loss.