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Uehara M, Ikegami S, Oba H, Miyaoka Y, Hatakenaka T, Kurogochi D, Fukuzawa T, Sasao S, Mimura T, Takahashi J. Impact of osteosclerosis on cervical pedicle screw insertion using preoperative CT-based navigation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2298-2303. [PMID: 38573386 DOI: 10.1007/s00586-024-08230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/20/2024] [Accepted: 03/13/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Preoperative computed tomography (CT)-based navigation is used for cervical pedicle screw (CPS) insertion to mitigate the risk of spinal cord and vertebral artery injury. In vertebrae with osteosclerosis due to degeneration or other factors, however, probing may not proceed easily, with difficulty creating the CPS insertion hole. This study investigated the impact of osteosclerosis on the accuracy of CPS insertion. METHODS A total of 138 patients with CPS inserted at the C3-C7 level using preoperative CT navigation were retrospectively analyzed. Pre- and postoperative CT was employed to investigate screw position and Hounsfield unit (HU) values at the lateral mass to evaluate the degree of osteosclerosis in the CPS insertion pathway. RESULTS Among 561 CPS insertions, the Grade 3 perforation rate was 1.8%, and the Grade 2 or higher perforation rate was 8.0%. When comparing insertions with and without CPS perforation, HU values were significantly higher in the perforation group (578 ± 191 vs. 318 ± 191, p < 0.01). The frequency of CPS insertion into the mid-cervical spine was also significantly greater in the perforation group (68.9% vs. 62.5%, p < 0.01). Logistic regression analysis revealed that a high HU value at the lateral mass (odds ratio 1.09, 95% confidence interval: 1.07-1.11, p < 0.01) was a significant independent factor associated with CPS deviation. CONCLUSIONS The screw perforation rate of Grade 2 or higher in CPS insertion using preoperative CT-based navigation was 8.0%. Since osteosclerosis was an independent factor related to CPS deviation, additional care may be required during insertion into affected vertebrae.
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Affiliation(s)
- Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hiroki Oba
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yoshinari Miyaoka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Terue Hatakenaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Daisuke Kurogochi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takuma Fukuzawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Shinji Sasao
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tetsuhiko Mimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Kaneyama S, Sugawara T. Assessing the Accuracy and Safety Thresholds of Patient-Specific Screw Guide Template System in Cervical and Thoracic Spine Surgeries Using DAST Measurements. Spine Surg Relat Res 2024; 8:297-305. [PMID: 38868793 PMCID: PMC11165503 DOI: 10.22603/ssrr.2023-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/08/2023] [Indexed: 06/14/2024] Open
Abstract
Introduction To analyze the reliability of the newly developed patient-specific Screw Guide Template (SGT) system as an intraoperative navigation device for spinal screw insertion. Methods We attempted to place 428 screws for 51 patients. The accuracy of the screw track was assessed by deviation of the screw axis from the preplanned trajectory on postoperative CT. The safety of the screw insertion was evaluated by the bone breach of the screw. The bone diameter available for screw trajectory (DAST) was measured, and the relations to the bone breach were analyzed. Results In the inserted screws, 98.4% were defined as accurate, and 94.6% were contained in the target bone. In the cervical spine, the screw deviation between breaching (0.57 mm) and contained screws (0.43 mm) did not significantly differ, whereas DAST for breaching screws (3.62 mm) was significantly smaller than contained screws (5.33 mm) (p<0.001). Cervical screws with ≥4.0 mm DAST showed a significantly lower incidence of bone breach (0.4%) than ≤3.9 mm DAST (28.3%) (p<0.001). In the thoracic spine, screw deviation and DAST had significant differences between breaching (1.54 mm, 4.41 mm) and contained (0.75 mm, 6.07 mm) (p<0.001). The incidence of the breach was significantly lower in thoracic screws with ≥5.0 mm (1.9%) than ≤4.9 (21.9%) DAST (p<0.001). Conclusions This study demonstrated that our SGT system could support precise screw insertion for 98.4% accuracy and 94.6% safety. DAST was recommended to be ≥4.0 and ≥5.0 mm in the cervical and thoracic spines for safe screw insertion.
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Affiliation(s)
- Shuichi Kaneyama
- Department of Spine Surgery, Kashiwa Kousei General Hospital, Kashiwa, Japan
- Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan
| | - Taku Sugawara
- Department of Spine Surgery, Akita Cerebrospinal and Cardiovascular Center, Akita, Japan
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Jiang J, Song CY, Wu ZZ, Xie ZZ, Shi B, Xu T, Wang H, Qiu Y, Wang B, Zhu ZZ, Yu Y. Free-hand technique of C7 pedicle screw insertion using a simply defined entry point without fluoroscopic guidance for cervical spondylotic myelopathy patients with C3 to C6 instrumented by lateral mass screws: a retrospective cohort study. BMC Surg 2024; 24:74. [PMID: 38424546 PMCID: PMC10903032 DOI: 10.1186/s12893-024-02358-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Nowadays, both lateral mass screw (LMS) and pedicle screw were effective instrumentation for posterior stabilization of cervical spine. This study aims to evaluate the feasibility of a new free-hand technique of C7 pedicle screw insertion without fluoroscopic guidance for cervical spondylotic myelopathy (CSM) patients with C3 to C6 instrumented by lateral mass screws. METHODS A total of 53 CSM patients underwent lateral mass screws instrumentation at C3 to C6 levels and pedicle screw instrumentation at C7 level were included. The preoperative 3-dimenional computed tomography (CT) reconstruction images of cervical spine were used to determine 2 different C7 pedicle screw trajectories. Trajectory A passed through the axis of the C7 pedicle while trajectory B selected the midpoint of the base of C7 superior facet as the entry point. All these 53 patients had the C7 pedicle screw inserted through trajectory B by free-hand without fluoroscopic guidance and the postoperative CT images were obtained to evaluate the accuracy of C7 pedicle screw insertion. RESULTS Trajectory B had smaller transverse angle, smaller screw length, and smaller screw width but both similar sagittal angle and similar pedicle height when compared with trajectory A. A total of 106 pedicle screws were inserted at C7 through trajectory B and only 8 screws were displaced with the accuracy of screw placement as high as 92.5%. CONCLUSION In CSM patients with C3 to C6 instrumented by LMS, using trajectory B for C7 pedicle screw insertion is easy to both identify the entry point and facilitate the rod insertion.
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Affiliation(s)
- Jun Jiang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Chen-Yu Song
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zheng-Zheng Wu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zuo-Zhi Xie
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Bo Shi
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Tao Xu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Han Wang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Bin Wang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ze-Zhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yang Yu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
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Wang Y, Hu B, Wu J, Chen W, Wang Z, Zhu J, Fan W, Liu M, Zhao J, Liu P. Subaxial Cervical Pedicular Screw Insertion via the Nonanatomic Axis: Identification of Entry Point and Trajectory Based on a Radiographic Study and Workshop. Global Spine J 2023; 13:360-367. [PMID: 33618552 PMCID: PMC9972273 DOI: 10.1177/2192568221996310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN A radiological study and workshop. OBJECTIVE To propose a novel technique for subaxial cervical pedicle screw (CPS) insertion via the nonanatomic axis (nAA) and identify a new entry point (EP) and trajectory based on a radiological study. METHODS The new EP was determined to be the center of the upper half of the lateral mass, and the nAA was defined as the line connecting the EP and center of the pedicle. CT images of 493 subaxial cervical pedicles from 51 adults were utilized. The pedicle axis length (PAL/nPAL), pedicle transverse angle (PTA/nPTA), sagittal and transverse pedicle screw depth ratio (S-DO, T-DO), and sagittal and transverse angles (S-angle, T-angle) were measured in the anatomical axis (AA) and nAA. nAA-CPS insertions were conducted on dry specimens, and the positions of the screws were graded. RESULTS The nPTA (22.35° ± 1.57°), nPAL (23.75 ± 2.07 mm), T-DO (45.61% ± 3.10%), and S-DO (70.46% ± 4.44%) of the nAA-CPS were significantly different from the PTA (41.86° ± 2.77°), PAL (31.98 ± 2.40 mm), T-DO and S-DO of the AA-CPS (both 100% in ideal conditions), respectively (P < .05). The T-angle and S-angle were 92.78° ± 3.07° and 92.18° ± 3.78°, respectively. A constant EP and consistent trajectory of the nAA-CPS identified by 2 perpendicular angles were summarized and utilized as the manipulation protocols of the workshop, and a perfect position was achieved in 80.00% (24/30) of screws. CONCLUSION The nAA-CPS is a novel alternative to the classic CPS technique. A constant entry point and 2 perpendicular angles in the sagittal and transverse planes for identifying the trajectory of the nAA-CPS should be taken into account in the establishment of a manipulation protocol.
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Affiliation(s)
- Yingbo Wang
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Bo Hu
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Jian Wu
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Wei Chen
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Zhong Wang
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Jun Zhu
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Weili Fan
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Mingyong Liu
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Jianhua Zhao
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Peng Liu
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China,State Key Laboratory of Trauma, Burns
and Combined Wound, Army Medical University, Chongqing, China,Peng Liu, Division of Spine Surgery, Center
for Orthopedics, Daping Hospital, Army Medical University, No. 10,
Changjiangzhilu, Daping Street, Yuzhong District, Chongqing, 400042, China.
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Anatomical and Imaging Study on the Optimum Entry Point and Trajectory for Anterior Transpedicular Root Screw Placement into the Lower Cervical Spine. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8159570. [PMID: 35983525 PMCID: PMC9381211 DOI: 10.1155/2022/8159570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022]
Abstract
Objective To study the optimum entry point and trajectory for anterior transpedicular root screw (ATPRS) placement into the lower cervical spine (LCS), so as to provide a basis for clinical application. Methods A retrospective analysis of cervical CT images of patients who underwent cervical CT examination in the Spinal Surgery of Ningbo No. 6 Hospital from January 2020 to August 2021 was conducted. The data were obtained and modeled. On the coronal plane, the vertebral body (VB) between the anterior midline of cervical vertebral segments C3-7 and the left P line (by drawing the line parallel to the anterior midline of the VB at the intersection of the anterior edge of the Luschka's joint and the upper endplate) was equally divided into 9 zones (a-i). The ideal entry point and path of cervical ATPRS were designed and recorded. Additionally, 7 cadaveric specimens were selected, and the screw placement parameters were regenerated according to the above methods for screw placement. Results Zone i of each segment, with the longest screw length, was the best area for screw placement. In all patients, the horizontal angles of vertebrae C3-7 in zones a, d, and g, zones b, e, and h, and zones c, f, and i showed a gradually decreasing trend. The sagittal angle range of C3-7 in all patients showed a gradually increasing trend in zones a-c, d-f, and g-i. The distance from the anterior midline of C3-7 to the P line increased in all patients, and the distance was longer in males than in females, with statistical significance. Pedicle screws were successfully inserted in all the 7 cadaveric specimens. Conclusions ATPRS placement can be used for LCS internal fixation, and the precise screw placement parameters can be simulated by the software, which provides theoretical basis for its future clinical application.
