Table 1.
Review of the literature on screw perforation and neurovascular injury
| Author | Method of insertion | No. of screws (No. of patients) | No. of breached screws (rate) | Grading system of breached screws | Neurovascular injury | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Vertebral artery injury | Nerve root injury | ||||||||||
| Abumi et al.39) | Lateral fluoroscopy | 669 (180) | 45 (6.7%) | 1 | 2 | ||||||
| Yoshimoto et al.27) | Lateral fluoroscopy | 134 (26) | 15 (11.1%) | Partial (<1/2 of screw diameter) | Complete (>1/2 of screw diameter) | 0 | 0 | ||||
| 10 (7.4%) | 5 (3.7%) | ||||||||||
| Yukawa et al.31) | Pedicle axis view by fluoroscopy | 620 (144) | 81 (13.1%) | Screw exposure (<1/2 of screw diameter) | Pedicle perforation (>1/2 of screw diameter) | 1 | 1 | ||||
| 57 (9.2%) | 24 (3.9%) | ||||||||||
| Kotani et al.44) | CT navigation | 78 (17) | 1 (1.2%) | 0 | 0 | ||||||
| Ito et al.43) | 3D navigation (Iso-C3D) | 176 (50) | 5 (2.8%) | Grade 1 (no perforation) | Grade 2 (≤2 mm) | Grade 3 (>2 mm) | 0 | 0 | |||
| 171 (97.2%) | 5 (2.8%) | 0 (0%) | |||||||||
| Ishikawa et al.41) | Lateral fluoroscopy | 126 (30) | 34 (27%) | Grade 0 (no perforation) | Grade 1 (<1 mm) | Grade 2 (≥1 and <2 mm) | Grade 3 (≥2 mm) | 1 | 0 | ||
| 92 (73.0%) | 12 (9.5%) | 6 (4.8%) | 16 (12.7%) | ||||||||
| 3D navigation (Iso-C3D) | 150 (32) | 28 (18.7%) | Grade 0 (no perforation) | Grade 1 (<1 mm) | Grade 2 (≥1 and <2 mm) | Grade 3 (≥2 mm) | 1 | 0 | |||
| 122 (81.3%) | 17 (11.3%) | 6 (4%) | 5 (3.3%) | ||||||||
| Ishikawa et al.42) | 3D navigation (O-arm) | 108 (21) | 12 (11.1%) | Grade 0 (no perforation) | Grade 1 (<2 mm) | Grade 2 (≥2 and <4 mm) | Grade 3 (>4 mm) | ||||
| 96 (88.9%) | 9 (8.3%) | 3 (2.8%) | 0 (0%) | ||||||||
| Chachan et al.40) | 3D navigation (O-arm) | 241 (44) | 17 (7.05%) | Grade 0 (no perforation) | Grade 1 (<2 mm) | Grade 2 (≥2 and <4 mm) | Grade 3 (>4 mm) | 0 | 0 | ||
| 224 (92.95%) | 10 (4.15%) | 7 (2.90%) | 0 (0%) | ||||||||
| Jo et al.46) | Laminoforaminotomy | 104 (12) | 29 (27.9%) | Grade 0 (no perforation) | Grade 1 (<25% of screw diameter) | Grade 2 (25–50% of screw diameter) | Grade 3 (>50% of screw diameter) | 0 | 0 | ||
| 75 (72.1%) | 20 (19.2%) | 6 (5.8%) | 3 (2.9%) | ||||||||
| Lu et al.36) | 3D-template | 88 (25) | 17 (19.3%) | Grade 0 (no perforation) | Grade 1 (<2 mm) | Grade 2 (≥2 and <4 mm) | Grade 3 (>4 mm) | 0 | 0 | ||
| 71 (80.7%) | 14 (15.9%) | 3 (3.4%) | 0 (0%) | ||||||||
| Kaneyama et al.47) | 3D-template | 80 (20) | 2 (2.5%) | Grade 0 (no perforation) | Grade 1 (<50% of screw diameter) | Grade 2 (>50% of screw diameter) | Grade 3 (complete perforation) | 0 | 0 | ||
| 78 (97.5%) | 2 (2.5%) | 0 (0%) | 0 (0%) | ||||||||
| Park et al.26,30,48) | Freehand | 979 (162) | 38 (3.8%) | Grade 0 (no perforation) | Grade 1 (not violating the largest diameter of VA foramen) | Grade 2 (violating the largest diameter of VA foramen) | Grade 3 (complete occlusion of VA foramen) | 0 | 0 | ||
| 941 (96.2%) | 25 (2.6%) | 5 (0.5%) | 0 | ||||||||