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Bhogal H, Martinov S, Buteau P, Bath O, Hernigou J. Bone conductivity and spine fluoroscopy, Hand-Eye-Ear dialogue, during pedicle screw positioning: a new human cognitive system for precision and radiation-decrease; better than artificial intelligence and machine learning system? INTERNATIONAL ORTHOPAEDICS 2023; 47:421-428. [PMID: 35931830 DOI: 10.1007/s00264-022-05533-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/24/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE There is an increasing need for pedicle screw positioning while decreasing radiation exposure. This study compares intra-operative radiation dose using posterior internal fixation using impedancemetry-guided pedicle positioning by the Pediguard system versus standard free-hand sighting when surgery was performed with a trainee or expert surgeon. MATERIAL AND METHODS Using the electrical properties of bone, the Pediguard detects iatrogenic penetration of the pedicle wall and gives auditory feedback to the surgeon. A single centre, two surgeons (one experienced and the other novice) conducted a continuous prospective randomized study for one year. Twenty patients were randomized into one group (free-hand control group) receiving pedicle instrumentation without the use of the Pediguard and the second group receiving pedicle instrumentation with the use of the Pediguard. The total screw placement times and fluoroscopic times for each screw was recorded and pedicle screw position was analyzed on post-operative CT scan. RESULTS Among the 104 screwed pedicles, 22 unrecognized perforations were detected by CT scan, while no perforation signal was observed intra-operatively. Only one perforation was greater than 2 mm. The overall screwing time was 4.33 ± 1.2 minutes per screw for experienced surgeon and 5.84 ± 2.5 minutes per screw for the novice. Pediguard did not increased significantly the time (0.3 mn per screw) for the experienced surgeon, but the time with Pediguard was longer (2 mn more per screw) for the novice surgeon, particularly at the thoracic level. The overall fluoroscopic average time per screw for the experienced surgeon is 5.8 ± 2.3 s and 10.4 ± 4.5 s for the novice surgeon. For the novice surgeon, radiation time reduced from 12 (without Pediguard) to 6 s (with Pediguard). There was no significant difference for the experienced surgeon in terms of improvement in radiation time with the use of Pediguard. CONCLUSION The overall time was longer for the novice surgeon with the Pediguard system, but allowed to decrease by 50% the fluoroscopy time.
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Affiliation(s)
- Harkirat Bhogal
- Orthopedic Department, EpiCURA Baudour Hornu Ath Hospital, Saint-Ghislain, Hainaut, Belgium
| | - Sagi Martinov
- Orthopedic Department, EpiCURA Baudour Hornu Ath Hospital, Saint-Ghislain, Hainaut, Belgium
| | - Pauline Buteau
- Orthopedic Department, EpiCURA Baudour Hornu Ath Hospital, Saint-Ghislain, Hainaut, Belgium
| | - Olivier Bath
- Orthopedic Department, EpiCURA Baudour Hornu Ath Hospital, Saint-Ghislain, Hainaut, Belgium
| | - Jacques Hernigou
- Orthopedic Department, EpiCURA Baudour Hornu Ath Hospital, Saint-Ghislain, Hainaut, Belgium. .,Université Libre de Bruxelles, Bruxelles, Belgium.
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Wang YD, A RN, Xu YY, Li ZJ, Jin F, Wu C, Zhang YF, He YJ, Gao MJ, Guan HH, Dai LN, Wang HY, Li XH. Three-dimensional digital measurement of the facet joint in normal and lumbar intervertebral disc herniation aged 13-18 years. Asian J Surg 2021; 45:269-276. [PMID: 34158200 DOI: 10.1016/j.asjsur.2021.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/07/2021] [Accepted: 05/20/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Lumbar facet joint is an important element of spinal "three-joint complex". Whether there is a relationship between strange structure of facet joint and adolescent lumbar disc herniation (ALDH) is nonetheless controversial, and the current research is mainly centered on adults. OBJECTIVE To find out the normal lumbar facet joints between 13 and 18 years old to provide anatomical basis for early diagnosis and therapy of lumbar disc herniation. METHODS CT imaging information of 32 sufferers with lumbar disc herniation aged from 13 to 18 years old in Inner Mongolia have been collected as the ALDH group, and 62 wholesome subjects in the equal period had been chosen as the normal group. Uncooked records of continuous scanning lumbar tomography pix were imported into MIMICS 21.0 for evaluation and size in DICOM format. The parameters include facet joint height, facet joint width, et al. RESULTS 1. The left and right transverse angle of L5S1 segment in the ALDH group were (52.41 ± 9.2) ° and (55.99 ± 10.91) ° (P < 0.05), and the differences were statistically significant. The right side is larger than the left side. 2. Facet joint thickness in L3-L5 segment of the normal group was significantly higher than that of male (1.63 ± 0.32) mm than that of female (1.38 ± 0.25) mm; In 16-18 years old group, comparison of facet joint cross-sectional area was statistically significant (22.1 ± 3.04) mm2 in male than (18.92 ± 3.71) mm2 in female. 3. In comparison between normal and ALDH group, there was significant difference in L3-4 transverse angle (P < 0.05), L4-5 facet joint height and facet joint thickness (P < 0.05), L5S1 facet joint thickness and transverse angle (P < 0.05). CONCLUSION When ALDH occurs in the L5S1 segment, there is a substantial difference between the left and right sides of the transverse angle, and there is a difference in the thickness and the facet joint cross-sectional area between males and females, which is generally larger in males than in females. Facet joint height is larger, transverse angle of left and right is asymmetric, inferior articular process is larger, and facet joint thickness is smaller can indicate that lumbar disc herniation is effortless to occur.
