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Zhang G, Li J, Zhang L, Song J, Shao J, Lv C, Bai T, Du Y, Xi Y. Biomechanical Effect of Different Posterior Fixation Techniques on Stability and Adjacent Segment Degeneration in Treating Thoracolumbar Burst Fracture With Osteoporosis: A Finite Element Analysis. Spine (Phila Pa 1976) 2024; 49:E229-E238. [PMID: 38721831 PMCID: PMC11232937 DOI: 10.1097/brs.0000000000005034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/28/2024] [Indexed: 07/11/2024]
Abstract
STUDY DESIGN Finite element analysis. OBJECTIVE To investigate the biomechanical effect of four posterior fixation techniques on stability and adjacent segment degeneration in treating thoracolumbar burst fractures with osteoporosis. SUMMARY OF BACKGROUND DATA In terms of stability and adjacent segment degeneration, there remains no consensus or guidelines on the optimal technique for the treatment of thoracolumbar burst fractures in patients with osteoporosis. MATERIALS AND METHODS Images of CT scans were imported into MIMICS and further processed by Geomagic to build three-dimensional models of the T10-L5 region. A v-shaped osteotomy was performed on the L1 vertebral body to simulate a burst fracture in the setting of osteoporosis. Subsequently, four fixation techniques were designed using SolidWorks software. Range of motion (ROM) of the global spine, ROM distribution, ROM of adjacent segment, Von Mises stress on adjacent intervertebral disks, and facet joints were analyzed. RESULTS Among the four groups, the cortical bone screw fixation (CBT) showed the highest global ROM at 1.86°, while long-segmented pedicle screw fixation (LSPS) had the lowest global ROM at 1.25°. The LSPS had the smallest percentage of ROM of fractured vertebral body to fixed segment at 75.04%, suggesting the highest stability after fixation. The maximum ROM of the adjacent segment was observed in the CBT at 1.32°, while the LSPS exhibited the smallest at 0.89°. However, the LSPS group experienced larger maximum stress on the adjacent intervertebral disks (9.60 MPa) and facet joints (3.36 MPa), indicating an increasing risk of adjacent segment disease. CONCLUSION LSPS provided the greatest stability, while CBT provided the smallest amount of stability. However, the elevated stress on adjacent intervertebral disks and facet joints after LSPS fixation increased the possibility of adjacent segment degeneration. Cement-augmented pedicle screw fixation (CAPS) and combined cortical bone screw and pedicle screw fixation (CBT-PS) demonstrated significant biomechanical advantages in providing moderate fixation strength while reducing stress on the intervertebral disks and facet joints.
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Affiliation(s)
- Guodong Zhang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- Department of Spinal Surgery, Tengzhou Central People's Hospital, Tengzhou, Shandong, China
| | - Jianyi Li
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Li Zhang
- Department of Operation Room, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jie Song
- Department of Health Care, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jiale Shao
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Changlin Lv
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Tianyu Bai
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yukun Du
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yongming Xi
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Chen H, Kang Y, Yan Y, Wang H, Peng W, Liao Y, Zou M, Xu Z, Song X, Wang W, Wang C. Biomechanical analysis of the tandem spinal external fixation in a multiple-level noncontiguous lumbar fractures model: a finite element analysis. Front Bioeng Biotechnol 2024; 12:1395197. [PMID: 38962665 PMCID: PMC11219947 DOI: 10.3389/fbioe.2024.1395197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/29/2024] [Indexed: 07/05/2024] Open
Abstract
Objective This study aimed to investigate the biomechanical characteristics of the tandem spinal external fixation (TSEF) for treating multilevel noncontiguous spinal fracture (MNSF) using finite element analysis and provide a theoretical basis for clinical application. Methods We constructed two models of L2 and L4 vertebral fractures that were fixed with the TSEF and the long-segment spinal inner fixation (LSIF). The range of motion (ROM), maximum stresses at L2 and L4 vertebrae, the screws and rods, and the intervertebral discs of the two models were recorded under load control. Subsequently, the required torque, the maximum stress at L2 and L4 vertebrae, the screws and rods, and the intervertebral discs were analyzed under displacement control. Results Under load control, the TSEF model reserved more ROM than the LSIF model. The maximum stresses of screws in the TSEF model were increased, while the maximum stresses of rods were reduced compared to the LSIF model. Moreover, the maximum stresses of L2 and L4 vertebrae and discs in the TSEF model were increased compared to the LSIF model. Under displacement control, the TSEF model required fewer moments (N·mm) than the LSIF model. Compared to the LSIF model, the maximum stresses of screws and rods in the TSEF model have decreased; the maximum stresses at L2 and L4 in the TSEF model were increased. In the flexion condition, the maximum stresses of discs in the TSEF model were less than the LSIF model, while the maximum stresses of discs in the TSEF model were higher in the extension condition. Conclusion Compared to LSIF, the TSEF has a better stress distribution with higher overall mobility. Theoretically, it reduces the stress concentration of the connecting rods and the stress shielding of the fractured vertebral bodies.
