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Ghenbot Y, Ahmad HS, Chauhan D, Wathen C, Arena J, Turlip R, Parr R, Gibby W, Yoon JW. Effects of Augmented Reality on Thoracolumbar Pedicle Screw Instrumentation Across Different Levels of Surgical Experience. World Neurosurg 2024; 182:e284-e291. [PMID: 38008167 DOI: 10.1016/j.wneu.2023.11.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE Augmented reality (AR) is an emerging technology that may accelerate skill acquisition and improve accuracy of thoracolumbar pedicle screw placements. We aimed to quantify the relative assistance of AR compared with freehand (FH) pedicle screw accuracy across different surgical experience levels. METHODS A spine fellowship-trained and board-certified attending neurosurgeon, postgraduate year 4 neurosurgery resident, and second-year medical student placed 32 FH and 32 AR-assisted thoracolumbar pedicle screws in 3 cadavers. A cableless, voice-activated AR system was paired with a headset. Accuracy was assessed using χ2 analysis and the Gertzbein-Robbins scale. Angular error, distance error, and time per pedicle screw were collected and compared. RESULTS The attending neurosurgeon had 91.6% (11/12) clinically acceptable (Gertzbein-Robbins scale A or B) insertion in both FH and AR groups; the resident neurosurgeon had 100% (9/9) FH and AR in both cases; the medical student had 72.3% (8/11) FH accuracy and 81.8% (9/11) AR accuracy. The medical student displayed significantly lower ideal (Gertzbein-Robbins scale A) FH accuracy compared with the resident neurosurgeon (P = 0.017) and attending neurosurgeon (P = 0.005), but no difference when using AR. FH screw placement was faster by both the attending neurosurgeon (median 46 seconds vs. 94.5 seconds, P = 0.0047) and the neurosurgery resident neurosurgeon (median 144 seconds vs. 140 seconds, P = 0.05). Total clinically acceptable AR and FH accuracy was 90.6% (29/32) and 87.5% (28/32), respectively (P = 0.69). CONCLUSIONS AR screw placement allowed an inexperienced medical student to double their accuracy in 1 training session. With subsequent iterations, this promising technology could serve as an important tool for surgical training.
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Affiliation(s)
- Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Arena
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Turlip
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Parr
- Novarad Corporation, Provo, Utah, USA
| | - Wendell Gibby
- Novarad Corporation, Provo, Utah, USA; Department of Radiology, University of California San Diego School of Medicine, San Diego, California, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Hong JK, Bae IS, Kang HI, Kim JH, Jwa C. Development of a Pedicle Screw Fixation Simulation Model for Surgical Training Using a 3-Dimensional Printer. World Neurosurg 2023; 171:e554-e559. [PMID: 36563851 DOI: 10.1016/j.wneu.2022.12.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Training surgeons in pedicle screw fixation (PSF) techniques during actual surgery is limited because of patient safety, complications, and surgical efficiency issues. Recent technical developments are leading the world to an era of personalized three-dimensional (3D) printing. This study aimed to evaluate the educational effect of using a 3D-printed spine model to train beginners in PSF techniques to improve screw accuracy and procedure time. METHODS Computed tomography (CT) scan data were used in a 3D printer to produce a life-size lumbar spine replica of L1-3 vertebrae. Four residents performed PSF thrice. Each resident performed 18 screw fixations on both sides (6 screws per trial). The time to complete the procedure and pedicle violation was recorded. RESULTS The average time for the 3 procedures was 42.1±2.9 minutes, 38.8±3.3 minutes, and 32.1±2.5 minutes, respectively. Furthermore, the average pedicle screw score for the 3 procedures was 13.0±0.8, 14.5±0.6, and 16.0±0.8, respectively. As the trial was repeated, the procedure time decreased and the accuracy of screw fixation tended to be more accurate. CONCLUSIONS It was possible to decrease the procedure time and increase accuracy through repeated training using the 3D-printed spine model. By implementing a 3Dprinted spine model based on the patient's actual CT data, surgeons can perform simulation surgery before the actual surgery. Therefore, this technology can be useful in educating residents to improve their surgical skills.
