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Chandirasegaran S, Chan CYW, Chiu CK, Chung WH, Hasan MS, Kwan MK. Analysis of duration of different stages of surgery in posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) patients: comparison between severe versus non-severe AIS. Eur Spine J 2024; 33:1683-1690. [PMID: 38294535 DOI: 10.1007/s00586-023-08124-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/05/2023] [Accepted: 12/26/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE Prolonged surgical duration in severe adolescent idiopathic scoliosis (AIS) patients is associated with increased blood loss and perioperative complications. The aim of this study was to compare the duration of each stage of posterior spinal fusion (PSF) in severe AIS (Cobb angle ≥ 90°) with non-severe AIS patients. This analysis will identify the most time-consuming stage of PSF and help surgeons formulate strategies to shorten operative time. METHODS Retrospective study whereby 90 AIS patients (Lenke type 2, 3, 4, and 6) who underwent PSF from 2019 to 2023 were recruited. Twenty-five severe AIS patients were categorized in Gp1 and 65 non-severe AIS patients in Gp2. Propensity score matching (PSM) with one-to-one with nearest neighbor matching (match tolerance 0.05) was performed. Outcomes measured via operation duration of each stage of surgery, blood loss, number of screws, fusion levels and screw density. RESULTS Twenty-five patients from each group were matched. Total operative time was significantly higher in Gp1 (168.2 ± 30.8 vs. 133.3 ± 24.0 min, p < 0.001). The lengthiest stage was screw insertion which took 58.5 ± 13.4 min in Gp1 and 44.7 ± 13.7 min in Gp2 (p = 0.001). Screw insertion contributed 39.5% of the overall increased surgical duration in Gp1. Intraoperative blood loss (1022.2 ± 412.5 vs. 714.2 ± 206.7 mL, p = 0.002), number of screws (17.1 ± 1.5 vs. 15.5 ± 1.1, p < 0.001) and fusion level (13.1 ± 0.9 vs. 12.5 ± 1.0, p = 0.026) were significantly higher in Gp1. CONCLUSION Screw insertion was the most time-consuming stage of PSF and was significantly longer in severe AIS. Adjunct technologies such as CT-guided navigation and robotic-assisted navigation should be considered to reduce screw insertion time in severe AIS.
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Affiliation(s)
- Saturveithan Chandirasegaran
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- Department of Anesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, Faculty of Medicine, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
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Wu X, Shi X, Hu W, Ma H, Gao YZ, Wang H, Jiang Z. Clinical Application and Curative Effect Analysis of Postural Awareness Surgical Tool Assisted Nail Placement in Adolescent Idiopathic Scoliosis. Orthop Surg 2024. [PMID: 38509016 DOI: 10.1111/os.14038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/18/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVE The pedicle screw technique has been widely used in adolescent idiopathic scoliosis orthopedic surgery, but misplacement of screws may damage important structures such as blood vessels and nerves around the pedicle, resulting in serious consequences. Therefore, our research team has independently developed a surgical tool to assist in the placement of pedicle screws. This study aims to investigate the safety and accuracy of postural awareness tool assisted nail placement in orthopedic surgery for adolescent idiopathic scoliosis. METHOD A retrospective analysis was performed on 24 adolescent patients with idiopathic scoliosis admitted to our hospital from July 2019 to July 2022, including 10 males and 14 females, with an average age of 14.88 ± 2.36 years (10-19 years). The mean follow-up was 15.67 ± 2.20 months (12-20 months). We divided the patients into postural awareness group (n = 12) and C-arm group (n = 12) according to whether the postural awareness surgical tool was used during the operation. All patients were treated with posterior spinal orthopedic surgery. The postural awareness group was assisted by pedicle screw placement with a postural awareness surgical tool, while the C-arm group was given a pedicle screw placement with freehand technique. The operative time, intraoperative blood loss, intraoperative fluoroscopy times, nail placement related complications, nail placement accuracy, and scoliosis correction rate were recorded and compared between the two groups. RESULTS The operative time, intraoperative blood loss and fluoroscopy times in the postural awareness group were significantly lower than those in the C-arm group, with statistical significance (p < 0.05). The postural awareness group implanted 163 screws with an accuracy rate of 91.41%, while the C-arm group implanted 159 screws with an accuracy rate of 83.02%. The accuracy rate of screw placement in the postural awareness group was higher than that in the C-arm group, with a statistically significant difference (p = 0.024). According to the imaging of the patients, there was no significant difference between the Cobb Angle of the main bend measured at three time points before surgery, 1 week after surgery and the last follow-up between the two groups. Similarly, there was no significant difference in the rate of lateral curvature correction between the two groups. CONCLUSION The application of postural awareness surgical tool in posterior orthopedic surgery for adolescent idiopathic scoliosis can improve screw placement accuracy, shorten screw placement time, and make auxiliary screw placement safer and more accurate.