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Affiliation(s)
- Huarong Chen
- The First Affiliated Hospital, Department of Spine Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
- Central People’s Hospital of Zhanjiang, Zhanjiang, Guangdong, China
| | - Yu Kang
- The First Affiliated Hospital, Department of Spine Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
- The Third Affiliated Hospital of Sun Yat-sen University, Department of Spine Surgery, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yiguo Yan
- The First Affiliated Hospital, Department of Spine Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Hu Wang
- The First Affiliated Hospital, Department of Spine Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Wen Peng
- The First Affiliated Hospital, Department of Spine Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Yijia Liao
- The First Affiliated Hospital, Department of Spine Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
- Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang, Henan, China
| | - Mingxiang Zou
- The First Affiliated Hospital, Department of Spine Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Zhun Xu
- The First Affiliated Hospital, Department of Spine Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Xizheng Song
- The First Affiliated Hospital, Department of Spine Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Wenjun Wang
- The First Affiliated Hospital, Department of Spine Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Cheng Wang
- The First Affiliated Hospital, Department of Spine Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan, China
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Long Z, Yu H, Yang H, Guo M, Meng L, Yuan H, Xiang L, Wang Q. Biomedical analysis of four fixation systems in treatment of type II traumatic spondylolisthesis of the axis: a finite element analysis. Med Biol Eng Comput 2024; 62:843-852. [PMID: 38052881 DOI: 10.1007/s11517-023-02981-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023]
Abstract
This study aimed to compare the properties and safety of self-designed plates in type II traumatic spondylolisthesis of the axis with those of traditional devices via finite element (FE) analysis. We constructed a hangman's fracture FE model from the occipital bone (C0) level to the C3 level. Then, FE models were constructed for the following four fixation systems: an anterior cervical L-shaped plate with four vertebral screws (4-ACLP), or six screws (6-ACLP), an anterior cervical orion plate (ACOP), and a posterior fixation system. A preloaded compressive force of 50 N and a moment of 1.5 N·m were applied to each model under six working conditions. The mobility of the C2/3 segment decreased significantly in four fixation models. In the Mises stress cloud diagram, 4-ACLP showed a better stress distribution in both the bone graft and fixation system than 6-ACLP and ACOP. The resultant force of 4-ACLP was lower but higher than ACOP in axial force. Additionally, the cage in the 4-ACLP configuration experienced the highest stress in the six working conditions. Hence, this novel self-designed plate has the potential to mitigate the operational difficulties, provide sufficient stability, reduce the risk of plate or screw fractures, and improve bone fusion.
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Affiliation(s)
- Zuoyao Long
- General Hospital of Northern Theater Command, Shenyang, China
| | - Hailong Yu
- General Hospital of Northern Theater Command, Shenyang, China
| | - Huifeng Yang
- General Hospital of Northern Theater Command, Shenyang, China
| | - Mingming Guo
- General Hospital of Northern Theater Command, Shenyang, China
| | - Lingzhi Meng
- General Hospital of Northern Theater Command, Shenyang, China
| | - Hong Yuan
- General Hospital of Northern Theater Command, Shenyang, China
| | - Liangbi Xiang
- General Hospital of Northern Theater Command, Shenyang, China.
| | - Qi Wang
- General Hospital of Northern Theater Command, Shenyang, China.
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Yang JX, Luo L, Liu JH, Wang N, Xi ZP, Li JC. Incomplete insertion of pedicle screws triggers a higher biomechanical risk of screw loosening: mechanical tests and corresponding numerical simulations. Front Bioeng Biotechnol 2024; 11:1282512. [PMID: 38260754 PMCID: PMC10800439 DOI: 10.3389/fbioe.2023.1282512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Screw loosening is a widely reported issue after spinal screw fixation and triggers several complications. Biomechanical deterioration initially causes screw loosening. Studies have shown that incomplete insertion of pedicle screws increases the risk of screw breakage by deteriorating the local mechanical environment. However, whether this change has a biomechanical effect on the risk of screw loosening has not been determined. This study conducted comprehensive biomechanical research using polyurethane foam mechanical tests and corresponding numerical simulations to verify this topic. Pedicle screw-fixed polyurethane foam models with screws with four different insertion depths were constructed, and the screw anchoring ability of different models was verified by toggle tests with alternating and constant loads. Moreover, the stress distribution of screw and bone-screw interfaces in different models was computed in corresponding numerical mechanical models. Mechanical tests presented better screw anchoring ability with deeper screw insertion, but parameters presented no significant difference between groups with complete thread insertion. Correspondingly, higher stress values can be recorded in the model without complete thread insertion; the difference in stress values between models with complete thread insertion was relatively slight. Therefore, incomplete thread insertion triggers local stress concentration and the corresponding risk of screw loosening; completely inserting threads could effectively alleviate local stress concentration and result in the prevention of screw loosening.