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Himstead AS, Shahrestani S, Brown NJ, Produturi G, Shlobin NA, Al Jammal O, Choi EH, Ransom SC, Daniel Diaz-Aguilar L, Sahyouni R, Abraham M, Pham MH. Bony fixation in the era of spinal robotics: A systematic review and meta-analysis. J Clin Neurosci 2022; 97:62-74. [DOI: 10.1016/j.jocn.2022.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 01/01/2022] [Accepted: 01/08/2022] [Indexed: 01/02/2023]
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Uehara M, Ikegami S, Kuraishi S, Oba H, Takizawa T, Munakata R, Hatakenaka T, Takahashi J. Ten-year clinical and radiographic results of computer-assisted cervical pedicle screw fixation combined with laminoplasty. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Yang X, Luo Q, Li ZQ, Zhang N, Chen XY, Zhou Y, Deng HL, Jiang J, Liu JM. Using the lamina nutrient foramen as the entry point for posterior cervical pedicle screw placement. Clin Neurol Neurosurg 2021; 207:106711. [PMID: 34102421 DOI: 10.1016/j.clineuro.2021.106711] [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: 02/11/2021] [Revised: 04/07/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
STUDY DESIGN A prospective study and technique description. OBJECTIVE This study introduced a method for posterior cervical pedicle screw placement by using the bilateral posterior lamina nutrient foramens as the entry point. METHODS Firstly, 30 dry C3-C7 vertebrae specimens were harvested for measurement. The lamina nutrient foramens were used as the entry points for posterior cervical pedicle screw placement and four linear and two angle parameters were obtained from a computed tomography scan(CT). Then, 60 patients who underwent C3-C7 pedicle screw fixation using this method were included, linear and angle parameters were obtained from a postoperative CT. RESULTS The average incidences of lamina nutrient foramen on the C3-C7 specimens were 88.3%, 90.0%, 95.0%, 95.0%, and 96.7%, respectively. The distances from the entry point to the pedicle screw tip (OD), the pedicle transverse angles (α), and the pedicle sagittal angles (β) measure for the entry points from C3-C7 were 28.74 ± 3.45-30.15 ± 2.01 mm, 26.88 ± 6.89° to 32.72 ± 5.91°, and 12.48 ± 9.31° to 19.71 ± 8.45°, respectively, with no significant differences between the left and right sides. In the 60 patients who underwent surgery, the lengths of the pedicle screws (PL) were 28.34 ± 2.25-30.15 ± 2.31 mm, the pedicle transverse angles (α) were 26.89 ± 6.86° to 32.36 ± 5.65°, and the pedicle sagittal angles (β) were 12.49 ± 9.11° to 20.06 ± 8.91°. The new method had a 96.8% (454/469) success rate among these patients, with no screws penetrating the spinal canal or signs of vertebral artery injury. CONCLUSION Entry at the bilateral lamina nutrient foramen represents an alternative posterior cervical pedicle screw placement technique that is feasible and safe.
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Affiliation(s)
- Xuan Yang
- Medical Innovation Center, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China; The First Clinical Medical College of Nanchang University, Nanchang 330006, PR China
| | - Qing Luo
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China
| | - Zhi-Qiang Li
- Medical Innovation Center, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China; Institute of Spine and Spinal Cord, Nanchang University, Nanchang 330006, PR China
| | - Ning Zhang
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China
| | - Xuan-Yin Chen
- Medical Innovation Center, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China; Institute of Spine and Spinal Cord, Nanchang University, Nanchang 330006, PR China
| | - Yang Zhou
- Medical Innovation Center, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China; Institute of Spine and Spinal Cord, Nanchang University, Nanchang 330006, PR China
| | - Hui-Lin Deng
- Medical Innovation Center, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China; Institute of Spine and Spinal Cord, Nanchang University, Nanchang 330006, PR China
| | - Jian Jiang
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China.
| | - Jia-Ming Liu
- Medical Innovation Center, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China; Institute of Spine and Spinal Cord, Nanchang University, Nanchang 330006, PR China.
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Alsaleh K, Essbaiheen F, Aldosari K, Alsubei B, Alabdulkareeem M. Morphometric Analysis of Subaxial Cervical Spine Pedicles in a Middle Eastern Population. Int J Spine Surg 2021; 15:413-417. [PMID: 33963031 DOI: 10.14444/8061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pedicle screw instrumentation of the posterior cervical spine is the most secure form of fixation available to surgeons. It has not achieved widespread use yet in the Middle East, mostly due to concerns regarding its feasibility in the target population. A detailed morphometric analysis of the lower cervical spine pedicles using computerized tomography (CT) was proposed to address this issue. METHODS Two hundred and seventy patients were enrolled in the study. CT scans were reviewed by two experienced assessors, and measurements of pedicle width (PW), height (PH), and transverse angle (TA) were recorded for all patients. Interobserver and intraobserver reliability were calculated using the kappa statistic. Sex differences were also recorded and analyzed. The t test was used to assess for any significant differences in measurements due to sex (P < .05). RESULTS The mean PW varied from 4.4 mm in C3 to 6.1 mm in C7. The mean PH was 6.4 mm in C3 and 6.8 mm in C7. Pedicle TA varied from 42 to 51 degrees between the different levels. Sex differences were observed and were statistically significant for PW and PH. Interobserver reliability was high for PW and PH, but was low for TA. Intraobserver reliability was 0.99 for both assessors. CONCLUSION This study provides reliable PW and PH measurements and demonstrates that cervical pedicle screw instrumentation is feasible in our local population. Significant variability exists, however, and each patient must be addressed individually for best results. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE This study shows that the morphology of the subaxial cervical pedicle permits instrumentation in a majority of cases of our target population.
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Affiliation(s)
- Khalid Alsaleh
- Department or Orthopedics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Essbaiheen
- Department of Radiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Bandar Alsubei
- Department or Orthopedics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Niu G, Chen H, Liu L, Zhou G, Zhou Q, Li C, Dai J, Nie H, Bai J, Zhang J. Surgical treatment for upper cervical deformity with atlantoaxial joint dislocation using individualized 3D printing occipitocervical fusion instrument: A case report and literature review. Medicine (Baltimore) 2021; 100:e25202. [PMID: 33761705 PMCID: PMC9282051 DOI: 10.1097/md.0000000000025202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/25/2021] [Indexed: 01/05/2023] Open
Abstract
To introduce a novel technique of using individualized 3D printing occipitocervical fusion instrument (3D-OCF) for the treatment of upper cervical deformity with atlantoaxial joint dislocation.The surgery for deformity of the craniocervical junction area is a challenge in the field of spine. If the surgical deviation is too large to injure the spinal cord or vertebral artery, it will cause catastrophic damage to the patient. Therefore, it is controversial whether these patients should undergo surgical treatment. We provide a novel surgical approach for the challenging upper cervical surgery through 3D-OCF and a typical patient.We present a 54-year-old female patient, who suffered from dizziness and numbness in her limbs for 8 months. After the patient was admitted, we performed the three-dimensional CT scan, modeled using Mimics software 17.0, and designed customized occipitocervical fusion instrument. Besides, we repeatedly perform simulated surgery based on 3D-printed models before surgery.The operative time was 142 minutes and the intraoperative blood loss was 700 mL. X-ray showed reduction of atlantoaxial dislocation and accurate position of internal fixation. The patient's symptoms were significantly relieved: the sensation of dizziness and numbness of limbs was obviously relieved, and the sense of banding in chest, abdomen, and ankle was disappeared. At the last follow-up, imaging showed that 3D-OCF had bone-integration and Syringomyelia was disappeared. The patient's cervical JOA (Japanese Orthopaedic Association) score increased from 10 points to 17 points.Individualized 3D-OCF can improve the safety and accuracy of upper cervical surgery, reduce the operative time and the number of fluoroscopy. Our study provides a novel surgical approach for the challenging upper cervical surgery.
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Affiliation(s)
- Guoqi Niu
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu
| | - Hui Chen
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu
| | - Lutan Liu
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu
| | - Gong Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu
| | - Qiankun Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu
| | - Chao Li
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu
| | - Jianhao Dai
- Department of Orthopaedics, The First People's Hospital of Huai Nan City, Huai Nan, Anhui, China
| | - Hu Nie
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu
| | - Jianzhong Bai
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu
| | - Jingquan Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu
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Kumar S, Saini NK, Singh D, Chadha M, Mehrotra G. Computed tomographic analysis of cervical spine pedicles in the adult Indian population. Surg Neurol Int 2021; 12:68. [PMID: 33767872 PMCID: PMC7982095 DOI: 10.25259/sni_926_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/02/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Cervical pedicle screw insertion is a technically demanding procedure that carries the risk of catastrophic damage to surrounding neurovascular structures. Here, we analyzed computed tomography (CT)-based three-dimensional cervical spine pedicle geometry to determine the level and sex-specific morphologic differences in the adult Indian population. Methods: The CT scans of 200 patients (2400 pedicles) without significant cervical spine pathology were collected. The mean pedicle width (PW), pedicle height (PH), pedicle axial length (PAL), and pedicle transverse angle (PTA) from C2 to C7 were measured. Results: The smallest mean PW was at C3 in both males (4.85 ± 0.73 mm) and females (4.31 ± 0.43 mm); 7.08% of all pedicles were found to have mean PW of <4 mm. The smallest mean PH was at C5 in both males (6.25 ± 0.67mm) and females (5.54 ± 0.52 mm). The smallest mean PAL was at C2 in both males (27.46 ± 1.69mm) and females (25.90 ± 1.88 mm). The mean PW, PH, and PAL were significantly greater in males than females at all levels (P < 0.05). The smallest mean PTA was at C3 in males (41.79 ± 2.53°) and at C7 in females (42.40 ± 2.27°). Conclusion: In the adult Indian population, the PW, PH and PAL were smaller than in the typical western population. Females had even smaller PW, PH and PAL as compared to males. We recommend that a small inventory of 3.5mm screws between 20mm to 30mm length be used in most cases where cervical pedicle screws are being used in the Indian population. However, individual vertebrae should be screened preoperatively with CT scans to exclude gross anatomical variations, especially in females and at the C3 and C4 levels.
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Affiliation(s)
- Sanjeev Kumar
- Department of Orthopedics, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, India
| | - Naresh Kumar Saini
- Department of Orthopedics, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, India
| | - Devender Singh
- Department of Orthopedics, Dr Ram Manohar Lohia Hospital, University College of Medical Sciences, New Delhi, India
| | - Manish Chadha
- Department of Orthopedics, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, India
| | - Gopesh Mehrotra
- Department of Radiology, Guru Teg Bahadur Hospital, University College of Medical Sciences, New Delhi, India
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12
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Morphometric characteristics of cervical vertebrae in subjects with short, normal, and long faces. Surg Radiol Anat 2020; 43:865-872. [PMID: 33128647 DOI: 10.1007/s00276-020-02599-0] [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: 08/31/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The prolonged change in the head posture alters the morphological characteristics of cervical vertebrae. The difference in the head posture among subjects with short, normal, and long anterior facial heights might have a significant influence on the morphological characteristics of cervical vertebrae. Thus, the present study was conducted to evaluate the morphometric characteristics of cervical vertebrae in subjects with short, normal, and long faces. METHODS Based on Frankfort mandibular plane angle (FMA) on lateral cephalograms, 135 subjects were equally divided into three groups, i.e. Group I [Short face], II [Normal face], and III [Long face]. The angular variables like Atlas-dens angle (ADA), Pars interarticularis-dens angle (PDA), Pars interarticularis-vertebrae angle of C3 vertebrae (PVA3), Pars interarticularis-vertebrae angle of C4 vertebrae (PVA4), Lamina-Pars interarticularis angle of C2 vertebrae (LP2), Lamina-Pars interarticularis angle of C3 vertebrae (LP3), and Lamina-Pars interarticularis angle of C4 vertebrae (LP4) in the first four cervical vertebrae were measured, analyzed, and compared. Descriptive statistics, analysis of variance, Bonferroni, and Pearson's correlation coefficient tests were used. The P value of 0.05 was considered as the level of significance. RESULTS All parameters except PDA and PVA3 were comparable among the groups. The PDA was 54.350 ± 1.870, 57.890 ± 1.550, and 60.290 ± 2.830 in Group I, II, and III, respectively; these differences were statistically significant [P < 0.001]. The PVA3 was 42.700 ± 5.640 in Group I, 45.850 ± 3.820 in Group II, and 45.590 ± 5.530 in Group III subjects that were also statistically significant [P < 0.01]. A fairly strong positive correlation was observed between FMA and PDA. CONCLUSION A significant difference was found in the PDA among subjects with short, normal, and long faces. The vertical height of the face had a strong correlation with the morphology of axis vertebra.
