Posterior First and Second Cervical Vertebrae Fusion by Screw Fixation Technique using the Modern Pre-fabricated Template Method on Cadaver Samples

Indirect Puncture Using a Novel Arc Puncture-Guided Device in Percutaneous Transforaminal Puncture on Goat Lumbar Spine Specimens

OBJECTIVE

We investigated the indirect puncture method using a novel arc puncture-guided device in percutaneous transforaminal puncture to improve puncture accuracy and reduce the fluoroscopy, puncture, and operation times.

METHODS

We have designed a novel arc puncture-guided device consisting of a 90° arc block and a 30° arc block. Punctures were performed on 8 fresh goat lumbar spine specimens. A senior doctor performed indirect punctures on the left side of the L2-L3, L3-L4, and L4-L5 levels using the novel device (group A) and on the right side of the L2-L3, L3-L4, and L4-L5 levels using the conventional method (group B). We recorded the fluoroscopy, puncture, and operation times.

RESULTS

In group A, the first puncture could successfully reach the target after 1-3 punctures, and the one-time success rate of the second needle puncture was 91.67%. The total fluoroscopy time was 14.88 ± 0.99 minutes in group A and 16.08 ± 2.22 minutes in group B (P = 0.027). The puncture times were 3.00 ± 0.66 minutes in group A and 6.04 ± 2.13 minutes in group B (P < 0.01). The operation time was 273.75 ± 30.19 minutes in group A and 361.25 ± 69.57 minutes in group B (P < 0.01). The differences in fluoroscopy times, puncture times, and operation times between the 2 groups were statistically significantly (P < 0.05).

CONCLUSIONS

Indirect puncture using the novel arc puncture-guided device for percutaneous transforaminal puncture can significantly improve puncture accuracy and reduce the fluoroscopy, puncture, and operation times. Indirect puncture using the novel device in percutaneous transforaminal endoscopic discectomy is a potential and practical puncture method.

Anatomical and Imaging Study on the Optimum Entry Point and Trajectory for Anterior Transpedicular Root Screw Placement into the Lower Cervical Spine

Objective

To study the optimum entry point and trajectory for anterior transpedicular root screw (ATPRS) placement into the lower cervical spine (LCS), so as to provide a basis for clinical application.

Methods

A retrospective analysis of cervical CT images of patients who underwent cervical CT examination in the Spinal Surgery of Ningbo No. 6 Hospital from January 2020 to August 2021 was conducted. The data were obtained and modeled. On the coronal plane, the vertebral body (VB) between the anterior midline of cervical vertebral segments C_3-7 and the left P line (by drawing the line parallel to the anterior midline of the VB at the intersection of the anterior edge of the Luschka's joint and the upper endplate) was equally divided into 9 zones (a-i). The ideal entry point and path of cervical ATPRS were designed and recorded. Additionally, 7 cadaveric specimens were selected, and the screw placement parameters were regenerated according to the above methods for screw placement.

Results

Zone i of each segment, with the longest screw length, was the best area for screw placement. In all patients, the horizontal angles of vertebrae C_3-7 in zones a, d, and g, zones b, e, and h, and zones c, f, and i showed a gradually decreasing trend. The sagittal angle range of C_3-7 in all patients showed a gradually increasing trend in zones a-c, d-f, and g-i. The distance from the anterior midline of C_3-7 to the P line increased in all patients, and the distance was longer in males than in females, with statistical significance. Pedicle screws were successfully inserted in all the 7 cadaveric specimens.

Conclusions

ATPRS placement can be used for LCS internal fixation, and the precise screw placement parameters can be simulated by the software, which provides theoretical basis for its future clinical application.