Effect of pedicle morphology on screw placement method in adolescent idiopathic scoliosis surgery

Introduction: Adolescent idiopathic scoliosis is common in society and is among the major surgeries of the orthopedic department. Different techniques are used when placing pedicle screws in patients diagnosed with AIS. Since 3D navigation techniques are expensive and the amount of radiation dose is high, and the free hand technique is based only on experience and knowledge, surgeons He feels the need for intraoperative fluoroscopy. In this study, we tried to reveal where the need for intraoperative fluoroscopy will occur according to the vertebral morphology. Materials and methods: Our study was planned on the scoliosis surgery of patients diagnosed with AIS in our clinic. Preoperative computed tomography was taken for these patients and images were prepared. These images were used in the intraoperative process. During the surgery, we started with the free hand technique and fluoroscopy assistance was received if necessary. Basically, the levels that require fluoroscopy are determined. Vertebral morphologies were revealed. Results: 30 patients were included in the study. A total of 657 pedicle screws were placed in 30 patients. We found a relationship between the decrease in pedicle diameter and the need for fluoroscopy with p = 0.00 in the pedicle screws in which we used intraoperative fluoroscopy. We did not find a relationship between the increase in the amount of vertebral rotation and the need for fluoroscopy. This was also determined by intraoperative computerized analysis. We thought it was related to the use of tomography images. Conclusions: We argue that the vertebral morphology obtained by computerized tomography while placing pedicle screws in patients diagnosed with adolescent idiopathic scoliosis will facilitate the surgeon who will perform the procedure, reduce the use of fluoroscopy, improve the surgical time and reduce the amount of complications.