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Amin MR, Haque M, Nath HD, Hossain ABMM, Bari MS. Cervicothoracic Fixation by Domino Connector in Cervicothoracic Junction Tuberculosis–A Case Report. INDIAN JOURNAL OF NEUROTRAUMA 2020. [DOI: 10.1055/s-0040-1713077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractCervicothoracic junction tuberculosis involves the C7 to D3 levels of the spine which constitutes 5% of all spinal tuberculosis. As the cervicothoracic junction is transitional zone and a weight-bearing area, the anatomical considerations for treatment of cervicothoracic junction is very difficult. We did a lateral mass screw for C5, 6, and 7 and pedicle screw of D3 and 4 levels, and connected cervical 3.5 mm rod with thoracic 5.5 mm rod using a domino connector. We gave antituberculosis therapy for 18 months. We followed-up the patient routinely and she significantly improved.
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Affiliation(s)
- Md. Rezaul Amin
- Department of Spinal Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Moududul Haque
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Haradhan Dev Nath
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - ABM Manwar Hossain
- Department of Neurosurgery, National Institute of Neurosciences, Dhaka, Bangladesh
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Markerless robotic pedicle screw placement based on structured light tracking. Int J Comput Assist Radiol Surg 2020; 15:1347-1358. [PMID: 32577986 DOI: 10.1007/s11548-020-02215-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Most existing robot systems for pedicle screw placement rely on optical markers to establish the spatial relationship between the surgical tool and the surgical path. Marker installation and registration are time-consuming, and error may also accumulate along the complicated coordinate transformation chain. Therefore, we proposed a markerless structured light-based method to simplify the surgery workflow and the coordinate transformation chain. METHODS Firstly, a structured light camera is used to directly track both the surgical tool and the bone anatomy without using markers. Secondly, a markerless "two-direction" approach for robot-camera registration together with a feedback robot control method is developed. Lastly, a prototype system is built and examined with precision validation experiments and pedicle screw drilling experiments. RESULTS Precision validation experiments show satisfactory positioning accuracy of the system. In drilling experiments, 42 paths were drilled on three synthesized cervical vertebrae phantoms and all the paths successfully went through the pedicles. The mean position error of the entry point was 0.28 ± 0.16 mm, and the mean angle error was 0.49 ± 0.24°, which can meet the clinical requirement. CONCLUSION The results show the feasibility of the proposed structured light-based method for pedicle screw placement, which has a simple workflow and can achieve good accuracy without using optical markers.
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Fan M, Liu Y, He D, Han X, Zhao J, Duan F, Liu B, Tian W. Improved Accuracy of Cervical Spinal Surgery With Robot-Assisted Screw Insertion: A Prospective, Randomized, Controlled Study. Spine (Phila Pa 1976) 2020; 45:285-291. [PMID: 31568094 DOI: 10.1097/brs.0000000000003258] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective, randomized, controlled trial. OBJECTIVE To compare robot-assisted and conventional implantation techniques by evaluating the accuracy and safety of implanting screws in cervical vertebrae. SUMMARY OF BACKGROUND DATA Cervical spinal surgery is difficult and dangerous as screw misplacement might lead not only to decreased stability but also neurological, vascular, and visceral injuries. A new robot-assisted surgical procedure has been introduced to improve the accuracy of implant screw positioning. METHODS We randomly assigned 135 patients with newly diagnosed cervical spinal disease and who required screw fixation using either robot-assisted or conventional fluoroscopy-assisted cervical spinal surgery. The primary outcomes were the discrepancies between the planned trajectories and the actual screw positions. RESULTS Altogether, 127 patients underwent the assigned intervention (61 robot-assisted and 66 conventional fluoroscopy-assisted). The baseline characteristics including the screw types, were similar in the two groups. Altogether, 390 screws were planed and placed in the cervical vertebrae, and 94.9% were acceptable. The robot-assisted group had a better screw placement accuracy than the conventional fluoroscopy-assisted group with associated P values <0.001 (0.83 [0.44, 1.29] vs. 1.79 [1.41, 2.50] mm). The Gertzbein and Robbins scales also showed a significant difference between the two groups (P < 0.001). Furthermore, the robot-assisted group experienced significantly less blood loss during surgery than the conventional fluoroscopy-assisted group (200 [50, 375] vs. 350 [100, 500] mL; P = 0.002) and shorter length of stay after surgery (P = 0.021). These two groups did not differ significantly regarding the duration of the operation (P = 0.525). Neurological injury occurred in one case in the conventional fluoroscopy-assisted group. CONCLUSION The accuracy and clinical outcomes of cervical spinal surgery using the robot-assisted technique tended to be superior to those with the conventional fluoroscopy-assisted technique in this prospective, randomized, controlled trial. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Mingxing Fan
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Yajun Liu
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Da He
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaoguang Han
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Jingwei Zhao
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
| | - Fangfang Duan
- Epidemiological Research Department, Beijing Jishuitan Hospital, Beijing, China
| | - Bo Liu
- Spine Department, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Tian
- Spine Department, Beijing Jishuitan Hospital, Beijing, China.,Beijing Key Laboratory of Robotic Orthopaedics, Beijing, China
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16
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Upendra B, Raghavendra R. Techniques of cervical pedicle screw insertion in lower cervical spine - A review. J Clin Orthop Trauma 2020; 11:794-801. [PMID: 32879566 PMCID: PMC7452216 DOI: 10.1016/j.jcot.2020.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 11/29/2022] Open
Abstract
Cervical pedicle screws (CPS) have been used for stabilization of lower cervical spine since its first description by Abumi et al., in 1994, but the usage has been limited due to the feared complications. Cadaveric studies have discouraged use of CPS in lower cervical spine due to high misplacement rates. On the contrary, clinical studies have shown limited complications due to screw misplacements and have highlighted the benefits of CPS with its superior biomechanical strength. Therefore surgeons have always tried to find a reliable, reproducible and safe CPS insertion technique to expand the usage of CPS with minimal complications. As of today Abumi et al. technique is the most popular free-hand technique used by surgeons, though many modifications have evolved to make the CPS insertions more safe and reproducible. The free hand technique should be considered as the cornerstone technique for CPS insertion and the navigation tools are essential to improve the safety of CPS in complex surgeries with altered cervical anatomy. The present review brings together the literature on the various aspects of cervical pedicle anatomy, the free-hand screw insertion techniques with their modifications, the screw misplacement rates and complications.
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17
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Zhang ZF. Freehand Pedicle Screw Placement Using a Universal Entry Point and Sagittal and Axial Trajectory for All Subaxial Cervical, Thoracic and Lumbosacral Spines. Orthop Surg 2019; 12:141-152. [PMID: 31828963 PMCID: PMC7031565 DOI: 10.1111/os.12599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/29/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022] Open
Abstract
Objective Existing techniques of freehand pedicle screw placement primarily focus on various entry points with or without axial trajectory. The objective of this paper is to propose a universal entry point and sagittal and axial trajectory for all subaxial cervical, thoracic and lumbosacral spines freehand pedicle screw placements, and to report the results from a single‐surgeon clinical experience with freehand pedicle screw placement. Methods Two spine vertebrae specimens and 20 cases of three‐dimensional (3D) reconstructions of spine CT images were used for observation of the entry point and sagittal and axial trajectory. The author retrospectively reviewed a total of 610 consecutive patients who underwent open, freehand pedicle screw fixation using a universal entry point and sagittal and axial trajectory for all subaxial cervical, thoracic and lumbosacral spine placements, during an 8‐year period from January 2010 to December 2017. The junction of the lateral margin of the superior articulating process and the transverse process for the thoracic and lumbosacral spines, or lateral mass for the subaxial cervical spine, was determined. The entry point was chosen at 1 mm, 2 mm, and 3 mm (2 mm on average) caudally and medially to this junction for subaxial cervical, thoracic and lumbosacral spines placements, respectively. Both sagittal and axial trajectories were perpendicular to the sagittal and axial planes of the laminae of the isthmus. Among them, 68 patients underwent postoperative computed tomography (CT) scans, including 26 cervical cases, 19 scoliosis thoracic cases, 10 non‐scoliosis thoracic cases, 8 lumbar cases, and 5 sacral cases. Placements of pedicle screws were assessed using CT data and outcome‐based classifications systems. Results After placing the iron scurf at the junction of the lateral margin of the superior articulating process and the transverse process, the present universal entry point was located at 1 o'clock or 11 o'clock of the pedicle's axial view. After inserting the 2.5 mm Gram needle or the pedicle virtual pin tracts according to the entry point and sagittal and axial trajectory described above, the presented trajectory was located in the pedicle's axial trajectory as in the described technique. A total of 766 pedicle screws were placed in 68 CT scan patients with a 99% accuracy rate in the non‐kyphoscoliosis group and 92% in the kyphoscoliosis group. Conclusions Freehand pedicle screw placement based on the universal entry point and sagittal and axial trajectory for all subaxial cervical, thoracic and lumbosacral spines can be performed with acceptable safety and accuracy.
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Affiliation(s)
- Zheng-Feng Zhang
- Department of Orthopaedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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18
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Zhang G, Yu Z, Chen X, Chen X, Wu C, Lin Y, Huang W, Lin H. Accurate placement of cervical pedicle screws using 3D-printed navigational templates : An improved technique with continuous image registration. DER ORTHOPADE 2019; 47:428-436. [PMID: 29387914 DOI: 10.1007/s00132-017-3515-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Accurate placement of cervical pedicle screws remains a surgical challenge. This study aimed to test the feasibility of using a novel three-dimensional (3D-)printed navigational template to overcome this challenge. METHODS Cervical spines were scanned using computed tomography (CT). A 3D model of the cervical spines was created. The screw trajectory was designed to pass through the central axis of the pedicle. Thereafter, a navigational template was designed by removing the soft tissue from the bony surface in the 3D model. A 3D printer was used to print the navigational template. The screws were then placed in the cadavers following CT scanning. The 3D model of the designed trajectory and the placed screws were registered. The coordinates of the entry and exit points of the designed trajectory and the actual trajectory were recorded. The numbers of qualified points that met the different degrees of accuracy were compared using a χ2 test. RESULTS A total of 158 screws were placed. Five screws breached the pedicle cortex with a distance <2 mm. There was no significant difference between the pre- and postoperative entry points with a degree of accuracy ≥1.7 mm (P = 0.131). Meanwhile, there was no significant difference between the pre- and postoperative exit points with degrees of accuracy ≥6.4 mm (P = 0.071). CONCLUSION A navigational template can be designed by removing the soft tissue from the bony surface in a CT-generated 3D model. This guiding tool may effectively prevent intraoperative drifting and accurately places cervical pedicle screws.
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Affiliation(s)
- Guodong Zhang
- Department of Orthopedics, Affiliated Hospital of Putian University Teaching Hospital of Fujian Medical University, Affiliated Putian Hospital of Southern Medical University, Affiliated Hospital of Putian University, 351100, Putian, Fujian, China.,Department of Human Anatomy, Southern Medical University School of Basic Medical Sciences, 510515, Guangzhou, China
| | - Zhengxi Yu
- Department of Orthopedics, Affiliated Hospital of Putian University Teaching Hospital of Fujian Medical University, Affiliated Putian Hospital of Southern Medical University, Affiliated Hospital of Putian University, 351100, Putian, Fujian, China
| | - Xuanhuang Chen
- Department of Orthopedics, Affiliated Hospital of Putian University Teaching Hospital of Fujian Medical University, Affiliated Putian Hospital of Southern Medical University, Affiliated Hospital of Putian University, 351100, Putian, Fujian, China
| | - Xu Chen
- Department of Orthopedics, Affiliated Hospital of Putian University Teaching Hospital of Fujian Medical University, Affiliated Putian Hospital of Southern Medical University, Affiliated Hospital of Putian University, 351100, Putian, Fujian, China
| | - Changfu Wu
- Department of Orthopedics, Affiliated Hospital of Putian University Teaching Hospital of Fujian Medical University, Affiliated Putian Hospital of Southern Medical University, Affiliated Hospital of Putian University, 351100, Putian, Fujian, China
| | - Yijun Lin
- Department of Orthopedics, Affiliated Hospital of Putian University Teaching Hospital of Fujian Medical University, Affiliated Putian Hospital of Southern Medical University, Affiliated Hospital of Putian University, 351100, Putian, Fujian, China
| | - Wenhua Huang
- Department of Human Anatomy, Southern Medical University School of Basic Medical Sciences, 510515, Guangzhou, China.
| | - Haibin Lin
- Department of Orthopedics, Affiliated Hospital of Putian University Teaching Hospital of Fujian Medical University, Affiliated Putian Hospital of Southern Medical University, Affiliated Hospital of Putian University, 351100, Putian, Fujian, China.
