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Chen Y, Yang J, Liang J, Wu W. The optimal introversion angle and length of pedicle screw to avoid L1-S1 vascular damage. BMC Surg 2024; 24:194. [PMID: 38907190 PMCID: PMC11191234 DOI: 10.1186/s12893-024-02483-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 06/14/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND posterior pedicle screw fixation is common method, one of the most severe complications is iatrogenic vascular damage, no report investigated association of different introversion angles (INTAs) and length of pedicle screw. The aims were to investigate the optimal introversion angle and length of pedicle screw for improving the safety of the operation, and to analyze the differences of vascular damage types at L1-S1. METHODS Lumbar CT imaging data from110 patients were analyzed by DICOM software, and all parameters were measured by new Cartesian coordinate system, INTAs (L1-L5:5°,10°,15°,S1: 0°, 5°,10°,15°), DO-AVC (the distance between the origin (O) with anterior vertebral cortex (AVC)), DAVC-PGVs (the distance between AVC and the prevertebral great vessels (PGVs)), DO-PGVs (the distance between the O and PGVs). At different INTAs, DAVC-PGVs were divided into four grades: Grade III: DAVC-PGVs ≤ 3 mm, Grade II: 3 mm < DAVC-PGVs ≤ 5 mm, Grade I: DAVC-PGVs > 5 mm, and N: the not touching PGVs. RESULTS The optimal INTA was 5° at L1-L3, the left was 5° and the right was 15° at L4, and screw length was less than 50 mm at L1-L4. At L5, the left optimal INTA was 5° and the right was 10°, and screw length was less than 45 mm. The optimal INTA was 15° at S1, and screw length was less than 50 mm. However, screw length was less than 40 mm when the INTA was 0° or 5° at S1. CONCLUSIONS At L5-S1, the risk of vascular injury is the highest. INTA and length of the pedicle screw in lumbar operation are closely related. 3 mm interval of screw length may be more preferable to reduce vascular damage.
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Affiliation(s)
- Ying Chen
- Yichang Central People's Hospital Hubei, Hubei, China
| | - Junyi Yang
- Department of Orthopedics, The First College of Clinical Medical Science, China Three Gorges University, Hubei, China
| | - Jie Liang
- Department of Orthopedics, The First College of Clinical Medical Science, China Three Gorges University, Hubei, China
- Yichang Central People's Hospital Hubei, Hubei, China
| | - Weifei Wu
- Department of Orthopedics, The First College of Clinical Medical Science, China Three Gorges University, Hubei, China.
- Yichang Central People's Hospital Hubei, Hubei, China.
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林 旭, 尚 利, 沈 素, 王 庆, 付 晓, 赵 刚. [Clinical application of percutaneous pedicle screw placement guided by ultrasound volume navigation combined with X-ray fluoroscopy: a prospective randomized controlled study]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:1253-1258. [PMID: 37848321 PMCID: PMC10581874 DOI: 10.7507/1002-1892.202306071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 10/19/2023]
Abstract
Objective To explore the feasibility and accuracy of ultrasound volume navigation (UVN) combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation through a prospective randomized controlled study. Methods Patients with thoracic and lumbar vertebral fractures scheduled for percutaneous pedicle screw fixation between January 2022 and January 2023 were enrolled. Among them, 60 patients met the selection criteria and were included in the study. There were 28 males and 32 females, with an average age of 49.5 years (range, 29-60 years). The cause of injury included 20 cases of traffic accidents, 21 cases of falls, 17 cases of slips, and 2 cases of heavy object impact. The interval from injury to hospital admission ranged from 1 to 5 days (mean, 1.57 days). The fracture located at T 12 in 15 cases, L 1 in 20 cases, L 2 in 19 cases, and L 3 in 6 cases. The study used each patient as their own control, randomly guiding pedicle screw implantation using UVN combined with X-ray fluoroscopy on one side of the vertebral body and the adjacent segment (trial group), while the other side was implanted under X-ray fluoroscopy (control group). A total of 4 screws and 2 rods were implanted in each patient. The implantation time and fluoroscopy frequency during implantation of each screw, angle deviation and distance deviation between actual and preoperative planned trajectory by imaging examination, and the occurrence of zygapophysial joint invasion were recorded. Results In terms of screw implantation time, fluoroscopy frequency, angle deviation, distance deviation, and incidence of zygapophysial joint invasion, the trial group showed superior results compared to the control group, and the differences were significant ( P<0.05). Conclusion UVN combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation can yreduce screw implantation time, adjust dynamically, reduce operational difficulty, and reduce radiation damage.
