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Wang T, Wang J, Hu X, Hao K, Xiang G, Wu Z, Ma Z, Li T, Chen Y, Zhao X, Zhang Y, Ma T, Ren J, Lei W, Feng Y. Diabetes-related Screw Loosening: The Distinction of Surgical Sites and the Relationship among Diabetes, Implant Stabilization and Clinical Outcomes. Orthop Surg 2023; 15:3136-3145. [PMID: 37853938 PMCID: PMC10694010 DOI: 10.1111/os.13915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/05/2023] [Accepted: 09/12/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVES Diabetes mellitus (DM) is correlated with poor clinical outcomes in spinal surgery. However, the effect of it on screw stabilization has not been investigated. The aim of this study was to evaluate the screw loosening rate and postoperative outcomes in diabetic patients and to identify potential risk factors associated with loosening. METHODS This was a retrospective study. Two hundred and forty-three patients who received cervical or lumbar internal fixation between 2015 and 2019 were enrolled. Screw loosening was assessed on radiography, and clinical outcomes were evaluated by the improvement of visual analogue scale (VAS), Oswestry disability index (ODI) or Japanese Orthopaedic Association (JOA) scores. The relationship of DM, screw loosening and clinical outcomes were analyzed with chi-square tests and regression analyses. RESULTS One hundred and twenty-two patients (50.2%) with diabetes were included in this study. Diabetes led to the increase of the rate of screw loosening in the lumbar spine, while the loosening rate did not vary significantly in the cervical spine. The occurrence of screw loosening in the lumbar spine was more likely to be associated with clinical outcomes for motor performance including walking and sitting. However, no significant effect on JOA and VAS scores in the cervical spine of screw loosening was found. Moreover, the history of DM affected the outcomes of the patients who underwent spinal surgery. CONCLUSION DM had an adverse effect on screw stabilization. The impaired improvement of clinical outcomes in diabetics after spinal surgery was related to screw loosening. In addition to the direct effects on operative wounds and neural function, the impact on the screws due to DM was also worth noting.
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Affiliation(s)
- Tianji Wang
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Jing Wang
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Xiaofan Hu
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Kaili Hao
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Geng Xiang
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Zixiang Wu
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Zhensheng Ma
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Tianqing Li
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Yu Chen
- Department of Critical Care MedicineXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Xiong Zhao
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Yang Zhang
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Tiancheng Ma
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Jingjuan Ren
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Wei Lei
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
| | - Yafei Feng
- Department of OrthopedicsXijing Hospital, The Fourth Military Medical UniversityXi'anChina
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Tannoury T, Saade A, Thomas DC, Wisco J, Ajmi Q, Singh V, AbdalKader M, Tannoury C. The "V" Sign: A Reliable Anatomic and Radiographic Landmark for Posterior Percutaneous S1 Screw Placement. JB JS Open Access 2023; 8:e22.00079. [PMID: 37675205 PMCID: PMC10476810 DOI: 10.2106/jbjs.oa.22.00079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Background Sacral (S1) pedicle screw misplacement in posterior percutaneous fixation (PPF) can be related to anatomical variability and a lack of reliable radiographic landmarks. This study highlights a reproducible anatomical landmark (the "V" sign) for the safe localization of the S1 pedicle entry point under fluoroscopy. Methods Human cadavers (n = 14) were dissected for the anatomical description of the "V" landmark and its relationship with the entry point of the S1 pedicle screw. The "V" landmark was defined medially by the lateral border of the superior articulating process of S1 and laterally by the posterior projection of the sacral ala. The mean distance was measured between the bottom point of the "V" landmark and the anatomical entry point to the S1 pedicle (V-S1 entry point distance). A similar measurement was conducted on computed tomography (CT) scans of 135 patients who underwent PPF using the "V" sign as a landmark for S1 pedicle screw placement (270 screws). These were retrospectively evaluated for appropriateness of S1 screw entry points and for proper S1 screw alignment and breaches. Results In the 14 cadavers, irrespective of the laterality and sex, the V-S1 entry point distance averaged 11.7 mm. On the medial-lateral axis, all entry points converged within 2 mm of a vertical line intersecting the base of the "V." Additionally, the CT scan analysis (135 patients, 270 screws) revealed an optimal entry point for 100% of the screws and a 3.3% (n = 9 screws) breach rate. Six of the 9 identified breaches were minor, and only 1 (0.4% of the 270 screws) warranted revision. Conclusions The "V" sign serves as a reliable anatomical and radiographic landmark for identifying the S1 pedicle entry point under fluoroscopic guidance. This landmark can help surgeons overcome the radiographic ambiguity of the sacral anatomy and ultimately reduces the rate of S1 pedicle screw misplacement. Level of evidence Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tony Tannoury
- Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Aziz Saade
- Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Jonathan Wisco
- Boston University School of Medicine, Boston, Massachusetts
| | - Qasim Ajmi
- Boston Medical Center, Boston, Massachusetts
| | - Varun Singh
- Boston Medical Center, Boston, Massachusetts
| | - Mohamad AbdalKader
- Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Chadi Tannoury
- Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
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Matsuoka A, Toyone T, Okano I, Kudo Y, Ishikawa K, Maruyama H, Ozawa T, Shirahata T, Inagaki K. Comparison of pedicle screw placement accuracy between two types of imaging support (Artis Zeego versus two-dimensional fluoroscopy): a cross-sectional observational study. BMC Musculoskelet Disord 2022; 23:644. [PMID: 35790951 PMCID: PMC9254419 DOI: 10.1186/s12891-022-05602-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/28/2022] [Indexed: 02/07/2023] Open
Abstract
Background The pedicle screw system is widely used in spine surgery, and it provides rigid fixation and leads to successful subsequent deformity correction and bony fusion. The standard imaging technique for pedicle screw insertion is two-dimensional images obtained from C-arm-type X-ray fluoroscopy. Artis Zeego is an emerging intraoperative imaging technique that can provide conventional two-dimensional fluoroscopic images and rapid three-dimensional fluoroscopic computed tomography reconstruction imaging. The aim of this study is to compare the insertion accuracies of PS placement using Artis Zeego and conventional 2D X-ray fluoroscopy. Methods In this study, we retrospectively reviewed the postoperative images of thoracolumbar fusion patients who underwent surgery using pedicle screws between 2013 and 2018. Pedicle screw malplacement was assessed using a four-grade classification by Rao et al. Misplacement rates were compared between pedicle screws assisted with Artis Zeego and two-dimensional fluoroscopy. Results A total of 1107 pedicle screws in 153 patients were inserted using Artis Zeego, and 427 pedicle screws in 80 patients were inserted using fluoroscopy. The overall perforation rate was 4.2% (46 perforations of 1106 pedicle screws) in the Artis Zeego group and 7.7% (33 perforations of 427 pedicle screws) in the fluoroscopy group. In the Artis Zeego group, 43 (3.9%) screws were classified as grade 1, and three (0.3%) screws were classified as grade 2. In the fluoroscopy group, 21 (4.9%) screws were classified as grade 1, 10 (2.3%) screws were classified as grade 2, and 2 (0.5%) screws were classified as grade 3. The use of Artis Zeego was associated with a significantly lower screw malplacement rate than was the use of fluoroscopy (p < 0.001). Conclusions Our results demonstrated that pedicle screw placement with Artis Zeego was associated with a lower malplacement rate than was conventional two-dimensional fluoroscopy. No severe malplacement was observed in the Artis Zeego group. Thus, Artis Zeego could be a good option for improving pedicle screw accuracy.
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Garg B, Mehta N. Letter to the Editor on "Transpedicular Screw Placement Accuracy Using the O-Arm Versus Freehand Technique at a Single Institution. Global Spine Journal" by Crawford et al. Global Spine J 2021; 11:416-417. [PMID: 33764181 PMCID: PMC8013948 DOI: 10.1177/2192568220979660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Nishank Mehta
- Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre, New Delhi, India,Nishank Mehta, Department of Orthopaedics, Jai Prakash Narayan Apex Trauma Centre, Ansari Nagar, New Delhi 110029, India.
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Murata K, Fujibayashi S, Otsuki B, Shimizu T, Masamoto K, Matsuda S. Accuracy of fluoroscopic guidance with the coaxial view of the pedicle for percutaneous insertion of lumbar pedicle screws and risk factors for pedicle breach. J Neurosurg Spine 2021; 34:52-59. [PMID: 32858519 DOI: 10.3171/2020.5.spine20291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this study the authors aimed to evaluate the rate of malposition, including pedicle breach and superior facet violation, after percutaneous insertion of pedicle screws using the coaxial fluoroscopic view of the pedicle, and to assess the risk factors for pedicle breach. METHODS In total, 394 percutaneous screws placed in 85 patients using the coaxial fluoroscopic view of the pedicle between January 2014 and September 2017 were assessed, and 445 pedicle screws inserted in 116 patients using conventional open procedures were used for reference. Pedicle breach and superior facet violation were evaluated by postoperative 0.4-mm slice CT. RESULTS Superior facet violation was observed in 0.5% of the percutaneous screws and 1.8% of the conventionally inserted screws. Pedicle breach occurred more frequently with percutaneous screws (28.9%) than with conventionally inserted screws (11.9%). The breaches in percutaneous screws were minor and did not reduce the interbody fusion rate. The angle difference between the percutaneous and conventionally inserted screws was comparable. Insertion at the L3 or L4 level, right-sided insertion, placement around a trefoil canal, smaller pedicle angle, and a small difference between the screw and pedicle diameters were found to be risk factors for pedicle breach by percutaneous pedicle screws. CONCLUSIONS Percutaneous pedicle screw placement using the coaxial fluoroscopic view of the pedicle carries a low risk of superior facet violation. The screws should be placed carefully considering the level and side of insertion, canal shape, and pedicle angle.
