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  1. The use of fluoroscopic guided percutaneous pedicle screws in the upper thoracic spine (T1-T6): Is it safe?
    Kwan MK, Chiu CK, Chan CYW, Zamani R, Hansen-Algenstaedt N
    J Orthop Surg (Hong Kong), 2017 7 28;25(2):2309499017722438.
    PMID: 28748740 DOI: 10.1177/2309499017722438
    PURPOSE: This study analysed the accuracy and safety of the fluoroscopic guided percutaneous screws in the upper thoracic vertebrae (T1-T6).

    METHODS: Computed tomography scans from 74 patients were retrospectively evaluated between January 2008 and December 2012. Pedicle perforations were classified by two types of grading systems. For medial, lateral, superior and inferior perforations: grade 0 - no violation; grade 1 - <2 mm; grade 2 - 2-4 mm and grade 3 - >4 mm. For anterior perforations: grade 0 - no violation; grade 1 - <4 mm; grade 2 - 4-6 mm and grade 3 - >6 mm.

    RESULTS: There were 35 (47.3%) male and 39 (52.7%) female patients with a total 260 thoracic pedicle screws (T1-T6) analysed. There were 32 screw perforations which account to a perforation rate of 12.3% (11.2% grade 1, 0.7% grade 2 and 0.4% grade 3). None led to pedicle screw-related complications. The perforation rate was highest at T1 (33.3%, all grade 1 perforations), followed by T6 (14.5%) and T4 (14.0%).

    CONCLUSION: Fluoroscopic guided percutaneous pedicle screws of the upper thoracic spine (T1-T6) are technically more demanding and carry potential risks of serious complications. Extra precautions need to be taken when fluoroscopic guided percutaneous pedicle screws are placed at T1 and T2 levels, due to high medial pedicular angulation and obstruction of lateral fluoroscopic images by the shoulder girdle and at T4-T6 levels, due to smaller pedicular width.

    Matched MeSH terms: Surgery, Computer-Assisted/instrumentation
  2. A new modified speculum guided single nostril technique for endoscopic transnasal transsphenoidal surgery: an analysis of nasal complications
    Waran V, Tang IP, Karuppiah R, Abd Kadir KA, Chandran H, Muthusamy KA, et al.
    Br J Neurosurg, 2013 Dec;27(6):742-6.
    PMID: 23647078 DOI: 10.3109/02688697.2013.791667
    Abstract The endoscopic transnasal, transsphenoidal surgical technique for pituitary tumour excision has generally been regarded as a less invasive technique, ranging from single nostril to dual nostril techniques. We propose a single nostril technique using a modified nasal speculum as a preferred technique. We initially reviewed 25 patients who underwent pituitary tumour excision, via endoscopic transnasal transsphenoidal surgery, using this new modified speculum-guided single nostril technique. The results show shorter operation time with reduced intra- and post-operative nasal soft tissue injuries and complications.
    Matched MeSH terms: Surgery, Computer-Assisted/instrumentation*
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