The Awl-staple versus guidewire method for placing vertebral screws in thoracoscopic anterior spinal fusion and instrumentation for adolescent idiopathic scoliosis

STUDY DESIGN: A retrospective chart and radiograph review in a consecutive series of patients at a single institution. OBJECTIVE: To compare 2 methods of placing vertebral body screws in thoracoscopic anterior spinal fusion and instrumentation with respect to radiographic, clinical, and perioperative variables. SUMMARY OF BACKGROUND DATA: Placing vertebral body screws in thoracoscopic anterior spinal fusion and instrumentation for adolescent idiopathic scoliosis can be performed using 2 methods: the awl/staple technique and the guidewire method. There are no current studies that have compared both of these techniques. METHODS: Two groups of patients were analyzed depending on the method of screw placement: The AS group (n≤15) used the awl/staple method and the GW group (n≤27) used the guidewire method. Surgical times and estimated blood loss were obtained from the medical record. Fluoroscopy times were obtained from the radiology technician. Preoperative posteroanterior standing, bending, and immediate postoperative radiographs were examined to determine the primary curve magnitude, postoperative curve correction, curve flexibility, and the Lenke classification. RESULTS: The AS group had significantly less fluoroscopy times (156.6±71.4 vs. 328.±171. 6‰s) and operative times (416.1±65.4 vs. 505.6±61. 8‰min) compared with the GW group (P<0.05). When calculating the duration per fusion level, the AS group was also shorter for fluoroscopy times (27.1±13.2 vs. 49.3±24.5‰s/level) (P<0.05) and surgical times (72.0±15.2 vs. 76.9±9.8‰min/level) (P≤0.10). There was a trend toward a lower incidence of screw plow or pullout (0.0% vs. 14.8%) for the AS group (P≤0.157). CONCLUSIONS: The awl/staple technique is the preferred technique for placing vertebral body screws when performing thoracoscopic anterior spinal fusion/instrumentation because it has shorter fluoroscopy times, surgical times, and a lower incidence of screw plow/pullout than the traditional guidewire method.