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Affiliation(s)
- Jie-Xiang Yang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Luzhou Key Laboratory of Orthopedic Disorders, Southwest Medical University, Luzhou, Sichuan, China
| | - Lin Luo
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Luzhou Key Laboratory of Orthopedic Disorders, Southwest Medical University, Luzhou, Sichuan, China
| | - Jin-Hui Liu
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Nan Wang
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Zhi-Peng Xi
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Jing-Chi Li
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China
- Luzhou Key Laboratory of Orthopedic Disorders, Southwest Medical University, Luzhou, Sichuan, China
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Solitro GF, Welborn MC, Mehta AI, Amirouche F. How to Optimize Pedicle Screw Parameters for the Thoracic Spine? A Biomechanical and Finite Element Method Study. Global Spine J 2024; 14:187-194. [PMID: 35499547 PMCID: PMC10676166 DOI: 10.1177/21925682221099470] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Pedicle screw study. OBJECTIVE The selection of pedicle screw parameters usually involves the surgeon's analysis of preoperative CT imaging along with anatomical landmarks and tactile examination. However, there is minimal consensus on a standardized guideline for selection methods on pedicle screws. We aimed to determine the effects of thoracic screw diameter to pedicle width on pullout strength determined by cortical bone purchase. METHODS Biomechanical study performed with human cadaveric thoracic vertebrae and experimentally validated three-dimensional finite element model instrumented with pedicle screws of various diameters. We used a variable (SD/PW) ratio to express the screw selection. We hypothesized a positive correlation between the pullout load determined by the bone purchase and the SD/PW. This relationship was first investigated in a validated finite element model considering bone purchase related to the strength of an upper thoracic vertebra. Then, the correlation to the entire spine is evaluated. RESULTS The failure load ranged from 371.3 to 1601.0 N, respectively, for 3 and 6 mm screws. The determinant coefficient was increased to R2=.421 when a linear relationship between pullout load and the SD/PW ratio was used. The peak loads of 1216 and 1288N were found for an SD/PW ratio of .83. CONCLUSION We have found that the screw pullout load is more correlated to SD/PW than other pedicle measures for a maximized SD/PW ratio of .83. This particular value should be considered the upper limit of the indicated SD/PW ratio and a means to determine the optimal screw diameter to enhance pullout strength.
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Affiliation(s)
| | - Michelle C. Welborn
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA
| | - Ankit I. Mehta
- Department of Orthopaedic Surgery, NorthShore University HealthSystem, Evanston, Il, USA
| | - Farid Amirouche
- Department of Orthopaedics, Louisiana State University, Chicago, Il, USA
- College of Medicine, University of Illinois at Chicago, Chicago, Il, USA
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Pose-Díez-de-la-Lastra A, Ungi T, Morton D, Fichtinger G, Pascau J. Real-time integration between Microsoft HoloLens 2 and 3D Slicer with demonstration in pedicle screw placement planning. Int J Comput Assist Radiol Surg 2023; 18:2023-2032. [PMID: 37310561 PMCID: PMC10589185 DOI: 10.1007/s11548-023-02977-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE Up to date, there has been a lack of software infrastructure to connect 3D Slicer to any augmented reality (AR) device. This work describes a novel connection approach using Microsoft HoloLens 2 and OpenIGTLink, with a demonstration in pedicle screw placement planning. METHODS We developed an AR application in Unity that is wirelessly rendered onto Microsoft HoloLens 2 using Holographic Remoting. Simultaneously, Unity connects to 3D Slicer using the OpenIGTLink communication protocol. Geometrical transform and image messages are transferred between both platforms in real time. Through the AR glasses, a user visualizes a patient's computed tomography overlaid onto virtual 3D models showing anatomical structures. We technically evaluated the system by measuring message transference latency between the platforms. Its functionality was assessed in pedicle screw placement planning. Six volunteers planned pedicle screws' position and orientation with the AR system and on a 2D desktop planner. We compared the placement accuracy of each screw with both methods. Finally, we administered a questionnaire to all participants to assess their experience with the AR system. RESULTS The latency in message exchange is sufficiently low to enable real-time communication between the platforms. The AR method was non-inferior to the 2D desktop planner, with a mean error of 2.1 ± 1.4 mm. Moreover, 98% of the screw placements performed with the AR system were successful, according to the Gertzbein-Robbins scale. The average questionnaire outcomes were 4.5/5. CONCLUSIONS Real-time communication between Microsoft HoloLens 2 and 3D Slicer is feasible and supports accurate planning for pedicle screw placement.
