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Caelers I, Berendsen R, Droeghaag R, Pecasse N, Rijkers K, Van Hemert W, De Bie R, Van Santbrink H. Comparing radiation dose of image-guided techniques in lumbar fusion surgery with pedicle screw insertion; A systematic review. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 13:100199. [PMID: 36747986 PMCID: PMC9898805 DOI: 10.1016/j.xnsj.2023.100199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
Background Context Fluoroscopic devices can be used to visualize subcutaneous and osseous tissue, a useful feature during pedicle screw insertion in lumbar fusion surgery. It is important that both patient and surgeon are exposed as little as possible, since these devices use potential harmful ionizing radiation. Purpose This study aims to compare radiation exposure of different image-guided techniques in lumbar fusion surgery with pedicle screw insertion. Study Design Systematic review. Methods Cochrane, Embase, PubMed and Web of Science databases were used to acquire relevant studies. Eligibility criteria were lumbar and/or sacral spine, pedicle screw, mGray and/or Sievert and/or mrem, radiation dose and/or radiation exposure. Image-guided techniques were divided in five groups: conventional C-arm, C-arm navigation, C-arm robotic, O-arm navigation and O-arm robotic. Comparisons were made based on effective dose for patients and surgeons, absorbed dose for patients and surgeons and exposure. Risk of bias was assessed using the 2017 Cochrane Risk of Bias tool on RCTs and the Cochrane ROBINS-I tool on NRCTs. Level of evidence was assessed using the guidelines of Oxford Centre for Evidence-based Medicine 2011. Results A total of 1423 studies were identified of which 38 were included in the analysis and assigned to one of the five groups. Results of radiation dose per procedure and per pedicle screw were described in dose ranges. Conventional C-arm appeared to result in higher effective dose for surgeons, higher absorbed dose for patients and higher exposure, compared to C-arm navigation/robotic and O-arm navigation/robotic. Level of evidence was 3 to 4 in 29 studies. Risk of bias of RCTs was intermediate, mostly due to inadequate blinding. Overall risk of bias score in NRCTs was determined as 'serious'. Conclusions Ranges of radiation doses using different modalities during pedicle screw insertion in lumbar fusion surgery are wide. Based on the highest numbers in the ranges, conventional C-arm tends to lead to a higher effective dose for surgeons, higher absorbed dose for patients and higher exposure, compared to C-arm-, and O-arm navigation/robotic. The level of evidence is low and risk of bias is fairly high. In future studies, heterogeneity should be limited by standardizing measurement methods and thoroughly describing the image-guided technique settings.
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Affiliation(s)
- I.J.M.H. Caelers
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands,Department of Neurosurgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, the Netherlands,Department of Neurosurgery, Maastricht University Medical Center+, Maastricht, the Netherlands,Corresponding author.