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A Comparative Study Between Minimally Invasive Spine Surgery and Traditional Open Surgery for Patients With Spinal Metastasis. Spine (Phila Pa 1976) 2021; 46:62-68. [PMID: 32925689 DOI: 10.1097/brs.0000000000003690] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study was conducted. OBJECTIVE This study aims to compare the perioperative outcomes of minimal invasive spine surgery (MISS) and traditional open surgery (TOS) for thoracolumbar spine metastasis. SUMMARY OF BACKGROUND DATA TOS for metastatic spinal tumors has many disadvantages, such as significant blood loss and high complication rate. MISS may change the treatment modality, but its safety and efficacy for spinal metastasis are lacking. METHODS We retrospectively reviewed clinical data from 154 consecutive patients registered in our institute who underwent separation surgery for spinal metastases from January 2017 to December 2019. Forty-nine patients received MISS and 105 patients had TOS. The demographic and perioperative data were collected and compared between two approaches. RESULTS There were no significant differences in baseline characteristics between the MISS and TOS group, except the sex (P = 0.04). The mean intraoperative blood loss in MISS group was lower than that in TOS group (748.57 vs. 950.48 mL, P = 0.039). The operative time was comparable between both groups (mean 213.45 vs. 221.03 minutes, P = 0.78). The postoperative drainage before discharge in MISS group was remarkably less than that in TOS group (mean 494.02 vs. 1099.10 mL, P = 0.0004). As compared to TOS group, patients in MISS group had lower complication rate, although the difference is not significant (9.52% vs. 6.12%, P = 0.55). The infection rate of MISS group was two-fold lower than that in the TOS group, although the difference is not significant (P = 0.43). The mean hospital stay of MISS group is 7.35 days, which is significantly shorter than TOS group (9.94 days, P = 0.0007). Patients in both groups exhibited similar postoperative neurological outcomes. CONCLUSION MISS is a safe and effective technique that could be considered the optimal treatment for patients with spinal metastasis and myelopathy and thus is an excellent alternative in managing thoracolumbar spine metastasis. LEVEL OF EVIDENCE 3.
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Chung WH, Eu WC, Chiu CK, Chan CYW, Kwan MK. Minimally invasive reduction of thoracolumbar burst fracture using monoaxial percutaneous pedicle screws: Surgical technique and report of radiological outcome. J Orthop Surg (Hong Kong) 2020; 28:2309499019888977. [PMID: 31876259 DOI: 10.1177/2309499019888977] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To describe the reduction technique of thoracolumbar burst fracture using percutaneous monoaxial screws and its radiological outcomes compared to polyaxial screws. METHODS All surgeries were performed by minimally invasive technique with either percutaneous monoaxial or percutaneous polyaxial screws inserted at adjacent fracture levels perpendicular to both superior end plates. Fracture reduction is achieved with adequate rod contouring and distraction maneuver. Radiological parameters were measured during preoperation, postoperation, and follow-up. RESULTS A total of 21 patients were included. Eleven patients were performed with monoaxial pedicle screws and 10 patients performed with polyaxial pedicle screws. Based on AO thoracolumbar classification system, 10 patients in the monoaxial group had A3 fracture type and 1 had A4. In the polyaxial group, six patients had A3 and four patients had A4. Total correction of anterior vertebral height (AVH) ratio was 0.30 ± 0.10 and 0.08 ± 0.07 in monoaxial and polyaxial groups, respectively (p < 0.001). Total correction of posterior vertebral height (PVH) ratio was 0.11 ± 0.05 and 0.02 ± 0.02 in monoaxial and polyaxial groups, respectively (p < 0.001). Monoaxial group achieved more correction of 13° (62.6%) in local kyphotic angle compared to 8.2° (48.0%) in polyaxial group. Similarly, in regional kyphotic angle, 16.5° (103.1%) in the monoaxial group and 8.1° (76.4%) in the polyaxial group were achieved. CONCLUSIONS Monoaxial percutaneous pedicle screws inserted at adjacent fracture levels provided significantly better fracture reduction compared to polyaxial screws in thoracolumbar fractures.
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Affiliation(s)
- Weng Hong Chung
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wei Cheong Eu
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Ding B, Zhou T, Zhao J. A novel system for accurate lumbar spine pedicle screw placement based on three-dimensional computed tomography reconstruction. J Orthop Translat 2020; 23:101-106. [PMID: 32642424 PMCID: PMC7322241 DOI: 10.1016/j.jot.2020.03.010] [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: 07/31/2019] [Accepted: 03/23/2020] [Indexed: 12/04/2022] Open
Abstract
Objectives The accuracy of pedicle screw placement strongly affects the outcome of spinal surgery and has mainly relied on the surgeons’ experience. There is no simple, low-cost, and effective pedicle screw placement system to assist new spinal surgeons with less experience. Methods We designed a localization system with six parameters (starting point height [SP-H], starting point length [SP-L], transverse section angle, sagittal section angle [SSA], pedicle width [W] and height [H]) based on preoperative computed tomography reconstruction and combined it with the Roussouly classification to guide lumbar spine pedicle screw placement and analysed the change patterns of the six parameters in 50 participants. Results Based on the system, we confirmed that combining SP-H and SP-L can localize the entrance of the pedicle screw. Furthermore, we considered that SP-L and transverse section angle would be a new standard for determination of the transverse orientation of the pedicle screw. More importantly, the linear regression equations between H and W and SP-H and H were concealed. In addition, H and W can guide the appropriate selection of pedicle screw. Moreover, change patterns of SSA combined with the Roussouly classification indicate that SSA of L3 can be used as a benchmark to guide the establishment of sagittal alignment of the lumbar spine. Conclusions Understanding and applying the six-parameter localization system are essential for achieving accuracy in lumbar spine pedicle screw placement, and the system is a useful guide in the establishment of sagittal alignment. The translational potential of this article This study provides a new pedicle-screw placement system for accurate lumbar spine pedicle screw placement based on three-dimensional CT reconstruction, requiring six parameters to guide the system.
