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Li P, Li S, Li Z, Lu W, Shao W, Li Z, Xu Y, Zhang H, Ju B, Shen J, Cui Y. Ultrasound propagation characteristics within the bone tissue of miniature ultrasound probes: implications for the spinal navigation of pedicle screw placement. Quant Imaging Med Surg 2024; 14:4878-4892. [PMID: 39022289 PMCID: PMC11250325 DOI: 10.21037/qims-24-377] [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: 02/26/2024] [Accepted: 05/15/2024] [Indexed: 07/20/2024]
Abstract
Background The accuracy of pedicle screw fixation is crucial for patient safety. Traditional navigation methods based on computed tomography (CT) imaging have several limitations. Therefore, this study aimed to investigate the ultrasonic propagation characteristics of bone tissue and their relationship with CT imaging results, as well as the potential application of ultrasound navigation in pedicle screw fixation. Methods The study used three bovine spine specimens (BSSs) and five human vertebral allograft bones (HABs) to progressively decrease the thickness of the cancellous bone layer, simulating the process of pedicle screw perforation. Five unfocused miniature ultrasound probes with frequencies of 2.2, 2.5, 3, 12, and 30 MHz were employed for investigating the ultrasonic propagation characteristics of cancellous and cortical bone through ultrasound transmission and backscatter experiments. The CT features of the bone tissue was obtained with the Skyscan 1174 micro-CT scanner (Bruker, Billerica, MA, USA). Results The experimental results demonstrated that low-frequency (2-3 MHz) ultrasound effectively penetrated the cancellous bone layer up to a depth of approximately 5 mm, with an attenuation coefficient below 10 dB/cm. Conversely, high-frequency (12 MHz) ultrasound exhibited significant signal attenuation in cancellous bone, reaching up to 55.8 dB/cm. The amplitude of the backscattered signal at the cancellous bone interface exhibited a negative correlation with the bone sample thickness (average r=-0.84), meaning that as the thickness of the cancellous bone layer on the cortical bone decreases, the backscattered signal amplitude gradually increases (P<0.05). Upon reaching the cortical bone interface, there was a rapid surge in echo signal amplitude, up to 8 times higher. Meanwhile, the statistical results indicated a significant correlation between the amplitude of the echo signal and the micro-CT scanning results of bone trabecular structure. Conclusions Theoretically, using multiple ultrasonic probes (≥3) and regions of interest (ROIs) (≥5) has the potential to provide surgeons with early warning signals for pedicle perforation based on three or more successive increases in echo signal amplitude or a sudden substantial increase. The statistical results indicate a significant correlation between the amplitude of the echo signal and the micro-CT scanning results of bone trabeculae, suggesting the potential use of ultrasound as opposed to CT for real-time intraoperative bone navigation.
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Affiliation(s)
- Peiyang Li
- Academy for Engineering & Technology, Fudan University, Shanghai, China
| | - Suoyuan Li
- Department of Orthopeadics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Zhiqiang Li
- Department of Orthopeadics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Wenjia Lu
- Suzhou GuoKe Ultra Medical Technology Co., Ltd., Suzhou, China
| | - Weiwei Shao
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Zhangjian Li
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Yiwen Xu
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Hong Zhang
- Department of Orthopeadics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Bin Ju
- College of Electrical Engineering and Automation, Anhui University, Hefei, China
| | - Jun Shen
- Department of Orthopeadics, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
- Suzhou Key Laboratory of Orthopedic Medical Engineering, Suzhou, China
| | - Yaoyao Cui
- Academy for Engineering & Technology, Fudan University, Shanghai, China
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Tannoury T, Seo HH, Saade A, Chahine MN, Atallah B, Tannoury C. Evaluating the safe zone for lumbar pedicle screws: are midline crossing screws indicative of pedicle breach? Spine J 2024; 24:617-624. [PMID: 37939920 DOI: 10.1016/j.spinee.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/02/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND CONTEXT Pedicle screw breach (PSB) is not uncommon following lumbar instrumentation, and in some instances, it may lead to vascular and/or neurologic complications. Previous literature suggested that screws crossing the vertebral midline on an anterior-posterior (AP) radiograph (or midsagittal on CT) are concerning for medial pedicle breach. OBJECTIVE Our primary aim was to map out the safe zones (SZ) of bilateral pedicle instrumentation and their relationship at each lumbar vertebral level. Our secondary aim was to evaluate the presence of SZs' intersection at each lumbar level, denoting safe midline pedicle screw crossing not otherwise associated with medial pedicle breach. STUDY DESIGN/SETTING Retrospective Anatomical Study. PATIENT SAMPLE Adult patients in the from "The Cancer Imaging Archive" (TCIA) database who have not had thoraco-lumbo-sacral fusion. OUTCOME MEASURES Physiologic measures obtained through 3D analysis of CT images and virtual pedicle screws. METHOD CT scans of 51 patients were randomly selected from "The Cancer Imaging Archive" (TCIA) online database for analysis. The Sectra 3D Spine software was used to create 3D renderings, place virtual screws, and make measurements. At each lumbar vertebra, the right and left pedicle corridors were mapped. At each pedicle, two screw positions were templated, the "medial limit screw" (MLS) and the "lateral limit screw" (LLS). Each limit screw was the most extreme position that the screw could exist in without causing a medial or lateral breach. The safe zone was defined as the zone between MLS and LLS. Measurements were taken for each level (between L1 and L5) and side (Left, Right). RESULTS A total of 253 lumbar vertebrae from 51 patients (mean age 53.1, 56.9% male) were included. Two vertebrae from two patients were removed for poor image quality. Out of the 506 screw positions analyzed in our study, 97.4% had overlapping SZ and crossed the midplane without medial pedicle breach. The significant factors (p<.01) for safe midplane-crossing screws included: the screw length (L1-L5); the laterality of the screw entry point (L1-L4); and the pedicle diameter (L2 and L5). CONCLUSIONS A midline crossing pedicle screw on a lumbar AP radiograph is not necessarily indicative of a medial pedicle screw breach. Anatomical (ie, larger pedicle diameter) and technical (ie, longer screws, and lateral entry points) factors allow for safety zone intersections and indicate safe midline crossing by pedicle screws.
