Transpediküler vidanın yerleştirilmesinde cerrahın el baskınlığının rolü

Öz

Amaç: Bu çalışmanın amacı transpediküler vidanın yerleştirilmesi sırasında cerrahın el baskınlığının herhangi bir rol oynayıp oynamadığını belirlemekti.

Çalışma planı: Çalışmada sağ elini kullanan iki cerrah tarafından serbest el tekniği ile ve hastaların farklı taraflarında durularak yerleştirilen toplam 269 pedikül vidası incelendi. Lateral radyografide vertebraların uç plağına paralel bir hat çizildi. Vida ile uç plağına paralel hat arasındaki açı ölçüldü. Açılar, vidanın ucu uç plağından geçen hattın üzerinde kaldığında kranial ‘+’, uç plağından geçen hattın altında kaldığında ise kaudal ‘-’ şeklinde sınıflandırıldı. Sağ taraftan yerleştirilen vidaların açıları sol taraftan yerleştirilenlerin açıları ile kıyaslandı.

Bulgular: Sol taraftan yerleştirilen vidaların 80 adedi (%58.4) kranial, sağ taraftan yerleştirilenlerin ise 82 adedi (%62.1) kaudal olarak sınıflandırıldı. Yönelimdeki bu fark istatistiksel olarak anlamlı bulundu (p<0.0001).

Çıkarımlar: Görünüşe göre cerrahın el baskınlığı pedikül vidalarının yönelimini etkilemektedir. Bu durum, üst seviyelere sol, alt seviyelere ise sağ taraftan vida yerleştirirken sağ elini kullanan cerrahlar için sorun yaratabilir. Bu bulgu ışığında, omurga cerrahlarına verilen pedikül vidası yerleştirme eğitiminde el kullanımındaki belirsizliğe dikkat çekilmesi önem kazanmaktadır.

Anahtar Kelimeler

• El baskınlığı; pedikül; vida; yerleştirme.

Role of surgeon handedness in transpedicular screw insertion

Öz

Objective: The aim of this study was to determine the role surgeon handedness plays in transpedicular screw placement.

Methods: The study included 269 pedicle screws inserted by two right-handed surgeons who stood on different sides of patients and used the free-hand technique. A parallel line was drawn to the endplate of the vertebrae on lateral radiograph. Measurement was made to observe the angle between the screw and the line parallel to the endplate. Angles were classified as cranial ‘+’ when the tip of the screw stood above the endplate line and as caudal ‘-’ when it stood below the endplate line. Angles of screws placed from the right side were compared to those placed from the left.

Results: On the left side, 80 screws (58.4%) were classified as cranial and 82 screws (62.1%) on the right side were classified as caudal. The difference in orientation was statistically significant (p<0.0001).

Conclusion: Surgeon handedness appears to have an influence over the orientation of pedicle screws. This may create problems for right-handed surgeons in the insertion of upper level screws from the left side and lower level screws from the right side. Based on this finding, it may be necessary to include ambiguity in handedness as a part of pedicle screw insertion training for spinal surgeons.

Anahtar Kelimeler

• Handedness
• insertion
• pedicle
• screw

Kaynakça

1. Kim YJ, Lenke LG. Thoracic pedicle screw placement: free-hand technique. Neurol India 2005;53:512-9. CrossRef
2. Lehman RA Jr, Polly DW Jr, Kuklo TR, Cunningham B, Kirk KL, Belmont PJ Jr. Straight-forward versus anatomic trajectory technique of thoracic pedicle screw fixation: a biomechanical analysis. Spine 2003;28:2058-65. CrossRef
3. Heini P, Schöll E, Wyler D, Eggli S. Fatal cardiac tampon- ade associated with posterior spinal instrumentation. A case report. Spine 1998;23:2226-30. CrossRef
4. Minor ME, Morrissey NJ, Peress R, Carroccio A, Ellozy S, Agarwal G, et al. Endovascular treatment of an iatro- genic thoracic aortic injury after spinal instrumentation: case report. J Vasc Surg 2004;39:893-6. CrossRef
5. Cho KJ, Suk SI, Park SR, Kim JH, Kang SB, Kim HS, et al. Risk factors of sagittal decompensation after long pos- terior instrumentation and fusion for degenerative lumbar scoliosis. Spine 2010;35:1595-601. CrossRef
6. Husson JL, Mallet JF, Parent H, Cavagna R, Vital JM, Bla- moutier A, et al. Applications in spinal imbalance. Orthop Traumatol Surg Res 2010 May 4. [Epub ahead of print]
7. Korovessis P, Repantis T, Papazisis Z, Iliopoulos P. Effect of sagittal spinal balance, levels of posterior instrumenta- tion, and length of follow-up on low back pain in patients undergoing posterior decompression and instrumented fusion for degenerative lumbar spine disease: a multifacto- rial analysis. Spine 2010;35:898-905. CrossRef
8. Lonner BS, Auerbach JD, Sponseller P, Rajadhyaksha AD, Newton PO. Variations in pelvic and other sagittal spinal parameters as a function of race in adolescent idio- pathic scoliosis. Spine 2010;35:E374-7.

9. Schwab F, Lafage V, Patel A, Farcy JP. Sagittal plane considerations and the pelvis in the adult patient. Spine 2009;34:1828-33. CrossRef
10. Hackenberg L, Link T, Liljenqvist U. Axial and tangen- tial fixation strength of pedicle screws versus hooks in the thoracic spine in relation to bone mineral density. Spine . 2002;27:937-42. CrossRef
11. Lee CS, Kim MJ, Ahn YJ, Kim YT, Jeong KI, Lee DH. Thoracic pedicle screw insertion in scoliosis using pos- teroanterior C-arm rotation method. J Spinal Disord Tech 2007;20:66-71. CrossRef
12. Liljenqvist U, Hackenberg L, Link T, Halm H. Pullout strength of pedicle screws versus pedicle and laminar hooks in the thoracic spine. Acta Orthop Belg 2001;67:157-63.
13. Wang VY, Chin CT, Lu DC, Smith JS, Chou D. Free- hand thoracic pedicle screws placed by neurosurgery resi- dents: a CT analysis. Eur Spine J 2010;19:821-7. CrossRef
14. Belmont PJ Jr, Klemme WR, Dhawan A, Polly DW Jr. In vivo accuracy of thoracic pedicle screws. Spine 2001;26:2340-6. CrossRef
15. Fisher CG, Sahajpal V, Keynan O, Boyd M, Graeb D, Bai- ley C, et al. Accuracy and safety of pedicle screw fixation in thoracic spine trauma. J Neurosurg Spine 2006;5:520-6.
16. Guzey FK, Emel E, Hakan Seyithanoglu M, Serdar Bas N, Ozkan N, Sel B, et al. Accuracy of pedicle screw place- ment for upper and middle thoracic pathologies without coronal plane spinal deformity using conventional meth- ods. J Spinal Disord Tech 2006;19:436-41. CrossRef
17. Suk SI, Kim WJ, Lee SM, Kim JH, Chung ER. Thoracic pedicle screw fixation in spinal deformities: are they really safe? Spine 2001;26:2049-57.