| | - R.C.M. Berendsen
- Department of Medical Physics, Zuyderland Medical Center, Sittard-Geleen/Heerlen, the Netherlands
| | - R. Droeghaag
- Department of Orthopedic surgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, the Netherlands
| | - N.J.J. Pecasse
- Biomedical Sciences, Faculty of Health, Medicine and Life Sciences, Maastricht University, the etherlands
| | - K. Rijkers
- Department of Neurosurgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, the Netherlands,Department of Neurosurgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - W.L.W. Van Hemert
- Department of Orthopedic surgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, the Netherlands
| | - R.A. De Bie
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands,Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - H. Van Santbrink
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands,Department of Neurosurgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, the Netherlands,Department of Neurosurgery, Maastricht University Medical Center+, Maastricht, the Netherlands
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Sitoci-Ficici KH, Jiang H, Esmael A, Ruess D, Reinshagen C, Brautferger U, Schackert G, Molcanyi M, Pinzer T, Hudak R, Zivcak J, Rieger B. Patient reported outcomes after navigated minimally invasive hybrid lumbar interbody fusion (nMIS-HLIF) using cortical bone trajectory screws. Medicine (Baltimore) 2022; 101:e31955. [PMID: 36550797 PMCID: PMC9771287 DOI: 10.1097/md.0000000000031955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 11/01/2022] [Indexed: 12/24/2022] Open
Abstract
Prospective observational study. To evaluate patient-reported outcomes after navigation-guided minimally invasive hybrid lumbar interbody fusion (nMIS-HLIF) for decompression and fusion in degenerative spondylolisthesis (Meyerding grade I-II). Posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) are well-known standard procedures for lumbar spinal fusion. nMIS-HLIF is a navigation-guided combined percutaneous and open procedure that combines the advantages of PLIF and TLIF procedures for the preparation of a single-port endoscopic approach. 33 patients underwent nMIS-HLIF. Core outcome measure index (COMI), oswestry disability index (ODI), numeric rating scale (NRS) back, NRS leg, and short form health-36 (SF-36) were collected preoperatively and at follow-up of 6 weeks, 3 months, 6 months, and 1 year. The impact of body mass index (BMI) was also analyzed. Computed tomography reconstruction was used to assess realignment and verify fused facet joints and vertebral bodies at the 1-year follow-up. 28 (85%) completed the 1-year follow-up. The median BMI was 27.6 kg/m2, age 69 yrs. The mean reduction in listhesis was 8.4% (P < .01). BMI was negatively correlated with listhesis reduction (P = .032). The improvements in the NRS back, NRS leg, ODI, and COMI scores were significant at all times (P < .001-P < .01). The SF-36 parameters of bodily pain, physical functioning, physical component summary, role functioning/physical functioning, and social functioning improved (P < .003). The complication rate was 15.2% (n = 5), with durotomy (n = 3) being the most frequent. To reduce the complication rate and allow transitioning to a fully endoscopic approach, expandable devices have been developed. The outcomes of nMIS-HLIF are comparable to the current standard open and minimally invasive techniques. A high BMI hinders this reduction. The nMIS-HLIF procedure is appropriate for learning minimally invasive dorsal lumbar stabilization. The presented modifications will enable single-port endoscopic lumbar stabilization in the future.
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Affiliation(s)
| | - Hongzen Jiang
- Department of Neurosurgery, Dresden University Hospital, Dresden, Germany
- University Comprehensive Spine Center, Dresden University Hospital, Dresden, Germany
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Agrin Esmael
- Department of Neurosurgery, Cologne University Hospital, Cologne, Germany
| | - Daniel Ruess
- Department of Stereotactic and Functional Neurosurgery, Cologne University Hospital, Cologne, Germany
| | - Clemens Reinshagen
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Uta Brautferger
- Department of Urology, Rostock University Hospital, Rostock, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, Dresden University Hospital, Dresden, Germany
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Marek Molcanyi
- Institute of Neurophysiology, Medical Faculty, University of Cologne, Cologne, Germany
- Department of Neurosurgery, Medical University of Graz, Graz, Austria
| | - Thomas Pinzer
- Department of Neurosurgery, Dresden University Hospital, Dresden, Germany
| | - Radovan Hudak
- Department of Biomedical Engineering, Technical University of Košice, Koišce-Sever, Slovakia
| | - Jozef Zivcak
- Department of Biomedical Engineering, Technical University of Košice, Koišce-Sever, Slovakia
| | - Bernhard Rieger
- Department of Neurosurgery, Dresden University Hospital, Dresden, Germany
- Department of Neurosurgery, Cologne University Hospital, Cologne, Germany
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- AMEOS Klinikum Halberstadt, Halberstadt, Germany
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Zhang H, Wang Z, Wang Y, Li Z, Chao B, Liu S, Luo W, Jiao J, Wu M. Biomaterials for Interbody Fusion in Bone Tissue Engineering. Front Bioeng Biotechnol 2022; 10:900992. [PMID: 35656196 PMCID: PMC9152360 DOI: 10.3389/fbioe.2022.900992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/21/2022] [Indexed: 12/04/2022] Open
Abstract
In recent years, interbody fusion cages have played an important role in interbody fusion surgery for treating diseases like disc protrusion and spondylolisthesis. However, traditional cages cannot achieve satisfactory results due to their unreasonable design, poor material biocompatibility, and induced osteogenesis ability, limiting their application. There are currently 3 ways to improve the fusion effect, as follows. First, the interbody fusion cage is designed to facilitate bone ingrowth through the preliminary design. Second, choose interbody fusion cages made of different materials to meet the variable needs of interbody fusion. Finally, complete post-processing steps, such as coating the designed cage, to achieve a suitable osseointegration microstructure, and add other bioactive materials to achieve the most suitable biological microenvironment of bone tissue and improve the fusion effect. The focus of this review is on the design methods of interbody fusion cages, a comparison of the advantages and disadvantages of various materials, the influence of post-processing techniques and additional materials on interbody fusion, and the prospects for the future development of interbody fusion cages.
