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Wu J, Fan M, He D, Wei Y, Duan F, Jiang X, Tian W. Accuracy and clinical characteristics of robot-assisted cervical spine surgery: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2024; 48:1903-1914. [PMID: 38613575 DOI: 10.1007/s00264-024-06179-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/02/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE To evaluate the accuracy and feasibility of robot-assisted cervical screw placement and factors that may affect the accuracy. METHODS A comprehensive search was made on PubMed, Embase, Cochrane Library, Web of Science, CNKI, and Wanfang Med for the selection of potential eligible literature. The outcomes were evaluated in terms of the relative risk (RR) or standardized mean difference (MD) and corresponding 95% confidence interval (CI). Subgroup analyses of the accuracy of screw placement at different cervical segments and with different screw placement approaches were performed. A comparison was made between robotic navigation and conventional freehand cervical screw placement. RESULTS Six comparative cohort studies and five case series studies with 337 patients and 1342 cervical screws were included in this study. The perfect accuracy was 86% (95% CI, 82-89%) and the clinically acceptable rate was 98% (95% CI, 95-99%) in robot-assisted cervical screw placement. The perfect accuracy of robot-assisted C1 lateral mass screw placement was the highest (96%), followed by C6-7 pedicle screw placement (93%) and C2 pedicle screw placement (86%), and the lowest was C3-5 pedicle screw placement (75%). The open approach had a higher perfect accuracy than the percutaneous/intermuscular approach (91% vs 83%). Compared with conventional freehand cervical screw placement, robot-assisted cervical screw placement had a higher accuracy, a lower incidence of perioperative complications, and less intraoperative blood loss. CONCLUSION With good collaboration between the operator and the robot, robot-assisted cervical screw placement is accurate and feasible. Robot-assisted cervical screw placement has a promising prospect.
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Affiliation(s)
- Jiayuan Wu
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Mingxing Fan
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Da He
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
| | - Yi Wei
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Fangfang Duan
- Epidemiological Research Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
| | - Xieyuan Jiang
- Trauma Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China
- Beijing Jishuitan Orthopaedic Robot Engineering Research Center Co., Ltd, Beijing, 100035, China
| | - Wei Tian
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
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Dong WX, Hu Y, Yuan ZS. Research into the anatomy of the subaxial cervical pedicle for ensuring screw insertion safety. Medicine (Baltimore) 2024; 103:e34646. [PMID: 38489680 PMCID: PMC10939661 DOI: 10.1097/md.0000000000034646] [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: 02/02/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 03/17/2024] Open
Abstract
The study aimed to determine the optimal entry points and trajectories for posterior subaxial cervical pedicle screw (CPS) fixation. Computed tomography (CT) and Mimics software were used to evaluate the subaxial cervical pedicle in 42 cervical spine CT scans. The width of the cervical pedicle was measured and compared at medial angulations of 30°, 35°, 40°, 45°, 50°, 55°, and 60° relative to the midline sagittal plane. Based on an observational examination of the positions of all cervical 3-dimensional models and screws, the proposed entry point for C3-7 CPS was analyzed. Although the variations in C3-6 pedicle width (PW) among 45°, 50°, and 55° were not statistically significant, they were significantly larger than the differences among 30°, 35°, 40°, and 60° angles (P < .05). The differences in C7 PW between the 30°, 35°, 40°, and 45° angles were not statistically different even though the 30°, 35°, 40°, and 45° angles were significantly bigger. (P < .05). The proposed entry point for C3-7 CPS was below the junction of the lateral and lower borders of the superior articular process joint surface. The entry point for C3-7 levels was below the junction of the lateral and lower borders of the superior articular process joint surface. The optimal medial angulation for the posterior C3-6 CPS was 45°-55° and that for the posterior C7 CPS was 30°-45°. The sagittal angle of the posterior C3-7 CPS was parallel to the corresponding upper endplate.