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Affiliation(s)
- Baozhi Ding
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, PR China
| | - Tangjun Zhou
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, PR China
| | - Jie Zhao
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, PR China
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Accuracy in Percutaneous Transpedicular Screws Placement Using Biplane Radioscopy: Systematic Review and Meta-Analysis. Clin Spine Surg 2019; 32:198-207. [PMID: 30762838 DOI: 10.1097/bsd.0000000000000801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Systematic review and descriptive data meta-analysis. OBJECTIVE The objective of this study was to appropriately establish the accuracy in the percutaneous transpedicular screws (PTS) placement using biplane radioscopy (Rx-2D). SUMMARY OF BACKGROUND DATA The Rx-2D is a widely-used technique for PTS as it is practical, ubiquitous, and cost-effective. However, the reported "acceptable" accuracy attained by this method is widely variable ranging between 76% and 100%. METHODS A systematic review was conducted to screen publications about PTS placement using Rx-2D guidance. PubMed/MEDLINE database was consulted using the search term "percutaneous pedicle screw" from 1977 to 2017. Previous meta-analysis and reference lists of the selected articles were reviewed. Accuracy values were assessed fulfilling the proposed criteria. Observational data meta-analysis was performed. Cochran's Q test was used to determine heterogeneity among data extracted from the series, which was quantified by I test. P-values≤0.05 were considered statistically significant. The results were depicted by Forest plots. Funnel plots were outlined to visualize a possible bias of publication among the selected articles. RESULTS In total, 27 articles were included in the analysis. Results of the accuracy were as follow, 91.5% (n=7993; 95% CI, 89.3%-93.6%) of the screws were placed purely intrapedicular, and 96.1% (n=8579; 95% CI, 94.0%-98.2%) when deviation from the pedicle was up to 2 mm. CONCLUSIONS This meta-analysis is the largest review of PTS placed with Rx-2D guidance reported up to date. We concluded that the procedure is a safe and reproducible technique. The key values obtained in this work set reliable references for both clinical and training outcome assessing.
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Nam TW, Oh HM, Lee JE, Kim JH, Hwang JM, Park E, Jung TD. An unusual complication of sacral nerve root injury following bone marrow harvesting: a case report. BMC Cancer 2019; 19:347. [PMID: 30975123 PMCID: PMC6458794 DOI: 10.1186/s12885-019-5567-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) remains an important therapeutic option for many hematologic malignancies. Bone marrow harvesting from an appropriate donor must be conducted for hematopoietic stem cell transplantation (HSCT). Many previous studies show complications of the recipient after hematopoietic stem cell transplantation (HSCT). However, complications of the donor after bone marrow harvesting are rare. We here report a unique case of a patient who developed sacral nerve root injury after bone marrow harvesting. CASE PRESENTATION A 26-year-old man was admitted to our medical center complaining of acute onset painful burning and tingling sensation at the left posterior thigh and calf. He was a bone marrow donor for his brother's bone marrow transplantation. He had underwent a bone marrow harvesting procedure two days before admission as a bone marrow donor, using both posterior superior iliac spine (PSIS) as the puncture site. Pelvic magnetic resonance image (MRI) showed enhancement around the left S2 nerve root in T1 and T2-weighted images. Nerve conduction studies (NCS) revealed normal conduction velocity and amplitude on both lower extremities. Electromyography (EMG) presented abnormal spontaneous activity and neurogenic motor unit potentials on the S2-innervated intrinsic foot muscle and gastrocnemius, soleus muscle on the left. The patient was treated with pregabalin for pain control. The patient was followed up after 3, 6, and 12 months. Neuropathic pain improved to Visual Analogue Scale (VAS) 1, and recovery state was confirmed by re-innervation patterns of motor unit potentials in electromyography. CONCLUSION Bone marrow harvesting is a relatively safe procedure. However, variable complications may occur. Accurate anatomical knowledge and carefulness are required to avoid sacral nerve root injury when performing the bone marrow harvesting procedure.