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Affiliation(s)
- Tony Tannoury
- Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | | | | | - Mirna N Chahine
- The Lebanese University Faculty of Medicine, Beirut, Lebanon
| | - Bachir Atallah
- The Lebanese University Faculty of Medicine, Beirut, Lebanon
| | - Chadi Tannoury
- Boston Medical Center, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.
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Zhu Z, Hu S, Zeng W, Cen S, Liu Y, Zhang W, Shi B. Effect of L5 spinal canal type on pedicle screw placement based on CT imaging: a retrospective clinical 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 2024; 33:298-306. [PMID: 37659047 DOI: 10.1007/s00586-023-07904-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/03/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The objective of this study was to investigate the optimal entry point and pedicle camber angle for L5 pedicle screws of different canal types. METHODS CT imaging data were processed by Mimics for simulated pedicle screw placement, and PD (Pedicle diameter), PCA (Pedicle camber angle), LD (Longitudinal distance), TD (Transverse distance), and PBG (Pedicle screw breach grade) were measured. Then they were divided into the Round group and Trefoil group according to the type of spinal canal. When comparing PD, PCA, LD, TD, and PBG, the two sides of the pedicle were compared separately, so they were first divided into the round-type pedicle group and the trefoil-type pedicle group. RESULTS In the round-type pedicle group (n = 134) and the trefoil-type pedicle group (n = 264), there was no significant difference in PD and LD, but there was a significant difference in PCA between the two groups (t = - 4.072, P < 0.05). A statistically significant difference in the distance of the Magerl point relative to the optimal entry point (t = - 3.792, P < 0.05), and the distance of the Magerl point relative to the optimal entry point was greater in the trefoil-type pedicle group than in the round-type pedicle group. CONCLUSION The optimal entry point for L5 is more outward than the Magerl point, and the Trefoil spinal canal L5 is more outwardly oriented than the Round spinal canal L5, with a greater angle of abduction during pedicle screw placement.
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Affiliation(s)
- Zhemin Zhu
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Shengxuan Hu
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Weibo Zeng
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Shuizhong Cen
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Yubin Liu
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Wei Zhang
- Department of Bone and Joint, Panyu Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China.
| | - Benchao Shi
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, 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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Chen S, Li B, Liu S, Zhao J, Zhou X, Zhai X, Gu X, Hou C, Shi Z, Bai Y, Li M, Mao N. Sagittal imaging study of the lumbar spine with the short rod technique. 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; 31:3536-3543. [PMID: 36173555 DOI: 10.1007/s00586-022-07373-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 08/13/2022] [Accepted: 08/28/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The short rod technique (SRT) is a novel method for lumbar pedicle screw placement to reduce surgical trauma and avoid damage to the facet joint and articular surface. The core concept is to change the entry point and angle of the screw on the vertebrae at both ends in the sagittal plane to shorten the length of the longitudinal rods. The purpose of this study is to determine the sagittal screw angle (SSA) and its safe Maximum (MAX) value on each lumbar vertebra for the SRT and to observe the shortening effect on the longitudinal rods. METHODS A total of 152 healthy adults were investigated by measuring the lumbar spine lateral view images. The SSA and MAX-SSA were measured with SRT as reference to the conventional placement technique method. The distance between the entry points of the proximal and distal vertebrae was measured to compare the changes in the length of the longitudinal rods using the two screw placement techniques. RESULTS + SSA increased from L1 to L4, and -SSA increased from L2 to L5, in which the -SSA of L2, L3, and L4 were significantly greater than those of + SSA (P < 0.05). + MAX-SSA at L1-L4 was 23.26 ± 3.54°, 23.68 ± 3.37°, 24.12 ± 3.29°, and 24.26 ± 3.42°, respectively. -MAX-SSA at L2-L5 was 36.25 ± 3.26°, 38.26 ± 3.73°, 38.62 ± 3.63° and 37.33 ± 3.31°, respectively. Theoretical reductions by calculation for the 2-segment lumbar pedicles were: L1-2: 9 mm, L2-3: 9.29 mm, L3-4: 6.23 mm, and L4-5: 7.08 mm; And the 3-segment lumbar pedicles were: L1-3: 16.97 mm, L2-4: 16.73 mm, L3-5, and 18.24 mm, respectively. CONCLUSIONS The application of the SRT to lumbar pedicles is a safe screw placement method that can significantly shorten the length of the used longitudinal rods.
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Affiliation(s)
- Shaofeng Chen
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Bo Li
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Shu Liu
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Jian Zhao
- Department of Neurology, The General Hospital of Western Theater Command, Chengdu, China
| | - Xiaoyi Zhou
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Xiao Zhai
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Xiaochuan Gu
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Canglong Hou
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Zhicai Shi
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Yushu Bai
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China.
| | - Ming Li
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China.
| | - Ningfang Mao
- Department of Orthopaedic Surgery, Changhai Hospital, The Navy Military Medical University, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China.
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