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Affiliation(s)
- Wei-Xin Dong
- Department of Spinal Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang Province, China
| | - Yong Hu
- Department of Spinal Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang Province, China
| | - Zhen-Shan Yuan
- Department of Spinal Surgery, Ningbo No.6 Hospital, Ningbo, Zhejiang Province, China
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Sasapardhi SB, Verma PK, Srivastava AK, Das KK, Kumar A, Dikshit P, Maurya VP, Bhaisora KS, Mehrotra A, Jaiswal AK, Mishra P, Behari S, Kumar R, Mishra H, Shahare K. An institutional study on accuracy of freehand cervical C1 C2 screws placement by knock and drill technique in craniovertebral anomalous bony anatomy: An evaluation of more than 600 screws based on SGPGI screw accuracy criteria. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:83-91. [PMID: 38644916 PMCID: PMC11029100 DOI: 10.4103/jcvjs.jcvjs_116_23] [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: 09/07/2023] [Accepted: 01/29/2024] [Indexed: 04/23/2024] Open
Abstract
Purpose To assess the accuracy of freehand cervical C1 C2 screws placement by knock and drill (K and D) technique in craniovertebral anomalous bony anatomy. Materials and Methods From January 2017 to December 2022, 682 consecutive C1 C2 screws in 215 patients with craniovertebral junction (CVJ) anomalies were enrolled. All patients underwent posterior fixation with K and D technique without any fluoroscopic guidance. The patient's demographic details, clinical details, radiological details, major intraoperative events, and postoperative complications were noted. The screws malposition grades and direction on CT images in the axial and sagittal plane were defined as new per proposed "SGPGI accuracy criteria." All patients had a clinical evaluation at 3-month follow-up. Results Total 682 C1, C2 screws were placed in 215 patients for CVJ anomalies using K and D technique. The accuracy of screws placement by freehand technique was 84.46% (576/682). So with technique explained the rate of malplacement in simple (16.35%) and complex (15.19%) groups were almost comparable and comparison difference was not significant (P = 0.7005). Conclusion The freehand technique, as described, is effective in cases of anomalous bony anatomy, and it is mandatory in complex CVJ anomalies. The accuracy of screw placement and VA injury is comparable with major studies. This technique is supposedly cost-effective and less hazardous to both health-care workers and patients.
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Affiliation(s)
- Sudhir Bisan Sasapardhi
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pawan Kumar Verma
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashutosh Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | - Ved Prakash Maurya
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh Singh Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhaker Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Raj Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Harshit Mishra
- Department of Neuroanesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kalyani Shahare
- Department of Neuroanesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Takigawa T, Morita T, Kajiki Y, Ito Y. Application of a Navigated Drill for Cervical Pedicle Screw Insertion at C3-6. Cureus 2023; 15:e47710. [PMID: 38022028 PMCID: PMC10675841 DOI: 10.7759/cureus.47710] [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] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Background Perforation of the cervical pedicle screw, especially lateral perforation, may lead to critical complications, such as vertebral artery injury. Sub-axial cervical spines (C3-6) are at risk of complications because these levels have limited area and angle. This study aimed to compare a navigated drill and a navigated probe for the insertion of cervical pedicle screws at C3-6. Methodology This retrospective study included 106 patients treated with cervical pedicle screws at C3-6. In total, 52 patients with 200 cervical pedicle screws using a navigated drill (group D) and 54 patients with 170 cervical pedicle screws using a navigated probe (group P) were compared. The perforation rate, anatomical medial angle of the pedicle, and actual angle of the screw were investigated using computed tomography. The planning error was defined as when the pedicle screw was applied for a small pedicle width of <3.5 mm. All perforations except for planning errors were defined as technical perforations. Results Grade 1 screw perforations were identified in 16 and 17 screws in groups D and P, respectively. Overall, 88% of the perforations were medial in group D, and 82% of perforations were lateral in group P. Technical perforations were found in 7/191 (3.7%, group D) and 15/168 (8.9%, group P) screws. There were no significant differences in the anatomical angle of the pedicle between the groups. The mean medial angle of the pedicle screws was 24.7° (group D) and 30.9° (group P) (p < 0.05). Conclusions The perforation rate of group D was less than half of that of group P. This was because a navigated drill was able to create a bony pilot hole at the hard medial cortical wall of the pedicle with a small medial angle, which was difficult to do with a navigated probe. A navigated drill can be useful for cervical pedicle screw insertion at C3-6 because of its easiness and safety.