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Kovalenko RA, Rudenko VV, Kashin VA, Cherebillo VY, Ptashnikov DA. Application of patient-specific 3D navigation templates for pedicle screw fixation of subaxial and upper thoracic vertebrae. HIRURGIÂ POZVONOČNIKA (SPINE SURGERY) 2019. [DOI: 10.14531/ss2019.2.35-41] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective. To analyze the safety and accuracy of pedicle screw placement in the subaxial cervical and upper thoracic spine using patient-specific 3D navigation templates.Material and Methods. The study included 16 patients who underwent transpedicular implantation of screws in the subaxial cervical and upper thoracic vertebrae using patient-specific 3D navigation templates. A total of 88 screws were installed. All patients underwent preoperative CT angiography to assess visualization of the vertebral artery. Customized vertebral models and navigation templates were created using 3D printing technology. Models and templates were sterilized and used during surgery. The results of screw implantation, as well as the safety and accuracy of the placement, were assessed by postoperative CT.Results. The average deviation from the planned trajectory was 1.8 ± 0.9 mm. Deviation was estimated as class 1 (<2 mm) for 57 (64.77 %) screws, class 2 (2–4 mm) for 29 (32.95 %), and class 3 for two (2.27 %). The safety of screw implantation of grade 0 (the screw is completely inside the bone structure) was in 79 (89.77 %) cases, of grade 1 (<50 % of the screw diameter perforates the bone) – in 5 (5.68 %), and of grade 3 – in 2 (2.27 %).Conclusion. Using 3D navigation templates is an affordable and safe method of installing pedicle screws in the cervical and upper thoracic spine. The method can be used as an alternative to intraoperative CT navigation.
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Affiliation(s)
| | - V. V. Rudenko
- Russian Scientific Research Institute of Traumatology and Orthopedics n.a. R.R. Vreden
| | | | | | - D. A. Ptashnikov
- Russian Scientific Research Institute of Traumatology and Orthopedics n.a. R.R. Vreden
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20
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Wang Q, Xing R, Zeng Y. Design and application of subaxial cervical pedicle screw placement guide device. Exp Ther Med 2019; 17:4357-4362. [PMID: 31086571 PMCID: PMC6488976 DOI: 10.3892/etm.2019.7479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 05/11/2018] [Indexed: 11/30/2022] Open
Abstract
In the present study, a novel subaxial cervical pedicle screw placement guide device was designed and developed. In cervical specimens (C3-C7), a pedicle screw was inserted into the left pedicle using the guide device with a keyhole partial laminectomy and tapping technique, and the right pedicle by drilling using the Abumi technique. After removing the pedicle screws, the channel wall of each pedicle screw was probed with a pedicle probe. The vertebral body was then dissociated for direct observation of the screw channel. Among the 10 specimens, 2 of the 50 pedicles (4%) in the guide device group were perforated. Screw placement failed in 8 of 50 pedicles (16%) in the Abumi technique group. Significant differences were observed in the outcomes for the guide device and Abumi technique groups. The subaxial cervical pedicle screw placement guide device developed in the present study decreased the failure rate of pedicle screw placement.
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Affiliation(s)
- Qiang Wang
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
| | - Runlin Xing
- Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210000, P.R. China
| | - Yiwen Zeng
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, P.R. China
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Abstract
STUDY DESIGN This study investigated the subaxial cervical pedicles from C3 to C7 to provide information for accurately transpedicular screw fixation in this region. OBJECTIVE This study was evaluated the morphology of the subaxial cervical pedicle to determine the size and trajectory of screw fixation. SUMMARY OF BACKGROUND DATA Cervical vertebrae are an important structure to protect the neurovascular structure. The cervical spine surgery using screw fixation is an effective method to treat the cervical spine instability. There have been many research morphological data of subaxial cervical vertebrae. However, no studies have reports on dried cervical vertebrae of Thai's people. METHODS The measurement was conducted in 130 dried cervical vertebrae (C3-C7), including 61 males and 69 females. The measurement parameters were pedicle width (PW), pedicle length (PL), pedicle height (PH), pedicle axis length (PAL), pedicle transverse angle (PTA), and pedicle sagittal angle (PSA), which determined using ImageJ software. RESULTS The results of morphological data of C3 to C7 was found that the mean of PW, PL, PH, PAL, PTA, and PSA that obtained from male were significantly higher than female excepted for PL (C7) and PTA (C3, C5). Except for the C6 PW, C3 PL, C4 to C5 to C7 PTA, and C4 PSA, there were no significant differences of these parameters between male and female. CONCLUSION The appropriate pedicle screw size is 4.0 mm for C3 and C4, and 4.5 mm for C5 to C7. The results of this study are the useful information for cervical spine fixation while prevent the vascular and neurological injuries from the large screw causing pedicle breakage. LEVEL OF EVIDENCE 3.
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22
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Wang S, Yang G, Zhu C, Kang J, Wang Q. Morphological analysis for subaxial cervical pedicle screw insertion in developmental and non-developmental canal stenosis. BMC Musculoskelet Disord 2019; 20:205. [PMID: 31077170 PMCID: PMC6511180 DOI: 10.1186/s12891-019-2577-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 04/16/2019] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to evaluate the safety and feasibility of subaxial cervical pedicle screw (CPS) insertion by comparing the morphological parameters between developmental canal stenosis (DCS) and non-developmental canal stenosis (NDCS) patients. Methods A total of 120 Chinese patients who had undergone cervical spinal multiplanar CT imaging from September 2010 to December 2014 were included in this study. According to the Pavlov ratio (PR), participants were classified into a DCS group (PR < 0.82) and an NDCS group (PR ≥0.82). CT reconstruction images of the cervical pedicles from C3 to C7 were selected for further analysis, and detailed morphological parameters for subaxial CPS insertion including pedicle outer width (POW), tiny cervical pedicle (TCP), pedicle transverse angle (PTA), and range of safe angle (RSA) were measured and compared in these two groups. Results A total of 600 images (1200 pedicles) from these 120 patients were measured. The POW in the DCS group was wider than that in the NDCS group at each level, while the number of TCPs in the DCS group was significantly less than that in the NDCS group at the C3, C4, and C5 vertebrae. There was no significant difference in PTA at any level between the two groups, however the RSA in the DCS group was greater than that in the NDCS group from C4 to C7. Conclusions Subaxial CPS for DCS patients may be safer and more feasible than that for NDCS patients. However, as the subaxial cervical pedicle is relatively small, CPS insertion is difficult and preoperative CT evaluation is recommended for both DCS and NDCS patients.
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Affiliation(s)
- Song Wang
- Department of Spine Surgery, the Affiliated Hospital of Southwest Medical University, No. 25 Taiping St., Luzhou, 646000, Sichuan, China
| | - Gangyi Yang
- Department of Orthopedics, Mianyang Central Hospital, Mianyang, 621000, Sichuan, China
| | - Ce Zhu
- Department of Spine Surgery, the Affiliated Hospital of Southwest Medical University, No. 25 Taiping St., Luzhou, 646000, Sichuan, China
| | - Jianping Kang
- Department of Spine Surgery, the Affiliated Hospital of Southwest Medical University, No. 25 Taiping St., Luzhou, 646000, Sichuan, China
| | - Qing Wang
- Department of Spine Surgery, the Affiliated Hospital of Southwest Medical University, No. 25 Taiping St., Luzhou, 646000, Sichuan, China.
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Westermann L, Spemes C, Eysel P, Simons M, Scheyerer MJ, Siewe J, Baschera D. Computer tomography-based morphometric analysis of the cervical spine pedicles C3-C7. Acta Neurochir (Wien) 2018; 160:863-871. [PMID: 29411117 DOI: 10.1007/s00701-018-3481-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 01/25/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Our aim was to examine the specific dimensions of cervical pedicles in a large Caucasian cohort on high dissolving CT scans. METHODS A retrospective analysis of 100 cervical spine CT scans with a maximum slice thickness of 1 mm in axial, sagittal, and coronal reconstructions was performed. The pedicle axial length (PAL), inner and outer pedicle diameter (IPD/OPD), pedicle sagittal and transverse angle (PSA/PTA), pedicle height (PH), pedicle width (PW), and the cortical thickness (COT) at different margins were measured by two independent observers. A total of 1000 cervical pedicles (C3-C7) of 52 male (age 58 ± 17.47 years, height 177.97 ± 8.17 cm) and 48 female patients (age 57 ± 19.07 years, height 165.50 ± 7.44) were measured. RESULTS Cortical thickness at the medial limitation of the pedicle was 1.77 ± 0.43 and 0.90 ± 0.36 mm at the lateral limitation (p < 0.001). The mean PAL ranged from 30.5 mm at C4 level to 35.3 mm at C6 level. PW and PAL were smaller in the female than in the male patients. The smallest values for PW were at C3 with 29.17% of males and 52.88% of females < 4.5 mm. The percentage of patients with PW < 4.5 mm decreased caudally with less than 10% of pedicles below C4 in male participants and below C6 in female participants. Mean PTA ranged from 34.6° to 48.02° peaking at C4 and C5 levels. No gender-specific difference was found for PTA and PSA (p ≥ 0.13). IPD and OPD were larger in males (p < 0.001), and body height correlated significantly with IPW (p ≤ 0.019) and OPW (p ≤ 0.003). The interrater reliability was very good for PW, PH, and IPD (0.84-0.86), good for OPD, PTA, and PSA (0.64-0.79), and moderate for PAL (0.54) and cortical thickness (0.44). CONCLUSIONS Peculiarities of pedicle dimension of this central European cohort are comparable to morphometric studies in other ethnicities. Preoperative planning before cervical pedicle screw insertion on fine-cut CT scans demonstrates good interrater reliability for all important dimensions and angulations. More than half of female patients and almost a third of male patients had a PW of less than 4.5 mm at C3 level. Even though this percentage decreases caudally, pedicle screws might not be safe to insert in a noteworthy percentage of patients.
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Kashyap A, Kadur S, Mishra A, Agarwal G, Meena A, Maini L. Cervical pedicle screw guiding jig, an innovative solution. J Clin Orthop Trauma 2018; 9:226-229. [PMID: 30202153 PMCID: PMC6128793 DOI: 10.1016/j.jcot.2018.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 07/14/2018] [Indexed: 11/25/2022] Open
Abstract
Pedicle screws are one the commonest used modality in spinal instrumentation. However, the method of pedicle screw fixation in cervical spine as compared to thoracic and lumbar spine is still technically demanding because it carries the risk of catastrophic damage to the surrounding neurovascular structures We have utilized virtual planning and 3D (3-dimension) printing to develop a patient specific jig to guide the accurate placement of pedicle screws. A patient with bifacetal dislocation C7 over D1 classified as flexion-distraction injury type 3 who was planned for decompression and fusion by posterior instrumentation at C6, C7, D1 and D2 was selected. A CT scan with 1 mm cuts was used to produce DICOM images of the same. Using these DICOM images virtual planning was done on MIMICS and 3 MATICS software to create patient specific jigs. These jigs were then 3D printed using a 3D printer and used for accurate placement of pedicle screws intra-operatively after adequate sterilization. Our procedure is low cost but high technology based. It is simple, accurate, and very cost effective. The technology transfer is very easy and can be adopted easily.
