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Goffart LM, Precht C, Fosgate GT, Maiolini A, Hettlich BF. Accuracy of end-on fluoroscopy in predicting implant position in relation to the vertebral canal in dogs. Front Vet Sci 2022; 9:982560. [PMID: 36337187 PMCID: PMC9630941 DOI: 10.3389/fvets.2022.982560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/29/2022] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate the accuracy of end-on fluoroscopy in predicting implant position in relation to the vertebral canal in the canine thoracolumbar vertebral column. Study design In vitro imaging and anatomic study. Animals Canine cadaveric thoracolumbar vertebral columns (n = 5). Methods Smooth Steinmann pins were inserted bicortically into the thoracolumbar vertebral columns between T10 and L7 using recommended insertion angles. Penetration of the spinal canal was not strictly avoided. After pin placement, end-on fluoroscopy images were obtained of each pin. Pin position was subsequently assessed by four evaluators and determined to either being out of the vertebral canal or in, with the latter being additionally divided into partially or completely penetrating the canal. To assess potential differences in modalities, fluoroscopy images were gray-scale inverted and evaluated again later by the same four individuals. Correct identification of pin position in relationship to the vertebral canal was assessed for both fluoroscopy images. Anatomic preparation of the spines was used for verification of pin position in relation to the spinal canal. Some data from this study were compared with historical data on accuracy using orthogonal radiography and computed tomography (CT). Results Overall sensitivity and specificity of F to detect vertebral canal penetration was 98.8 % (95% confidence interval (CI), 96.0–99.6) and 98.0% (95% CI, 77.0–99.9), respectively. For Fi, sensitivity and specificity were 97.0% (95% CI, 91.5–99.0) and 98.5% (95% CI, 81.5–99.9) respectively. F exceeded Fi for the sensitivity of detecting pin penetration into the vertebral canal (p = 0.039) but specificities were not different (p = 0.585). When comparing to historical data, the overall accuracy of end-on fluoroscopy (F) and inverted fluoroscopy (Fi) was statistical better than conventional radiographic assessment (p < 0.001). Conclusion End-on fluoroscopy is a highly accurate method for the assessment of pin position in relationship to the thoracolumbar spinal canal in cadaveric dogs. Clinical significance End-on fluoroscopy, with or without inversion, is accurate in identifying vertebral canal violation by bicortically placed Steinmann pins. When CT is not available, end-on fluoroscopy might be a valuable imaging modality to determine pin position in the canine vertebral column.
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Affiliation(s)
- Laura M. Goffart
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Christina Precht
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Geoffrey T. Fosgate
- Department of Production Animal Studies, University of Pretoria, Onderstepoort, Pretoria, South Africa
| | - Arianna Maiolini
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Bianca F. Hettlich
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
- *Correspondence: Bianca F. Hettlich
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Gougeon E, Meheust P. Pedicle screws implantation in polymethylmethacrylate construct to stabilise sixth lumbar vertebral body fracture in dogs: 5 cases (2015-2018). J Small Anim Pract 2021; 62:1007-1015. [PMID: 34314046 DOI: 10.1111/jsap.13400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 05/27/2021] [Accepted: 06/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the feasibility and outcome of pedicle screw implantation on sixth lumbar vertebral body fractures. MATERIALS AND METHODS Dogs with sixth lumbar vertebral body fractures stabilised using L6 and L7 (±L5) pedicular implantation via a dorsal approach preferentially and conventional vertebral body implantation otherwise were reviewed. Coaptation was made with bone cement. Complete neurological examination, pre and postoperative imaging consistent with L6 body fracture (radiographs ± CT scan) and follow up including clinical examination and radiographs 3 to 5 weeks post-operatively were required as inclusion criteria. When available, owner interview and/or clinical examination and imaging (radiographs ± CT scan) at least 1 year after surgery were reported. RESULTS Five dogs met the inclusion criteria. Dorsal pedicle screws implantation was feasible in all L7 vertebrae and in four L6 vertebrae. Adequate implantation was observed in all of the post-operative radiographs and on all of the three CT scans available. At 3 to 6 weeks after surgery, neurological status and locomotion were normal in four dogs, while one dog suffering from severe sciatic neuropathy did not regain normal locomotion. At least 1 year after surgery, clinical outcome was excellent for four dogs and imaging by radiography and CT scan were available for three dogs and showed complete healing of the fracture and correct positioning of the implants. The dog suffering from sciatic neuropathy had a further trauma and was euthanased 7 weeks after the surgery. CLINICAL SIGNIFICANCE In this case series, pedicle screw implantation achieved stabilisation of L6 vertebral body fractures, with full recovery observed in four out of five dogs. Further studies are required to confirm the safety and the effectiveness of this intervention.