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Affiliation(s)
- Tomoyuki Takigawa
- Department of Orthopaedic Surgery, Kobe Red Cross Hospital, Kobe, JPN
| | - Takuya Morita
- Department of Orthopaedic Surgery, Kobe Red Cross Hospital, Kobe, JPN
| | - Yuya Kajiki
- Department of Orthopaedic Surgery, Kobe Red Cross Hospital, Kobe, JPN
| | - Yasuo Ito
- Department of Orthopaedic Surgery, Kobe Red Cross Hospital, Kobe, JPN
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Mao JZ, Soliman MA, Karamian BA, Khan A, Fritz AG, Avasthi N, DiMaria S, Levy BR, O’Connor TE, Schroeder G, Pollina J, Vaccaro AR, Mullin JP. Anatomical and Technical Considerations of Robot-Assisted Cervical Pedicle Screw Placement: A Cadaveric Study. Global Spine J 2023; 13:1992-2000. [PMID: 35195035 PMCID: PMC10556891 DOI: 10.1177/21925682211068410] [Citation(s) in RCA: 0] [Impact Index Per Article: 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 Cadaver study. OBJECTIVES Assess the feasibility of robot-assisted cervical pedicle screw (RA-CPS) placement and understand the anatomical considerations of this technique. METHODS Four cadaver specimens free from bony pathology were acquired. Anatomical considerations, such as pedicle width (PW) and height (PH), transverse pedicle angle (TPA), and maximal screw length (MSL), were recorded from preoperative computational tomography (CT) scans. Intraoperative cone-beam CT was acquired and registered to the robotic system. After cervical levels were segmented, screw sizes and trajectories were planned, and RA-CPS were placed. Accuracy was assessed using Gertzbein and Robbin's classification on postoperative CT scans. RESULTS Thirty-five RA-CPS were placed. Major breaches (≥Grade C) occurred in 28.57% screws. Grade A or B accuracy was found in 71.43% of screws, with the most common direction of breach being medial (81.3%). The greatest proportion of breach per level occurred in the upper subaxial levels, (C3:71.4%, C4 66.6%, C5:50%) which had the smallest PW (C3: 4.34 ± .96 mm, C4: 4.48 ± .60, C5: 5.76 ± 1.11). PH was greatest at C2 (8.14 ± 1.89 mm) and ranged subaxial from 6.36 mm (C3) to 7.48 mm (C7). The mean PW was 5.37 mm and increased caudally from 4.34 mm (C3) to 6.31 mm (C7). The mean TPA was 39.9° and decreased moving caudally 46.9°) to C7 (34.4°). The MSL was 37.1 mm and increased from C2 (26.3 mm) to C7 (41.0 mm). CONCLUSION RA-CPS has the potential to be feasible, but technological and instrument modifications are necessary to increase the accuracy in the cervical region.
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Affiliation(s)
- Jennifer Z. Mao
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY, USA
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia PA, USA
| | - Mohamed A.R. Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY, USA
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Brian A. Karamian
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia PA, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY, USA
| | - Alexander G. Fritz
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY, USA
| | - Naval Avasthi
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY, USA
| | - Stephen DiMaria
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia PA, USA
| | - Bennett R. Levy
- George Washington University, School of Medicine and Health Sciences, Washington DC, USA
| | - Timothy E. O’Connor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY, USA
| | - Gregory Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia PA, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY, USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia PA, USA
| | - Jeffrey P. Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo NY, USA
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6