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Affiliation(s)
- Yi-Dan Wang
- Graduate School of Inner Mongolia Medical University, Hohhot, 010110, PR China
| | - Ru-Na A
- College of Mongolian Medicine, Inner Mongolia Medical University, Hohhot, 010110, PR China
| | - Yang-Yang Xu
- Department of Physiatry, Changzhi People's Hospital, Changzhi, 046000, PR China
| | - Zhi-Jun Li
- Department of Anatomy, College of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010110, PR China
| | - Feng Jin
- Department of Imaging, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010110, PR China
| | - Chao Wu
- Graduate School of Inner Mongolia Medical University, Hohhot, 010110, PR China; Imaging Department of Baotou Central Hospital, Baotou, 014000, PR China
| | - Yun-Feng Zhang
- Department of Imaging, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010055, PR China
| | - Yu-Jie He
- Department of Physiatry, Changzhi People's Hospital, Changzhi, 046000, PR China
| | - Ming-Jie Gao
- Graduate School of Inner Mongolia Medical University, Hohhot, 010110, PR China; Department of Physiatry, Changzhi People's Hospital, Changzhi, 046000, PR China
| | - Huan-Huan Guan
- Graduate School of Inner Mongolia Medical University, Hohhot, 010110, PR China
| | - Li-Na Dai
- Department of Physiatry, Changzhi People's Hospital, Changzhi, 046000, PR China
| | - Hai-Yan Wang
- Department of Physiatry, Changzhi People's Hospital, Changzhi, 046000, PR China.
| | - Xiao-He Li
- Department of Physiatry, Changzhi People's Hospital, Changzhi, 046000, PR China.
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Amaral R, Pimenta L, Netto AG, Pokorny GH, Fernandes R. Parafusos pediculares e violação facetária – A importância do ângulo entre a faceta e o parafuso. Rev Bras Ortop 2020; 55:642-648. [PMID: 33093731 PMCID: PMC7575402 DOI: 10.1055/s-0040-1709200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/27/2020] [Indexed: 11/09/2022] Open
Abstract
Objective
To verify whether, regardless of the screw placement technique, there is a safe distance or angle in relation to the facets that can prevent violation of the facet joint when the screws are placed.
Methods
Retrospective, single, comparative, non-randomized center. We evaluated by axial computed tomography: the angle of the screw/rod in relation to the midline, the angle of the center of the facets in relation to the midline, the distance between the head of the screw/rod to the midline, and the distance from the center of the facets to the midline; the violation of the facet joint will be evaluated in a gradation of 0 to 2. Also will be measured the difference between the angle os the facets and the angle of the screws (Δ Angle) and, the difference between the facet distance and the screw distance (Δ Distance).
Results
A total of 212 patients and 397 facets were analyzed (196 on the left and 201 on the right). Of these, 303 were not violated (grade 0), corresponding to 76,32%, and 94 suffered some type of violation (grade 1 and 2), corresponding to 23,68%. The mean of Δ angle was 9.87° +/− 4.66° (grade 0), and of 3.77° +/− 4.93° in facets (grade 1 and 2) (
p
< 0.001), and the Δ mean distance in cases in which there was no violation was 0.94 arbitrary units (a.u.) +/− 0.39 a.u., while the Δ distance in G1 and G2 cases was 0.56 a.u. +/− 0.25 a.u. (
p
< 0.001).
Conclusion
The measurements of angle and distance between facet and screw can help in the placement of screws. These parameters can be used as safety measures with the most frequent use of surgical navigation techniques.
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Affiliation(s)
- Rodrigo Amaral
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brasil
| | - Luiz Pimenta
- Instituto de Patologia da Coluna (IPC), São Paulo, SP, Brasil
- University of California, UCSD, San Diego, CA, Estados Unidos da América
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Chen W, Zhang Y. Prominent and fruitful development of orthopaedic research in China. INTERNATIONAL ORTHOPAEDICS 2018; 42:455-459. [PMID: 29478208 DOI: 10.1007/s00264-018-3840-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Wei Chen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.,Hebei Institute of Orthopaedics and Traumatology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yingze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Hebei Institute of Orthopaedics and Traumatology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Chinese Academy of Engineering, Beijing, 100088, People's Republic of China.
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