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Affiliation(s)
| | - Tamas Ungi
- Laboratory for Percutaneous Surgery, School of Computing, Queen's University, Kingston, ON, K7M2N8, Canada
| | - David Morton
- Laboratory for Percutaneous Surgery, School of Computing, Queen's University, Kingston, ON, K7M2N8, Canada
| | - Gabor Fichtinger
- Laboratory for Percutaneous Surgery, School of Computing, Queen's University, Kingston, ON, K7M2N8, Canada
| | - Javier Pascau
- Departamento de Bioingeniería, Universidad Carlos III de Madrid, 28911, Leganés, Spain
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Sharma S, Mohanraj TG, Amadio JP, Khadem M, Alambeigi F. A Concentric Tube Steerable Drilling Robot for Minimally Invasive Spinal Fixation of Osteoporotic Vertebrae. IEEE Trans Biomed Eng 2023; 70:3017-3027. [PMID: 37130252 PMCID: PMC10623809 DOI: 10.1109/tbme.2023.3272306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Spinal fixation with rigid pedicle screws have shown to be an effective treatment for many patients. However, this surgical option has been proved to be insufficient and will eventually fail for patients experiencing osteoporosis. This failure is mainly attributed to the lack of dexterity in the existing rigid drilling instruments and the complex anatomy of vertebrae, forcing surgeons to implant rigid pedicle screws within the osteoporotic regions of anatomy. To address this problem, in this article, we present the design, fabrication, and evaluation of a unique flexible yet structurally strong concentric tube steerable drilling robot (CT-SDR). The CT-SDR is capable of drilling smooth and accurate curved trajectories through hard tissues without experiencing buckling and failure; thus enabling the use of novel flexible pedicle screws for the next generation of spinal fixation procedures. Particularly, by decoupling the control of bending and insertion degrees of freedom (DoF) of the CT-SDR, we present a robotic system that (i) is intuitive to steer as it does not require an on-the-fly control algorithm for the bending DoF, and (ii) is able to address the contradictory requirements of structural stiffness and dexterity of a flexible robot interacting with the hard tissue. The robust and repeatable performance of the proposed CT-SDR have been experimentally evaluated by conducting various drilling procedures on simulated bone materials and animal bone samples. Experimental results indicate drilling times as low as 35 seconds for curved trajectories with 41 mm length and remarkable steering accuracy with a maximum 2% deviation error.
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Zhang G, Du Y, Jiang G, Kong W, Li J, Zhu Z, Xi Y. Biomechanical evaluation of different posterior fixation techniques for treating thoracolumbar burst fractures of osteoporosis old patients: a finite element analysis. Front Bioeng Biotechnol 2023; 11:1268557. [PMID: 38026889 PMCID: PMC10646582 DOI: 10.3389/fbioe.2023.1268557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objective: To investigate the biomechanical characteristics of different posterior fixation techniques in treatment of osteoporotic thoracolumbar burst fractures by finite element analysis. Methods: The Dicom format images of T10-L5 segments were obtained from CT scanning of a volunteer, and transferred to the Geomagic Studio software, which was used to build digital models. L1 osteoporotic burst fracture and different posterior fixation techniques were simulated by SolidWorks software. The data of ROM, the maximum displacement of fixed segment, ROM of fractured L1 vertebrae, the stress on the screws and rods as well as on fractured L1 vertebrae under different movement conditions were collected and analysed by finite element analysis. Results: Among the four groups, the largest ROM of fixed segment, the maximum displacement of fixed segment and ROM of fractured vertebrae occurred in CBT, and the corresponding data was 1.3°, 2.57 mm and 1.37°, respectively. While the smallest ROM of fixed segment, the maximum displacement of fixed segment and ROM of fractured vertebrae was found in LSPS, and the corresponding data was 0.92°, 2.46 mm and 0.89°, respectively. The largest stress of screws was 390.97 Mpa, appeared in CBT, and the largest stress of rods was 84.68 MPa, appeared in LSPS. The stress concentrated at the junction area between the root screws and rods. The maximum stress on fractured vertebrae was 93.25 MPa, appeared in CBT and the minimum stress was 56.68 MPa, appeared in CAPS. And the stress of fractured vertebrae concentrated in the middle and posterior column of the fixed segment, especially in the posterior edge of the superior endplate. Conclusion: In this study, long-segment posterior fixation (LSPF) provided with the greatest stability of fixed segment after fixation, while cortical bone screw fixation (CBT) provided with the smallest stability. Cement-augmented pedicle screw-rod fixation (CAPS) and combined using cortical bone screw and pedicle screw fixation (CBT-PS) provided with the moderate stability. CBT-PS exhibited superiority in resistance of rotational torsion for using multiple connecting rods. CAPS and CBT-PS maybe biomechanically superior options for the surgical treatment of burst TL fractures in osteoporotic patients.