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Affiliation(s)
- 旭鑫 林
- 湖南中医药大学研究生院(湖南长沙 410208)Graduate School, Hunan University of Chinese Medicine, Changsha Hunan, 410208, P. R. China
- 河南省洛阳正骨医院(河南省骨科医院)脊柱微创一科(河南洛阳 471000)First Department of Minimally Invasive Spine, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471000, P. R. China
| | - 利杰 尚
- 湖南中医药大学研究生院(湖南长沙 410208)Graduate School, Hunan University of Chinese Medicine, Changsha Hunan, 410208, P. R. China
| | - 素红 沈
- 湖南中医药大学研究生院(湖南长沙 410208)Graduate School, Hunan University of Chinese Medicine, Changsha Hunan, 410208, P. R. China
| | - 庆丰 王
- 湖南中医药大学研究生院(湖南长沙 410208)Graduate School, Hunan University of Chinese Medicine, Changsha Hunan, 410208, P. R. China
| | - 晓燕 付
- 湖南中医药大学研究生院(湖南长沙 410208)Graduate School, Hunan University of Chinese Medicine, Changsha Hunan, 410208, P. R. China
| | - 刚 赵
- 湖南中医药大学研究生院(湖南长沙 410208)Graduate School, Hunan University of Chinese Medicine, Changsha Hunan, 410208, P. R. China
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Tannoury T, Saade A, Thomas DC, Wisco J, Ajmi Q, Singh V, AbdalKader M, Tannoury C. The "V" Sign: A Reliable Anatomic and Radiographic Landmark for Posterior Percutaneous S1 Screw Placement. JB JS Open Access 2023; 8:e22.00079. [PMID: 37675205 PMCID: PMC10476810 DOI: 10.2106/jbjs.oa.22.00079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Background Sacral (S1) pedicle screw misplacement in posterior percutaneous fixation (PPF) can be related to anatomical variability and a lack of reliable radiographic landmarks. This study highlights a reproducible anatomical landmark (the "V" sign) for the safe localization of the S1 pedicle entry point under fluoroscopy. Methods Human cadavers (n = 14) were dissected for the anatomical description of the "V" landmark and its relationship with the entry point of the S1 pedicle screw. The "V" landmark was defined medially by the lateral border of the superior articulating process of S1 and laterally by the posterior projection of the sacral ala. The mean distance was measured between the bottom point of the "V" landmark and the anatomical entry point to the S1 pedicle (V-S1 entry point distance). A similar measurement was conducted on computed tomography (CT) scans of 135 patients who underwent PPF using the "V" sign as a landmark for S1 pedicle screw placement (270 screws). These were retrospectively evaluated for appropriateness of S1 screw entry points and for proper S1 screw alignment and breaches. Results In the 14 cadavers, irrespective of the laterality and sex, the V-S1 entry point distance averaged 11.7 mm. On the medial-lateral axis, all entry points converged within 2 mm of a vertical line intersecting the base of the "V." Additionally, the CT scan analysis (135 patients, 270 screws) revealed an optimal entry point for 100% of the screws and a 3.3% (n = 9 screws) breach rate. Six of the 9 identified breaches were minor, and only 1 (0.4% of the 270 screws) warranted revision. Conclusions The "V" sign serves as a reliable anatomical and radiographic landmark for identifying the S1 pedicle entry point under fluoroscopic guidance. This landmark can help surgeons overcome the radiographic ambiguity of the sacral anatomy and ultimately reduces the rate of S1 pedicle screw misplacement. Level of evidence Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tony Tannoury
- Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Aziz Saade
- Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Jonathan Wisco
- Boston University School of Medicine, Boston, Massachusetts
| | - Qasim Ajmi
- Boston Medical Center, Boston, Massachusetts
| | - Varun Singh
- Boston Medical Center, Boston, Massachusetts
| | - Mohamad AbdalKader
- Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Chadi Tannoury
- Boston Medical Center, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
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Changoor S, Faloon MJ, Dunn CJ, Sahai N, Issa K, Sinha K, Hwang KS, Emami A. Does Percutaneous Lumbosacral Pedicle Screw Instrumentation Prevent Long-Term Adjacent Segment Disease after Lumbar Fusion? Asian Spine J 2020; 15:301-307. [PMID: 32872750 PMCID: PMC8217847 DOI: 10.31616/asj.2020.0157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/27/2020] [Indexed: 12/31/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. PURPOSE To assess long-term clinical outcomes of adjacent segment disease (ASD) in patients who underwent lumbar interbody fusion with percutaneous pedicle screw (PS) instrumentation. OVERVIEW OF LITERATURE ASD is a well-known sequela of spinal fusion, and is reported to occur