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Wolff S, Adler S, Eppler E, Fischer K, Lux A, Rothkötter HJ, Skalej M. Correlation of CT-based bone mineralization with drilling-force measurements in anatomical specimens is suitable to investigate planning of trans-pedicular spine interventions. Sci Rep 2024; 14:1579. [PMID: 38238459 PMCID: PMC10796759 DOI: 10.1038/s41598-023-50204-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/16/2023] [Indexed: 01/22/2024] Open
Abstract
This interdisciplinary study examined the relationship between bone density and drilling forces required during trans-pedicular access to the vertebra using fresh-frozen thoraco-lumbar vertebrae from two female body donors (A, B). Before and after biomechanical examination, samples underwent high-resolution CT-quantification of total bone density followed by software-based evaluation and processing. CT density measurements (n = 4818) were calculated as gray values (GV), which were highest in T12 for both subjects (GVmaxA = 3483.24, GVmaxB = 3160.33). Trans-pedicular drilling forces F (Newton N) were highest in L3 (FmaxB = 5.67 N) and L4 (FmaxA = 5.65 N). In 12 out of 13 specimens, GVs significantly (p < 0.001) correlated with force measurements. Among these, Spearman correlations r were poor in two lumbar vertebrae, fair in five specimens, and moderately strong in another five specimens, and highest for T11 (rA = 0.721) and L5 (rB = 0.690). Our results indicate that CT-based analysis of vertebral bone density acquired in anatomical specimens is a promising approach to predict the drilling force appearance as surrogate parameter of its biomechanical properties by e.g., linear regression analysis. The study may be of value as basis for biomechanical investigations to improve planning of the optimal trajectory and to define safety margins for drilling forces during robotic-assisted trans-pedicular interventions on the spine in the future.
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Affiliation(s)
- Stefanie Wolff
- Clinic for Internal Medicine, Municipal Hospital St. Georg Leipzig, Delitzscher Straße 141, 04129, Leipzig, Germany
- Clinic of Neuroradiology, University Hospital Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Simon Adler
- Automatisation and Informatics, Harz University of Applied Sciences, Friedrichstraße 57-59, 38855, Wernigerode, Germany
- Fraunhofer Institute for Factory Operation and Automation IFF, Sandtorstraße 22, 39106, Magdeburg, Germany
| | - Elisabeth Eppler
- Institute of Anatomy, University of Bern, Baltzerstraße 2, 3012, Bern, Switzerland
- Institute of Anatomy and Cell Biology, University of Halle-Wittenberg, Große Steinstraße 52, 06108, Halle (Saale), Germany
| | - Karin Fischer
- Institute of Anatomy, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Anke Lux
- Institute of Biometry and Medical Informatics, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Hermann-Josef Rothkötter
- Institute of Anatomy, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Martin Skalej
- Clinic of Neuroradiology, University Hospital Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany.
- Neuroradiology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
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2
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Ye SQ, Zhao LJ, Hou ZP, Zhang JH, Yu L, Gu YJ. Measurement of anatomical parameters of anterior transpedicular root screw intervertebral fusion system of cervical spine. BMC Musculoskelet Disord 2023; 24:905. [PMID: 37990231 PMCID: PMC10662538 DOI: 10.1186/s12891-023-06995-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/28/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE This study aims to investigate the feasibility of the anterior transpedicular root screw (ATPRS) intervertebral fusion system for the cervical spine and provide a basis for the design of the ATPRS intervertebral fusion system. METHODS A total of 60 healthy adult cervical spine CT images examined from our hospital were selected, including 30 males and 30 females, with an average age of 39.6 ± 4.8 years. The image data was imported into Mimics 21.0 software in DICOM format for 3D model reconstruction. Simulated screw insertion was performed on both sides of the midline of the intervertebral space. The entry point (P1) was determined when the upper and lower screw paths did not overlap. When the screw was tangent to the medial edge of the Luschka joint, the insertion point was determined as the entry point (P2). Measurements were taken and recorded for the following parameters: distance from the screw entry point to the midline of the intervertebral space (DPM), the simulated screw length, inclination angle, cranial/caudal tilted angle, the anterior-posterior (AP) and mediolateral (ML) diameters of the cervical intervertebral space, the heights of the anterior, middle, and posterior edges of the cervical intervertebral space, and the curvature diameter