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Zhao J, Zhang Y, Zhan S, Zhang Q, Wang D, Peng F, Cui S, Wang B, Shi Z, He D, Liu B, Yang Z. Pedicle screw path planning for multi-level vertebral fixation. Med Phys 2024; 51:1547-1560. [PMID: 38215725 DOI: 10.1002/mp.16890] [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: 02/20/2023] [Revised: 07/28/2023] [Accepted: 08/16/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND For the spinal internal fixation procedures, connecting rods to the pedicle screws are commonly used in all spinal segments from the cervical to sacral spine. So far, we have only seen single vertebral screw trajectory planning methods in literatures. Joint screw placements in multi-level vertebrae with the constraint of an ipsilateral connecting rod are not considered. PURPOSE In this paper, a screw trajectory planning method that considers screw-rod joint system with both multi-level vertebral constraints and individual vertebral safety tolerance are proposed. METHODS The proposed method addresses three challenging constraints jointly for multi-level vertebral fixation with pedicle screws. First, a cylindrical screw safe passage model is suggested instead of a unique mathematical optimal trajectory for a single pedicle. Second, the flexible screw cap accessibility model is also included. Third, the connecting rod is modeled to accommodate the spine contour and support the needed gripping capacity. The retrospective clinical data of relative normal shape spines from Beijing Jishuitan hospital were used in the testing. The screw trajectories from the existing methods based on single vertebra and the proposed method based on multi-level vertebrae optimization are calculated and compared. RESULTS The results showed that the calculated screw placements by the proposed method can achieve 88% success rate without breaking the pedicle cortex and 100% in clinical class A quality (allow less than 2 mm out of the pedicle cortex) compared to 86.1% and 99.1%, respectively, with the existing methods. Expert evaluation showed that the screw path trajectories and the connecting rod calculated by the new method satisfied the clinical implantation requirements. CONCLUSIONS The new screw planning approach that seeks an overall optimization for multi-level vertebral fixation is feasible and more advantageous for clinical use than the single vertebral approaches.
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Affiliation(s)
- Jingwei Zhao
- Spine Surgery Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Yunxian Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Shi Zhan
- Spine Surgery Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Qi Zhang
- Spine Surgery Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Dan Wang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Fan Peng
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Shangqi Cui
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Binbin Wang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Zhe Shi
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Da He
- Spine Surgery Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Bo Liu
- Spine Surgery Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Zhi Yang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
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Yongjun T, Yuntian Z, Biao C, Zenghui J. Intraoperative triggered electromyographic monitoring of pedicle screw efficiently reduces the lumbar pedicle breach and re-operative rate-a retrospective analysis based on postoperative computed tomography scan. BMC Musculoskelet Disord 2023; 24:535. [PMID: 37386387 DOI: 10.1186/s12891-023-06658-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND To investigate whether intraoperative triggered electromyographic (T-EMG) monitoring could effectively reduce the breach rate of pedicle screws and the revision rate. METHODS Patients with posterior pedicle screw fixation from L1-S1 were enrolled between June 2015 and May 2021. The patients in whom T-EMG was utilized were placed in the T-EMG group, and the remaining patients were considered in the non-T-EMG group. Three spine surgeons evaluated the images. The two groups were divided into subgroups based on screw position (lateral/superior and medial/inferior) and breach degree (minor and major). Patient demographics, screw positions, and revision procedures were reviewed. RESULTS A total of 713 patients (3403 screws) who underwent postoperative computed tomography (CT) scans were included. Intraobserver and interobserver reliabilities were perfect. The T-EMG and non-T-EMG groups had 374(1723 screws) and 339 (1680 screws) cases, respectively. T-EMG monitoring efficiently reduced the overall screw breach (T-EMG 7.78% vs. non-T-EMG 11.25%, p = 0.001). in the subgroup analysis, the medial/inferior breach rate was higher in the T-EMG group than in the non-T-EMG group (T-EMG 6.27% vs. non-T-EMG 8.93%, p = 0.002); however, no difference was observed between the lateral and superior breaches (p = 0.064). A significant difference was observed between the minor (T-EMG 6.21% vs. non-T-EMG 8.33%, p = 0.001) and major (T-EMG 0.06% vs. non-T-EMG 0.6%, p = 0.001) medial or inferior screw breach rates. Six screws (all in the non-T-EMG group) underwent revision, with a significant difference between the groups (T-EMG 0.0% vs. non-T-EMG 3.17%, p = 0.044). CONCLUSIONS T-EMG is a valuable tool in improving the accuracy of screw placement and reducing the screw revision rate. The screw-nerve root distance is vital in causing symptomatic screw breach. TRIAL REGISTRATION The study is retrospective registered in China National Medical Research Registration and Archival information system in Nov 17th 2022.
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Affiliation(s)
- Tong Yongjun
- Department of Orthopedics, Zhejiang Hospital, No.1229, Gudun Rd, Hangzhou, 310030, Zhejiang, China
| | - Zhao Yuntian
- Sage Ridge School, 2515 Crossbow Ct, Reno, NV, 89511, USA
| | - Chen Biao
- Department of Orthopedics, Zhejiang Hospital, No.1229, Gudun Rd, Hangzhou, 310030, Zhejiang, China
| | - Jiang Zenghui
- Department of Orthopedics, Zhejiang Hospital, No.1229, Gudun Rd, Hangzhou, 310030, Zhejiang, China.
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Altaf S, Rehman L, Javeed F, Ahmed A, Hatif Y. Comparison of the accuracy of intraoperative lateral fluoroscopy versus postoperative computed tomography in spinal fusions. Surg Neurol Int 2023; 14:71. [PMID: 36895236 PMCID: PMC9990634 DOI: 10.25259/sni_73_2023] [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: 01/23/2023] [Accepted: 02/15/2023] [Indexed: 03/11/2023] Open
Abstract
Background This study compared the accuracy of intraoperative lateral fluoroscopic images versus postoperative computed tomography (CT) 3D studies in the treatment of thoracolumbar spinal fusions. Methods In a tertiary care hospital (study duration 6 months), we compared the use of lateral fluoroscopic images with the postoperative CT scans in 64 patients with thoracic or lumbar fractures undergoing spinal fusions. Results Out of the 64 patients, 61% were lumbar followed by 39% thoracic fractures. In the lumbar spine, the accuracy of screw placement utilizing lateral fluoroscopy versus postoperative CT 3D was 97.4%, while in thoracic spine, accuracy was reduced to 84.4%. Of the 64 patients, just 4 (6.2%) patients demonstrated lateral pedicle cortex penetration, 1 (1.5%) patient had a medial pedicle cortex breach, while none exhibited anterior vertebral body cortex penetration. Conclusion This study documented the efficacy of lateral fluoroscopy in intraoperative thoracic and lumbar spinal fixation as confirmed by postoperative CT 3D studies. These findings support the continued use of fluoroscopy rather than CT intraoperatively to lower the risk of radiation exposure to both patients and surgeons.
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Affiliation(s)
- Sehrish Altaf
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Lal Rehman
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Farrukh Javeed
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Anas Ahmed
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Yousra Hatif
- Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
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