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Affiliation(s)
- Joon-Ki Hong
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - In-Suk Bae
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.
| | - Hee In Kang
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Jae Hoon Kim
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Cheolsu Jwa
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
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Cong T, Sivaganesan A, Mikhail CM, Vaishnav AS, Dowdell J, Barbera J, Kumagai H, Markowitz J, Sheha E, Qureshi SA. Facet Violation With Percutaneous Pedicle Screw Placement: Impact of 3D Navigation and Facet Orientation. HSS J 2021; 17:281-288. [PMID: 34539268 PMCID: PMC8436351 DOI: 10.1177/15563316211026324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The gold standard for percutaneous pedicle screw placement is 2-dimensional (2D) fluoroscopy. Data are sparse on the accuracy of 3-dimensional (3D) navigation percutaneous screw placement in minimally invasive spine procedures. Objective: We sought to compare a single surgeon's percutaneous pedicle screw placement accuracy using 2D fluoroscopy versus 3D navigation, as well as to investigate the effect of facet orientation on facet violation when using 2D fluoroscopy. Methods: We conducted a retrospective radiographic study of consecutive cohort of patients who underwent percutaneous lumbar instrumentation using either 2D fluoroscopy or 3D navigation. All procedures were performed by a single surgeon at 2 academic institutions between 2011 and 2018. Radiographic measurement of screw accuracy was assessed using a postoperative computed tomographic scan. The primary outcome was facet violation, and secondary outcomes were endplate/tip breaches, the Gertzbein-Robbins classification for cortical breaches, and the Simplified Screw Accuracy grade. Statistical comparisons were made between screws placed using 2D fluoroscopy versus 3D navigation. Axial facet angles were also measured to correlate with facet violation rates. Results: In the 138 patients included, 376 screws were placed with fluoroscopy and 193 with navigation. Superior (unfused) level facet violation was higher with 2D fluoroscopy than with 3D navigation (9% vs 0.5%), which comprises the main cause for poor screw placement. Axial facet angles exceeding 45° at L4 and 60° at L5 were correlated with facet violations. Conclusion: This retrospective study found that 3D navigation is associated with lower facet violation rates in percutaneous lumbar pedicle screw placement when compared with 2D fluoroscopy. These findings suggest that 3D navigation may be of particular value when facet joints are coronally oriented.
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Affiliation(s)
- Ting Cong
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | - Joseph Barbera
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Evan Sheha
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Sheeraz A. Qureshi
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
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Zhao Y, Yuan S, Tian Y, Liu X. Risk Factors Related to Superior Facet Joint Violation During Lumbar Percutaneous Pedicle Screw Placement in Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF). World Neurosurg 2020; 139:e716-e723. [PMID: 32360675 DOI: 10.1016/j.wneu.2020.04.118] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the incidence of superior facet joint violation (FJV) during percutaneous pedicle screw placement in minimally invasive transforaminal lumbar interbody fusion, and assess the possible risk factors for FJV. METHODS An analysis of 91 patients with lumbar degenerative diseases treated with percutaneous pedicle screw placement via minimally invasive transforaminal lumbar interbody fusion from 2012 to 2018 was performed. Superior FJV was evaluated and graded by 3-dimensional lumbar computed tomography reconstruction. Analysis of possible risk factors included general condition of patients, anatomical characteristics of facet joint (FJ; axial, sagittal, and coronal diameters of FJ, facet angle, lumbar lordosis angle, lumbar lordosis index, and depth of lamina), and surgical factors (pedicle screw angle, screw-superior FJ distance, cranial angle, proximal rod length, and rod contouring). RESULTS The overall violation rate of superior FJ was 34.07% (62/182), and high-grade violation rate was 16.06% (27/182). The logistic regression analysis revealed that body mass index ≥30 kg/m2 and pedicle screw placement at L5 were independent risk factors of FJV. Anatomical factors showed that the incidence of FJV was significantly increased when axial, sagittal, and coronal diameters of FJ were all ≥12 mm or FA was ≥40°. Surgical factors showed that the FJV group had a smaller pedicle screw angle and screw-superior FJ distance compared with the non-FJV group (P < 0.05). CONCLUSIONS Body mass index ≥30 kg/m2 and pedicle screw placement at L5 were independent risk factors of superior FJV. FJV was more likely to occur in hypertrophic FJ (axial, sagittal, and coronal diameters ≥12 mm) or coronal orientation (FA ≥40°).