of the lower end plate of the cervical vertebral body. Statistical analysis was performed on the measurement results. RESULTS The screw entry area (P1P2) showed an increasing trend from C3-C7 in both male (2.92-6.08 mm) and female (2.32-5.12 mm) groups. There were statistical differences between men and women at the same level (P < 0.05). The average screw length of men and women was greater than 20 mm, and the upper and lower screw lengths showed an increasing trend from C3 to C7. In the area where screws could be inserted, the range of screw inclination was as follows: male group upper screw (47.73-66.76°), lower screw (48.05-65.35°); female group upper screw (49.15-65.66°) and lower screw (49.42-63.29°); The range of cranial/caudal tilted angle of the screw was as follows: male group upper screw (32.06-39.56°), lower screw (29.12-36.95°); female group upper screw (30.97-38.92°) and lower screw (27.29-37.20°). The anterior-posterior diameter and mediolateral diameter of the cervical intervertebral space showed an increasing trend from C3 to C7 in both male and female groups. The middle height (MH) of the cervical intervertebral space was greater than the anterior edge height (AH) and posterior edge height (PD), with statistical differences (P < 0.05). CONCLUSIONS Through the study of CT images of the cervical spine, it was determined that the ATPRS intervertebral fusion system has a feasible area for screw insertion in the cervical intervertebral space.
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Affiliation(s)
- Sen-Qi Ye
- Department of Spinal Surgery, Yuyao People's Hospital, Ningbo, 315499, Zhejiang Province, China
| | - Liu-Jun Zhao
- Department of Spinal Surgery, Ningbo No.6 hospital of Ningbo University, Ningbo, Zhejiang Province, 315040, China.
| | - Zhi-Peng Hou
- Health Science Center, Ningbo University, Ningbo, 315211, Zhejiang Province, China
| | - Ji-Hui Zhang
- Department of Spinal Surgery, Ningbo No.6 hospital of Ningbo University, Ningbo, Zhejiang Province, 315040, China
| | - Liang Yu
- Department of Spinal Surgery, Ningbo No.6 hospital of Ningbo University, Ningbo, Zhejiang Province, 315040, China
| | - Yong-Jie Gu
- Department of Spinal Surgery, Ningbo No.6 hospital of Ningbo University, Ningbo, Zhejiang Province, 315040, China
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3
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Zhai X, Li B, Chen K, Chen Z, Shao J, Chen K, Xu Q, Meng D, Fei Q, Jiang L, Bai Y, Li M. Spine Surgery with Electronic Conductivity Device: A Prospectively Multicenter Randomized Clinical Trial and Literature Review. Orthop Surg 2023; 15:2872-2880. [PMID: 37735987 PMCID: PMC10622289 DOI: 10.1111/os.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE Improving accuracy and safety of pedicle screw placement is of great clinical importance. Electronic conductivity device (ECD) can be a promising technique with features of affordability, portability, and real-time detection capabilities. This study aimed to validate the safety and effectiveness of a modified ECD. METHODS The ECD underwent a modification where six lamps of various colors, and it was utilized in a prospectively multicenter randomized controlled clinical trial involving 96 patients across three hospitals from June 2018 to December 2018. The trial incorporated a self-control randomization with an equal distribution of left or right side of vertebral pedicle among two groups: the free-hand group and the ECD group. A total of 496 pedicle screws were inserted, with 248 inserted in each group. The primary outcomes focused on the accuracy of pedicle screw placement and the frequency of intraoperative X-rays. Meanwhile, the secondary indicator measured the time required for pedicle screw placement. Results were presented as means ± SD. Paired samples t-test and χ2 -test were used for comparison. Furthermore, an updated review was conducted, which included studies published from 2006 onwards. RESULTS Baseline patient characteristics were recorded. The primary accuracy outcome revealed a 96.77% accuracy rate in the ECD group, compared to a 95.16% accuracy rate in the free-hand group, with no significant differences noted. In contrast, ECD demonstrated a significant reduction in radiation exposure frequency when compared to the free-hand group (1.11 ± 0.32 vs. 1.30 ± 0.53; p < 0.001), resulting in a 14.6% reduction. Moreover, ECD displayed a decrease of 30.38% in insertion time (70.88 ± 30.51 vs. 101.82 ± 54.00 s; p < 0.001). According to the results of the 21 studies, ECD has been utilized in various areas of the spine such as the atlas, thoracic and lumbar spine, as well as sacral 2-alar-iliac. The accuracy of ECD ranged from 85% to 100%. CONCLUSION The prospectively randomized trial and the review indicate that the use of ECD presents a secure and precise approach to the placement of pedicle screws, with the added benefit of reducing both procedure time and radiation exposure.