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Affiliation(s)
- Tae-Woo Nam
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
| | - Hyun-Min Oh
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
| | - Jae-Eun Lee
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
| | - Ju-Hyun Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
| | - Jong-Moon Hwang
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
| | - Eunhee Park
- Department of Rehabilitation Medicine, Kyungpook National University Medical Center, Daegu, South Korea.,Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 41404, South Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea. .,Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu, 41404, South Korea.
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Perdomo-Pantoja A, Ishida W, Zygourakis C, Holmes C, Iyer RR, Cottrill E, Theodore N, Witham TF, Lo SFL. Accuracy of Current Techniques for Placement of Pedicle Screws in the Spine: A Comprehensive Systematic Review and Meta-Analysis of 51,161 Screws. World Neurosurg 2019; 126:664-678.e3. [PMID: 30880208 DOI: 10.1016/j.wneu.2019.02.217] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pedicle screws (PSs) are routinely used for stabilization to enhance fusion in a variety of spinal diseases. Although the accuracy of different PS placement methods has been previously reported, most of these studies have been limited to 1 or 2 techniques. The purpose was to determine the current accuracy of PS placement among 4 modalities of PS insertion (freehand [FH], fluoroscopy-assisted [FA], computed tomography navigation-guided [CTNav], and robot-assisted [RA]) and analyze variables associated with screw misplacement. METHODS A systematic review was performed of peer-reviewed articles reporting PS accuracy of 1 technique from January 1990 to June 2018. Accuracy of PS placement, PS insertion technique, and pedicle breach (PB) data were collected. A meta-analysis was performed to estimate the overall pooled (OP) rates of PS accuracy as a primary outcome, stratified by screw insertion techniques. Potential determinants were analyzed via meta-regression analyses. RESULTS Seventy-eight studies with 7858 patients, 51,161 PSs, and 3614 cortical PBs were included. CTNav showed the highest PS placement accuracy compared with other techniques: OP accuracy rates were 95.5%, 93.1%, 91.5%, and 90.5%, via CTNav, FH, FA, and RA techniques, respectively. RA and CTNav were associated with the highest PS accuracy in the thoracic spine, compared with FH. CONCLUSIONS The OP data show that CTNav has the highest PS accuracy rates. Thoracic PSs were associated with lower accuracy rates; however, RA showed fewer breaches in the thoracic spine compared with FH and FA. Given the heterogeneity among studies, further standardized and comparative investigations are required to confirm our findings.
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Affiliation(s)
| | - Wataru Ishida
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Corinna Zygourakis
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christina Holmes
- Florida A&M University-Florida State University College of Engineering, Tallahassee, Florida, USA
| | - Rajiv R Iyer
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ethan Cottrill
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sheng-Fu L Lo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Tan LA, Yerneni K, Tuchman A, Li XJ, Cerpa M, Lehman RA, Lenke LG. Utilization of the 3D-printed spine model for freehand pedicle screw placement in complex spinal deformity correction. JOURNAL OF SPINE SURGERY 2018; 4:319-327. [PMID: 30069524 DOI: 10.21037/jss.2018.05.16] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We aim to demonstrate the safety and efficacy of utilizing 3D-printed spine models to facilitate freehand pedicle screw placement in complex spinal deformity correction. Currently there is no data on using 3D-printed models for freehand pedicle screw placement spinal deformity correction. Methods All patients undergoing spinal deformity correction over a 16-month period (September 2015 - December 2016) at the Spine Hospital of Columbia University Medical Center by the senior surgeon were reviewed. 3D-printed spine models were used to facilitate intraoperative freehand pedicle screw placement in patients with severe spinal deformities. Intraoperative O-arm imaging was obtained after pedicle screw placement in all patients. Screws were graded as intrapedicular, <2 mm breach, 2-4 mm breach, and >4 mm breach; anterior breaches >4 mm were also recorded. Screw accuracy was compared to a historical cohort (not using 3D-printed models) using SPSS 23.0 (Chicago, IL, USA). Results A total of 513 freehand pedicle screws were placed from T1 to S1 in 23 patients. Overall, 494 screws (96.3%) were placed in acceptable positions according to the pre-operative plan, which had no statistically significant difference (P=0.99) compared to a historical cohort with less severe deformities. There were 84.2% screw that were intrapedicular or <2 mm breach; among the 81 screws (15.8%) with >2 mm breach, 67 were lateral breaches (most are intended juxtapedicular placement), whereas 14 were medial breaches. There were 11 screws (2.1%) that required repositioning due to pedicle violation, and eight screws (1.6%) had >4 mm anterior breach and required shortening. There was no neuromonitoring change or any other complications directly or indirectly related to freehand pedicle screw placement. Conclusions The 3D-printed spinal model can make freehand pedicle screw placement safer in severe spinal deformity cases with acceptable accuracy, and no neurological or vascular complications.