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Affiliation(s)
- Yiwei Zhao
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong Province, P. R. China; Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, P. R. China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong Province, P. R. China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong Province, P. R. China
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, Shandong Province, P. R. China.
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Does the accuracy of pedicle screw placement differ between the attending surgeon and resident in navigated robotic-assisted minimally invasive spine surgery? J Robot Surg 2019; 14:567-572. [PMID: 31542860 PMCID: PMC7347677 DOI: 10.1007/s11701-019-01019-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 08/28/2019] [Indexed: 10/27/2022]
Abstract
Robotic assistance with integrated navigation is an area of high interest for improving the accuracy of minimally invasive pedicle screw placement. This study analyzes the accuracy of pedicle screw placement between an attending spine surgeon and a resident by comparing the left and right sides of the first 101 consecutive cases using navigated robotic assistance in a private practice clinical setting. A retrospective, Institutional Review Board-exempt review of the first 106 navigated robot-assisted spine surgery cases was performed. One attending spine surgeon and one resident performed pedicle screw placement consistently on either the left or right side (researchers were blinded). A CT-based Gertzbein and Robbins system (GRS) was used to classify pedicle screw accuracy, with grade A or B considered accurate. There were 630 consecutive lumbosacral pedicle screws placed. Thirty screws (5 patients) were placed without the robot due to surgeon discretion. Of the 600 pedicle screws inserted by navigated robotic guidance (101 patients), only 1.5% (9/600) were repositioned intraoperatively. Based on the GRS CT-based grading of pedicle breach, 98.67% (296/300) of left-side screws were graded A or B, 1.3% (4/300) were graded C, and 0% (0/300) were graded D. For the right-side screws, 97.67% (293/300) were graded A or B, 1.67% (5/300) were graded C, and 0.66% (2/300) were graded D. This study demonstrated a high level of accuracy (based on GRS) with no significant differences between the left- and right-side pedicle screw placements (98.67% vs. 97.67%, respectively) in the clinical use of navigated, robot-assisted surgery.
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Kouyoumdjïan P, Gras-Combe G, Grelat M, Fuentes S, Blondel B, Tropiano P, Zairi F, Beaurain J, Charles YP, Dhenin A, Elfertit H, Le Roy J, Greffier J, Lonjon N. Surgeon's and patient's radiation exposure during percutaneous thoraco-lumbar pedicle screw fixation: A prospective multicenter study of 100 cases. Orthop Traumatol Surg Res 2018; 104:597-602. [PMID: 29969721 DOI: 10.1016/j.otsr.2018.05.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/26/2018] [Accepted: 05/16/2018] [Indexed: 02/02/2023]
Abstract
HYPOTHESIS Percutaneous pedicle screw fixations (PPSF) are increasingly used in spine surgery, minimizing morbidity through less muscle breakdown but at the cost of intraoperative fluoroscopic guidance that generates high radiation exposure. Few studies have been conducted to measure them accurately. MATERIAL AND METHODS The objective of our study is to quantify, during a PPSF carried out in different experimented centers respecting current radiation protection recommendations, this irradiation at the level of the surgeon and the patient. We have prospectively included 100 FPVP procedures for which we have collected radiation doses from the main operator. For each procedure, the doses of whole-body radiation, lens and extremities were measured. RESULTS Our results show a mean whole body, extremity and lens exposure dose per procedure reaching 1.7±2.8μSv, 204.7±260.9μSv and 30.5±25.9μSv, respectively. According to these values, the exposure of the surgeon's extremities and lens will exceed the annual limit allowed by the International Commission on Radiological Protection (ICRP) after 2440 and 4840 procedures respectively. CONCLUSION Recent European guidelines will reduce the maximum annual exposure dose from 150 to 20mSv. The number of surgical procedures to not reach the eye threshold, according to our results, should not exceed 645 procedures per year. Pending the democratization of neuronavigation systems, the use of conventional fluoroscopy exposes the eyes in the first place. Therefore they must be protected by leaded glasses. LEVEL OF PROOF IV, case series.