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Affiliation(s)
- XiaoNan Wu
- Department of Spinal Cord Surgery, People's Hospital of Henan University, Zhengzhou, China
| | - Xinge Shi
- Department of Spinal Cord Surgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - Weiran Hu
- Department of Spinal Cord Surgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - Haohao Ma
- Department of Spinal Cord Surgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yan-Zheng Gao
- Department of Spinal Cord Surgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - Haoxu Wang
- Department of Spinal Cord Surgery, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Zhengfa Jiang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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张 学, 顾 祖, 张 宇, 李 果. [Comparison of Clinical Effects of Cortical Bone Trajectory Screws and Traditional Pedicle Screws in Posterior Lumbar Fusion]. Sichuan Da Xue Xue Bao Yi Xue Ban 2024; 55:303-308. [PMID: 38645868 PMCID: PMC11026896 DOI: 10.12182/20240360205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Indexed: 04/23/2024]
Abstract
Objective To compare the clinical effects of cortical bone trajectory screws and traditional pedicle screws in posterior lumbar fusion. Methods A retrospective study was conducted to analyze lumbar degeneration patients who underwent surgical treatment at our hospital between January 2016 and January 2019. A total of 123 patients who met the inclusion criteria were enrolled. The subjects were divided into two groups according to their surgical procedures and the members of the two groups were matched by age, sex, and the number of fusion segments. There were 63 patients in the traditional pedicle screws (PS) group and 60 in the cortical bone trajectory screws (CBTS) group. The outcomes of the two groups were compared. The primary outcome measures were perioperative conditions, including operation duration, estimated intraoperative blood loss (EBL), and length-of-stay (LOS), visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, and interbody fusion rate. The secondary outcome measures were the time to postoperative ambulation and the incidence of complications. VAS scores and ODI scores were assessed before operation, 1 week, 1 month, 3 months, and 12 months after operation, and at the final follow-up. The interbody fusion rate was assessed in 1 year and 2 years after the operation and at the final follow-up. Results The CBTS group showed a reduction in operation duration ([142.8±13.1] min vs. [174.7±15.4] min, P<0.001), LOS ([9.5±1.5] d vs. [12.0±2.0] d, P<0.001), and EBL ([194.2±38.3] mL vs. [377.5±33.1] mL, P<0.001) in comparison with the PS group. The VAS score for back pain in the CBTS group was lower than that in the PS group at 1 week and 1 month after operation and the ODI score in the CBTS group was lower than that in the PS group at 1 month after operation, with the differences being statistically significant (P<0.05). At each postoperative time point, the VAS score for leg pain and the interbody fusion rate did not show significant difference between the two groups. The VAS score for back and leg pain and the ODI score at each time point after operation in both the CBTS group and the PS group were significantly lower than those before operation (P<0.05). No significant difference was found in the time to postoperative ambulation or the overall complication incidence between the two groups. Conclusion The CBTS technique could significantly shorten the operation duration and LOS, reduce EBL, and achieve the same effect as the PS technique does in terms of intervertebral fusion rate, pain relief, functional improvement, and complication incidence in patients undergoing posterior lumbar fusion.