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Affiliation(s)
- Guodong Zhang
- Department of Spinal Surgery, Tengzhou Central People’s Hospital, Tengzhou, China
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yukun Du
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guangzong Jiang
- Department of Spinal Surgery, Tengzhou Central People’s Hospital, Tengzhou, China
| | - Weiqing Kong
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianyi Li
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhongjiao Zhu
- Department of Spinal Surgery, Tengzhou Central People’s Hospital, Tengzhou, China
| | - Yongming Xi
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Jia S, Weng Y, Wang K, Qi H, Yang Y, Ma C, Lu WW, Wu H. Performance evaluation of an AI-based preoperative planning software application for automatic selection of pedicle screws based on computed tomography images. Front Surg 2023; 10:1247527. [PMID: 37753530 PMCID: PMC10518392 DOI: 10.3389/fsurg.2023.1247527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Recent neurosurgical applications based on artificial intelligence (AI) have demonstrated its potential in surgical planning and anatomical measurement. We aimed to evaluate the performance of an AI planning software application on screw length/diameter selection and insertion accuracy in comparison with freehand surgery. Methods A total of 45 patients with 208 pedicle screw placements on thoracolumbar segments were included in this analysis. The novel AI planning software was developed based on a deep learning model. AI-based pedicle screw placements were selected on the basis of preoperative computed tomography (CT) data, and freehand surgery screw placements were observed based on postoperative CT data. The performance of AI pedicle screw placements was evaluated on the components of screw length, diameter, and Gertzbein grade in comparison with the results achieved by freehand surgery. Results Among 208 pedicle screw placements, the average screw length/diameters selected by the AI model and used in freehand surgery were 48.65 ± 5.99 mm/7.39 ± 0.42 mm and 44.78 ± 2.99 mm/6.1 ± 0.27 mm, respectively. Among AI screw placements, 85.1% were classified as Gertzbein Grade A (no cortical pedicle breach); among free-hand surgery placements, 64.9% were classified as Gertzbein Grade A. Conclusion The novel AI planning software application could provide an accessible and safe pedicle screw placement strategy in comparison with traditional freehand pedicle screw placement strategies. The choices of pedicle screw dimensional parameters made by the model, including length and diameter, may provide potential inspiration for real clinical discretion.
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Affiliation(s)
- Shanhang Jia
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Yuanzhi Weng
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Pharmaceutical Materials Science and Translational Medicine, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen, China
| | - Kai Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Huan Qi
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Yuhua Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chi Ma
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Weijia William Lu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Pharmaceutical Materials Science and Translational Medicine, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen, China
| | - Hao Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
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Mandelka E, Gierse J, Zimmermann F, Gruetzner PA, Franke J, Vetter SY. Implications of navigation in thoracolumbar pedicle screw placement on screw accuracy and screw diameter/pedicle width ratio. BRAIN & SPINE 2023; 3:101780. [PMID: 38020982 PMCID: PMC10668071 DOI: 10.1016/j.bas.2023.101780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/22/2023] [Accepted: 07/10/2023] [Indexed: 12/01/2023]
Abstract
Introduction There is ample evidence that higher accuracy can be achieved in thoracolumbar pedicle screw placement by using spinal navigation. Still, to date, the evidence regarding the influence of the use of navigation on the screw diameter to pedicle width ratio remains limited. Research question The aim of this study was to investigate the implications of navigation in thoracolumbar pedicle screw placement not only on screw accuracy, but on the screw diameter to pedicle width ratio as well. Material and methods In this single-center single-surgeon study, 45 Patients undergoing navigated thoracolumbar pedicle screw placement were prospectively included. The results were compared with a matched comparison group of patients in which screw placement was performed under fluoroscopic guidance. The screw accuracy and the screw diameter to pedicle width ratio of every screw were compared between the groups. Results Screw accuracy was significantly higher in the navigation group compared to the fluoroscopic guidance group, alongside with a significant increase of the screw diameter to pedicle width ratio by approximately 10%. In addition, both the intraoperative radiation dose and the operating time tended to be lower in the study group. Conclusion This study was able to show that navigated thoracolumbar pedicle screw placement not only increases the accuracy of screw placement but also facilitates the selection of the adequate screw sizes, which according to the literature has positive effects on fixation strength. Meanwhile, the use of navigation did not negatively affect the time needed for surgery or the patient's intraoperative exposure to radiation.