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Affiliation(s)
- Xiao Zhai
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Bo Li
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Kai Chen
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Ziqiang Chen
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Jie Shao
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Kai Chen
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Qintong Xu
- Department of Orthopaedic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Dehua Meng
- Department of Orthopaedic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Qinming Fei
- Department of Orthopaedic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Leisheng Jiang
- Spine Center, Xinhua HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yushu Bai
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Ming Li
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
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Ding B, Zhou T, Ma H, Zhao J. A novel radiographic analysis system for subaxial cervical spine pedicle screw placement. J Orthop Surg Res 2023; 18:581. [PMID: 37553693 PMCID: PMC10408217 DOI: 10.1186/s13018-023-03999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Precise pedicle screw placement of the subaxial cervical spine is difficult. Not every hospital is equipped with a guidance system that can provide effective help. Computed tomography (CT) scanning is almost a routine preoperative examination for cervical spine surgery in all hospitals. Appropriate measurement and analysis of the CT images could assist optimal cervical pedicle screw placement. The purpose of this study is to propose a new and universal method using computed tomography (CT) morphological parameters analysis to assist optimal cervical pedicle screw placement from C3 to C7. METHODS A localization system with six parameters was designed based on preoperative CT reconstruction to guide subaxial cervical spine pedicle screw placement. The six parameters were distance from the starting point to the midline [D1], distance from the starting point to the lower edge of the inferior articular process [D2], transverse section angle [TSA], sagittal section angle [SSA], pedicle width [PW], and pedicle height [PH]. The six parameters were analyzed in 53 participants. RESULTS Combining D1 and D2 could localize the entrance of the pedicle screw, and we concluded that D1 and TSA and D2 and SSA could be a new standard for determination of the transverse and sagittal orientation of the pedicle screw. The six parameters were closely related to the patient's gender, height, and weight. PH and PW were linearly correlated and could guide selection of the appropriate pedicle screw. SSA was an independent parameter of the relevant vertebral body, and changes in SSA had nothing to do with the curvature or posture of the cervical spine. CONCLUSIONS Understanding and applying the six-parameter localization system are essential for achieving accurate and optimal pedicle screw placement in subaxial cervical spine, regardless of cervical sagittal alignment.
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Affiliation(s)
- Baozhi Ding
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai, People's Republic of China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China
| | - Tangjun Zhou
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai, People's Republic of China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China
| | - Hui Ma
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai, People's Republic of China.
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China.
| | - Jie Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai, People's Republic of China.
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China.