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Affiliation(s)
- 学磊 张
- 成都市中西医结合医院/成都市第一人民医院 骨科 (成都 610016)Department of Orthopedics, Chengdu Integrated Traditional Chinese Medicine & Western Medicine Hospital/Chengdu First People's Hospital, Chengdu 610016, China
| | - 祖超 顾
- 成都市中西医结合医院/成都市第一人民医院 骨科 (成都 610016)Department of Orthopedics, Chengdu Integrated Traditional Chinese Medicine & Western Medicine Hospital/Chengdu First People's Hospital, Chengdu 610016, China
| | - 宇 张
- 成都市中西医结合医院/成都市第一人民医院 骨科 (成都 610016)Department of Orthopedics, Chengdu Integrated Traditional Chinese Medicine & Western Medicine Hospital/Chengdu First People's Hospital, Chengdu 610016, China
| | - 果 李
- 成都市中西医结合医院/成都市第一人民医院 骨科 (成都 610016)Department of Orthopedics, Chengdu Integrated Traditional Chinese Medicine & Western Medicine Hospital/Chengdu First People's Hospital, Chengdu 610016, China
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Hsieh MK, Lee DM, Chen WP, Li YD, Kao FC, Lin YC, Tsai TT, Lai PL, Tai CL. Forcefully engaging rods into tulips with gap discrepancy leading to pedicle screw loosening-a biomechanical analysis using long porcine spine segments. Spine J 2024:S1529-9430(24)00118-9. [PMID: 38499068 DOI: 10.1016/j.spinee.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/05/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND CONTEXT Long-segment pedicle screw instrumentation is widely used to treat complex spinal disorders. Rods are routinely precontoured to maximize assistance on the correcting side of the deformity, but there often exists a residual gap discrepancy between the precontoured rods and screw tulips. No previous research has investigated the diminished pullout strength of the most proximal or distal pedicle screw resulting from a mismatched rod in long-segment pedicle screw instrumentation. PURPOSE The present study aimed to investigate the decreased pullout force of pedicle screws affected by the gap discrepancy when forcefully engaging a mismatched rod into a tulip in a normal-density porcine spine. STUDY DESIGN The pedicle screw fixation strength under axial pullout force was compared among three different gap discrepancies between rods and tulips using long porcine spine segments. METHODS Twelve porcine lumbar vertebrae (L3-L6) were implanted with pedicle screws and rods. Screws on one side had no gap between the tulip and rod (0-mm group), while the most proximal screw on the other side had an intentional gap of 3 mm (3-mm group) or 6 mm (6-mm group). Three hours after forcefully engaging the rod into the tulips at room temperature, the set screws in all specimens were loosened, and each specimen was dissected into individual vertebrae for subsequent pullout testing. RESULTS The control group exhibited significantly greater pullout strength (1987.68 ± 126.80 N) than the groups from different rod-tulip configurations (p<.05), with significantly greater strength in the 3-mm group (945.62 ± 97.43 N) than the 6-mm group (655.30 ± 194.49 N) (p<.05). Only 47.6% and 33.0% of the pullout strength was retained in the 3-mm and 6-mm groups, respectively, compared to the control group. CONCLUSIONS Gap discrepancies between rods and tulips can significantly reduce pedicle screw pullout strength, with a correlation between decreased strength and increased gaps. Surgeons should avoid forcefully engaging mismatched rods and consider well-fitted contoured rods in spinal surgery to minimize the risk of screw loosening. CLINICAL SIGNIFICANCE The gap discrepancy between rod and tulip significantly affected pullout strength, with greater gaps leading to reduced strength. Forcefully engaging mismatched rods into tulips in degenerative spinal surgery should be avoided to minimize the risk of early screw pullout.