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Affiliation(s)
- Eric Mandelka
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Jula Gierse
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Felix Zimmermann
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Paul A. Gruetzner
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Sven Y. Vetter
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
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Sakti YM, Lanodiyu ZA, Ichsantyaridha M, Wijanarko S, Filza MR, Taufan T, Susanto DB, Tampubolon YO, Baskara AANN, Nurshal AA, Mustofa FD, Rosfadilla A, Magetsari R, Rukmoyo T. Pedicle morphometry analysis of main thoracic apex adolescent idiopathic scoliosis. BMC Surg 2023; 23:34. [PMID: 36759804 PMCID: PMC9912543 DOI: 10.1186/s12893-022-01877-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 12/05/2022] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Screw insertion during scoliosis surgery uses free-hand pedicle screw insertion methods. However, there is a wide variation in pedicle shapes, sizes, and morphometry, especially in scoliosis patients. CT scan pedicle measurements in main thoracic Lenke type 1 adolescent idiopathic scoliosis can help visualize this diversity. This study aimed to highlight the features of pedicle morphometry on the concave and convex sides, including pedicle diameter (width in axial and height in the sagittal plane), the depth to the anterior cortex, and Watanabe Pedicle classification in patients with main thoracic apex adolescent idiopathic scoliosis. MATERIALS AND METHODS This study was a cross-sectional observational study of Adolescent Idiopathic Scoliosis (AIS) patients whose apex in the main thoracic patient underwent deformity correction procedures. We used a three-dimensional CT scan to evaluate pedicle morphometry on the apex vertebrae, three consecutive vertebrae above and below the apex. RESULTS A total of 6 patients with apex main thoracic AIS with 84 pedicles consisting of 42 pedicles from each concave and convex curve were analyzed. All of the samples were female, with the mean age at the procedure being 21.2 ± 5.56. The mean cobb angle was 62° ± 23°, with the main apex between VT8-VT10. The size of the pedicle was bigger from upper to lower vertebrae. The mean pedicle depth, pedicle width, and pedicle height for the concave side were 36.06 ± 4.31 mm, 3.91 ± 0.66 mm, and 9.16 ± 1.52 mm, respectively. Meanwhile, the convex side is 37.52 ± 1.84 mm, 5.20 ± 0.55 mm, and 11.05 ± 0.70 mm, respectively. We found a significant difference between the concave and convex sides for the pedicle width and height. The concave and convex sides were mainly classified as type C (38%) and type A (50%) Watanabe pedicle. CONCLUSION Pedicle width and pedicle height are significantly different between the concave and the convex side with convex side has better Watanabe pedicle classification. Pre-operative CT evaluation is essential for planning proper pedicle screw placement in AIS patients.
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Affiliation(s)
- Yudha Mathan Sakti
- Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia.
| | - Zikrina Abyanti Lanodiyu
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Mahardhika Ichsantyaridha
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Sonny Wijanarko
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Muhammad Riyad Filza
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Taufan Taufan
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Dwi Budhi Susanto
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Yunus Oksikimbawan Tampubolon
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Anak Agung Ngurah Nata Baskara
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Aidil Akbar Nurshal
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Fuad Dheni Mustofa
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Annissa Rosfadilla
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Rahadyan Magetsari
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
| | - Tedjo Rukmoyo
- grid.8570.a0000 0001 2152 4506Orthopedic and Traumatology Department, Sardjito General Hospital/Gadjah Mada University, Yogyakarta, Indonesia
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12
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Statistical shape modelling of the thoracic spine for the development of pedicle screw insertion guides. Biomech Model Mechanobiol 2023; 22:123-132. [PMID: 36121529 PMCID: PMC9958142 DOI: 10.1007/s10237-022-01636-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 09/06/2022] [Indexed: 11/02/2022]
Abstract
Spinal fixation and fusion are surgical procedures undertaken to restore stability in the spine and restrict painful or degenerative motion. Malpositioning of pedicle screws during these procedures can result in major neurological and vascular damage. Patient-specific surgical guides offer clear benefits, reducing malposition rates by up to 25%. However, they suffer from long lead times and the manufacturing process is dependent on third-party specialists. The development of a standard set of surgical guides may eliminate the issues with the manufacturing process. To evaluate the feasibility of this option, a statistical shape model (SSM) was created and used to analyse the morphological variations of the T4-T6 vertebrae in a population of 90 specimens from the Visible Korean Human dataset (50 females and 40 males). The first three principal components, representing 39.7% of the variance within the population, were analysed. The model showed high variability in the transverse process (~ 4 mm) and spinous process (~ 4 mm) and relatively low variation (< 1 mm) in the vertebral lamina. For a Korean population, a standardised set of surgical guides would likely need to align with the lamina where the variance in the population is lower. It is recommended that this standard set of surgical guides should accommodate pedicle screw diameters of 3.5-6 mm and transverse pedicle screw angles of 3.5°-12.4°.
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13
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De Kater EP, Weststeijn CF, Sakes A, Breedveld P. A Toggling Resistant In-Pedicle Expandable Anchor: A Preliminary Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3313-3317. [PMID: 36086162 DOI: 10.1109/embc48229.2022.9871068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Loosening of pedicle screws after spinal fusion surgery can prevent the desired fusion between vertebrae and may be a reason for revision surgery. Especially in osteoporotic bone, toggling of pedicle screws is a common problem that compromises the fixation strength of these screws and can lead to loosening or axial pull-out of the screw. In this study, we explore the use of an in-pedicle expandable anchor that shapes to the pedicle to increase the toggling resistance of the anchor by increasing the contact area between the anchor and the dense cortical bone of the pedicle. A scaled-up, two-dimensional prototype was designed. The prototype consists of a bolt and ten stainless steel wedges that expand by tensioning the bolt. During the expansion, the wedges are required to compress the cancellous bone. Based on the first preliminary experiment, it was found that the expansion of the wedges resulted in successful compression of 5 PCF cancellous bone phantom (Sawbones). This preliminary study shows that an expandable in-pedicle anchor could be a feasible option to increase the toggling resistance of spinal bone anchors, especially in osteoporotic bone. Clinical Relevance- Toggling of pedicle screws is a major cause of screw loosening. In this preliminary study, the use of an in-pedicle expandable anchor to increase the toggling resistance of spinal bone anchors is explored.