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Affiliation(s)
- E Gougeon
- Clinique Vétérinaire Vétocéane, 9 allée Alphonse Fillion, 44120, Vertou, France
| | - P Meheust
- Clinique Vétérinaire Vétocéane, 9 allée Alphonse Fillion, 44120, Vertou, France
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Mariani CL, Zlotnick JA, Harrysson O, Marcellin-Little DJ, Malinak K, Gavitt A, Guevar J. Accuracy of three-dimensionally printed animal-specific drill guides for implant placement in canine thoracic vertebrae: A cadaveric study. Vet Surg 2020; 50:294-302. [PMID: 33373470 DOI: 10.1111/vsu.13557] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/07/2020] [Accepted: 11/26/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the accuracy of three-dimensionally (3-D) printed drill guides in constraining the trajectory of drill tracts for implants in canine thoracic vertebrae. STUDY DESIGN Experimental ex vivo study. SAMPLE POPULATION Five canine thoracic vertebral column specimens. METHODS Guides to constrain drill trajectories were designed on the basis of computed tomographic (CT) imaging of six thoracic vertebrae (T8-T13) and were 3-D printed. The guides were used to create drill tracts in these vertebrae by both an experienced and a novice surgeon, and CT imaging was repeated. The entry point and angulation of actual and planned drill tracts were compared for both surgeons. Unintended cortical violations were also assessed by using a modified Zdichavsky classification. RESULTS Fifty-eight drill tracts were created in 30 vertebrae. Mean entry point deviation was 1.4 mm (range, 0.4-3.4), and mean angular deviation was 5.1° (range, 1.5°-10.8°). There were no differences between surgeons in entry point deviation (P = .07) or angular deviation (P = .22). There were no unintended cortical bone violations, and all drill tracts were classified as modified Zdichavsky grade I. CONCLUSION The 3-D printed guides used in the current study yielded drill tracts with small linear and angular errors from intended paths and 100% accuracy for placement within vertebral pedicles and bodies. This technique was conveniently used by both an experienced and a novice surgeon. CLINICAL SIGNIFICANCE This technique might be immediately applicable to clinical cases requiring thoracic vertebral stabilization and may allow safe and accurate implant placement for surgeons with varying experience levels.
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Affiliation(s)
- Christopher L Mariani
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina.,Comparative Neuroimmunology & Neuro-oncology Laboratory, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina.,Veterinary Hospital, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Joshua A Zlotnick
- Comparative Neuroimmunology & Neuro-oncology Laboratory, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Ola Harrysson
- Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, North Carolina.,Center for Additive Manufacturing and Logistics, North Carolina State University, Raleigh, North Carolina
| | - Denis J Marcellin-Little
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina.,Veterinary Hospital, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Kristen Malinak
- Comparative Neuroimmunology & Neuro-oncology Laboratory, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Ashley Gavitt
- Comparative Neuroimmunology & Neuro-oncology Laboratory, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Julien Guevar
- Veterinary Hospital, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
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Toni C, Oxley B, Behr S. Atlanto-axial ventral stabilisation using 3D-printed patient-specific drill guides for placement of bicortical screws in dogs. J Small Anim Pract 2020; 61:609-616. [PMID: 32783206 DOI: 10.1111/jsap.13188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- C Toni
- Neurology-Neurosurgery Service, Willows Veterinary Centre and Referral Service, Solihull, West Midlands, B90 4NH, UK
| | - B Oxley
- Vet 3D, Coventry, West Midlands, UK
| | - S Behr
- Neurology-Neurosurgery Service, Willows Veterinary Centre and Referral Service, Solihull, West Midlands, B90 4NH, UK