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Wang Y, Hu B, Wu J, Chen W, Wang Z, Zhu J, Fan W, Liu M, Zhao J, Liu P. Subaxial Cervical Pedicular Screw Insertion via the Nonanatomic Axis: Identification of Entry Point and Trajectory Based on a Radiographic Study and Workshop. Global Spine J 2023; 13:360-367. [PMID: 33618552 PMCID: PMC9972273 DOI: 10.1177/2192568221996310] [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] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN A radiological study and workshop. OBJECTIVE To propose a novel technique for subaxial cervical pedicle screw (CPS) insertion via the nonanatomic axis (nAA) and identify a new entry point (EP) and trajectory based on a radiological study. METHODS The new EP was determined to be the center of the upper half of the lateral mass, and the nAA was defined as the line connecting the EP and center of the pedicle. CT images of 493 subaxial cervical pedicles from 51 adults were utilized. The pedicle axis length (PAL/nPAL), pedicle transverse angle (PTA/nPTA), sagittal and transverse pedicle screw depth ratio (S-DO, T-DO), and sagittal and transverse angles (S-angle, T-angle) were measured in the anatomical axis (AA) and nAA. nAA-CPS insertions were conducted on dry specimens, and the positions of the screws were graded. RESULTS The nPTA (22.35° ± 1.57°), nPAL (23.75 ± 2.07 mm), T-DO (45.61% ± 3.10%), and S-DO (70.46% ± 4.44%) of the nAA-CPS were significantly different from the PTA (41.86° ± 2.77°), PAL (31.98 ± 2.40 mm), T-DO and S-DO of the AA-CPS (both 100% in ideal conditions), respectively (P < .05). The T-angle and S-angle were 92.78° ± 3.07° and 92.18° ± 3.78°, respectively. A constant EP and consistent trajectory of the nAA-CPS identified by 2 perpendicular angles were summarized and utilized as the manipulation protocols of the workshop, and a perfect position was achieved in 80.00% (24/30) of screws. CONCLUSION The nAA-CPS is a novel alternative to the classic CPS technique. A constant entry point and 2 perpendicular angles in the sagittal and transverse planes for identifying the trajectory of the nAA-CPS should be taken into account in the establishment of a manipulation protocol.
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Affiliation(s)
- Yingbo Wang
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Bo Hu
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Jian Wu
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Wei Chen
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Zhong Wang
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Jun Zhu
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Weili Fan
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Mingyong Liu
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Jianhua Zhao
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China
| | - Peng Liu
- Division of Spine Surgery, Center for
Orthopedics, Daping Hospital, Army Medical University, Chongqing, China,State Key Laboratory of Trauma, Burns
and Combined Wound, Army Medical University, Chongqing, China,Peng Liu, Division of Spine Surgery, Center
for Orthopedics, Daping Hospital, Army Medical University, No. 10,
Changjiangzhilu, Daping Street, Yuzhong District, Chongqing, 400042, China.
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Martin-Schutz GO, Amaral CAB, Labronici PJ, Pires LAS. MORPHOMETRIC STUDY OF THE C6 AND C7 PEDICLE: A COMPUTERIZED TOMOGRAPHY ANALYSIS. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222104262589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT Objective: Measure the diameter and thickness of the C6 and C7 pedicles using computed tomography, to analyze the security of the act surgery and the difference between males and females. Methods: This is a retrospective study. Two hundred computerized tomography scans of the cervical spine, one hundred male and one hundred female, from the Hospital Santa Teresa Radiology sector were evaluated. The pedicle thickness was measured in the axial plane, and the height was measured in sagittal slices. The student’s t-test was used to compare differences between the sexes, and a p-value lower than 0.05 was considered significant. Results: The mean age of the individuals included in the sample was 35±9 years. The mean height of the C6 and C7 pedicles were 7.1±0.9 mm and 7.8±0.9 mm, respectively. The mean thickness of the C6 and C7 pedicles were 5.2±0.7 mm and 5.9±0.8 mm, respectively. The statistical test showed that the values were significantly lower for female patients. Conclusions: The present study demonstrated parameters that can be used and can be the rule for preoperative planning of transpedicular cervical fixation surgeries, both in C6 and C7. As it is a procedure that can cause iatrogenic damage to important structures, the screw size must be chosen with care in pre-operative planning to avoid vessel rupture or damage to adjacent nerves. Level of Evidence III; retrospective study.