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Affiliation(s)
- Ming-Kai Hsieh
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 5, Fushing St., Kweishan Dist., Taoyuan City 33305, Taiwan
| | - De-Mei Lee
- Department of Mechanical Engineering, Chang Gung University, No. 259, Wenhua 1(st) Rd., Kweishan Dist., Taoyuan City 33302, Taiwan
| | - Weng-Pin Chen
- Department of Mechanical Engineering, National Taipei University of Technology, No. 1, Sec. 3, Zhongxiao E. Rd., Daan Dist., Taipei City 10608, Taiwan
| | - Yun-Da Li
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 5, Fushing St., Kweishan Dist., Taoyuan City 33305, Taiwan; Department of Biomedical Engineering, Chang Gung University, No. 259, Wenhua 1(st) Rd., Kweishan Dist., Taoyuan City 33302, Taiwan
| | - Fu-Cheng Kao
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 5, Fushing St., Kweishan Dist., Taoyuan City 33305, Taiwan
| | - Yue-Chen Lin
- Department of Mechanical Engineering, Chang Gung University, No. 259, Wenhua 1(st) Rd., Kweishan Dist., Taoyuan City 33302, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 5, Fushing St., Kweishan Dist., Taoyuan City 33305, Taiwan
| | - Po-Liang Lai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 5, Fushing St., Kweishan Dist., Taoyuan City 33305, Taiwan
| | - Ching-Lung Tai
- Department of Orthopaedic Surgery, Spine Section, Bone and Joint Research Center, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 5, Fushing St., Kweishan Dist., Taoyuan City 33305, Taiwan; Department of Biomedical Engineering, Chang Gung University, No. 259, Wenhua 1(st) Rd., Kweishan Dist., Taoyuan City 33302, Taiwan.
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Abel F, Lebl DR, Gorgy G, Dalton D, Chazen JL, Lim E, Li Q, Sneag DB, Tan ET. Deep-learning reconstructed lumbar spine 3D MRI for surgical planning: pedicle screw placement and geometric measurements compared to CT. Eur Spine J 2024:10.1007/s00586-023-08123-3. [PMID: 38472429 DOI: 10.1007/s00586-023-08123-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/06/2023] [Accepted: 12/26/2023] [Indexed: 03/14/2024]
Abstract
PURPOSE To test equivalency of deep-learning 3D lumbar spine MRI with "CT-like" contrast to CT for virtual pedicle screw planning and geometric measurements in robotic-navigated spinal surgery. METHODS Between December 2021 and June 2022, 16 patients referred for spinal fusion and decompression surgery with pre-operative CT and 3D MRI were retrospectively assessed. Pedicle screws were virtually placed on lumbar (L1-L5) and sacral (S1) vertebrae by three spine surgeons, and metrics (lateral deviation, axial/sagittal angles) were collected. Vertebral body length/width (VL/VW) and pedicle height/width (PH/PW) were measured at L1-L5 by three radiologists. Analysis included equivalency testing using the 95% confidence interval (CI), a margin of ± 1 mm (± 2.08° for angles), and intra-class correlation coefficients (ICCs). RESULTS Across all vertebral levels, both combined and separately, equivalency between CT and MRI was proven for all pedicle screw metrics and geometric measurements, except for VL at L1 (mean difference: - 0.64 mm; [95%CI - 1.05, - 0.24]), L2 (- 0.65 mm; [95%CI - 1.11, - 0.20]), and L4 (- 0.78 mm; [95%CI - 1.11, - 0.46]). Inter- and intra-rater ICC for screw metrics across all vertebral levels combined ranged from 0.68 to 0.91 and 0.89-0.98 for CT, and from 0.62 to 0.92 and 0.81-0.97 for MRI, respectively. Inter- and intra-rater ICC for geometric measurements ranged from 0.60 to 0.95 and 0.84-0.97 for CT, and 0.61-0.95 and 0.93-0.98 for MRI, respectively. CONCLUSION Deep-learning 3D MRI facilitates equivalent virtual pedicle screw placements and geometric assessments for most lumbar vertebrae, with the exception of vertebral body length at L1, L2, and L4, compared to CT for pre-operative planning in patients considered for robotic-navigated spine surgery.
