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Abstract
PURPOSE OF REVIEW The goal of the review is to discuss the common general applications of navigation in the context of minimally invasive spine surgery and assess its value in the published literature comparing against non-navigated or navigated techniques. RECENT FINDINGS There is increasing utilization of computer navigation in minimally invasive spine surgery. There is synergy between navigation and minimally invasive technologies, such that one enhances or facilitates the other, thus leading to wider applications for both. Specifically, navigation has been shown to improve performance of percutaneous pedicle screw placement, vertebral augmentation, and minimally invasive fusion procedures. Overall, clinical studies have shown better accuracy and less radiation exposure with the use of navigation in spine surgery. The use of navigation in minimally invasive spine surgery enhances the accuracy of instrumentation and decreases radiation exposure. It is yet to be determined whether patient-reported outcomes will differ. Further research on its effect on clinical outcomes may further define the future impact of navigation in minimally invasive spine surgery.
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Affiliation(s)
- Jonathan N Sembrano
- Department of Orthopaedic Surgery, University of Minnesota Medical School, 2450 Riverside Ave S R200, Minneapolis, MN, 55454, USA.
| | - Sharon C Yson
- Department of Orthopaedic Surgery, University of Minnesota Medical School, 2450 Riverside Ave S R200, Minneapolis, MN, 55454, USA
| | - Jeffrey J Theismann
- Department of Orthopaedic Surgery, University of Minnesota Medical School, 2450 Riverside Ave S R200, Minneapolis, MN, 55454, USA
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The Use of Bone Morphogenetic Protein in the Intervertebral Disk Space in Minimally Invasive Transforaminal Lumbar Interbody Fusion: 10-year Experience in 688 Patients. Clin Spine Surg 2019; 32:E272-E276. [PMID: 30839419 DOI: 10.1097/bsd.0000000000000800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
STUDY DESIGN Retrospective Cohort. OBJECTIVE The objective of this study was to characterize one surgeon's experience over a 10-year period using rhBMP-2 in the disk space for minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). SUMMARY OF BACKGROUND DATA MIS TLIF has been utilized as a technique for decreasing patients' immediate postoperative pain, decreasing blood loss, and shortened hospital stays. Effectiveness and complications of rhBMP-2's use in the disk space is limited because of its off-label status. METHODS Retrospective analysis of consecutive MIS TLIFs performed by senior author between 2004 and 2014. rhBMP-2 was used in the disk space in all cases. Patients were stratified based on the dose of rhBMP-2 utilized. Patients had 9 to 12 month computerized tomography scan to evaluate for bony fusion and continued follow-up for 18 months. RESULTS A total of 688 patients underwent a MIS TLIF. A medium kit of rhBMP-2 was utilized in 97 patients, and small kit was used in 591 patients. Fusion rate was 97.9% and this was not different between the 2 groups with 96/97 patients fusing in the medium kit group and 577/591 patients fusing in the small kit group. Five patients taken back to the operating room for symptomatic pseudoarthrosis, 4 reoperated for bony hyperostosis, and 10 radiographic pseudoarthroses that did not require reoperation. A statistically significant difference in the rate of foraminal hyperostosis was found when using a medium sized kit of rhBMP-2 was 4.12% (4/97 patients), compared with a small kit (0/591 patients, P=0.0004). CONCLUSIONS Utilization of rhBMP-2 in an MIS TLIF leads to high fusion rate (97.9%), with an acceptable complication profile. The development of foraminal hyperostosis is a rare complication that only affected 0.6% of patients, and seems to be a dose related complication, as this complication was eliminated when a lower dose of rhBMP-2 was utilized. LEVEL OF EVIDENCE Level IV.
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Siasios ID, Pollina J, Khan A, Dimopoulos VG. Percutaneous screw placement in the lumbar spine with a modified guidance technique based on 3D CT navigation system. JOURNAL OF SPINE SURGERY 2017; 3:657-665. [PMID: 29354745 DOI: 10.21037/jss.2017.12.05] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Several guidance techniques have been employed to increase accuracy and reduce surgical time during percutaneous placement of pedicle screws (PS). The purpose of our study was to present a modified technique for percutaneous placement of lumbar PS that reduces surgical time. We reviewed 23 cases of percutaneous PS placement using our technique for minimally invasive lumbar surgeries and 24 control cases where lumbar PS placement was done via common technique using Jamshidi needles (Becton, Dickinson and Company, Franklin Lakes, NJ, USA). An integrated computer-guided navigation system was used in all cases. In the technique modification, a handheld drill with a navigated guide was used to create the path for inserting guidewires through the pedicles and into the vertebral bodies. After drill removal, placement of the guidewires through the pedicles took place. The PS were implanted over the guidewires, through the pedicles and into the vertebral bodies. Intraoperative computed tomography was performed after screw placement to ensure optimal positioning in all cases. There were no intraoperative complications with either technique. PS placement was correct in all cases. The average time for each PS placement was 6.9 minutes for the modified technique and 9.2 minutes for the common technique. There was no significant difference in blood loss. In conclusion, this modified technique is efficient and contributes to reduced operative time.
