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Transpedicular screw insertion has become widely accepted for the correction of spinal deformity as well as degenerative and traumatic injury, but adoption of this technique has remained less widespread in the thoracic compared to the lumbar spine. This is thought to be associated with the relative technical difficulty of screw insertion into the narrower widths of the thoracic pedicles and the neurologic and mechanical risks associated with breach of the pedicle wall. The surgical decision making involves determining the appropriate sized screw for maximum fixation strength while simultaneously respecting the structural integrity of the vertebral pedicles to prevent a breach and provide better fixation. This paper presents a systematic review of criteria for thoracic pedicle screw diameter (SD) selection in order to orient inexperienced surgeons on the impact of this selection on pedicle breaching and fixation strength.

Currently Adopted Criteria for Pedicle Screw Diameter Selection