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Affiliation(s)
- Abhishek Kashyap
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Shreesh Kadur
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India,Corresponding author. #52, flat no: 202, Saathwik Residency, Ramanjaneya Nagar, Chikkalsandra, Banagalore, 560061, India.
| | - Abhishek Mishra
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Gaurang Agarwal
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Abhay Meena
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Lalit Maini
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Chen W, Fang XM, Qian PY, Sanjeev Kumar PS, Chen HW, Xiao-Yun HU. Evaluation of Multi-Slice Spiral Computed Tomography in In vivo Simulation of Individualized Cervical Pedicle Screw Placement at C3-C7 in Chinese Healthy Population. Indian J Orthop 2018; 52:651-656. [PMID: 30532307 PMCID: PMC6241050 DOI: 10.4103/ortho.ijortho_3_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cervical pedicle screw fixation through posterior approach has shown greater cervical stability advantage. The cervical pedicle screw fixation technique through posterior approach is demanding. The key to the technique is the choice of point and angle of screw entrance. The angle of screw placement is variable. Morphometric measurements of the cervical pedicle are a prerequisite for individualized screw. CT imaging has become the most reliable and important means to obtain cervical pedicle's measurement data and morphology in vivo. This study explores the feasibility and application of precise in vivo measurements by multi-slice computed tomography (MSCT) for individualized cervical transpedicular screw placement at C3-C7 in Chinese healthy population. MATERIALS AND METHODS 80 adults who underwent cervical examination by enhanced and nonenhanced computed tomography angiography, respectively, were selected and submitted to bone algorithm reconstruction for slice thickness and interval of 0.75 mm to acquire clear images and detailed bone structures. Simulation of individualized screw placement was performed with a 4.0 mm diameter screw with the help of postprocessing workstation. Pedicle transverse angle (PTA) and sagittal angle (PSA) were measured using the single- and double-line methods (analog nailing, 4.0 mm in diameter) in 160 pairs of C3-C7 pedicles, setting positive and negative values for cranial direction and foot side PSAs, respectively. Comparison of the measured change scope in PTA and PSA between the two methods was carried out; the range was defined as the error range. RESULTS Significantly, different results (P < 0.05) were obtained between the single- and double-line methods in the error ranges of PTA and PSA in C3-C7 pedicles. Interestingly, the double-line method was better in simulating the actual needs of individualized nailing. The mean values of PTA and PSA were 42.9°, 45.5°, 42.4°, 37.1°, 29.0° and 8.4°, 5.0°, -4.0°, and -7.8°, -8.1°, respectively, with the double-line method. CONCLUSION MSCT reconstruction techniques can determine the direction and required parameters for individualized screw placement. In addition, accurate in vivo measurements of PTA and PSA, particularly PSA, provide the orthopedic surgeon with theoretical guidance and reliable basis in screw placement.
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Affiliation(s)
- Wei Chen
- Department of Intervention Radiology, Huai’an First People's Hospital, Nanjing Medical University, Jiangsu Province, China
| | - Xiang-Ming Fang
- Imaging Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, Jiangsu Province, China
| | - Ping-Yan Qian
- Imaging Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, Jiangsu Province, China
| | - PS Sanjeev Kumar
- Department of Medical Imaging, Parexel International Pvt Ltd, Hyderabad, Telangana, India
| | - Hong-wei Chen
- Imaging Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, Jiangsu Province, China
| | - HU Xiao-Yun
- Imaging Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, Jiangsu Province, China,Address for correspondence: Dr. Xiao-Yun HU, Imaging Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, No. 299, Qingyang Road, Wuxi 214023, Jiangsu Province, China. E-mail:
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Li G, Wang Q, Liu H. CT analysis of anatomical variation and injury affecting posterior pedicle screw fixation for unstable Hangman fractures. Medicine (Baltimore) 2017; 96:e6847. [PMID: 28489773 PMCID: PMC5428607 DOI: 10.1097/md.0000000000006847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to evaluate the anatomical variations and injuries in patients with unstable Hangman fractures that affected the posterior pedicle screw placement of C2 to C3 and retrospectively review our experience with management of these fractures. Clinical data were reviewed in 72 patients with unstable Hangman fractures, especially using 3-dimensional computed tomography (3D-CT) scan to identify the presence of anatomical variations or injuries and analyzing the treatment strategies we used. Twenty-two patients (22/72, 30.6%) with 39 (C2 or C3) risk factors were not fit for safe C2 to C3 pedicle screw placement, due to factors such as small pedicle size of C2 or C3, high-riding vertebral arteries, fractured fragments encased into vertebral canal, or transverse process foramen of C2, sclerotic pedicles and pedicle fractures of C3. One or more than one of these risk factors could pose more risks of arterial or neural structures damages to pedicle screw fixation for unstable Hangman fractures. Individualized treatment plans were made to minimize the risks of surgery for the 22 patients. There is a high incidence of anatomical variations and injuries in the C2 to C3 region in patients with unstable Hangman fractures that affect the pedicle screw placement. Preoperative evaluation of these conditions using 3D-CT scans is of paramount importance to avoid and decrease operative complications and to choose appropriate surgical techniques.
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Affiliation(s)
- Guangzhou Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Qing Wang
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Hao Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu
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MACHADO LUCASCASTRILLONCARMO, LETAIF OLAVOBIRAGHI, MARCON RAPHAELMARTUS, CRISTANTE ALEXANDREFOGAÇA, OLIVEIRA REGINALDOPERILO, BARROS FILHO TARCÍSIOELOYPESSOADE. TOMOGRAPHIC ANALYSIS OF SUBAXIAL CERVICAL VERTEBRAE IN CHILDREN BETWEEN 0 AND 12 YEARS. COLUNA/COLUMNA 2017. [DOI: 10.1590/s1808-185120171601163228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: Tomographic and anatomic analysis of cervical vertebrae in children from 0 to 12 years of age to verify the possibility of utilization of lateral mass screws. Methods: Twenty-five cervical spine tomographies of children between 0 and 12 years of age, admitted to the emergency room of Hospital das Clínicas of São Paulo were retrospectively analyzed. The following distances were measured: width and length of the lateral masses in the axial section; width and height in the coronal section; height, length and diagonal diameter in the sagittal section. The variables studied were correlated with age and sex and submitted to statistical analysis. Results: The analysis of tomographic measurements of 20 patients showed a correlation between age and dimensions of the lateral mass, which were higher after 6 years of age. In relation to sex, greater measures were observed in males in all axes. With regard to the passage of the screws, we only had 22 masses (11%) that prevented their use. However, when stratified by age, we noticed that no patients had restrictions on the use of the lateral mass screw after the age of 6. Conclusion: This study analyzed the measurements of 200 lateral masses, making it possible to infer that there is an increase of dimensions with age and in males. Through the data, it was possible to affirm that in this sample, considering the implants available in the market, the lateral mass screws could be used in 89% of the lateral masses.
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Deng T, Jiang M, Lei Q, Cai L, Chen L. The accuracy and the safety of individualized 3D printing screws insertion templates for cervical screw insertion. Comput Assist Surg (Abingdon) 2016; 21:143-149. [PMID: 27973960 DOI: 10.1080/24699322.2016.1236146] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Ting Deng
- Department of Orthopaedics, The Third Hospital of Changsha, Changsha, China
| | - Minghui Jiang
- Department of Orthopaedics, The Third Hospital of Changsha, Changsha, China
| | - Qing Lei
- Department of Orthopaedics, The Third Hospital of Changsha, Changsha, China
| | - Lihong Cai
- Department of Radiology, The Third Hospital Of Changsha, Changsha, China
| | - Li Chen
- Department of Orthopaedics, The Third Hospital of Changsha, Changsha, China
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ZELADA FLÁVIOGERARDOBENITES, LETAIF OLAVOBIRAGHI, MARCON RAPHAELMARTUS, CRISTANTE ALEXANDREFOGAÇA, OLIVEIRA REGINALDOPERILO, BARROS FILHO TARCÍSIOELOYPESSOADE. COMPUTED TOMOGRAPHY MORPHOMETRIC ANALYSIS OF THE VERTEBRAE C7 AND T1. COLUNA/COLUMNA 2016. [DOI: 10.1590/s1808-185120161503146815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: The anatomical study of the vertebrae C7 and T1 of the cervicothoracic junction aimed to evaluate quantitatively, by axial computerized tomography (CT), the linear and angular dimensions of the anatomical laminae of the vertebrae of the cervicothoracic junction C7 and T1 in adults over 18 years. Methods: We retrospectively analyzed 49 CT of the cervical and thoracic spine (C7 and T1) of individuals over 18 years, of both sexes. We also evaluated the length and thickness of the laminae, as well as spinolaminar angle in axial sections of C7 and T1 at the point of least thickness between the inner cortical layers. The variables were correlated with age groups and sex of the individuals. Statistical analysis was performed using the t test and the results were considered significant when p<0.05. Results: After analyzing tomographic measurements of 49 patients, it was found that men had greater laminae thickness than women, both in C7 and T1, with 71% of C7 laminae and 92% of T1 laminae thicker than 5mm, and 97% of C7 laminae and 100% of T1 thicker than 4mm. The mean spinolaminar angle was 56.40 degrees in C7 and 57.31 degrees in T1. Conclusion: This study brings important anatomical information about the cervicothoracic junction C7 and T1 in the Brazilian population, showing that fixation of C7 and T1 with intralaminar screws is anatomically possible.