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Affiliation(s)
- Frederik Abel
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
| | - Darren R Lebl
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - George Gorgy
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - David Dalton
- Department of Spine Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - J Levi Chazen
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Elisha Lim
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Qian Li
- Biostatistics Core, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Darryl B Sneag
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
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Youssef S, McDonnell JM, Wilson KV, Turley L, Cunniffe G, Morris S, Darwish S, Butler JS. Accuracy of augmented reality-assisted pedicle screw placement: a systematic review. Eur Spine J 2024; 33:974-984. [PMID: 38177834 DOI: 10.1007/s00586-023-08094-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Conventional freehand methods of pedicle screw placement are associated with significant complications due to close proximity to neural and vascular structures. Recent advances in augmented reality surgical navigation (ARSN) have led to its adoption into spine surgery. However, little is known regarding its overall accuracy. The purpose of this study is to delineate the overall accuracy of ARSN pedicle screw placement across various models. METHODS A systematic review was conducted of Medline/PubMed, Cochrane and Embase Library databases according to the PRISMA guidelines. Relevant data extracted included reports of pedicle screw placement accuracy and breaches, as defined by the Gertzbein-Robbins classification, in addition to deviation from pre-planned trajectory and entry point. Accuracy was defined as the summation of grade 0 and grade 1 events per the Gertzbein-Robbins classification. RESULTS Twenty studies reported clinically accurate placed screws. The range of clinically accurate placed screws was 26.3-100%, with 2095 screws (93.1%) being deemed clinically accurate. Furthermore, 5.4% (112/2088) of screws were reported as grade two breaches, 1.6% (33/2088) grade 3 breaches, 3.1% (29/926) medial breaches and 2.3% (21/926) lateral breaches. Mean linear deviation ranged from 1.3 to 5.99 mm, while mean angular/trajectory deviation ranged 1.6°-5.88°. CONCLUSION The results of this study highlight the overall accuracy of ARSN pedicle screw placement. However, further robust prospective studies are needed to accurately compare to conventional methods of pedicle screw placement.
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Affiliation(s)
- Salma Youssef
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Jake M McDonnell
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
- Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Kielan V Wilson
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland.
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Luke Turley
- Department of Orthopaedics, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Gráinne Cunniffe
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Seamus Morris
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Stacey Darwish
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
- Department of Orthopaedics, St. Vincent's University Hospital, Dublin, Ireland
| | - Joseph S Butler
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin, Ireland
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Vadalà G, Papalia GF, Russo F, Brigato P, Ambrosio L, Papalia R, Denaro V. Intraoperative Cone-Beam Computed Tomography Navigation Versus 2-Dimensional Fluoroscopy in Single-Level Lumbar Spinal Fusion: A Comparative Analysis. Neurospine 2024; 21:76-82. [PMID: 38569632 PMCID: PMC10992660 DOI: 10.14245/ns.2347106.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Several studies have advocated for the higher accuracy of transpedicular screw placement under cone-beam computed tomography (CBCT) compared to conventional 2-dimensional (2D) fluoroscopy. The superiority of navigation systems in perioperative and postoperative outcomes remains a topic of debate. This study aimed to compare operative time, screw placement time and accuracy, total radiation dose, perioperative and postoperative outcomes in patients who underwent transpedicular screw fixation for degenerative lumbar spondylolisthesis (DLS) using intraoperative CBCT navigation versus 2D fluoroscopy. METHODS A retrospective analysis was conducted on patients affected by single-level DLS who underwent posterior lumbar instrumentation with transpedicular screw fixation using surgical CBCT navigation (NV group) or 2D fluoroscopy-assisted freehand technique (FH group). Demographics, screw placement time and accuracy, operative time, total radiation dose, intraoperative blood loss, screw revision rate, complications, and length of stay (LOS) were assessed. RESULTS The study included a total of 30 patients (NV group: n = 15; FH group: n = 15). The mean screw placement time, operative time, and LOS were significantly reduced in the NV group compared to the FH group (p < 0.05). The total radiation dose was significantly higher in the NV group (p < 0.0001). No significant difference was found in terms of blood loss and postoperative complications. CONCLUSION This study suggests that intraoperative CBCT-navigated single-level lumbar transpedicular screw fixation is superior in terms of mean screw placement time, operative time, and LOS compared to 2D fluoroscopy, despite a higher intraoperative radiation exposure.
