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World J Orthop. Apr 18, 2014; 5(2): 112-123
Published online Apr 18, 2014. doi: 10.5312/wjo.v5.i2.112
Techniques and accuracy of thoracolumbar pedicle screw placement
Varun Puvanesarajah, Jason A Liauw, Sheng-fu Lo, Ioan A Lina, Timothy F Witham
Varun Puvanesarajah, Jason A Liauw, Sheng-fu Lo, Ioan A Lina, Timothy F Witham, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
Author contributions: Puvanesarajah V, Liauw JA, Lo SF, Lina IA and Witham TF contributed to research and writing of this manuscript.
Supported by Gordon and Marilyn Macklin Foundation
Correspondence to: Timothy F Witham, MD, Department of Neurosurgery, Johns Hopkins Hospital, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, United States.
Telephone: +1-410-5022383 Fax: + 1-410-5023399
Received: November 30, 2013
Revised: February 11, 2014
Accepted: March 13, 2014
Published online: April 18, 2014
Core Tip

Core tip: Pedicle screws are currently placed in the thoracolumbar spine via three main techniques: free-hand, fluoroscopy guidance, and stereotactic navigation. Various studies have reported success with each of these techniques. However, it is clear that there is some difficulty in comparing such studies due to differing definitions of accuracy and methods of evaluation. Regardless, it is evident that image-assisted techniques provide some benefit when cannulating mid-thoracic vertebral levels and vertebrae that have altered morphology due to deformation from complex pathologies. However, a surgeon’s ultimate decision must be based on individual experience and comfort with a given technique.