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Affiliation(s)
- Pascal Kouyoumdjïan
- Orthopedic Surgery, Spine Unit, Hôpital Carémeau, University Montpellier 1, CHU de Nîmes, 30029 Nîmes, France
| | - Guillaume Gras-Combe
- Neurosurgery Unit, Hôpital Gui-de-Chauliac, CHU de Montpellier, 34000 Montpellier, France
| | - Mickael Grelat
- Neurosurgery Unit, CHU Dijon-Bourgogne, 21000 Dijon, France
| | - Stéphane Fuentes
- Neurosurgery Unit, Hôpital la Timone, AP-HM, 13385 Marseille, France
| | - Benjamin Blondel
- Orthopedic Surgery, Spine Unit, Hôpital la Timone, AP-HM, 13385 Marseille, France
| | - Patrick Tropiano
- Orthopedic Surgery, Spine Unit, Hôpital la Timone, AP-HM, 13385 Marseille, France
| | - Fahed Zairi
- Neurosurgery Units, Hôpital Roger-Salengro, CHR, 59037 Lille, France
| | | | - Yann-Philippe Charles
- Orthopedic Surgery, Spine Unit, CHRU de Strasbourg, BP 426, 67091 Strasbourg, France
| | - Alexandre Dhenin
- Orthopedic Surgery, Spine Unit, Hôpital Carémeau, University Montpellier 1, CHU de Nîmes, 30029 Nîmes, France
| | - Hassan Elfertit
- Neurosurgery Unit, Hôpital Carémeau, CHU de Nîmes, 30029 Nîmes, France
| | - Julien Le Roy
- Department of radiation Physics, CHRU de Montpellier, 34295 Montpellier, France
| | - Joel Greffier
- Department of Medical Imaging, Hôpital Caremeau, CHU de Nîmes, 30029 Nîmes, France
| | - Nicolas Lonjon
- Neurosurgery Unit, Hôpital Gui-de-Chauliac, CHU de Montpellier, 34000 Montpellier, France.
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Landriel F, Hem S, Rasmussen J, Vecchi E, Yampolsky C. [Learning curve of minimally invasive pedicle screw placement]. Surg Neurol Int 2018; 9:S43-S49. [PMID: 29900033 PMCID: PMC5981185 DOI: 10.4103/sni.sni_428_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 12/11/2017] [Indexed: 02/02/2023] Open
Abstract
Objetivo: El objetivo de este estudio fue estimar la curva de aprendizaje necesaria para la correcta colocación de tornillos transpediculares percutáneos (TTP). Introducción: Los TTP son la forma de instrumentación más utilizada en el tratamiento quirúrgico de lesiones espinales que requieren estabilización. Métodos: Evaluamos retrospectivamente la inserción de 422 TTP (T5 a S1) en 75 pacientes operados entre 2013–2016, bajo guía fluoroscópica bidimensional. El cirujano 1 colocó siempre los tornillos del lado derecho y el cirujano 2, la totalidad del lado izquierdo. El posicionamiento y ruptura pedicular fue determinando con la clasificación tomográfica de Gertzbein. Se comparó la precisión en la colocación de TTP de nuestra serie con una tasa de ruptura de 8,08% (rango de 0,67-20,83%), valor de referencia obtenido de un meta-análisis propio. Resultados: De los 422 TTP, 395 fueron insertados en el pedículo sin violación de su cortical (Grado 1 = 93,6%), 27 (6,4%) rompieron la pared pedicular, de los cuales el 3,8% fue Grado 2, el 1,65% Grado 3 y sólo el 0,9% Grado 4. El Cirujano 1, presentó una tasa se ruptura global de 6,6%, alcanzando valores estándares de precisión al colocar 74 TTP; el Cirujano 2 presentó una tasa de ruptura de 6,1%, alcanzando valores de referencia a los 64 TTP; la diferencia entre ambos no fue estadísticamente significativa (P = 0,9009). Conclusión: En la serie evaluada se evidenció que se necesitan colocar aproximadamente 70 TTP para lograr resultados en términos de exactitud intrapedicular comparables con lo reportado por cirujanos experimentados en esta técnica mínimamente invasiva.