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Affiliation(s)
- Han Zhang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Zhonghan Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
- Orthopaedic Research Institute of Jilin Province, Changchun, China
| | - Yang Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Zuhao Li
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
- Orthopaedic Research Institute of Jilin Province, Changchun, China
| | - Bo Chao
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Shixian Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Wangwang Luo
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jianhang Jiao
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Minfei Wu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
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Salchow-Gille M, Rieger B, Reinshagen C, Molcanyi M, Lemke J, Brautferger U, Sitoci-Ficici KH, Polanski W, Pinzer T, Schackert G. Prospective surgical solutions in degenerative spine: spinal simulation for optimal choice of implant and targeted device development. Innov Surg Sci 2021; 6:11-24. [PMID: 34966835 PMCID: PMC8668033 DOI: 10.1515/iss-2019-1002] [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: 12/24/2019] [Accepted: 01/11/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives The most important goal of surgical treatment for spinal degeneration, in addition to eliminating the underlying pathology, is to preserve the biomechanically relevant structures. If degeneration destroys biomechanics, the single segment must either be surgically stabilized or functionally replaced by prosthetic restoration. This study examines how software-based presurgical simulation affects device selection and device development. Methods Based on videofluoroscopic motion recordings and pixel-precise processing of the segmental motion patterns, a software-based surrogate functional model was validated. It characterizes the individual movement of spinal segments relative to corresponding cervical or lumbar spine sections. The single segment-based motion of cervical or lumbar spine of individual patients can be simulated, if size-calibrated functional X-rays of the relevant spine section are available. The software plug-in “biokinemetric triangle” has been then integrated into this software to perform comparative segmental motion analyses before and after treatment in two cervical device studies: the correlation of implant-induced changes in the movement geometry and patient-related outcome was examined to investigate, whether this surrogate model could provide a guideline for implant selection and future implant development. Results For its validation in 253 randomly selected patients requiring single-level cervical (n=122) or lumbar (n=131) implant-supported restoration, the biokinemetric triangle provided significant pattern recognition in comparable investigations (p<0.05) and the software detected device-specific changes after implant-treatment (p<0.01). Subsequently, 104 patients, who underwent cervical discectomy, showed a correlation of the neck disability index with implant-specific changes in their segmental movement geometry: the preoperative simulation supported the best choice of surgical implants, since the best outcome resulted from restricting the extent of the movement of adjacent segments influenced by the technical mechanism of the respective device (p<0.05). Conclusions The implant restoration resulted in best outcome which modified intersegmental communication in a way that the segments adjacent to the implanted segment undergo less change in their own movement geometry. Based on our software-surrogate, individualized devices could be created that slow down further degeneration of adjacent segments by influencing the intersegmental communication of the motion segments.