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Zhou ZJ, Wen CL, Sun QM, Wang AP, Yan ZG, Liu F, Chen X, Cao Q, Zhou XB, Tan JG, Li YB. Morphometric measurement of the cervical spine for minimally invasive pedicle screw fixation using reverse engineering and three-dimensional reconstruction. Int J Med Robot 2016; 13. [PMID: 27538708 DOI: 10.1002/rcs.1765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 07/10/2016] [Accepted: 07/12/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Percutaneous cervical pedicle screw fixation has been proven to be an effective method of cervical screw instrumentation, which has the advantages of less invasiveness and low blood loss. Emerging evidence has indicated that the cervical spinous process plays an important role in percutaneous spine surgery. However, there is a limited amount of information on the fundamental research of pedicle and its associated imaging parameter measurement. The purpose of this study was to measure the anatomic data of the pedicle screw channel (PSC) using reverse engineering and three-dimensional reconstruction, and also to discuss the three-dimensional relationship between the cervical spinous process and the pedicle screw channel. METHODS Twenty adult subjects (10 males, 10 females, age range 19-46 years) were studied using the method of three-dimensional CT reconstruction and reverse engineering. The centrum was divided into 10 equal parts from front to back. The bisectors were defined as borderline depths of the centrum, from front to back, 100%, 90%, 80%, 70%, 60%, 50%, 40%, 30%, 20%, 10%, 0% of borderline depths were presented. Then, a 3D coordinate system was constructed to measure all the data, including the radius of the inscribed circle, the length of the PSC, the insertion angle, the distances from entry point to cervical spinous process and skin depth. All the indexes were measured from 70% to 90% borderline depth. RESULTS The radius of the inscribed circles from C3 to C7 at 90% borderline depth were 2.94 ± 0.55 mm, 3.04 ± 0.40 mm, 3.15 ± 0.36 mm, 3.28 ± 0.47 mm, 3.89 ± 0.54 mm, respectively. The lengths of the PSC were between 25 and 32 mm. The insertion angles for 70% to 90% borderline depth were 28.33°, 34.28°, 37.92°, respectively. The relationship between the PSC and spinous process was measured as the distance from the entry point to the end of the spinous process, which were, respectively, 26.91 mm, 28.18 mm, 30.03 mm, 35.67 mm, 41.99 mm from C3 to C7 .The distance from the skin to the entry point of C3-7 increased gradually. CONCLUSIONS The measurements of this study could provide detailed information for percutaneous cervical screw fixation. The data of the relationship between the cervical spinous process and the pedicle screw channel present valuable technical information for the design, optimization and clinical application of the aiming device for percutaneous cervical pedicle screw fixation. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Zi-Jia Zhou
- Departments of Anatomy, University of South China, Hengyang City, Hunan Province, 421001, PRC
| | - Chao-Lun Wen
- Spinal Surgery Department, The 169th hospital of P.L.A, Hengyang City, Hunan Province, 421001, PRC
| | - Qin-Min Sun
- Departments of Anatomy, University of South China, Hengyang City, Hunan Province, 421001, PRC
| | - Ai-Ping Wang
- Departments of Anatomy, University of South China, Hengyang City, Hunan Province, 421001, PRC
| | - Zheng-Guang Yan
- Radiology Department, The 169th hospital of P.L.A, Hengyang City, Hunan Province, 421001, PRC
| | - Fang Liu
- Departments of Anatomy, University of South China, Hengyang City, Hunan Province, 421001, PRC
| | - Xi Chen
- Departments of Anatomy, University of South China, Hengyang City, Hunan Province, 421001, PRC
| | - Qi Cao
- Spinal Surgery Department, The second affiliated hospital of university of south china, Hengyang City, Hunan Province, 421001, PRC
| | - Xiao-Bing Zhou
- Departments of Anatomy, University of South China, Hengyang City, Hunan Province, 421001, PRC
| | - Jian-Guo Tan
- Departments of Anatomy, University of South China, Hengyang City, Hunan Province, 421001, PRC
| | - Yan-Bing Li
- Departments of Anatomy, University of South China, Hengyang City, Hunan Province, 421001, PRC
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Lu T, Liu C, Dong J, Lu M, Li H, He X. Cervical screw placement using rapid prototyping drill templates for navigation: a literature review. Int J Comput Assist Radiol Surg 2016; 11:2231-2240. [PMID: 27160327 DOI: 10.1007/s11548-016-1414-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/29/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Due to the high screw malposition rate and the potential risk of neurovascular injury in cervical fixation surgeries, guided tools, mainly computer-assisted surgery navigation systems and rapid prototyping drill templates (RPDTs) have increasingly been developed to help surgeons improve screw placement accuracy. Although RPDTs have been used in cervical surgeries for almost 2 decades, no specific review has been performed detailing the state of this technique. Thus, in the current review, we fully discuss the status of applying RPDTs in cervical surgeries. METHODS Studies that tested the accuracy and reliability of RPDTs in guiding cervical screw placements were included in this review. The fabrication workflow and usage of RPDTs, the accuracy and reliability of using RPDTs for screw and plate placement, the advantages and disadvantages of RPDTs and their prospects for future applications as a part of cervical fixation instrumentation are discussed. RESULTS As the design of RPDTs becomes more rational, the accuracy and reliability of these devices have significantly improved in cervical fixation surgeries. Moreover, RPDTs decrease the intraoperative radiation exposure for surgeons and patients relative to conventional methods. However, some disadvantages also exist. The fabrication of RPDTs is time-consuming, and the time required to learn the related software is long. CONCLUSION We believe that because of their merits, the RPDT technique is worth promoting for use in cervical surgeries. However, the time-consuming fabrication workflow and the long period required to learn the related software might limit its widespread use. In the future, the workflow should be simplified to reduce the extra workload for surgeons. Moreover, more clinical studies with high-level evidence are still needed to further test its accuracy and feasibility.
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Affiliation(s)
- Teng Lu
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Chao Liu
- Department of Neurology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Jun Dong
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Meng Lu
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Haopeng Li
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China
| | - Xijing He
- Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi Province, China.
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Cervical pedicle screw placement using intraoperative computed tomography imaging with a mobile scanner gantry. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:1690-7. [DOI: 10.1007/s00586-016-4508-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 02/29/2016] [Accepted: 03/01/2016] [Indexed: 11/26/2022]
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Al-Saeed O, Marwan Y, Kombar OR, Samir A, Sheikh M. The feasibility of transpedicular screw fixation of the subaxial cervical spine in the Arab population: a computed tomography-based morphometric study. J Orthop Traumatol 2016; 17:231-8. [PMID: 26868419 PMCID: PMC4999373 DOI: 10.1007/s10195-016-0396-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 01/26/2016] [Indexed: 11/26/2022] Open
Abstract
Background Transpedicular screw fixation of the cervical spine provides excellent biomechanical stability. The feasibility of inserting a 3.5-mm screw in the pedicle requires a minimum pedicle diameter of 4.5 mm. This diameter allows at least 0.5 mm bony bridge medially and laterally in order to avoid pedicle violation which can result in neurovascular complications. We aim to evaluate the feasibility of this technique in Arab people since no data are available about this population. Materials and methods This cross-sectional study involved a retrospective review of computed tomography scans of normal cervical spines of 99 Arab adults. Ten morphometric measurements were obtained. Data were analyzed using a p value of ≤0.05 as the cut-off level of statistical significance. Results Our sample included 63 (63.6 %) males and 36 (36.4 %) females, with a mean age of 35.5 ± 16.5 years. The morphometric parameters of C3–C7 spine pedicles were larger in males than in females. The outer pedicle width (OPW) was <4.5 mm in >25 % of all subjects at C3–C6 vertebrae. Statistically significant differences in the OPW between males and females were noted at C3 (p = 0.032) and C6 (p = 0.004). Conclusions Inserting pedicle screws in the subaxial cervical spine is feasible among the majority of Arab people. Level of evidence Level 3.
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Affiliation(s)
- Osama Al-Saeed
- Department of Radiology, Faculty of Medicine, Health Sciences Center, Kuwait University, PO Box 24923, Safat, 13110, Kuwait City, Kuwait.
- Department of Radiology, Al-Amiri Hospital, Kuwait City, Kuwait.
| | - Yousef Marwan
- Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Osama Rabie Kombar
- Department of Radiology, Al-Amiri Hospital, Kuwait City, Kuwait
- Department of Radiology, Mansoura University, Mansoura, Egypt
| | - Ahmed Samir
- Department of Radiology, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Mehraj Sheikh
- Department of Radiology, Faculty of Medicine, Health Sciences Center, Kuwait University, PO Box 24923, Safat, 13110, Kuwait City, Kuwait
- Department of Radiology, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
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Marchese LRD, Letaif OB, Marcon RM, Cristante AF, Oliveira RP, Barros Filho TEPD. TOMOGRAPHIC ANALYSIS OF T-1 VERTEBRA TO INSERT LAMINAR SCREWS IN CHILDREN FROM 0 TO 12 YEARS. COLUNA/COLUMNA 2015. [DOI: 10.1590/s1808-185120151404147916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective : Tomographic analysis of the T1 vertebra in children from 0 to 12 years of age, in order to obtain anatomical parameters that assist intralaminar fixation in this pediatric population. Methods : Retrospectively analysis of the spine with CT (cervical and thoracic) of individuals aged between 0 and 12 years old, of both sexes, without anatomical deformities. The CT scans were evaluated separately, on each side, for length and thickness of the laminas as well as spinolaminar angle. The morphometric analysis was performed with iSite PACS Philips Healthcare Informatics(r) program and the values were expressed in millimeters (mm). The variables were correlated with age groups and sex of individuals. Statistical analysis was performed using t test and the results were considered significant when p<0.05. Results : By means of tomographic analysis of 24 patients it was found that age has no correlation with the angle of attack for intralaminar screws T1. However, the length and thickness of the T1 lamina increase proportionally with age. The total average length of the laminas was 28.62 ± 4.42 mm. The total average thickness was 4.75 ± 0.95 mm (3.2 to 6.5). Conclusion : This study shows relevant data on the use of Tran laminar screws currently commercially available with a minimum thickness of 3.5 mm. It is thus possible to say in this sample, they can be used in 87.5% of all laminas, being applicable in all lamina in patients older than 44 months of age.
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Saluja S, Patil S, Vasudeva N. Morphometric Analysis of Sub-axial Cervical Vertebrae and Its Surgical Implications. J Clin Diagn Res 2015; 9:AC01-4. [PMID: 26673539 DOI: 10.7860/jcdr/2015/15053.6808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 08/19/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The predilection of the cervical spine to a wide array of traumatic, degenerative and neoplastic diseases necessitates frequent surgical interventions. For successful surgical management of these conditions, a detailed anatomical knowledge of the cervical spine is required but variability in vertebral dimensions exists amongst different races and prevents the standardization of measurements. AIM The aim of this study was to present a morphometric reference database for cervical vertebrae of the Indian population and enable comparisons with other populations. MATERIALS AND METHODS The study was conducted on 203 typical (C3-C6) cervical vertebrae. Linear measurements of the vertebrae were taken with the help of digital Vernier caliper and angular measurements were determined with software Image J. STATISTICAL ANALYSIS Mean and standard deviation of the morphometric parameters taken into account were analysed. The comparison of morphometric dimensions of the right and left sides was performed using Student's t-test and p-value was calculated. RESULTS The morphometric analysis of the cervical vertebrae demonstrated that when compared with other races, the mean height (11.39 ± 1.08 mm) and transverse diameters (22.18 ± 2.52 mm) of the vertebral body were larger but antero-posterior diameter was less, making the vertebral bodies in Indians transversely longer. The dimensions of the pedicle, laminae, articular processes and spinous process were smaller when compared to other populations. There existed a highly significant difference (p=0.002) between the widths of the right and left superior & inferior articular processes. A great disparity of the pedicle transverse angle was noted in different populations but in Indians the angle was 44.47 ± 2.81. CONCLUSION The present morphometric study in Indian population would be valuable for the successful instrumentation of the cervical spine as smaller dimensions of the cervical vertebrae pose a challenge to the surgeons during application of plates and screws. The data would be helpful in designing spinal implants and permit identification of osteological remains.
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Affiliation(s)
- Sandeep Saluja
- Senior Resident, Department of Anatomy, Maulana Azad Medical College , New Delhi, India
| | - Sachin Patil
- Senior Resident, Department of Anatomy, Maulana Azad Medical College , New Delhi, India
| | - Neelam Vasudeva
- Director, Professor and HOD, Department of Anatomy, Maulana Azad Medical College , New Delhi, India
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Bredow J, Oppermann J, Kraus B, Schiller P, Schiffer G, Sobottke R, Eysel P, Koy T. The accuracy of 3D fluoroscopy-navigated screw insertion in the upper and subaxial cervical spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:2967-76. [DOI: 10.1007/s00586-015-3974-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 11/27/2022]
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Safe and accurate midcervical pedicle screw insertion procedure with the patient-specific screw guide template system. Spine (Phila Pa 1976) 2015; 40:E341-8. [PMID: 25584951 DOI: 10.1097/brs.0000000000000772] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Clinical trial for midcervical pedicle screw insertion using a novel patient-specific intraoperative screw guiding device. OBJECTIVE To evaluate the availability of the "Screw Guide Template" (SGT) system for insertion of midcervical pedicle screws. SUMMARY OF BACKGROUND DATA Despite many efforts for accurate midcervical pedicle screw insertion, there still remain unacceptable rate of screw malpositioning that might cause neurovascular injuries. We developed patient-specific SGT system for safe and accurate intraoperative screw navigation tool and have reported its availability for the screw insertion to C2 vertebra and thoracic spine. METHODS Preoperatively, the bone image on computed tomography was analyzed and the trajectories of the screws were designed in 3-dimensional format. Three types of templates were created for each lamina: location template, drill guide template, and screw guide template. During the operations, after engaging the templates directly with the laminae, drilling, tapping, and screwing were performed with each template. We placed 80 midcervical pedicle screws for 20 patients. The accuracy and safety of the screw insertion by SGT system were evaluated using postoperative computed tomographic scan by calculation of screw deviation from the preplanned trajectory and evaluation of screw breach of pedicle wall. RESULTS All templates fitted the laminae and screw navigation procedures proceeded uneventfully. All screws were inserted accurately with the mean screw deviation from planned trajectory of 0.29 ± 0.31 mm and no neurovascular complication was experienced. CONCLUSION We demonstrated that our SGT system could support the precise screw insertion in midcervical pedicle. SGT prescribes the safe screw trajectory in a 3-dimensional manner and the templates fit and lock directly to the target laminae, which prevents screwing error along with the change of spinal alignment during the surgery. These advantages of the SGT system guarantee the high accuracy in screw insertion, which allowed surgeons to insert cervical pedicle screws safely. LEVEL OF EVIDENCE 3.