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Affiliation(s)
- Federico Landriel
- Departamento de Neurocirugía, Hospital Italiano de Buenos Aires, Argentina
| | - Santiago Hem
- Departamento de Neurocirugía, Hospital Italiano de Buenos Aires, Argentina
| | - Jorge Rasmussen
- Departamento de Neurocirugía, Hospital Italiano de Buenos Aires, Argentina
| | - Eduardo Vecchi
- Departamento de Neurocirugía, Hospital Italiano de Buenos Aires, Argentina
| | - Claudio Yampolsky
- Departamento de Neurocirugía, Hospital Italiano de Buenos Aires, Argentina
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Teles AR, Paci M, Gutman G, Abduljabbar FH, Ouellet JA, Weber MH, Golan JD. Anatomical and technical factors associated with superior facet joint violation in lumbar fusion. J Neurosurg Spine 2017; 28:173-180. [PMID: 29219780 DOI: 10.3171/2017.6.spine17130] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the anatomical and surgical risk factors for screw-related facet joint violation at the superior level in lumbar fusion. METHODS The authors conducted a retrospective review of a consecutive series of posterior lumbar instrumented fusions performed by a single surgeon. Inclusion criteria were primary lumbar fusion of 1 or 2 levels for degenerative disorders. The following variables were analyzed as possible risk factors: surgical technique (percutaneous vs open screw placement), depth of surgical field, degree of anterior slippage of the superior level, pedicle and facet angle, and facet degeneration of the superior level. Postoperative CT scans were evaluated by 2 independent reviewers. Axial, sagittal, and coronal views were reviewed. Pedicle screws were graded as intra-articular if they clearly interposed between the superior and inferior facet joints of the superior level. Multivariate logistic regression analyses were conducted to assess the factors associated with this complication. RESULTS One hundred thirty-one patients were included. Interobserver reliability for facet joint violation assessment was high (κ = 0.789). The incidence of superior facet joint violation was 12.59% per top-level screw (33 of 262 proximal screws). The rate of facet violation was 28.0% in the percutaneous technique group (14 of 50 patients) and 12.3% in the open surgery group (10 of 81 patients) (OR 2.26, 95% CI 1.09-4.21; p = 0.024). In multivariate logistic regression analysis, independent predictors of facet violation were percutaneous screw placement (adjusted OR 3.31, 95% CI 1.42-7.73; p = 0.006), right-side pedicle screw (adjusted OR 3.14, 95% CI 1.29-7.63; p = 0.011), and facet angle > 45° (adjusted OR 10.95, 95% CI 4.64-25.84; p < 0.0001). CONCLUSIONS The incidence of facet joint violation was higher in percutaneous minimally invasive than in open technique for posterior lumbar spine surgery. Also, coronal orientation of the facet joint is a significant risk factor independent of the surgical technique.
