ANATOMIC CONSIDERATIONS OF PEDICLE SCREW PLACEMENT IN THE THORACIC SPINE ROY-CAMILLE TECHNIQUE VERSUS OPEN-LAMINA TECHNIQUE

Study Design. In this cadaveric study, the outcomes of two techniques for pedicle screw placement in the thoracic spine were compared. Objec tives. To assess the Roy-Camille technique, and to determine whether p edicle screw placement, aided by partial laminectomy, could decrease t he incidence of pedicle violations. Summary of Background Data. Pedicl e screw fixation in the thoracic spine remains technically challenging . The Roy-Camille method may be one of the leading techniques of thora cic pedicle screw placement. However, there are few studies evaluating this technique and determining methods to decrease the incidence of t horacic pedicle penetration with screw insertion. Methods. Ten cadaver ic thoracic spines from T1 to T10 were used for pedicle screw placemen t. Two techniques of transpedicular screw placement were used, the Roy -Camille technique (screw placed on the right side; used in 95 screw p lacements) and the open-lamina technique screw placement with combined partial laminectomy (screw placed on the left side; used in 94 screw placements). After screw placement, all specimens were evaluated visua lly to determine violation of the pedicle. Results. The screw placemen t with the Roy-Camille technique had a higher percentage of pedicle vi olation (54.7%) than did that with the open-lamina technique (15.9%). No Grade III violation was seen in the screw placement with the open-l amina technique. Conclusions. The Roy-Camille technique was associated with a high incidence of pedicle violation, whereas screw placement w ith a partial laminectomy significantly reduced the incidence of pedic le violation. Pedicle screw fixation in the thoracic spine remains a t echnical challenge and should not be used routinely. Screw placement w ith the open-lamina technique is recommended if pedicle screw fixation is strongly indicated in the thoracic spine.