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Abstract
BACKGROUND Anatomy of the pedicles of the seventh cervical vertebra (C7) at the cervicothoracic junction is different from other cervical vertebrae. Fixation of C7 is required during cervical vertebra and upper thoracic injuries in clinical practice. However, the typical pedicle screw insertion methods may have problems in clinical practice based on the anatomical features of C7. This study is to explore a new pedicle screw insertion technique for C7 and to provide anatomical and radiographic basis for clinical application. MATERIALS AND METHODS C7 vertebral specimens from six human cadavers were observed for the relative position between the posterior bony landmark and the pedicle projection. Computed tomography (CT) was performed for 30 patients with cervical spondylosis (26-61 years old, mean age was 42.3 years old). The CT scan data were processed by Mimics 8.1 software for associated parameter measurement. Appropriate screw entry points (Eps) and insertion angles were selected. A total of 12 pedicle screws were inserted and then observed. The six specimens were observed after inserting the screw using this method. The junction site of the middle 1/3 and outer 1/3 segment of line G [The junction between point A (the intersection point of the superior margin of the lamina of C7 and the medial margin of the superior articular process) and point B (the intersection point of the lateral margin of the inferior articular process and the transverse process)] was taken as the Ep. The screw insertion direction parallel horizontally to the upper terminal lamina of C7 and the sagittal angle was between 35° and 45°. RESULTS Gross and imaging observations revealed that pedicle projection was on the line (line G) between point A (the intersection point of the superior margin of the lamina of C7 and the medial margin of the superior articular process) and point B (the intersection point of the lateral margin of the inferior articular process and the transverse process) and located at the middle 1/3 and outer 1/3 segments of the line (point L[also it is the screw entry points (Eps)]. No significant difference in the measurements on the left and right sides were observed (P > 0.05). No penetration of the 12 screws through pedicle was observed. CONCLUSION The junction site of the middle 1/3 and outer 1/3 segments of line G are the projection points of C7 pedicles on the lateral mass. The junction site anatomical position was simply and easy to be controlled during surgery, simultaneously avoided uncertainty of other methods. This study provides a new method for determining an Ep for C7 pedicle screw insertion.
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Affiliation(s)
- Wensheng Liao
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China,Address for correspondence: Prof. Wensheng Liao, Department of Orthopedics, The First Affiliated Hospital of Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou 450052, China. E-mail:
| | - Liangbing Guo
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Heng Bao
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Limin Wang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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Abstract
BACKGROUND Cervical pedicle screw fixation is an effective method for treating traumatic and non traumatic injuries. But many studies have reported higher incidence of cervical pedicle penetration, so many research efforts have aimed at improving the accuracy of cervical screw fixation. Most of the anatomical studies on cervical pedicle screw placement previously published focused on the measurements of anatomical parameters, the entry point of pedicle screw is vague. We preliminarily designed a C3, C4 and C5 pedicle screw fixation method that had clear entry point and clinical cases confirmed that this method is feasible and safe. So we did this study of cervical pedicle screw fixation for C6 and C7 vertebrae. MATERIALS AND METHODS Fifteen cervical vertebrae specimens were prepared and bilateral pedicle screws were manually inserted into C6 and C7. The intersection of the horizontal line through the midpoint of the transverse process root and the vertical line through the intersection of the posterolateral and posterior planes of the isthmus was the entry point. The screws were inserted along the axis of the pedicle, with the screw axis coinciding with the pedicle. The pedicle was truncated axially and sagittally along the trajectory and the narrowest pedicular height (PH), pedicular width (PW), overall length of the screw channel (LSC), transverse angle (E) and vertical angle (F) were measured. RESULTS In C6, the PW and PH were 6.12 ± 0.78 and 7.48 ± 0.81 mm, respectively. In C7, the PW and PH were 6.85 ± 0.73 and 8.03 ± 0.38 mm, respectively. The LSC was 30.83 ± 0.91 mm. Two E angles were identified, namely E1 and E2 and their values were 89.61 ± 1.24 and 59.71 ± 1.10°, respectively. Meanwhile, F averaged 75.86 ± 1.12°. CONCLUSION The intersection of the horizontal line through the midpoint of the transverse process root and vertical line through the intersection of the posterolateral and posterior planes of the isthmus can be used as an entry point for C6 and C7 pedicle screw fixation. The screws should be inserted at 60 or 90° with the posterolateral isthmus in the horizontal plane and at 75° with the posterior isthmus in the sagittal plane. The LSC should not exceed 30 mm.
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Affiliation(s)
- Ye Li
- Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130031, China
| | - Jingchen Liu
- Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130031, China,Address for correspondence: Prof. Jingchen Liu, Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun 130031, China. E-mail:
| | - Yulong Liu
- Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130031, China
| | - Yuntao Wu
- Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130031, China
| | - Qingsan Zhu
- Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, Changchun 130031, China
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Mid-term results of computer-assisted cervical pedicle screw fixation. Asian Spine J 2014; 8:759-67. [PMID: 25558318 PMCID: PMC4278981 DOI: 10.4184/asj.2014.8.6.759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/29/2014] [Accepted: 02/04/2014] [Indexed: 11/19/2022] Open
Abstract
Study Design A retrospective study. Purpose The present study aimed to evaluate mid-term results of cervical pedicle screw (CPS) fixation for cervical instability. Overview of Literature CPS fixation has widely used in the treatment of cervical spinal instability from various causes; however, there are few reports on mid-term surgical results of CPS fixation. Methods Record of 19 patients who underwent cervical and/or upper thoracic (C2-T1) pedicle screw fixation for cervical instability was reviewed. The mean observation period was 90.2 months. Evaluated items included Japanese Orthopaedic Association (JOA) score and C2-7 lordotic angle before surgery and at 5 years after surgery. Postoperative computerized tomography was used to determine the accuracy of screw placement. Visual analog scale (VAS) for neck pain and radiological evidence of adjacent segment degeneration (ASD) at the 5-year follow-up were also evaluated. Results Mean JOA score was significantly improved from 9.0 points before surgery to 12.8 at 5 years after surgery (p=0.001). The C2-7 lordotic angle of the neutral position improved from 6.4° to 7.8° at 5 years after surgery, but this was not significant. The major perforation rate was 5.0%. There were no clinically significant complications such as vertebral artery injury, spinal cord injury, or nerve root injury caused by any screw perforation. Mean VAS for neck pain was 49.4 at 5 years after surgery. The rate of ASD was 21.1%. Conclusions Our mid-term results showed that CPS fixation was useful for treating cervical instability. Severe complications were prevented with the assistance of a computed tomography-based navigation system.
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Xiu P, Wang Q, Wang G, Wang S, Dai G, Lan Y. Morphological and clinical feasibility of C3 pedicle screw instrumentation in patients with congenital C2-3 fusion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:1730-6. [PMID: 24894411 DOI: 10.1007/s00586-014-3397-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 05/23/2014] [Accepted: 05/24/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Congenital C2-3 fusion (C2-3CF) is often involved in patients with atlantoaxial dislocation, and posterior occipitocervical fixation surgery is usually required. Hypoplasia of C2 pedicle is common in such patients, making C2 pedicle screws (PS) instrumentation inapplicable. Because of congenital fusion, C3PS instrumentation would be an ideal alternative for it will not sacrifice an additional motion segment; however, the morphological and clinical feasibility has not been previously reported. METHODS We included 42 C2-3CF patients to this study and evaluated pedicle trajectories of C2 and C3 using a three-dimensional CT. Clinical applications of C3PS instrumentation were evaluated and followed. RESULTS Among the 42 patients, 23 (54.8%) and 8 (19.0%) had C2 and C3 pedicle trajectory diameters <4.0 mm, respectively. The bisection line of the fused C2-3 lamina was used to represent the superior border of C3 articular mass; the entry point of C3 pedicle was located at 3 mm inferior to the assumed superior border and 3.2 mm medial to the lateral border. Bilateral C3PS instrumentations were successfully adopted in 22 patients. No spinal cord or vertebral artery injury occurred; postoperative CT showed a trajectory breach rate of 17.4% for C3PS. After mean of 3.6-year follow-up, no implant failure was documented. CONCLUSIONS C3PS instrumentation is morphologically and clinically feasible for a large proportion of patients with C2-3CF and can serve as another reliable alternative for C2PS instrumentation. Preoperative evaluation of pedicle trajectory of C2-3CF with three-dimensional CT is highly valuable in the choice of proper fixation methods.
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Affiliation(s)
- Peng Xiu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
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Chanplakorn P, Kraiwattanapong C, Aroonjarattham K, Leelapattana P, Keorochana G, Jaovisidha S, Wajanavisit W. Morphometric evaluation of subaxial cervical spine using multi-detector computerized tomography (MD-CT) scan: the consideration for cervical pedicle screws fixation. BMC Musculoskelet Disord 2014; 15:125. [PMID: 24725394 PMCID: PMC3991875 DOI: 10.1186/1471-2474-15-125] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical pedicle screw (CPS) insertion is a technically demanding procedure. The quantitative understanding of cervical pedicle morphology, especially the narrowest part of cervical pedicle or isthmus, would minimize the risk of catastrophic damage to surrounding neurovascular structures and improve surgical outcome. The aim of this study was to investigate morphology and quantify cortical thickness of the cervical isthmus by using Multi-detector Computerized Tomography (MD-CT) scan. METHODS The cervical CT scans were performed in 74 patients (37 males and 37 females) with 1-mm slice thickness and then retro-reconstructed into sagittal and coronal planes to measure various cervical parameters as follows: outer pedicle width (OPW), inner pedicle width (IPW), outer pedicle height (OPH), inner pedicle height (IPH), pedicle cortical thickness, pedicle sagittal angle (PSA), and pedicle transverse angle (PTA). RESULTS Total numbers of 740 pedicles were measured in this present study. The mean OPW and IPW significantly increased from C3 to C7 while the mean OPH and IPH of those showed non-significant difference between any measured levels. The medial-lateral cortical thickness was significantly smaller than the superior-inferior one. PTA in the upper cervical spine was significantly wider than the lower ones. The PSA changed from upward inclination at upper cervical spine to the downward inclination at lower cervical spine. CONCLUSIONS This study has demonstrated that cervical vertebra has relatively small and narrow inner pedicle canal with thick outer pedicle cortex and also shows a variable in pedicle width and inconsistent transverse angle. To enhance the safety of CPS insertion, the entry point and trajectories should be determined individually by using preoperative MD-CT scan and the inner pedicle width should be a key parameter to determine the screw dimensions.
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Affiliation(s)
| | | | | | | | | | | | - Wiwat Wajanavisit
- Department of Orthopedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Phaya Thai, Ratchathewi, Bangkok 10400, Thailand.
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Yoshihara H, Passias PG, Errico TJ. Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws. J Neurosurg Spine 2013; 19:614-23. [DOI: 10.3171/2013.8.spine13136] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Lateral mass screws (LMS) have been used extensively with a low complication rate in the subaxial spine. Recently, cervical pedicle screws (CPS) have been introduced, and are thought to provide more optimal stabilization of the subaxial spine in certain circumstances. However, because of the concern for neurovascular injury, the routine use of CPS in this location remains controversial. Despite this controversy, however, there are no articles directly comparing screw-related complications of each procedure in the subaxial cervical spine. The purpose of this study was to evaluate screw-related complications of LMS and CPS in the subaxial cervical spine.