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Affiliation(s)
- Gianluca Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Giuseppe Francesco Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Fabrizio Russo
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Paolo Brigato
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Luca Ambrosio
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Rocco Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, Italy
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Li Q, Zhao H, Yang J, Song S, Liu X. Optimization of Pedicle Screw Parameters for Enhancing Implant Stability Based on Finite Element Analysis. World Neurosurg 2024; 183:e345-e354. [PMID: 38151174 DOI: 10.1016/j.wneu.2023.12.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE To improve implant stability parameters, including pedicle screw (PS) outer diameter, thread depth, and pitch, by finite element analysis. METHODS Insertion and pullout of the PS were simulated by finite element analysis, and the precision of simulation was evaluated by comparison with mechanical tests. Influences of the parameters on the maximum insertion torque and maximum pullout force were analyzed by computational simulations, including single-factor analysis and orthogonal experiments. RESULTS The simulation results agreed with the mechanical test results. The order of parameters influencing insertion torque and pullout force was outer diameter > pitch > thread depth. When the pilot hole diameter is 0.1 mm larger than the inner diameter of the PS, the calculated Pearson correlation coefficient between the maximum insertion torque and maximum pullout force was r = 0.99. The optimized PS had a maximum insertion torque of 485.16 N·mm and a maximum pullout force of 1726.33 N, 23.9% and 9.1% higher, respectively, than the values of standard screws. CONCLUSIONS The presently used models are feasible for evaluating the implant stability of PSs. The maximum insertion torque and maximum pullout force of PSs are highly correlated and can be improved by increasing the outer diameter and decreasing pitch. Although with the parameters of the PS, pedicle size and bone mineral density are 2 additional factors to consider for better implant stability.
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Affiliation(s)
- Qiang Li
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China; Shanghai Engineering Research Center of High-Performance Medical Device Materials, Shanghai, People's Republic of China.
| | - Hu Zhao
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Jinshuai Yang
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Shihong Song
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Xuyan Liu
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
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Jiang J, Song CY, Wu ZZ, Xie ZZ, Shi B, Xu T, Wang H, Qiu Y, Wang B, Zhu ZZ, Yu Y. Free-hand technique of C7 pedicle screw insertion using a simply defined entry point without fluoroscopic guidance for cervical spondylotic myelopathy patients with C3 to C6 instrumented by lateral mass screws: a retrospective cohort study. BMC Surg 2024; 24:74. [PMID: 38424546 PMCID: PMC10903032 DOI: 10.1186/s12893-024-02358-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Nowadays, both lateral mass screw (LMS) and pedicle screw were effective instrumentation for posterior stabilization of cervical spine. This study aims to evaluate the feasibility of a new free-hand technique of C7 pedicle screw insertion without fluoroscopic guidance for cervical spondylotic myelopathy (CSM) patients with C3 to C6 instrumented by lateral mass screws. METHODS A total of 53 CSM patients underwent lateral mass screws instrumentation at C3 to C6 levels and pedicle screw instrumentation at C7 level were included. The preoperative 3-dimenional computed tomography (CT) reconstruction images of cervical spine were used to determine 2 different C7 pedicle screw trajectories. Trajectory A passed through the axis of the C7 pedicle while trajectory B selected the midpoint of the base of C7 superior facet as the entry point. All these 53 patients had the C7 pedicle screw inserted through trajectory B by free-hand without fluoroscopic guidance and the postoperative CT images were obtained to evaluate the accuracy of C7 pedicle screw insertion. RESULTS Trajectory B had smaller transverse angle, smaller screw length, and smaller screw width but both similar sagittal angle and similar pedicle height when compared with trajectory A. A total of 106 pedicle screws were inserted at C7 through trajectory B and only 8 screws were displaced with the accuracy of screw placement as high as 92.5%. CONCLUSION In CSM patients with C3 to C6 instrumented by LMS, using trajectory B for C7 pedicle screw insertion is easy to both identify the entry point and facilitate the rod insertion.
