The accuracy of multi-slice three-dimensional computerized tomography on the verification of the pedicle screw trajectory

The purpose of our study was to determine the diagnostic power of three-dimensional reformatted multi-slice computerized tomography (CT) images on misplaced pedicle screws in spinal surgery. Eighty-four consecutive patients with 458 screws in situ were investigated prospectively using both axial CT slices and reformatted images after operation by two blinded investigators. All the screw misplacements were documented and the differences between the two imaging modalities were recorded. Axial CT slices were able to show only 23 of 60 misplaced pedicle screws; multislice CT was three times more powerful in the diagnosis of pedicle screw complications in spinal surgery (p<0.05). We concluded that multi-slice CT reconstruction should be the primary diagnostic tool after screw implantation in the human spine.