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Elford JH, Oxley B, Behr S. Accuracy of placement of pedicle screws in the thoracolumbar spine of dogs with spinal deformities with three-dimensionally printed patient-specific drill guides. Vet Surg 2019; 49:347-353. [PMID: 31617955 DOI: 10.1111/vsu.13333] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/04/2019] [Accepted: 09/09/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the accuracy of pedicle screw placement in the thoracic spine of dogs with spinal deformities with three-dimensionally (3D) printed patient-specific drill guides. STUDY DESIGN Retrospective study. SAMPLE POPULATION Six dogs in which sixty pedicle screws were placed in the thoracolumbar spine. METHODS Medical records were searched between June 2017 and June 2018 for dogs with clinical signs associated with a thoracolumbar vertebral malformation. Inclusion criteria included MRI and computed tomography (CT) data that were used to create 3D printed patient-specific drill guides. All dogs were stabilized dorsally with guided bicortical pedicle screws and polymethylmethacrylate. Accuracy of screw placement was assessed by immediately postoperative CT according to a modified Zdichavsky classification. RESULTS Five pugs and one French bulldog met the inclusion criteria. Sixty bicortical pedicle screws were placed; 96.7% were graded as I (optimal placement), and 3.3% were classified as IIa (partial penetration of the medial pedicle wall) according to a modified Zdichavsky classification. CONCLUSION Three-dimensionally printed patient-specific drill guides allowed safe and accurate placement of pedicle screws in the thoracolumbar spine in dogs with vertebral malformation. CLINICAL SIGNIFICANCE Three-dimensionally printed patient-specific drill guides are a safe and effective method of placing pedicle screws in dogs with thoracolumbar vertebral malformations.
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Affiliation(s)
- James H Elford
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, United Kingdom
| | - Bill Oxley
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, United Kingdom
| | - Sebastien Behr
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, United Kingdom
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Canine atlantoaxial optimal safe implantation corridors - description and validation of a novel 3D presurgical planning method using OsiriX™. BMC Vet Res 2016; 12:188. [PMID: 27599482 PMCID: PMC5012052 DOI: 10.1186/s12917-016-0824-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 09/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Canine ventral atlantoaxial (AA) stabilization is most commonly performed in very small dogs and is technically challenging due to extremely narrow bone corridors. Multiple implantation sites have been suggested but detailed anatomical studies investigating these sites are lacking and therefore current surgical guidelines are based upon approximate anatomical landmarks. In order to study AA optimal safe implantation corridors (OSICs), we developed a method based on computed tomography (CT) and semi-automated three-dimensional (3D) mathematical modelling using OsiriX™ and Microsoft®Excel software. The objectives of this study were 1- to provide a detailed description of the bone corridor analysis method and 2- to assess the reproducibility of the method. CT images of the craniocervical junction were prospectively obtained in 27 dogs and our method of OSIC analysis was applied in all dogs. For each dog, 13 optimal implant sites were simulated via geometrical simplification of the bone corridors. Each implant 3D position was then defined with respect to anatomical axes using 2 projected angles (ProjA). The safety margins around each implant were also estimated with angles (SafA) measured in 4 orthogonal directions. A sample of 12 simulated implants was randomly selected and each mathematically calculated angle was compared to direct measurements obtained within OsiriX™ from 2 observers repeated twice. The landmarks simulating anatomical axes were also positioned 4 times to determine their effect on ProjA reproducibility. Results OsiriX could be used successfully to simulate optimal implant positions in all cases. There was excellent agreement between the calculated and measured values for both ProjA (ρc = 0.9986) and SafA (ρc = 0.9996). Absolute differences between calculated and measured values were respectively [ProjA = 0.44 ± 0.53°; SafA = 0.27 ± 0.25°] and [ProjA = 0.26 ± 0.21°; SafA = 0.18 ± 0.18°] for each observer. The 95 % tolerance interval comparing ProjA obtained with 4 different sets of anatomical axis landmarks was [−1.62°, 1.61°] which was considered appropriate for clinical use. Conclusions A new method for determination of optimal implant placement is provided. Semi-automated calculation of optimal implant 3D positions could be further developed to facilitate preoperative planning and to generate large descriptive anatomical datasets. Electronic supplementary material The online version of this article (doi:10.1186/s12917-016-0824-3) contains supplementary material, which is available to authorized users.