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Soliman MAR, Aguirre AO, Khan S, Kuo CC, Ruggiero N, Mariotti BL, Fritz AG, Sharma S, Nezha A, Levy BR, Khan A, Salem AA, Jowdy PK, Zeeshan Q, Ghannam MM, Starling RV, Rho K, Pollina J, Mullin JP. Complications associated with subaxial placement of pedicle screws versus lateral mass screws in the cervical spine (C2-T1): systematic review and meta-analysis comprising 4,165 patients and 16,669 screws. Neurosurg Rev 2023; 46:61. [PMID: 36849823 DOI: 10.1007/s10143-023-01968-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/09/2023] [Accepted: 02/19/2023] [Indexed: 03/01/2023]
Abstract
Lateral mass screw (LMS) and cervical pedicle screw (CPS) fixation are among the most popular techniques for posterior fusion of the cervical spine. Early research prioritized the LMS approach as the trajectory resulted in fewer neurovascular complications; however, with the incorporation of navigation assistance, the CPS approach should be re-evaluated. Our objective was to report the findings of a meta-analysis focused on comparing the LMS and CPS techniques in terms of rate of various complications with inclusion of all levels from C2 to T1. We conducted a systematic review of PubMed and EMBASE databases with final inclusion criteria focused on identifying studies that reported outcomes and complications for either the CPS or LMS technique. These studies were then pooled, and statistical analyses were performed from the cumulative data. A total of 60 studies comprising 4165 participants and 16,669 screws placed within the C2-T1 levels were identified. Within these studies, the LMS group had a significantly increased odds for lateral mass fractures (odds ratio [OR] = 43.2, 95% confidence interval [CI] = 2.62-711.42), additional cervical surgeries (OR = 5.56, 95%CI = 2.95-10.48), and surgical site infections (SSI) (OR = 5.47, 95%CI = 1.65-18.16). No other significant differences between groups in terms of complications were identified. Within the subgroup analysis of navigation versus non-navigation-guided CPS placement, no significant differences were identified for individual complications, although collectively significantly fewer complications occurred with navigation (OR = 5.29, 95%CI = 2.03-13.78). The CPS group had significantly fewer lateral mass fractures, cervical revision surgeries, and SSIs. Furthermore, navigation-assisted CPS placement was associated with a significant reduction in complications overall.
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Affiliation(s)
- Mohamed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alexander O Aguirre
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
| | - Slah Khan
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
| | - Nicco Ruggiero
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
| | - Brandon L Mariotti
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
| | - Alexander G Fritz
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA
| | - Siddharth Sharma
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
| | - Anxhela Nezha
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
| | - Bennett R Levy
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA
| | - Amany A Salem
- Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Patrick K Jowdy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA
| | - Qazi Zeeshan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA
| | - Moleca M Ghannam
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA
| | - Robert V Starling
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA
| | - Kyungduk Rho
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA.
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA.
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Template guided cervical pedicle screw instrumentation. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2022; 10:100120. [PMID: 35602175 PMCID: PMC9118173 DOI: 10.1016/j.xnsj.2022.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022]
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Eltes PE, Bartos M, Hajnal B, Pokorni AJ, Kiss L, Lacroix D, Varga PP, Lazary A. Development of a Computer-Aided Design and Finite Element Analysis Combined Method for Affordable Spine Surgical Navigation With 3D-Printed Customized Template. Front Surg 2021; 7:583386. [PMID: 33585544 PMCID: PMC7873739 DOI: 10.3389/fsurg.2020.583386] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/18/2020] [Indexed: 01/25/2023] Open
Abstract
Introduction: Revision surgery of a previous lumbosacral non-union is highly challenging, especially in case of complications, such as a broken screw at the first sacral level (S1). Here, we propose the implementation of a new method based on the CT scan of a clinical case using 3D reconstruction, combined with finite element analysis (FEA), computer-assisted design (CAD), and 3D-printing technology to provide accurate surgical navigation to aid the surgeon in performing the optimal surgical technique by inserting a pedicle screw at the S1 level. Materials and Methods: A step-by-step approach was developed and performed as follows: (1) Quantitative CT based patient-specific FE model of the sacrum was created. (2) The CAD model of the pedicle screw was inserted into the sacrum model in a bicortical convergent and a monocortical divergent position, by overcoming the geometrical difficulty caused by the broken screw. (3) Static FEAs (Abaqus, Dassault Systemes) were performed using 500 N tensile load applied to the screw head. (4) A template with two screw guiding structures for the sacrum was designed and manufactured using CAD design and 3D-printing technologies, and investment casting. (5) The proposed surgical technique was performed on the patient-specific physical model created with the FDM printing technology. The patient-specific model was CT scanned and a comparison with the virtual plan was performed to evaluate the template accuracy Results: FEA results proved that the modified bicortical convergent insertion is stiffer (6,617.23 N/mm) compared to monocortical divergent placement (2,989.07 N/mm). The final template was created via investment casting from cobalt-chrome. The template design concept was shown to be accurate (grade A, Gertzbein-Robbins scale) based on the comparison of the simulated surgery using the patient-specific physical model and the 3D virtual surgical plan. Conclusion: Compared to the conventional surgical navigation techniques, the presented method allows the consideration of the patient-specific biomechanical parameters; is more affordable, and the intraoperative X-ray exposure can be reduced. This new patient- and condition-specific approach may be widely used in revision spine surgeries or in challenging primary cases after its further clinical validation.