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Affiliation(s)
- Lee A Tan
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, CA, USA
| | - Ketan Yerneni
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, CA, USA
| | - Alexander Tuchman
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Xudong J Li
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Meghan Cerpa
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Ronald A Lehman
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Lawrence G Lenke
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
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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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Accuracy and Safety of Percutaneous Lumbosacral Pedicle Screw Placement Using Dual-Planar Intraoperative Fluoroscopy. Asian Spine J 2018; 12:238-245. [PMID: 29713404 PMCID: PMC5913014 DOI: 10.4184/asj.2018.12.2.238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/14/2017] [Accepted: 07/08/2017] [Indexed: 01/14/2023] Open
Abstract
Study Design Retrospective case series with prospective arm. Purpose To assess the safety and accuracy of percutaneous lumbosacral pedicle screw placement (PLPSP) in the lumbosacral spine using intraoperative dual-planar fluoroscopy (DPF). Overview of Literature There are several techniques available for achieving consistent, safe, and accurate results with PLPSP. There is a paucity of literature describing the beneficial operative, economic, and clinical outcomes of DPF, the most readily accessible image guidance system. Methods From 2004 to 2014, 451 consecutive patients underwent PLPSP using DPF, for a total of 2,345 screw placement. The results of prospectively obtained postoperative computed tomography (CT) examinations of an additional 41 consecutive patients were compared with the results of 104 CT examinations obtained postoperatively due to clinical symptomatology; these results were interpreted by three reviewers. The rates of revision indicated by misplaced screws with consistent clinical symptomatology were compared between groups. Pedicle screw placement was graded according to 2-mm increments in medial pedicle wall breach and measurement of screw axis placement. Results Seven of the 2,345 pedicle screws placed percutaneously with the use of the dual-planar fluoroscopic technique required revision because of a symptomatic misplaced screw, for a screw revision rate of 0.3%. There were no statistically significant demographic differences between patients who had screws revised and those who did not. All screws registered greater than 10 mA on electromyographic stimulation. In the 41 prospectively obtained CT examinations, one out of 141 screws (0.7%) was revised due to pedicle wall breach; whereas among the 104 patients with 352 screws, three screws were revised (0.9%). Conclusions DPF is an extremely accurate, safe, and reproducible technique for placement of percutaneous pedicle screws and is a readily available and cost-effective alternative to CT-guided pedicle screw placement techniques. Postoperative CT evaluation is not necessary with PLPSP unless the patient is symptomatic. Acceptable electromyographic thresholds may need to be reevaluated.
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Blizzard DJ, Thomas JA. MIS Single-position Lateral and Oblique Lateral Lumbar Interbody Fusion and Bilateral Pedicle Screw Fixation: Feasibility and Perioperative Results. Spine (Phila Pa 1976) 2018; 43:440-446. [PMID: 28704331 DOI: 10.1097/brs.0000000000002330] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data of the first 72 consecutive patients treated with single-position one- or two-level lateral (LLIF) or oblique lateral interbody fusion (OLLIF) with bilateral percutaneous pedicle screw and rod fixation by a single spine surgeon. OBJECTIVE To evaluate the clinical feasibility, accuracy, and efficiency of a single-position technique for LLIF and OLLIF with bilateral pedicle screw and rod fixation. SUMMARY OF BACKGROUND DATA Minimally-invasive lateral interbody approaches are performed in the lateral decubitus position. Subsequent repositioning prone for bilateral pedicle screw and rod fixation requires significant time and resources and does not facilitate increased lumbar lordosis. METHODS The first 72 consecutive patients (300 screws) treated with single-position LLIF or OLLIF and bilateral pedicle screws by a single surgeon between December 2013 and August 2016 were included in the study. Screw accuracy and fusion were graded using computed tomography and several timing parameters were recorded including retractor, fluoroscopy, and screw placement time. Complications including reoperation, infection, and postoperative radicular pain and weakness were recorded. RESULTS Average screw placement time was 5.9 min/screw (standard deviation, SD: 1.5 min; range: 3-9.5 min). Average total operative time (interbody cage and pedicle screw placement) was 87.9 minutes (SD: 25.1 min; range: 49-195 min). Average fluoroscopy time was 15.0 s/screw (SD: 4.7 s; range: 6-25 s). The pedicle screw breach rate was 5.1% with 10/13 breaches measured as < 2 mm in magnitude. Fusion rate at 6-months postoperative was 87.5%. Two (2.8%) patients underwent reoperation for malpositioned pedicle screws with subsequent resolution of symptoms. CONCLUSION The single-position, all-lateral technique was found to be feasible with accuracy, fluoroscopy usage, and complication rates comparable with the published literature. This technique eliminates the time and staffing associated with intraoperative repositioning and may lead to significant improvements in operative efficiency and cost savings. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Daniel J Blizzard
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC
| | - J Alex Thomas
- Atlantic Neurosurgical and Spine Specialists, Wilmington, NC