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Affiliation(s)
| | - Bernhard Rieger
- Short Care Clinic , Greifswald , Germany
- Klinikum Herford, Spine Surgery , Herford , Germany
- Department of Neurosurgery , University Hospital of Dresden , Dresden , Germany
- University Comprehensive Spine Center, University Hospital of Dresden , Dresden , Germany
| | - Clemens Reinshagen
- Department of Neurosurgery , Brigham and Women’s Hospital, Harvard Medical School , Boston , MA , USA
| | - Marek Molcanyi
- Institute of Neurophysiology, Medical Faculty, University of Cologne , Cologne , Germany
- Department of Neurosurgery , Research Unit for Experimental Neurotraumatology, Medical University Graz , Graz , Austria
| | | | - Uta Brautferger
- Department of Urology , University Hospital of Rostock , Rostock , Germany
| | | | - Witold Polanski
- Department of Neurosurgery , University Hospital of Dresden , Dresden , Germany
| | - Thomas Pinzer
- Department of Neurosurgery , University Hospital of Dresden , Dresden , Germany
| | - Gabriele Schackert
- Department of Neurosurgery , University Hospital of Dresden , Dresden , Germany
- University Comprehensive Spine Center, University Hospital of Dresden , Dresden , Germany
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Rieger B, Sitoci-Ficici KH, Reinshagen C, Brautferger U, Schackert G, Hudak R, Zivcak J, Molcanyi M, Pinzer T. Endoscopic and Microscopic Segmental Decompression via Translaminar Crossover Spinal Approach in Elderly Patients. World Neurosurg 2019; 125:e361-e371. [PMID: 30703594 DOI: 10.1016/j.wneu.2019.01.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/05/2019] [Accepted: 01/08/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE For effective minimally invasive lumbar decompression, we changed the routine of segmental decompression. Using a high-speed drill or an ultrasound knife, we created a working channel, starting at the base of the spinous process of the upper vertebra slightly above the disc level, to target and decompress the contralateral recess, and termed it the translaminar crossover decompression (TCD). We evaluated the feasibility and compared the outcomes of a navigation-guided endoscopic translaminar crossover approach for segmental decompression (eTCD) in elderly patients with microscopic decompression using the same approach (mTCD). METHODS A total of 740 elderly patients were enrolled in a prospective cohort study. Of the 740 patients, 297, who had undergone mTCD, and 253, who had undergone eTCD, completed a 1-year follow-up visit. In addition to the surgical data, numerical rating scales (NRSs) for back and leg pain, the Core Outcome Measures Index and Oswestry Disability Index were recorded preoperatively and 3, 6, and 12 months after surgery. The MacNab criteria were supplemented by qualitative assessment of the patients' postoperative pain-free walking distance. RESULTS A comparison of the preoperative and postoperative clinical scores showed significant improvement after TCD in both cohorts (P < 0.01): Oswestry Disability Index, from 50.3% ± 12.6% to 15.5% ± 7.43%; NRS (back), from 6.9 ± 1.9 to 2.5 ± 1.3; NRS (leg), from 8.0 ± 0.85 to 1.6 ± 0.33; Core Outcome Measures Index (back), from 7.8 ± 2.0 to 2.7 ± 1.5. No statistically significant differences were found in the outcomes between the 2 cohorts. CONCLUSIONS TCD inherently eliminated central stenosis and facilitated decompression of both recesses via mutual undercutting, with preservation of facet joint integrity.
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Affiliation(s)
- Bernhard Rieger
- Short Care Clinic, Greifswald, Germany; Department of Neurosurgery, Dresden University Hospital, Germany; University Comprehensive Spine Center, Dresden University Hospital, Germany.