Methods
A PubMed/MEDLINE and Cochrane Collaboration Library search was executed, using the key words “lateral mass screw” and “cervical pedicle screw.” Clinical studies evaluating surgical procedures of the subaxial cervical spine in which either LMS or CPS were used and complications were reported were included. Studies in which the number of patients who had subaxial cervical spine surgery and the number of screws placed from C-3 to C-7 could not be specified were excluded. Data on screw-related complications of each study were recorded and compared.
Results
Ten studies of LMS and 12 studies of CPS were included in the analysis. Vertebral artery injuries were slightly but statistically significantly higher with the use of CPS relative to LMS in the subaxial cervical spine. Although the use of LMS was associated with a higher rate of screw loosening, screw pullout, loss of reduction, pseudarthrosis, and revision surgery, this finding was not statistically significant.
Conclusions
Based on the available literature, it appears that perioperative neurological and late biomechanical complication rates, including pseudarthrosis, are similarly low for both LMS and CPS techniques. In contrast, vertebral artery injuries, although statistically significantly more common when using CPS, are extremely rare with both techniques, which may justify their nonroutine use in select cases. Given the paucity of well-designed studies available, this recommendation may be a reflection of deficiencies in the available studies. Surgeons using either technique should have intimate knowledge of cervical anatomy and an adequate preoperative evaluation for each patient, with the final selection based on individual case requirements and anatomical limitations.
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An analysis of the anatomic features of the cervical spine using computed tomography to select safer screw insertion techniques. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:2526-31. [PMID: 23832384 DOI: 10.1007/s00586-013-2883-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 06/03/2013] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of the present study was to evaluate the anatomic features of the cervical spine using computed tomography (CT) to select safer screw insertion techniques, particularly emphasizing the location of the transverse foramen. METHODS Fifty patients who underwent multiplanar CT reconstruction were evaluated. There were 34 males and 16 females with an average age of 67 years. The parameters included the following measurements: foramen width (the size of the transverse foramen FW), foramen height (the size of the transverse foramen FH), pedicle width (PW), foramen angle (FA the position of the transverse foramen), pedicle transverse angle (PTA) and lateral mass angle (LMA). RESULTS The mean FW ranged from 6.2 to 6.3 mm (n.s). The mean FH ranged from 5.0 to 5.7 mm, with significant differences between each vertebra, except for the FH between C4 and C5 and the FH between C5 and C6. The mean PW ranged from 5.4 to 6.1 mm. There were significant differences between each vertebra, except for the PW between C3 and C4 and the PW between C3 and C5. The mean FA ranged from 18.8° to 20.5°. There were significant differences between each vertebra, except for the FA between C3 and C6 and the FA between C4 and C5. The mean PTA ranged from 37.1° to 45.4°. There were significant differences between each vertebra, except for the PTA between C3 and C5. The mean LMA ranged from 1.0° to 5.3°. There were significant differences between each vertebra, except for the LMA between C4 and C5. The FW and FH exhibited no correlations with PW, PTA or LMA. FA was found to be positively correlated with both PTA and LMA. There was also a positive correlation between PTA and LMA. CONCLUSIONS We suggest that in cases in which pedicle screw insertion is difficult, lateral mass screws (LMS) can be inserted safely and longer sizes can be selected. In contrast, in cases in which LMS insertion is difficult, the insertion of pedicle screws can be performed relatively easy.
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Simşek S, Uz A, Er U, Apaydın N. Quantitative evaluation of the anatomical parameters for subaxial cervical spondylectomy: an anatomical study. J Neurosurg Spine 2013; 18:568-74. [PMID: 23600585 DOI: 10.3171/2013.3.spine12360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The object of this investigation was to conduct a morphometric study in cadavers to determine anatomical structures, their relationships, and their morphometry for subaxial cervical spondylectomy. METHODS Forty sides of 20 cadavers were used for this study. Dissections were performed in 2 stages (anteriorly and posteriorly). Twenty-one morphometric measurements were performed for both sides of the C3-6 vertebrae. Data were analyzed statistically. RESULTS Morphometry of the laminas, tuberculum posterius, pedicle, corpus, foramen transversarium, and processus costalis were measured. CONCLUSIONS Detailed quantitative anatomical knowledge for operations requiring wide dissection and resection, such as cervical spondylectomy, lowers the morbidity rate.
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Affiliation(s)
- Serkan Simşek
- Neurosurgery Clinic, Dışkapı Yıldırım Beyazıt Education and Research Hospital
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Abstract
STUDY DESIGN Applied anatomical study and clinical application. OBJECTIVE To design and optimize the method of cervical pedicle screw placement for cervical vertebrae C3-C5, and to test it in clinical applications. SUMMARY OF BACKGROUND DATA Most of the anatomical studies on cervical pedicle screw placement previously published focused on the lower cervical vertebrae. Clinically, it is much more difficult to place C3, C4, and C5 screws than C6 and C7 screws; therefore, anatomical measurements of C3-C5 pedicles and design of an appropriate screw placement method are required. METHODS A total of 20 cervical vertebrae specimens were prepared, and bilateral pedicle screws were manually inserted for C3-C5. The intersection of the horizontal line through the midpoint of the transverse process root and the vertical line through the mediolateral third of the superior articular process was used as the entry point. The screws were inserted along the axis of the pedicle, with the axis of the screw coinciding with that of the pedicle. The specimens were truncated along the horizontal or sagittal plane of the pedicle, and a variety of measurements were made to determine appropriate screw type and placement. Finally, this screw fixation technique was applied in clinical situations with the placement of 26 C3 screws, 26 C4 screws, and 38 C5 screws. RESULTS Pedicular height was larger than pedicular width for the same segment of C3-C5, and pedicular width of the different segments did not significantly vary. The lengths of the screw channels for C3-C5 screw placement were similar. The transverse angles of C3-C5 segments displayed a decreasing trend, whereas the vertical angles did not. In all clinical cases, all screws were properly within the pedicles examined using postoperative computed tomography scan. Only 1 C3 screw penetrated the medial cortex and slightly entered the spinal canal, but no clinical symptoms occurred. CONCLUSION The intersection of the horizontal line through the midpoint of the transverse process root and the vertical line through the mediolateral third of the superior articular process represents a superior frame of reference for the entry point for C3-C5 pedicle screw fixation. Clinically, we recommend the transverse angles to be 90° for C3 and 80° for C4 and C5, and the vertical angles to be 70° for C3-C5. We found that screws with a diameter of 3.5 mm and length of 20 mm or 22 mm to be safe, objective, and reliable.
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Shin BJ, Njoku IU, Tsiouris AJ, Härtl R. Navigated guide tube for the placement of mini-open pedicle screws using stereotactic 3D navigation without the use of K-wires. J Neurosurg Spine 2013. [DOI: 10.3171/2012.10.spine12569] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Three-dimensional spinal navigation increases screw accuracy, but its implementation in clinical practice has been difficult, mainly because of surgeons' concerns about increased operative times, disturbance of workflow, and safety. The authors present a custom-designed navigated guide that addresses some of these concerns by allowing for drilling, tapping, and placing the final screw via a minimally invasive approach without the need for K-wires. In this paper, the authors' goal was to describe the technical aspects of the navigated guide tube as well as pedicle screw accuracy.
Methods
The authors present the technical details of a navigated guide that allows drilling, tapping, and the placement of the final screw without the need for K-wires. The first 10 patients who received minimally invasive mini-open spinal pedicle screws are presented. The case series focuses on the immediate postoperative outcomes, pedicle screw accuracy, and pedicle screw–related complications. An independent board-certified neuroradiologist determined pedicle screw accuracy according to a 4-tiered grading system.
Results
The navigated guide allowed successful placement of mini-open pedicle screws as part of posterior fixation from L-1 to S-1 without the use of K-wires. Only 7-mm-diameter screws were placed, and 72% of screws were completely contained within the pedicle. Breaches less than 2 mm were seen in 23% of cases, and these were all lateral except for one screw. Breaches were related to the lateral to medial trajectory chosen to avoid the superior facet joint. There were no complications related to pedicle screw insertion.
Conclusions
A novel customized navigated guide tube is presented that facilitates the workflow and allows accurate placement of mini-open pedicle screws without the need for K-wires.
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Affiliation(s)
- Benjamin J. Shin
- 2Brain and Spine Center, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Innocent U. Njoku
- 2Brain and Spine Center, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | | | - Roger Härtl
- 2Brain and Spine Center, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
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Cervical pedicle screw fixation combined with laminoplasty for cervical spondylotic myelopathy with instability. Asian Spine J 2012; 6:241-8. [PMID: 23275807 PMCID: PMC3530698 DOI: 10.4184/asj.2012.6.4.241] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 12/17/2011] [Accepted: 01/17/2012] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN A retrospective study. PURPOSE To evaluate the surgical results of cervical pedicle screw (CPS) fixation combined with laminoplasty for treating cervical spondylotic myelopathy (CSM) with instability. OVERVIEW OF LITERATURE Cervical fixation and spinal cord decompression are required for CSM patients with instability. However, only a few studies have reported on CPS fixation combined with posterior decompression for unstable CSM patients. METHODS Thirteen patients that underwent CPS fixation combined with laminoplasty for CSM with instability were evaluated in this study. We assessed the clinical and radiological results of the surgical procedures. The Japanese Orthopedic Association (JOA) scoring system was used to evaluate the clinical results. The percentages of sli p, difference in sli p angle between maximum flexion and maximum extension of unstable intervertebrae, and perforation rate of CPS were evaluated. RESULTS The mean JOA scores before surgery, immediately after surgery, and at final follow-up were 9.1, 13.3, and 12.6, respectively. The mean percentages of sli p before surgery, immediately after surgery, and at final follow-up were 9.1%, 3.2%, and 3.5%, respectively; there were significant improvements immediately after surgery and at final follow-up. The difference in sli p angle between the maximum flexion and maximum extension of the unstable intervertebrae changed from 9.0° before surgery to 1.6° at the final follow-up. The perforation rate of CPS was 10.9%. CONCLUSIONS The results suggest that CPS fixation combined with laminoplasty is an effective surgical procedure for treating CSM with instability.
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Lee SH, Kim KT, Abumi K, Suk KS, Lee JH, Park KJ. Cervical Pedicle Screw Placement Using the “Key Slot Technique”. ACTA ACUST UNITED AC 2012; 25:415-21. [DOI: 10.1097/bsd.0b013e3182309657] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jo DJ, Seo EM, Kim KT, Kim SM, Lee SH. Cervical pedicle screw insertion using the technique with direct exposure of the pedicle by laminoforaminotomy. J Korean Neurosurg Soc 2012; 52:459-65. [PMID: 23323166 PMCID: PMC3539080 DOI: 10.3340/jkns.2012.52.5.459] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 08/01/2012] [Accepted: 11/22/2012] [Indexed: 11/27/2022] Open
Abstract
Objective To present the accuracy and safety of cervical pedicle screw insertion using the technique with direct exposure of the pedicle by laminoforaminotomy. Methods We retrospectively reviewed 12 consecutive patients. A total of 104 subaxial cervical pedicle screws in 12 patients had been inserted. We also assessed the clinical and radiological outcomes and analyzed the direction and grade of pedicle perforation (grade 0: no perforation, 1: <25%, 2: 20% to 50%, 3: >50% of screw diameter) on the postoperative vascular-enhanced computed tomography scans. Grade 2 and 3 were considered as incorrect position. Results The correct position was found in 95 screws (91.3%); grade 0-75 screws, grade 1-20 screws and the incorrect position in 9 screws (8.7%); grade 2-6 screws, grade 3-3 screws. There was no neurovascular complication related with cervical pedicle screw insertion. Conclusion This technique (technique with direct exposure of the pedicle by laminoforaminotomy) could be considered relatively safe and easy method to insert cervical pedicle screw.
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Affiliation(s)
- Dae-Jean Jo
- Department of Neurosurgery, Spine Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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