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Affiliation(s)
- Peter Endre Eltes
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary.,In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary.,School of Ph.D. Studies, Semmelweis University, Budapest, Hungary
| | | | - Benjamin Hajnal
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Agoston Jakab Pokorni
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Laszlo Kiss
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary.,In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary.,School of Ph.D. Studies, Semmelweis University, Budapest, Hungary
| | - Damien Lacroix
- Department of Mechanical Engineering, INSIGNEO Institute for In Silico Medicine, The University of Sheffield, Sheffield, United Kingdom
| | - Peter Pal Varga
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Aron Lazary
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary.,Department of Spinal Surgery, Semmelweis University, Budapest, Hungary
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Mao JZ, Mullin JP, Pollina J. Commentary: Integration of Technology Within the Spine Neurosurgical Training Paradigm. Oper Neurosurg (Hagerstown) 2020; 19:E538-E542. [DOI: 10.1093/ons/opaa248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/13/2022] Open
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9
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Wang C, Xu C, Li M, Li H, Xiao H, Zhong D, Liu H. Patient-specific instrument-assisted minimally invasive internal fixation of calcaneal fracture for rapid and accurate execution of a preoperative plan: A retrospective study. BMC Musculoskelet Disord 2020; 21:407. [PMID: 32593302 PMCID: PMC7321547 DOI: 10.1186/s12891-020-03439-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Traditional methods for minimally invasive internal fixation (MIIF) of calcaneal fractures require extensive intraoperative fluoroscopy, and fracture recovery is usually not ideal. We developed a new surgical procedure using digital surgical simulation and constructed a patient-specific instrument (PSI) for calcaneal fracture that we used during the operation. This study investigated whether PSI-assisted MIIF of calcaneal fracture enables rapid and accurate execution of the preoperative plan. Methods We retrospectively analyzed patients with Sanders type III or IV fresh calcaneal fractures who had undergone PSI-assisted MIIF at our hospital from January 2016 to December 2018. We analyzed perioperative data including intraoperative fluoroscopy time, concurrence of internal fixation actual usage (IFAU) with the preoperative plan, surgery time, and complications. We also compared pre- and postoperative actual measurements from X-ray radiographs and computed tomography images including Böhler, Gissane, and calcaneus valgus angles; subtalar joint width; and calcaneal volume overlap ratio with the preoperative design. All patients had been followed up and their American Orthopedic Foot and Ankle Score (AOFAS) score was available. Results Mean intraoperative fluoroscopy time was 3.95 ± 1.78 h; IFAU in 16 patients (16 ft) was the same as the preoperative plan; mean surgery time was 28.16 ± 10.70 min; and none of the patients developed complications. Böhler, Gissane, and calcaneus valgus angles and subtalar joint width did not differ between pre- and postoperative plans; however, the actual preoperative values of each of these parameters differed significantly from those measured postoperatively. The calcaneal volume overlap ratio with the preoperative design was 91.2% ± 2.3%. AOFAS scores increased with time, with significant differences in the score at each time point. Conclusions The newly developed PSI-assisted calcaneal fracture MIIF method can rapidly and accurately execute the preoperative plan.
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Affiliation(s)
- Chenggong Wang
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.,Department of foot and ankle surgery, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Can Xu
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.,Department of foot and ankle surgery, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Mingqing Li
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.,Department of foot and ankle surgery, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Hui Li
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.,Department of foot and ankle surgery, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Han Xiao
- Department of Sports Medicine, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Da Zhong
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Hua Liu
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China. .,Department of foot and ankle surgery, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.
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