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14
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Beyond the pedicle screw-a patent review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1553-1565. [PMID: 35380271 DOI: 10.1007/s00586-022-07193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This review provides an overview of the patent literature on posteriorly placed intrapedicular bone anchors. Conventional pedicle screws are the gold standard to create a fixation in the vertebra for spinal fusion surgery but may lack fixation strength, especially in osteoporotic bone. The ageing population demands new bone anchors that have an increased fixation strength, that can be placed safely, and, if necessary, can be removed without damaging the surrounding tissue. METHODS The patent search was conducted using a classification search in the Espacenet patent database. Only patents with a Cooperative Patent Classification of A61B17/70 or A61B17/7001 concerning spinal positioners and stabilizers were eligible for inclusion. The search query resulted in the identification of 731 patents. Based on preset inclusion criteria, a total of 56 unique patents on different anchoring methods were included, reviewed and categorized in this study. RESULTS Five unique fixation methods were identified; (1) anchors that use threading, (2) anchors that utilize a curved path through the vertebra, (3) anchors that (partly) expand, (4) anchors that use cement and (5) anchors that are designed to initiate bone ingrowth. Of the anchor designs included in this study, eight had a corresponding commercial product, six of which were evaluated in clinical trials. CONCLUSION This review provides insights into worldwide patented intrapedicular bone anchors that aim to increase the fixation strength compared to the conventional pedicle screw. The identified anchoring methods and their working principles can be used for clinical decision-making and as a source of inspiration when designing novel bone anchors.
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15
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Peeters CMM, van Houten L, Kempen DHR, Wapstra FH, Jutte PC, van den Akker-Scheek I, Faber C. Assessment of pedicle size in patients with scoliosis using EOS 2D imaging: a validity and reliability study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3473-3481. [PMID: 33895877 DOI: 10.1007/s00586-021-06839-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 12/30/2020] [Accepted: 04/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Free-hand pedicle screw insertion methods are widely used for screw insertion during scoliosis surgery. Preoperative knowledge about the pedicle size helps to maximize screw containment and minimize the risk of pedicle breach. Radiographs taken by a biplanar low-dose X-ray device (EOS) have no divergence in the vertical plane. The criterion validity and reliability of preoperative EOS images for pedicle size measurements in patients with idiopathic scoliosis (IS) was investigated in this study. METHODS Sixteen patients who underwent surgical treatment for IS were prospectively included. Intra- and extracortical pedicle height and width measurements on EOS images were compared with reconstructed intra-operative 3D images of the isthmus of included pedicles. Secondly, intra- and interobserver reliability of pedicle size measurements on EOS images was determined. RESULTS The total number of analyzed pedicles was 203. The correlation between the EOS and 3D scan measurements was very strong for the intra- and extracortical pedicle height and strong for the intra- and extracortical pedicle width. There are, however, significant, but likely clinically irrelevant differences (mean absolute differences < 0.43 mm) between the two measure methods for all four measurements except for extracortical pedicle height. For pedicles classified as Nash-Moe 0, no significant differences in intra- and extracortical pedicle width were observed. Both intra- and interobserver reliability was excellent for all pedicle size measurements on EOS images. CONCLUSION The results of this study indicate a good validity and reliability for pedicle size measurements on EOS radiographs. Therefore, EOS radiographs may be used for a preoperative estimation of pedicle size and subsequent screw diameter in patients with IS.
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Affiliation(s)
- C M M Peeters
- Department of Orthopaedics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - L van Houten
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - D H R Kempen
- Department of Orthopaedics, OLVG, Amsterdam, The Netherlands
| | - F H Wapstra
- Department of Orthopaedics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - P C Jutte
- Department of Orthopaedics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - I van den Akker-Scheek
- Department of Orthopaedics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - C Faber
- Department of Orthopaedics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
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16
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Losch MS, Swamy A, Elmi-Terander A, Edström E, Hendriks BHW, Dankelman J. Proton density fat fraction of the spinal column: an MRI cadaver study. Biomed Eng Online 2021; 20:7. [PMID: 33413458 PMCID: PMC7792224 DOI: 10.1186/s12938-020-00846-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background The increased popularity of minimally invasive spinal surgery calls for a revision of guidance techniques to prevent injuries of nearby neural and vascular structures. Lipid content has previously been proposed as a distinguishing criterion for different bone tissues to provide guidance along the interface of cancellous and cortical bone. This study aims to investigate how fat is distributed throughout the spinal column to confirm or refute the suitability of lipid content for guidance purposes. Results Proton density fat fraction (PDFF) was assessed over all vertebral levels for six human cadavers between 53 and 92 years of age, based on fat and water MR images. According to their distance to the vertebra contour, the data points were grouped in five regions of interest (ROIs): cortical bone (−1 mm to 0 mm), pre-cortical zone (PCZ) 1–3 (0–1 mm; 1–2 mm; 2–3 mm), and cancellous bone (\documentclass[12pt]{minimal}
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\begin{document}$$\ge $$\end{document}≥ 3 mm). For PCZ1 vs. PCZ2, a significant difference in mean PDFF of between −7.59 pp and −4.39 pp on average was found. For cortical bone vs. PCZ1, a significant difference in mean PDFF of between −27.09 pp and −18.96 pp on average was found. Conclusion A relationship between distance from the cortical bone boundary and lipid content could be established, paving the way for guidance techniques based on fat fraction detection for spinal surgery.