at a rate of 2%-3% per year. There is debate as to whether ASD is a result of the instrumentation and fusion method or is the natural history of the patient's disease. Minimally invasive percutaneous PS augmentation of lumbar interbody fusion aims to prevent the disruption of posterior soft tissue stabilizers. METHODS From 2004-2014, 419 consecutive patients underwent anterior, lateral, or minimally invasive transforaminal lumbar interbody fusion with percutaneous PS placement at a single institution. The mean follow-up was 4.5 years. The primary outcome measure was reoperation due to ASD. Patients were divided into two cohorts: those who underwent revision surgery secondary to ASD and those who did not require further surgery. Radiographic parameters were performed using postoperative radiographs. Patients with a pelvic incidence-lumbar lordosis (PI-LL) mismatch >10° were noted. RESULTS Revision proportion secondary to ASD was 4.77% (n=20). Mean time to revision surgery was 2.5 years. Revision rate secondary to ASD was 1.1% per year. Patients who developed ASD were younger than those who did not (50.5 vs. 56.9 years, p=0.015). There was no difference in number of levels fused between cohorts. Revision proportion secondary to ASD was similar between approaches (anterior, lateral, minimally invasive). There was no significant difference in PI-LL mismatch between those who underwent revision for ASD and those who did not (22.2% vs. 18.8%, p=0.758). CONCLUSIONS ASD rates in patients who underwent percutaneous PS placement were lower than those previously published after open PS placement, possibly related to greater preservation of the posterior stabilizing elements of the lumbar spine.
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Affiliation(s)
- Stuart Changoor
- Deparment of Orthopaedic Surgery, St. Joseph's Regional Medical Center, Paterson, NJ, USA
| | - Michael Joseph Faloon
- Deparment of Orthopaedic Surgery, St. Joseph's Regional Medical Center, Paterson, NJ, USA
| | - Conor John Dunn
- Deparment of Orthopaedic Surgery, St. Joseph's Regional Medical Center, Paterson, NJ, USA
| | - Nikhil Sahai
- Deparment of Orthopaedic Surgery, St. Joseph's Regional Medical Center, Paterson, NJ, USA
| | - Kimona Issa
- Deparment of Orthopaedic Surgery, St. Joseph's Regional Medical Center, Paterson, NJ, USA
| | - Kumar Sinha
- Deparment of Orthopaedic Surgery, St. Joseph's Regional Medical Center, Paterson, NJ, USA
| | - Ki Soo Hwang
- Deparment of Orthopaedic Surgery, St. Joseph's Regional Medical Center, Paterson, NJ, USA
| | - Arash Emami
- Deparment of Orthopaedic Surgery, St. Joseph's Regional Medical Center, Paterson, NJ, USA
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Kaliya-Perumal AK, Limthongkul W, Oh JYL. Utilization of Spinal Navigation to Facilitate Hassle-Free Rod Placement during Minimally-Invasive Long-Construct Posterior Instrumentation. Asian Spine J 2019; 13:511-514. [PMID: 30691260 PMCID: PMC6547385 DOI: 10.31616/asj.2018.0233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 10/21/2018] [Indexed: 11/23/2022] Open
Abstract
During minimally-invasive long-construct posterior instrumentation, it may be challenging to contour and place the rod as the screw heads are not visualized. To overcome this, we utilized the image data merging (IDM) facility of our spinal navigation system to visualize a coherent whole image of the construct throughout the procedure. Here, we describe this technique that was used for a patient in whom L1-L5 posterior instrumentation was performed. Using an IDM facility, screws are color coded and after placement, the final image is saved. Saved images of all previous screws are displayed and observed while placing the subsequent screws. Therefore, the entry point, depth, and mediolateral alignment of subsequent screws can be adjusted to fall in line with previous screws such that the rod can be placed without hassle. Moreover, final adjustments to the construct are kept to a minimum. The possibility of screw pullout due to force engaging the rod on poorly aligned screws is thus avoided.
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Affiliation(s)
- Arun-Kumar Kaliya-Perumal
- Spine Division, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.,Department of Orthopaedic Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Affiliated to The Tamil Nadu Dr MGR Medical University, Chennai, India
| | - Worawat Limthongkul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jacob Yoong-Leong Oh
- Spine Division, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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