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Affiliation(s)
- Jun Jiang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Chen-Yu Song
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zheng-Zheng Wu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zuo-Zhi Xie
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Bo Shi
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Tao Xu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Han Wang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Bin Wang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ze-Zhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yang Yu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
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10
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Gorgy G, Avrumova F, Paschal PK, Paschal GK, Carrino JA, Lebl DR. Assessing intraoperative pedicle screw placement accuracy using biplanar radiographs compared to three-dimensional imaging. J Robot Surg 2024; 18:68. [PMID: 38329623 DOI: 10.1007/s11701-023-01760-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/10/2023] [Indexed: 02/09/2024]
Abstract
To date, biplanar imaging (2D) has been the method of choice for pedicle screw (PS) positioning and verified for the anteroposterior view and (spinal midline) M-line method. In recent years, the use of intraoperative three-dimensional (3D) imaging has become available with the Gertzbein-Robbins system (GRS) to assess PS breach and positioning confirmation. The aim is to determine if 2D imaging is sufficient to assess PS position in comparison to advanced 3D imaging.Retrospective review of prospectively collected data from 204 consecutive adult patients who underwent posterior thoracic and lumbar instrumented fusion for degenerative spinal surgery by a single surgeon (2019-2022).Of the 204 patients, 187 (91.6%) had intraoperative images available for analysis. A total of 1044 PS implants were used; 922 (88.3%) were robotically placed. Postoperative CT scans were verified with M-line/GRS findings. Among 103 patients (50.5%) with a total of 362 screws, (34.7%) had postoperative CT, intraoperative 3D scan, and intraoperative 2D scan for analysis. Postoperative CT findings were consistent with all GRS findings, validating that 3D imaging was accurate. Screws (1%) were falsely verified by the M-line as 3D imaging confirmed false negative or positive findings.In our series, intraoperative 3D scan was as accurate as postoperative CT scan in assessing PS breach. A significant number of PS may be falsely read as accurate on 2D imaging, that is in fact inaccurate when assessed on 3D imaging. An intraoperative post-instrumentation 3D scan may be preferable to prevent postoperative recognition of a falsely verified screw on biplanar imaging.
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Affiliation(s)
- George Gorgy
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Fedan Avrumova
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Philip K Paschal
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Gregory K Paschal
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - John A Carrino
- Department of Radiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Darren R Lebl
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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11
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Liljenqvist U, Bullmann V. [Posterior instrumented correction and fusion of adolescent idiopathic scoliosis]. Oper Orthop Traumatol 2024; 36:21-32. [PMID: 37535085 DOI: 10.1007/s00064-023-00825-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 02/02/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE Balanced frontal curve correction with horizontal shoulder levels, restoration of sagittal plane and vertebral derotation with a fusion length as short as possible. INDICATIONS Curves larger than 40-50° Cobb angle; furthermore age, location, degree of rotation, and sagittal plane deviation have to be considered. SURGICAL TECHNIQUE Posteriorly, segmental pedicle screw instrumentation with a high screw density (80%) and both titanium alloy and cobalt chrome rods. Freehand screw placement under consideration of both natural and deformity-induced pedicle morphology. Correction via reduction screws or instruments. Combined correction technique with rod rotation, segmental screw approximation to the generally concave rod and segmental correction of vertebral translation. Moderate concave distraction and convex compression. If needed, final in situ bending of the rods. Schwab type I osteotomies; in rigid curves type II osteotomies. Fusion with local bone, allogenic bone and/or bone substitutes (i.e., tricalcium phosphate). Intraoperative placement of a thoracic epidural catheter for postoperative pain control. Neurological monitoring throughout the procedure. POSTOPERATIVE MANAGEMENT Mobilization on postoperative day 1 with focus on pain management and nutrition. Return to school after 4 weeks. Physiotherapy after 3 months, cycling after 3-6 months, and full sport activities after 1 year. RESULTS Frontal curve correction of 60-80%, sufficient sagittal plane correction. Correction of rib hump 40%. Patient satisfaction is high at 95% and long-term revision rates of < 10%.