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Chiu CK, Chan CYW, Kwan MK. The accuracy and safety of fluoroscopic-guided percutaneous pedicle screws in the thoracic and lumbosacral spine in the Asian population: A CT scan analysis of 1002 screws. J Orthop Surg (Hong Kong) 2018; 25:2309499017713938. [PMID: 28705124 DOI: 10.1177/2309499017713938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study investigates the safety and accuracy of percutaneous pedicle screws placed using fluoroscopic guidance in the thoracolumbosacral spine among Asian patients. METHODS Computerized tomography scans of 128 patients who had surgery using fluoroscopic-guided percutaneous pedicle screws were selected. Medial, lateral, superior, and inferior screw perforations were classified into grade 0 (no violation), grade 1 (<2 mm perforation), grade 2 (2-4 mm perforation), and grade 3(>4 mm perforation). Anterior perforations were classified into grade 0 (no violation), grade 1 (<4 mm perforation), grade 2 (4-6 mm perforation), and grade 3(>6 mm perforation). Grade 2 and grade 3 perforation were considered as "critical" perforation. RESULTS In total, 1002 percutaneous pedicle screws from 128 patients were analyzed. The mean age was 52.7 ± 16.6. There were 70 male patients and 58 female patients. The total perforation rate was 11.3% (113) with 8.4% (84) grade 1, 2.6% (26) grade 2, and 0.3% (3) grade 3 perforations. The overall "critical" perforation rate was 2.9% (29 screws) and no complications were noted. The highest perforation rates were at T4 (21.6%), T2 (19.4%), and T6 (19.2%). CONCLUSION The total perforation rate of 11.3% with the total "critical" perforation rate of 2.9% (2.6% grade 2 and 0.3% grade 3 perforations). The highest perforation rates were found over the upper to mid-thoracic region. Fluoroscopic-guided percutaneous pedicle screws insertion among Asians has the safety and accuracy comparable to the current reported percutaneous pedicle screws and open pedicle screws techniques.
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Affiliation(s)
- Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Siasios ID, Pollina J, Khan A, Dimopoulos VG. Percutaneous screw placement in the lumbar spine with a modified guidance technique based on 3D CT navigation system. JOURNAL OF SPINE SURGERY 2017; 3:657-665. [PMID: 29354745 DOI: 10.21037/jss.2017.12.05] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Several guidance techniques have been employed to increase accuracy and reduce surgical time during percutaneous placement of pedicle screws (PS). The purpose of our study was to present a modified technique for percutaneous placement of lumbar PS that reduces surgical time. We reviewed 23 cases of percutaneous PS placement using our technique for minimally invasive lumbar surgeries and 24 control cases where lumbar PS placement was done via common technique using Jamshidi needles (Becton, Dickinson and Company, Franklin Lakes, NJ, USA). An integrated computer-guided navigation system was used in all cases. In the technique modification, a handheld drill with a navigated guide was used to create the path for inserting guidewires through the pedicles and into the vertebral bodies. After drill removal, placement of the guidewires through the pedicles took place. The PS were implanted over the guidewires, through the pedicles and into the vertebral bodies. Intraoperative computed tomography was performed after screw placement to ensure optimal positioning in all cases. There were no intraoperative complications with either technique. PS placement was correct in all cases. The average time for each PS placement was 6.9 minutes for the modified technique and 9.2 minutes for the common technique. There was no significant difference in blood loss. In conclusion, this modified technique is efficient and contributes to reduced operative time.
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Affiliation(s)
- Ioannis D Siasios
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, NY, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, NY, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, NY, USA
| | - Vassilios George Dimopoulos
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, NY, USA
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Shao ZX, Wang JS, Lin ZK, Ni WF, Wang XY, Wu AM. Improving the trajectory of transpedicular transdiscal lumbar screw fixation with a computer-assisted 3D-printed custom drill guide. PeerJ 2017; 5:e3564. [PMID: 28717599 PMCID: PMC5511502 DOI: 10.7717/peerj.3564] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/20/2017] [Indexed: 11/20/2022] Open
Abstract
Transpedicular transdiscal screw fixation is an alternative technique used in lumbar spine fixation; however, it requires an accurate screw trajectory. The aim of this study is to design a novel 3D-printed custom drill guide and investigate its accuracy to guide the trajectory of transpedicular transdiscal (TPTD) lumbar screw fixation. Dicom images of thirty lumbar functional segment units (FSU, two segments) of L1-L4 were acquired from the PACS system in our hospital (patients who underwent a CT scan for other abdomen diseases and had normal spine anatomy) and imported into reverse design software for three-dimensional reconstructions. Images were used to print the 3D lumbar models and were imported into CAD software to design an optimal TPTD screw trajectory and a matched custom drill guide. After both the 3D printed FSU models and 3D-printed custom drill guide were prepared, the TPTD screws will be guided with a 3D-printed custom drill guide and introduced into the 3D printed FSU models. No significant statistical difference in screw trajectory angles was observed between the digital model and the 3D-printed model (P > 0.05). Our present study found that, with the help of CAD software, it is feasible to design a TPTD screw custom drill guide that could guide the accurate TPTD screw trajectory on 3D-printed lumbar models.