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Patient-Matched 3-D-Printed Guides for the Insertion of Cervical Pedicle Screws in Tumor Surgery. Case Rep Surg 2021; 2021:8135996. [PMID: 34925931 PMCID: PMC8678078 DOI: 10.1155/2021/8135996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Pedicle screw fixation in the cervical spine provides biomechanical advantages compared to other stabilization techniques. However, pedicle screw insertion in this area is challenging due to the anatomical conditions with a high risk of breaching the small pedicles and violating the vertebral artery or neural structures. Today, several techniques to facilitate screw insertion and to make the procedure safer are used. 3-D-printed patient-matched guides based on a CT reconstruction are a helpful technique which allows to reduce operation time and to improve the safety of pedicle screw insertion at the cervical spine. Cases 3-D-printed patient-matched drill guides based on a CT scan with a 3-D reconstruction of the spine were used in two challenging cervical spine surgical tumor cases to facilitate the implantation of the pedicle screws. The screw position was controlled postoperatively by means of the routinely performed CT scan. Results Postoperative imaging (conventional radiographs and CT scan) revealed the correct position of the pedicle screws. The time needed for screw insertion was short, and the need for intraoperative fluoroscopy could be reduced. There was no intra- or postoperative complication related to the pedicle screw implantation. Both tumors could be removed completely. Conclusion These preliminary results show that 3-D-printed patient-specific guides are a promising tool to support and facilitate the implantation of cervical pedicle screws. The time needed for insertion is short, and intraoperative fluoroscopy time can be reduced. This technique allows for both a meticulous preoperative planning and a correct and therefore safe intraoperative positioning of cervical spine pedicle screws.
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Gelinne A, Abumoussa AL, Sloboda CA, Bhowmick DA. Novel use of percutaneous cervical pedicle inlet screws for supplemental posterior fixation after anterior cervical deformity correction. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:302-305. [PMID: 34728998 PMCID: PMC8501810 DOI: 10.4103/jcvjs.jcvjs_74_21] [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: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Correction of cervical deformity can be achieved using anterior cervical fixation and fusion techniques. However, supplemental posterior fixation is a critical component for ensuring biomechanical longevity and favorable patient outcomes. We present a novel percutaneous technique for posterior cervical fixation in patients where cervical pedicle (CP) screws may not be feasible and midline muscle dissection is not needed. Methods Three patients presented to our hospital with cervical pathology amendable to circumferential cervical fusion. After adequate deformity correction was performed through an anterior cervical decompression and fusion, staged posterior supplemental fixation was achieved using percutaneous CP inlet (CPI) screws using a percutaneous muscle-sparing approach. Results All three patients underwent CPI screw placement without postoperative neurovascular complications. Postoperative radiographic follow-up showed the desired, proper screw placement, with continued maintained cervical alignment. Conclusions CPI screw placement may be alternative hybrid screw that achieves a advantageous safety profile while also avoiding an open midline exposure.
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Affiliation(s)
- Aaron Gelinne
- Department of Neurosurgery, University of North Carolina, Chapel Hill, Department of Neurosurgery, Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Andrew L Abumoussa
- Department of Neurosurgery, University of North Carolina, Chapel Hill, Department of Neurosurgery, Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Cole A Sloboda
- Department of Neurosurgery, University of North Carolina, Chapel Hill, Department of Neurosurgery, Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Deb A Bhowmick
- Department of Neurosurgery, University of North Carolina, Chapel Hill, Department of Neurosurgery, Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
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10
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Yang X, Luo Q, Li ZQ, Zhang N, Chen XY, Zhou Y, Deng HL, Jiang J, Liu JM. Using the lamina nutrient foramen as the entry point for posterior cervical pedicle screw placement. Clin Neurol Neurosurg 2021; 207:106711. [PMID: 34102421 DOI: 10.1016/j.clineuro.2021.106711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/07/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
STUDY DESIGN A prospective study and technique description. OBJECTIVE This study introduced a method for posterior cervical pedicle screw placement by using the bilateral posterior lamina nutrient foramens as the entry point. METHODS Firstly, 30 dry C3-C7 vertebrae specimens were harvested for measurement. The lamina nutrient foramens were used as the entry points for posterior cervical pedicle screw placement and four linear and two angle parameters were obtained from a computed tomography scan(CT). Then, 60 patients who underwent C3-C7 pedicle screw fixation using this method were included, linear and angle parameters were obtained from a postoperative CT. RESULTS The average incidences of lamina nutrient foramen on the C3-C7 specimens were 88.3%, 90.0%, 95.0%, 95.0%, and 96.7%, respectively. The distances from the entry point to the pedicle screw tip (OD), the pedicle transverse angles (α), and the pedicle sagittal angles (β) measure for the entry points from C3-C7 were 28.74 ± 3.45-30.15 ± 2.01 mm, 26.88 ± 6.89° to 32.72 ± 5.91°, and 12.48 ± 9.31° to 19.71 ± 8.45°, respectively, with no significant differences between the left and right sides. In the 60 patients who underwent surgery, the lengths of the pedicle screws (PL) were 28.34 ± 2.25-30.15 ± 2.31 mm, the pedicle transverse angles (α) were 26.89 ± 6.86° to 32.36 ± 5.65°, and the pedicle sagittal angles (β) were 12.49 ± 9.11° to 20.06 ± 8.91°. The new method had a 96.8% (454/469) success rate among these patients, with no screws penetrating the spinal canal or signs of vertebral artery injury. CONCLUSION Entry at the bilateral lamina nutrient foramen represents an alternative posterior cervical pedicle screw placement technique that is feasible and safe.