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Affiliation(s)
- Merle S Losch
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
| | - Akash Swamy
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.,Department of In-Body Systems, Philips Research, Royal Philips, NV, Eindhoven, The Netherlands
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Benno H W Hendriks
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.,Department of In-Body Systems, Philips Research, Royal Philips, NV, Eindhoven, The Netherlands
| | - Jenny Dankelman
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
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Does Augmented Reality Navigation Increase Pedicle Screw Density Compared to Free-Hand Technique in Deformity Surgery? Single Surgeon Case Series of 44 Patients. Spine (Phila Pa 1976) 2020; 45:E1085-E1090. [PMID: 32355149 DOI: 10.1097/brs.0000000000003518] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective comparison between an interventional and a control cohort. OBJECTIVE The aim of this study was to investigate whether the use of an augmented reality surgical navigation (ARSN) system for pedicle screw (PS) placement in deformity cases could alter the total implant density and PS to hook ratio compared to free-hand (FH) technique. SUMMARY OF BACKGROUND DATA Surgical navigation in deformity surgery provides the possibility to place PS in small and deformed pedicles were hooks would otherwise have been placed, and thereby achieve a higher screw density in the constructs that may result in better long-term patient outcomes. METHODS Fifteen deformity cases treated with ARSN were compared to 29 cases treated by FH. All surgeries were performed by the same orthopedic spine surgeon. PS, hook, and combined implant density were primary outcomes. Procedure time, deformity correction, length of hospital stay, and blood loss were secondary outcomes. The surgeries in the ARSN group were performed in a hybrid operating room (OR) with a ceiling-mounted robotic C-arm with integrated video cameras for AR navigation. The FH group was operated with or without fluoroscopy as deemed necessary by the surgeon. RESULTS Both groups had an overall high-density construct (>80% total implant density). The ARSN group, had a significantly higher PS density, 86.3% ± 14.6% versus 74.7% ± 13.9% in the FH group (P < 0.05), whereas the hook density was 2.2% ± 3.0% versus 9.7% ± 9.6% (P < 0.001). Neither the total procedure time (min) 431 ± 98 versus 417 ± 145 nor the deformity correction 59.3% ± 16.6% versus 60.1% ± 17.8% between the groups were significantly affected. CONCLUSION This study indicates that ARSN enables the surgeon to increase the PS density and thereby minimize the use of hooks in deformity surgery without prolonging the OR time. This may result in better constructs with possible long-term advantage and less need for revision surgery. LEVEL OF EVIDENCE 3.
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Elmi-Terander A, Burström G, Nachabé R, Fagerlund M, Ståhl F, Charalampidis A, Edström E, Gerdhem P. Augmented reality navigation with intraoperative 3D imaging vs fluoroscopy-assisted free-hand surgery for spine fixation surgery: a matched-control study comparing accuracy. Sci Rep 2020; 10:707. [PMID: 31959895 PMCID: PMC6971085 DOI: 10.1038/s41598-020-57693-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 12/09/2019] [Indexed: 02/06/2023] Open
Abstract
This study aimed to compare screw placement accuracy and clinical aspects between Augmented Reality Surgical Navigation (ARSN) and free-hand (FH) technique. Twenty patients underwent spine surgery with screw placement using ARSN and were matched retrospectively to a cohort of 20 FH technique cases for comparison. All ARSN and FH cases were performed by the same surgeon. Matching was based on clinical diagnosis and similar proportions of screws placed in the thoracic and lumbosacral vertebrae in both groups. Accuracy of screw placement was assessed on postoperative scans according to the Gertzbein scale and grades 0 and 1 were considered accurate. Procedure time, blood loss and length of hospital stay, were collected as secondary endpoints. A total of 262 and 288 screws were assessed in the ARSN and FH groups, respectively. The share of clinically accurate screws was significantly higher in the ARSN vs FH group (93.9% vs 89.6%, p < 0.05). The proportion of screws placed without a cortical breach was twice as high in the ARSN group compared to the FH group (63.4% vs 30.6%, p < 0.0001). No statistical difference was observed for the secondary endpoints between both groups. This matched-control study demonstrated that ARSN provided higher screw placement accuracy compared to free-hand.
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Affiliation(s)
- Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Gustav Burström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Rami Nachabé
- Department of Image Guided Therapy Systems, Philips Healthcare, Best, the Netherlands.
| | - Michael Fagerlund
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Ståhl
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Anastasios Charalampidis
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Paul Gerdhem
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden
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