| | - Kerim Hakan Sitoci-Ficici
- Department of Neurosurgery, Dresden University Hospital, Germany; University Comprehensive Spine Center, Dresden University Hospital, Germany
| | - Clemens Reinshagen
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Gabriele Schackert
- Department of Neurosurgery, Dresden University Hospital, Germany; University Comprehensive Spine Center, Dresden University Hospital, Germany
| | - Radovan Hudak
- Department of Biomedical Engineering, Technical University of Košice, Košice, Slovakia
| | - Jozef Zivcak
- Department of Biomedical Engineering, Technical University of Košice, Košice, Slovakia
| | - Marek Molcanyi
- Department of Neurosurgery, Medical University Graz, Austria; Institute of Neurophysiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Thomas Pinzer
- Department of Neurosurgery, Dresden University Hospital, Germany; University Comprehensive Spine Center, Dresden University Hospital, Germany
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Jiang H, Sitoci-Ficici KH, Reinshagen C, Molcanyi M, Zivcak J, Hudak R, Laube T, Schnabelrauch M, Weisser J, Schäfer U, Pinzer T, Schackert G, Zhang X, Wähler M, Brautferger U, Rieger B. Adjustable Polyurethane Foam as Filling Material for a Novel Spondyloplasty: Biomechanics and Biocompatibility. World Neurosurg 2018; 112:e848-e858. [PMID: 29410101 DOI: 10.1016/j.wneu.2018.01.174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate the biomechanics and biocompatibility of polyurethane (PU) foam with adjustable stiffness as a filling material for a novel spondyloplasty that is designed to reduce the risk of postoperative adjacent level fractures. METHODS Sixty individual porcine lumbar vertebrae were randomly split into 4 groups: A, B, C, and D. Group A served as unmodified vertebral body controls. Groups B, C, and D consisted of hollowed vertebral bodies. Vertebrae of groups C and D were filled with adjustable PU foams of different stiffness. The compressive strength and stiffness of vertebrae from groups A-D were recorded and analyzed. 3T3 mouse fibroblasts were cultured with preformed PU foams for 4 days to test biocompatibility. RESULTS The strength and stiffness of the hollowed groups were lower than in group A. However, the differences were not statistically significant between group A and group C (P > 0.05), and were obviously different between group A and group B or group D (P < 0.01 and <0.05, respectively). Moreover, the strength and stiffness after filling foams in group C or group D were significantly greater than in group B (P < 0.01 and <0.05, respectively). Live/dead staining of 3T3 cells confirmed the biocompatibility of the PU foam. CONCLUSIONS The new PU foam shows adaptability regarding its stiffness and excellent cytocompatibility in vitro. The results support the clinical translation of the new PU foams as augmentation material in the development of a novel spondyloplasty.
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Affiliation(s)
- Hongzhen Jiang
- Department of Neurosurgery, University Hospital of Dresden, Dresden, Germany; University Comprehensive Spine Center, University Hospital of Dresden, Dresden, Germany; Department of Orthopedic Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China; Minimal Invasive Spine Surgery Center, Chinese PLA General Hospital, Beijing, China
| | | | - Clemens Reinshagen
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marek Molcanyi
- Institute of Neurophysiology, Medical Faculty, University of Cologne, Cologne, Germany; Department of Neurosurgery, Medical University of Graz, Graz, Austria
| | - Jozef Zivcak
- Department of Biomedical Engineering, Technical University of Kosice, Kosice, Slovakia
| | - Radovan Hudak
- Department of Biomedical Engineering, Technical University of Kosice, Kosice, Slovakia
| | | | | | | | - Ute Schäfer
- Research Unit for Experimental Neurotraumatology, Medical University of Graz, Graz, Austria
| | - Thomas Pinzer
- Department of Neurosurgery, University Hospital of Dresden, Dresden, Germany; University Comprehensive Spine Center, University Hospital of Dresden, Dresden, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, University Hospital of Dresden, Dresden, Germany; University Comprehensive Spine Center, University Hospital of Dresden, Dresden, Germany
| | - Xifeng Zhang
- Minimal Invasive Spine Surgery Center, Chinese PLA General Hospital, Beijing, China
| | | | | | - Bernhard Rieger
- Department of Neurosurgery, University Hospital of Dresden, Dresden, Germany; University Comprehensive Spine Center, University Hospital of Dresden, Dresden, Germany; Lütten Klein Clinic, Rostock, Germany; Task Force Prospective Spine, Cologne, Germany; Short Care Clinic, Greifswald, Germany.
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