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Affiliation(s)
- Alisson R Teles
- 1McGill Scoliosis and Spine Group, McGill University Health Centre.,4Department of Neurosciences, Jewish General Hospital, Montreal, Quebec, Canada; and
| | | | - Gabriel Gutman
- 1McGill Scoliosis and Spine Group, McGill University Health Centre.,4Department of Neurosciences, Jewish General Hospital, Montreal, Quebec, Canada; and
| | - Fahad H Abduljabbar
- 1McGill Scoliosis and Spine Group, McGill University Health Centre.,Departments of2Orthopedic Surgery and.,5Department of Orthopedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jean A Ouellet
- 1McGill Scoliosis and Spine Group, McGill University Health Centre.,Departments of2Orthopedic Surgery and
| | - Michael H Weber
- 1McGill Scoliosis and Spine Group, McGill University Health Centre.,Departments of2Orthopedic Surgery and
| | - Jeff D Golan
- 1McGill Scoliosis and Spine Group, McGill University Health Centre.,3Neurosurgery, McGill University.,4Department of Neurosciences, Jewish General Hospital, Montreal, Quebec, Canada; and
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Nakahara M, Yasuhara T, Inoue T, Takahashi Y, Kumamoto S, Hijikata Y, Kusumegi A, Sakamoto Y, Ogawa K, Nishida K. Accuracy of Percutaneous Pedicle Screw Insertion Technique with Conventional Dual Fluoroscopy Units and a Retrospective Comparative Study Based on Surgeon Experience. Global Spine J 2016; 6:322-8. [PMID: 27190733 PMCID: PMC4868583 DOI: 10.1055/s-0035-1563405] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/08/2015] [Indexed: 11/04/2022] Open
Abstract
Study Design Retrospective comparative study. Objective To evaluate the accuracy of percutaneous pedicle screw (PPS) placement and intraoperative imaging time using dual fluoroscopy units and their differences between surgeons with more versus less experience. Methods One hundred sixty-one patients who underwent lumbar fusion surgery were divided into two groups, A (n = 74) and B (n = 87), based on the performing surgeon's experience. The accuracy of PPS placement and radiation time for PPS insertion were compared. PPSs were inserted with classic technique under the assistance of dual fluoroscopy units placed in two planes. The breach definition of PPS misplacement was based on postoperative computed tomography (grade I: no breach; grade II: <2 mm; grade III: ≤2 to <4 mm). Results Of 658 PPSs, only 21 screws were misplaced. The breach rates of groups A and B were 3.3% (grade II: 3.4%, grade III: 0%) and 3.1% (grade II: 2.6%, grade III: 0.6%; p = 0.91). One patient in grade III misplacement had a transient symptom of leg numbness. Median radiation exposure time during PPS insertion was 25 seconds and 51 seconds, respectively (p < 0.01). Conclusions Without using an expensive imaging support system, the classic technique of PPS insertion using dual fluoroscopy units in the lumbar and sacral spine is fairly accurate and provides good clinical outcomes, even among surgeons lacking experience.
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Affiliation(s)
- Masayuki Nakahara
- Department of Spinal Surgery, Fukuoka Wajiro Hospital, Fukuoka, Japan
| | - Takao Yasuhara
- Department of Spinal Surgery, Shinkomonji Hospital, Fukuoka, Japan
| | - Takafumi Inoue
- Department of Spinal Surgery, Fukuoka Wajiro Hospital, Fukuoka, Japan
| | - Yuichi Takahashi
- Department of Spinal Surgery, Shinkomonji Hospital, Fukuoka, Japan
| | - Shinji Kumamoto
- Department of Spinal Surgery, Shinkomonji Hospital, Fukuoka, Japan
| | | | - Akira Kusumegi
- Department of Spinal Surgery, Shinkomonji Hospital, Fukuoka, Japan
| | - Yushi Sakamoto
- Department of Spinal Surgery, Shinkomonji Hospital, Fukuoka, Japan
| | - Koichi Ogawa
- Department of Spinal Surgery, Shinkomonji Hospital, Fukuoka, Japan
| | - Kenki Nishida
- Department of Spinal Surgery, Shinkomonji Hospital, Fukuoka, Japan
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