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Affiliation(s)
- Zhen-Xuan Shao
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical School of Wenzhou Medical University, Digital Orthopedic Institute, Zhejiang Spine Surgery Center, Wenzhou, Zhejiang, China
| | - Jian-Shun Wang
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical School of Wenzhou Medical University, Digital Orthopedic Institute, Zhejiang Spine Surgery Center, Wenzhou, Zhejiang, China
| | - Zhong-Ke Lin
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical School of Wenzhou Medical University, Digital Orthopedic Institute, Zhejiang Spine Surgery Center, Wenzhou, Zhejiang, China
| | - Wen-Fei Ni
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical School of Wenzhou Medical University, Digital Orthopedic Institute, Zhejiang Spine Surgery Center, Wenzhou, Zhejiang, China
| | - Xiang-Yang Wang
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical School of Wenzhou Medical University, Digital Orthopedic Institute, Zhejiang Spine Surgery Center, Wenzhou, Zhejiang, China
| | - Ai-Min Wu
- Department of Spine Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Second Medical School of Wenzhou Medical University, Digital Orthopedic Institute, Zhejiang Spine Surgery Center, Wenzhou, Zhejiang, China
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Comparison Between Minimally Invasive Surgery and Conventional Open Surgery for Patients With Spinal Metastasis: A Prospective Propensity Score-Matched Study. Spine (Phila Pa 1976) 2017; 42:789-797. [PMID: 27584676 DOI: 10.1097/brs.0000000000001893] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective propensity score-matched study. OBJECTIVE To compare the outcomes of minimal invasive surgery (MIS) and conventional open surgery for spinal metastasis patients. SUMMARY OF BACKGROUND DATA There is lack of knowledge on whether MIS is comparable to conventional open surgery in treating spinal metastasis. METHODS Patients with spinal metastasis requiring surgery from January 2008 to December 2010 in two spine centers were recruited. The demographic, preoperative, operative, perioperative and postoperative data were collected and analyzed. Thirty MIS patients were matched with 30 open surgery patients using propensity score matching technique with a match tolerance of 0.02 based on the covariate age, tumor type, Tokuhashi score, and Tomita score. RESULTS Both groups had significant improvements in Eastern Cooperative Oncology Group (ECOG), Karnofsky scores, visual analogue scale (VAS) for pain and neurological status postoperatively. However, the difference comparing the MIS and open surgery group was not statistically significant. MIS group had significantly longer instrumented segments (5.5 ± 3.1) compared with open group (3.8 ± 1.7). Open group had significantly longer decompressed segment (1.8 ± 0.8) than MIS group (1.0 ± 1.0). Open group had significantly more blood loss (2062.1 ± 1148.0 mL) compared with MIS group (1156.0 ± 572.3 mL). More patients in the open group (76.7%) needed blood transfusions (with higher average units of blood transfused) compared with MIS group (40.0%). Fluoroscopy time was significantly longer in MIS group (116.1 ± 63.3 s) compared with open group (69.9 ± 42.6 s). Open group required longer hospitalization (21.1 ± 10.8 days) compared with MIS group (11.0 ± 5.0 days). CONCLUSION This study demonstrated that MIS resulted in comparable outcome to open surgery for patients with spinal metastasis but has the advantage of less blood loss, blood transfusions, and shorter hospital stay. LEVEL OF EVIDENCE 3.
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Yin Wei CC, Haw SS, Bashir ES, Beng SL, Shanmugam R, Keong KM. Biomechanical comparison between cortical screw-rod construct versus pedicle screw-rod construct in transforaminal lumbar interbody fusion. J Orthop Surg (Hong Kong) 2017; 25:2309499017690656. [PMID: 28219305 DOI: 10.1177/2309499017690656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare construct stiffness of cortical screw (CS)-rod transforaminal lumbar interbody fusion (TLIF) construct (G2) versus pedicle screw (PS)-rod TLIF construct (G1) in the standardized porcine lumbar spine. METHODS Six porcine lumbar spines (L2-L5) were separated into 12 functional spine units. Bilateral total facetectomies and interlaminar decompression were performed for all specimens. Non-destructive loading to assess stiffness in lateral bending, flexion and extension as well as axial rotation was performed using a universal material testing machine. RESULTS PS and CS constructs were significantly stiffer than the intact spine except in axial rotation. Using the normalized ratio to the intact spine, there is no significant difference between the stiffness of PS and CS: flexion (1.41 ± 0.27, 1.55 ± 0.32), extension (1.98 ± 0.49, 2.25 ± 0.44), right lateral flexion (1.93 ± 0.57, 1.55 ± 0.30), left lateral flexion (2.00 ± 0.73, 2.16 ± 0.20), right axial rotation (0.99 ± 0.21, 0.83 ± 0.26) and left axial rotation (0.96 ± 0.22, 0.92 ± 0.25). CONCLUSION The CS-rod TLIF construct provided comparable construct stiffness to a traditional PS-rod TLIF construct in a 'standardized' porcine lumbar spine model.
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Affiliation(s)
- Chris Chan Yin Wei
- 1 Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Sem Sei Haw
- 1 Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | | | - Saw Lim Beng
- 1 Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Rukmanikanthan Shanmugam
- 1 Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Kwan Mun Keong
- 1 Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
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