article · International Journal of Advances in Medicine
Pedicle screw insertion is critical for stabilising traumatic lumbar spine injuries, but surgical planning typically relies on computed tomography, which can be inaccessible in resource-limited settings. This prospective clinical evaluation tested magnetic resonance imaging as a radiation-free planning tool for choosing screw length. Surgeons measured pedicle-vertebral body length on preoperative scans to target at least seventy-five percent vertebral body purchase across two hundred screws inserted into lumbar levels one through five. The imaging measurements correlated strongly with final screw lengths. Postoperative scans confirmed an overall screw placement accuracy of ninety-two percent, while eighty-six percent of screws achieved the targeted purchase. Longer screws delivered greater purchase depth but showed a marginally higher rate of cortical breach. These clinical results demonstrate that magnetic resonance imaging provides a dependable substitute for preoperative computed tomography when planning lumbar screw fixation.
Surgeons treating spinal fractures need accurate imaging to select correct screw sizes and avoid dangerous surgical complications. In healthcare facilities where computed tomography scanners are unavailable or unaffordable, using magnetic resonance imaging ensures patients can still receive safe, well-planned spinal surgeries. This approach also eliminates surgical planning radiation exposure while maintaining high rates of screw placement accuracy and structural hold.
This study demonstrates an applied, clinically tested surgical planning protocol rather than a standalone commercial product. Orthopaedic and neurosurgical teams in resource-constrained hospitals can immediately adopt this technique using existing magnetic resonance imaging infrastructure. The methodology could also inform the development of digital surgical planning software or medical imaging protocols tailored specifically to environments lacking routine access to computed tomography scanners.
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Background: Accurate preoperative determination of pedicle screw length is essential for safe and effective spinal stabilisation in traumatic lumbar injuries. In resource‑limited settings where computed tomography (CT) may be unavailable, magnetic resonance imaging (MRI) offers a radiation‑free alternative. This prospective study evaluated the utility of MRI for predicting pedicle screw length, vertebral body purchase, and screw accuracy in traumatic lumbar spine injuries. Methods: A prospective study was conducted at National Orthopaedic Hospital Dala, Kano, from January 2025 to December 2025. Two hundred pedicle screws (6.5 mm diameter; lengths 40 mm, 45 mm, and 50 mm) were inserted in patients with traumatic lumbar fractures (L1-L5). Preoperative MRI measured the pedicle‑vertebral body length (PVBL). Screw length was selected to achieve ≥75% vertebral body purchase. Postoperative CT assessed screw accuracy using the Gertzbein‑Robbins classification, with inter‑observer agreement calculated. Results: Mean PVBL was 44.8±3.6 mm (range 38-54 mm), with significant variation across lumbar levels: L1 42.4±3.1 mm, L2 43.8±3.4 mm, L3 45.2±3.5 mm, L4 46.8±3.7 mm, and L5 45.6±3.9 mm. MRI‑predicted PVBL showed strong correlation with actual screw length (Pearson’s r=0.89, p<0.001). Vertebral body purchase ≥75% was achieved in 172 screws (86.0%). Screw accuracy (Gertzbein‑Robbins grades A/B) was 92.0% (184/200), with inter‑observer agreement of κ=0.87 (95% CI: 0.82-0.92). The 50 mm screws achieved the highest purchase (78.4±4.2%) but had a slightly higher breach rate (6.0%) compared with 45 mm screws (4.5%). Conclusions: MRI‑based preoperative planning effectively predicts pedicle screw length and achieves ≥75% vertebral body purchase in 86% of traumatic lumbar injuries. The strong correlation between MRI‑predicted PVBL and actual screw length supports MRI as a viable alternative to CT in resource‑limited settings, with high screw accuracy confirmed on postoperative CT.
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DOI: 10.18203/2349-3933.ijam20262829
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