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Brioschi V, Cook J, Arthurs GI. Can a surgeon drill accurately at a specified angle? Vet Rec Open 2016; 3:e000172. [PMID: 27547423 PMCID: PMC4964160 DOI: 10.1136/vetreco-2016-000172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/26/2016] [Accepted: 05/04/2016] [Indexed: 11/25/2022] Open
Abstract
Objectives To investigate whether a surgeon can drill accurately a specified angle and whether surgeon experience, task repetition, drill bit size and perceived difficulty influence drilling angle accuracy. Methods The sample population consisted of final-year students (n=25), non-specialist veterinarians (n=22) and board-certified orthopaedic surgeons (n=8). Each participant drilled a hole twice in a horizontal oak plank at 30°, 45°, 60°, 80°, 85° and 90° angles with either a 2.5 or a 3.5 mm drill bit. Participants then rated the perceived difficulty to drill each angle. The true angle of each hole was measured using a digital goniometer. Results Greater drilling accuracy was achieved at angles closer to 90°. An error of ≤±4° was achieved by 84.5 per cent of participants drilling a 90° angle compared with approximately 20 per cent of participants drilling a 30–45° angle. There was no effect of surgeon experience, task repetition or drill bit size on the mean error for intended versus achieved angle. Increased perception of difficulty was associated with the more acute angles and decreased accuracy, but not experience level. Clinical significance This study shows that surgeon ability to drill accurately (within ±4° error) is limited, particularly at angles ≤60°. In situations where drill angle is critical, use of computer-assisted navigation or custom-made drill guides may be preferable.
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Affiliation(s)
- Valentina Brioschi
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Gareth I Arthurs
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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Yang JH, Bhandarkar AW, Suh SW, Hong JY, Hwang JH, Ham CH. Evaluation of accuracy of plain radiography in determining the Risser stage and identification of common sources of errors. J Orthop Surg Res 2014; 9:101. [PMID: 25407253 PMCID: PMC4245837 DOI: 10.1186/s13018-014-0101-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 10/09/2014] [Indexed: 12/02/2022] Open
Abstract
Background Risser’s sign is an established radiological marker for predicting growth potential in adolescent idiopathic scoliosis, but the accuracy of Risser’s staging has been debated. This research was designed to evaluate the accuracy of Risser’s staging and to identify causes of errors in Risser’s staging. Materials and methods Plain radiographs of 89 adolescent idiopathic scoliosis patients were evaluated for Risser’s stage using both the Original and French methods. A three-dimensional computed tomography (3D-CT) was used to evaluate the accuracy of the plain radiographs. Inter- and intra-observer reliability of both methods was assessed on radiographs and 3D-CT images using weighted kappa statistics. The concordance rate for Risser’s staging between plain radiographs and 3D-CT images were calculated. The various sources of staging differences between the two imaging methods were noted, grouped, and analyzed to identify common error patterns. Results Intra- and inter-observer staging reliabilities on plain radiography were 0.91 and 0.94, respectively, using the Original method and 0.91 and 0.92, respectively, using the French method. Intra- and inter-observer reliabilities on 3D-CT were 0.98 and 0.99, respectively, using the Original method and 0.97 and 0.99, respectively, using the French method. Mean concordance rates between plain radiography and 3D-CT were 59.76% and 67.42% using the Original and French methods, respectively. Common sources of error leading to misinterpretation of Risser’s staging were miscalculation of apophysis excursion, skip ossification, isolated non-linear ossification, micro-fusion, and pseudo-fusion. Conclusions Risser’s staging by plain radiography is reliable but not accurate. Variations in the iliac apophysis ossification and misinterpretation of apophysis fusion are the main sources of error.
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Affiliation(s)
- Jae Hyuk Yang
- Department of Orthopedics, Scoliosis Research Institute, Korea University Guro Hospital, Guro, Korea.
| | - Amit Wasudeo Bhandarkar
- Department of Orthopedics, Scoliosis Research Institute, Korea University Guro Hospital, Guro, Korea.
| | - Seung Woo Suh
- Department of Orthopedics, Scoliosis Research Institute, Korea University Guro Hospital, Guro, Korea.
| | - Jae Young Hong
- Department of Orthopedics, Korea University Ansan Hospital, Guro, Korea.
| | - Jin Ho Hwang
- Division of Pediatric Orthopaedics, Orthopaedic Surgery, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea.
| | - Chang Hwa Ham
- Department of Orthopedics, Scoliosis Research Institute, Korea University Guro Hospital, Guro, Korea.
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