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Affiliation(s)
- Xuan Yang
- Medical Innovation Center, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China; The First Clinical Medical College of Nanchang University, Nanchang 330006, PR China
| | - Qing Luo
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China
| | - Zhi-Qiang Li
- Medical Innovation Center, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China; Institute of Spine and Spinal Cord, Nanchang University, Nanchang 330006, PR China
| | - Ning Zhang
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China
| | - Xuan-Yin Chen
- Medical Innovation Center, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China; Institute of Spine and Spinal Cord, Nanchang University, Nanchang 330006, PR China
| | - Yang Zhou
- Medical Innovation Center, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China; Institute of Spine and Spinal Cord, Nanchang University, Nanchang 330006, PR China
| | - Hui-Lin Deng
- Medical Innovation Center, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China; Institute of Spine and Spinal Cord, Nanchang University, Nanchang 330006, PR China
| | - Jian Jiang
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China.
| | - Jia-Ming Liu
- Medical Innovation Center, the First Affiliated Hospital of Nanchang University, Nanchang 330006, PR China; Institute of Spine and Spinal Cord, Nanchang University, Nanchang 330006, PR China.
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Jain M, Sahu RN, Gaikwad MR, Panda S, Tirpude A, Bag ND. Validation of Freehand Cervical Pedicle Screw Placement in Subaxial Spine Using the "Burcev Technique": A Cadaveric Study. J Neurosci Rural Pract 2021; 12:555-559. [PMID: 34295111 PMCID: PMC8289562 DOI: 10.1055/s-0041-1727410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present study attempted to validate the “Burcev freehand method” based on anatomical observations in Indian cadavers. The study was conducted on 32 cervical pedicle screws (CPSs) that were placed in four cadavers by the authors according to the “freehand technique,” described by Burcev et al, without the aid of fluoroscopy and the trajectory verified by computed tomography scans. The screws were designated as satisfactory, permissible, or unacceptable. Descriptive variables were represented in number and percentages, continuous variables were represented as mean ± standard deviation (SD). Of the 32 CPSs placed, 24 (75%) exhibited a satisfactory position, 1 (3%) exhibited a permissible position, and 7 (22%) exhibited an unacceptable position. Of the seven CPSs in the unacceptable group, four exhibited a lateral breach and three exhibited a medial breach, whereas the CPS in the permissible group exhibited a medial breach. The overall angle with contralateral lamina in the horizontal plane in terms of mean ± SD was 175.43 ± 2.82, 169.49, and 169.65 ± 6.46 degrees in the satisfactory, permissible, and unacceptable groups, respectively. In the sagittal plane, the screws exhibited an angle of 88.15 ± 3.56 degrees. No breach was observed superiorly or inferiorly. The “Burcev technique” is replicable with similar results in cadavers. Further studies must be conducted in a clinical setting to ensure its safety.
