Sherif R, Spence EC, Smith J, McCarthy MJH. Intraoperative imaging adequacy and its impact on unplanned return-to-theatre rates in pedicle screw instrumentation. World J Orthop 2025; 16(3): 103955 [PMID: 40124730 DOI: 10.5312/wjo.v16.i3.103955]
Corresponding Author of This Article
Ramy Sherif, MD, Department of Spinal Surgery, University Hospital of Wales, Heath Park Way, Cardiff CF14 4XW, United Kingdom. rsherif1983@yahoo.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. Mar 18, 2025; 16(3): 103955 Published online Mar 18, 2025. doi: 10.5312/wjo.v16.i3.103955
Intraoperative imaging adequacy and its impact on unplanned return-to-theatre rates in pedicle screw instrumentation
Ramy Sherif, Ella Clifford Spence, Jessica Smith, Michael John Haydon McCarthy
Ramy Sherif, Department of Spinal Surgery, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
Ella Clifford Spence, Jessica Smith, Michael John Haydon McCarthy, Department of Spinal Surgery, Cardiff University, Cardiff CF14 4XW, United Kingdom
Author contributions: All authors designed and contributed to the conception, design, and drafting of the manuscript.
Institutional review board statement: This study did not require approval from an Institutional Review Board (IRB) as it involved a retrospective analysis of anonymized data. Since the data were de-identified and did not include any personally identifiable information, the study met the criteria for exemption from ethical approval under current regulations.
Informed consent statement: Informed consent was not required for this study as it involved a retrospective analysis of anonymized data. Since the data were de-identified and did not include any personally identifiable information, obtaining informed consent from individuals was not applicable.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest related to the research, authorship, and/or publication of this study. No financial, personal, or professional affiliations have influenced the design, conduct, analysis, or reporting of the research presented.
Data sharing statement:sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ramy Sherif, MD, Department of Spinal Surgery, University Hospital of Wales, Heath Park Way, Cardiff CF14 4XW, United Kingdom. rsherif1983@yahoo.com
Received: December 5, 2024 Revised: January 13, 2025 Accepted: February 18, 2025 Published online: March 18, 2025 Processing time: 97 Days and 10.5 Hours
Abstract
BACKGROUND
Pedicle screw instrumentation is a critical technique in spinal surgery, offering effective stabilization for various spinal conditions. However, the impact of intraoperative imaging quality—specifically the use of both anteroposterior (AP) and lateral views—on surgical outcomes remains insufficiently studied. Evaluating whether the adequacy of these imaging modalities affects the risk of unplanned returns to theatre (URTT) within 90 days due to screw malplacement is essential for refining surgical practices and improving patient care.
AIM
To evaluate how intraoperative imaging adequacy influences unplanned return-to-theatre rates, focusing on AP and lateral fluoroscopic views.
METHODS
This retrospective cohort study analyzed 1335 patients who underwent thoracolumbar and sacral pedicle screw instrumentation between January 2013 and December 2022. Data on intraoperative imaging adequacy, screw placement, and URTT events were collected and statistically analyzed using IBM SPSS v23. Imaging adequacy was assessed based on the presence of both AP and lateral views, and outcomes were compared between imaging groups.
RESULTS
A total of 9016 pedicle screws were inserted, with 82 screws identified as malplaced in 52 patients. Of these, 46 patients required URTT due to screw malplacement, with 37 returning within 90 days (URTT90). Patients with both AP and lateral imaging saved intraoperatively had significantly lower URTT90 rates compared to those with only lateral imaging saved, demonstrating the critical role of imaging adequacy in improving surgical outcomes.
CONCLUSION
This study underscores that comprehensive intraoperative imaging with both AP and lateral views reduces unplanned returns, improves outcomes, enhances precision, and offers a cost-effective approach for better spinal surgery results.
Core Tip: This study underscores the importance of adequate intraoperative imaging in minimizing unplanned returns to theatre rates within 90 days after pedicle screw instrumentation. The findings reveal that using both anteroposterior and lateral fluoroscopic views significantly reduces the risk of revision surgeries caused by screw malplacement. This approach provides a practical, cost-effective method to enhance surgical precision, improve patient safety, and optimize resource utilization, particularly in healthcare settings with limited access to advanced imaging technologies.