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Affiliation(s)
- Ioannis D Siasios
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, NY, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, NY, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, NY, USA
| | - Vassilios George Dimopoulos
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, NY, USA
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Tsuang FY, Chen CH, Kuo YJ, Tseng WL, Chen YS, Lin CJ, Liao CJ, Lin FH, Chiang CJ. Percutaneous pedicle screw placement under single dimensional fluoroscopy with a designed pedicle finder-a technical note and case series. Spine J 2017. [PMID: 28645672 DOI: 10.1016/j.spinee.2017.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Minimally invasive spine surgery has become increasingly popular in clinical practice, and it offers patients the potential benefits of reduced blood loss, wound pain, and infection risk, and it also diminishes the loss of working time and length of hospital stay. However, surgeons require more intraoperative fluoroscopy and ionizing radiation exposure during minimally invasive spine surgery for localization, especially for guidance in instrumentation placement. In addition, computer navigation is not accessible in some facility-limited institutions. PURPOSE This study aimed to demonstrate a method for percutaneous screws placement using only the anterior-posterior (AP) trajectory of intraoperative fluoroscopy. STUDY DESIGN A technical report (a retrospective and prospective case series) was carried out. PATIENT SAMPLE Patients who received posterior fixation with percutaneous pedicle screws for thoracolumbar degenerative disease or trauma comprised the patient sample. METHOD We retrospectively reviewed the charts of consecutive 670 patients who received 4,072 pedicle screws between December 2010 and August 2015. Another case series study was conducted prospectively in three additional hospitals, and 88 consecutive patients with 413 pedicle screws were enrolled from February 2014 to July 2016. The fluoroscopy shot number and radiation dose were recorded. In the prospective study, 78 patients with 371 screws received computed tomography at 3 months postoperatively to evaluate the fusion condition and screw positions. RESULTS In the retrospective series, the placement of a percutaneous screw required 5.1 shots (2-14, standard deviation [SD]=2.366) of AP fluoroscopy. One screw was revised because of a medialwall breach of the pedicle. In the prospective series, 5.8 shots (2-16, SD=2.669) were required forone percutaneous pedicle screw placement. There were two screws with a Grade 1 breach (8.6%), both at the lateral wall of the pedicle, out of 23 screws placed at the thoracic spine at T9-T12. Forthe lumbar and sacral areas, there were 15 Grade 1 breaches (4.3%), 1 Grade 2 breach (0.3%), and 1 Grade 3 breach (0.3%). No revision surgery was necessary. CONCLUSION This method avoids lateral shots of fluoroscopy during screw placement and thus decreases the operation time and exposes surgeons to less radiation. At the same time, compared with the computer-navigated procedure, it is less facility-demanding, and provides satisfactory reliability and accuracy.
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Affiliation(s)
- Fon-Yih Tsuang
- Institute of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan No. 1, Sec. 1, Jen-Ai Road, Taipei City, 100, Taiwan; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan No. 7, Chung-Shan South Road, Taipei City 100, Taiwan; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan No. 579, Yun-Lin Road, Diou-Liu City, Yun-Lin County, 640, Taiwan; Kinmen Hospital, Ministry of Health and Welfare, Kinmen County, Taiwan No. 2, Fu-Xing Road, Kin-Hu Township, Kin-Men County, 891, Taiwan
| | - Chia-Hsien Chen
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, 23561, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedics, Taipei Medical University Hospital, Taipei City, Taiwan No. 252, Wu-Xing Street, Taipei City, 110, Taiwan; Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan No. 250, Wu-Xing Street, Taipei City, 110, Taiwan
| | - Wei-Lung Tseng
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan No. 7, Chung-Shan South Road, Taipei City 100, Taiwan; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan No. 579, Yun-Lin Road, Diou-Liu City, Yun-Lin County, 640, Taiwan
| | - Yuan-Shen Chen
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan No. 579, Yun-Lin Road, Diou-Liu City, Yun-Lin County, 640, Taiwan
| | - Chin-Jung Lin
- Kinmen Hospital, Ministry of Health and Welfare, Kinmen County, Taiwan No. 2, Fu-Xing Road, Kin-Hu Township, Kin-Men County, 891, Taiwan
| | - Chun-Jen Liao
- Industry Technology Research Institute, Hsinchu County, Taiwan No. 195, Sec. 4, Chung-Hsing Road., Chutung, Hsinchu County, 310, Taiwan
| | - Feng-Huei Lin
- Institute of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan No. 1, Sec. 1, Jen-Ai Road, Taipei City, 100, Taiwan; Division of Medical Engineering, National Health Research Institute, Miaoli County, Taiwan No. 35, Keyan Road, Zhunan, Miaoli County, 35053, Taiwan
| | - Chang-Jung Chiang
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, 23561, Taiwan; Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan No. 250, Wu-Xing Street, Taipei City, 110, Taiwan.
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