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Affiliation(s)
- Mantu Jain
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Rabi N Sahu
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Manisha R Gaikwad
- Department of Anatomy, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sashikanta Panda
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Amit Tirpude
- Department of Anatomy, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nerbadyswari D Bag
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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张 宇, 吴 优, 付 索, 夏 虹, 马 向, 章 凯, 艾 福. [Treatment of tuberculosis in craniovertebral junction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1507-1514. [PMID: 33319527 PMCID: PMC8171574 DOI: 10.7507/1002-1892.202005087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/02/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the method of treating tuberculosis in the craniovertebral junction and its effectiveness. METHODS The clinical data of 18 patients with tuberculosis in the craniovertebral junction between July 2010 and January 2019 was analyzed retrospectively. There were 14 males and 4 females, aged 21 months to 75 years (median, 35 years). The disease duration ranged from 2 weeks to 60 months (median, 4 months), and the affected segment was C 0-C 3. Preoperative visual analogue scale (VAS) score was 6.7±1.5 and the Japanese Orthopaedic Association (JOA) score was 16.1±1.8. The American Spinal Cord Injury Association (ASIA) grading system was applied to classify their neurological functions, according to which there were 6 cases of grade D and 12 cases of grade E. Among 18 patients, 4 patients underwent conservative treatment, 1 patient removed tuberculosis via transoral approach, 1 patient removed tuberculosis via posterior cervical approach, and 12 patients removed tuberculosis via transoral approach immediately after posterior cervical (atlantoaxial or occipitalcervical) fusion and internal fixation. The VAS score, ASIA grading, and JOA score were applied to evaluate effectiveness. X-ray film, CT, and MRI were taken after treatment to evaluate the tubercular recurrence, cervical stability, and bone healing. RESULTS All the patients were followed up 3 to 42 months (median, 12 months). At 3 months after treatment, the VAS score was 1.7±1.0, showing significant difference when compared with preoperative score ( t=15.000, P=0.000); and the JOA score was 16.7±1.0, showing no significant difference when compared with preoperative score ( t=1.317, P=0.205). According to ASIA grading, 6 patients with grade D before treatment had upgraded to grade E after treatment, while the remaining patients with grade E had no change in grading. The imaging examinations showed the good stability of the cervical spine. All patients had complete tuberculosis resection and no recurrence, and the patients who underwent internal fixation via posterior cervical approach achieved atlantoaxial or occipitalcervical bone fusion. CONCLUSION On the premise of regular chemotherapy, if there is no huge abscess causing dysphagia or dyspnea, atlantoaxial instability, and neurological symptoms, patients can undergo conservative treatment. If not, however, the transoral approach can be used to completely remove the tuberculosis lesion in the craniovertebral junction. One-stage debridement via transoral approach combined with posterior cervical fusion and internal fixation can achieve satisfactory effectiveness.
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Affiliation(s)
- 宇 张
- 中国人民解放军南部战区总医院骨科(广州 510010)Department of Orthopedics, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - 优 吴
- 中国人民解放军南部战区总医院骨科(广州 510010)Department of Orthopedics, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - 索超 付
- 中国人民解放军南部战区总医院骨科(广州 510010)Department of Orthopedics, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - 虹 夏
- 中国人民解放军南部战区总医院骨科(广州 510010)Department of Orthopedics, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - 向阳 马
- 中国人民解放军南部战区总医院骨科(广州 510010)Department of Orthopedics, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - 凯 章
- 中国人民解放军南部战区总医院骨科(广州 510010)Department of Orthopedics, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - 福志 艾
- 中国人民解放军南部战区总医院骨科(广州 510010)Department of Orthopedics, General Hospital of Southern Theater Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
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Upendra B, Raghavendra R. Techniques of cervical pedicle screw insertion in lower cervical spine - A review. J Clin Orthop Trauma 2020; 11:794-801. [PMID: 32879566 PMCID: PMC7452216 DOI: 10.1016/j.jcot.2020.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 11/29/2022] Open
Abstract
Cervical pedicle screws (CPS) have been used for stabilization of lower cervical spine since its first description by Abumi et al., in 1994, but the usage has been limited due to the feared complications. Cadaveric studies have discouraged use of CPS in lower cervical spine due to high misplacement rates. On the contrary, clinical studies have shown limited complications due to screw misplacements and have highlighted the benefits of CPS with its superior biomechanical strength. Therefore surgeons have always tried to find a reliable, reproducible and safe CPS insertion technique to expand the usage of CPS with minimal complications. As of today Abumi et al. technique is the most popular free-hand technique used by surgeons, though many modifications have evolved to make the CPS insertions more safe and reproducible. The free hand technique should be considered as the cornerstone technique for CPS insertion and the navigation tools are essential to improve the safety of CPS in complex surgeries with altered cervical anatomy. The present review brings together the literature on the various aspects of cervical pedicle anatomy, the free-hand screw insertion techniques with their modifications, the screw misplacement rates and complications.
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