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Affiliation(s)
- Ulf Liljenqvist
- Klinik für Wirbelsäulenchirurgie mit Skoliosezentrum, St. Franziskushospital Münster, Hohenzollernring 70, 48145, Münster, Deutschland.
| | - Viola Bullmann
- Klinik für Wirbelsäulenchirurgie, St. Franziskus-Hospital, Köln, Deutschland
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12
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Noto Y, Endo Y, Ohashi M, Hirano T, Kuramoto T, Chida K, Watanabe K. Usefulness of the spectral shaping dual-source computed tomography imaging technique in posterior corrective fusion for adolescent idiopathic scoliosis. Eur Spine J 2024; 33:706-712. [PMID: 38233628 DOI: 10.1007/s00586-023-08006-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/31/2023] [Accepted: 10/14/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE Since childhood exposure to radiation has been demonstrated to increase cancer risk with increase in radiation dose, reduced radiation exposure during computed tomography (CT) evaluation is desired for adolescent idiopathic scoliosis (AIS). Therefore, this retrospective study aimed to investigate the radiation dose of dual-source CT using a spectral shaping technique and the accuracy of the thoracic pedicle screw (TPS) placement for posterior spinal fusion (PSF) in patients with AIS. METHODS Fifty-nine female patients with thoracic AIS who underwent PSF using CT-guided TPSs were included and divided into two groups comprised of 23 patients who underwent dual-source CT (DSCT) with a tin filter (DSCT group) and 36 who underwent conventional multislice CT (MSCT group). We assessed the CT radiation dose using the CT dose index (CTDIvol), effective dose (ED), and accuracy of TPS insertion according to the established Neo's classification. RESULTS The DSCT and MSCT groups differed significantly (p < 0.001) in the mean CTDIvol (0.76 vs. 3.31 mGy, respectively) and ED (0.77 vs. 3.47 mSv, respectively). Although the correction rate of the main thoracic curve in the DSCT group was lower (65.7% vs. 71.2%) (p = 0.0126), the TPS accuracy (Grades 0-1) was similar in both groups (381 screws [88.8%] vs. 600 screws [88.4%], respectively) (p = 0.8133). No patient required replacement of malpositioned screws. CONCLUSION Spectral shaping DSCT with a tube-based tin filter allowed a 75% radiation dose reduction while achieving TPS insertion accuracy similar to procedures based on conventional CT without spectral shaping.
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Affiliation(s)
- Yoshiyuki Noto
- Division of Radiological Technology, Department of Technical Support, Niigata University Medical and Dental Hospital, Niigata, Japan
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yuki Endo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Masayuki Ohashi
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-Ku, Niigata, 951-8510, Japan
| | - Toru Hirano
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minami-Uonuma City, Niigata, Japan
| | - Tatsuya Kuramoto
- Division of Radiological Technology, Department of Technical Support, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Koichi Chida
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kei Watanabe
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-Ku, Niigata, 951-8510, Japan.
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13
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Ghenbot Y, Ahmad HS, Chauhan D, Wathen C, Arena J, Turlip R, Parr R, Gibby W, Yoon JW. Effects of Augmented Reality on Thoracolumbar Pedicle Screw Instrumentation Across Different Levels of Surgical Experience. World Neurosurg 2024; 182:e284-e291. [PMID: 38008167 DOI: 10.1016/j.wneu.2023.11.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE Augmented reality (AR) is an emerging technology that may accelerate skill acquisition and improve accuracy of thoracolumbar pedicle screw placements. We aimed to quantify the relative assistance of AR compared with freehand (FH) pedicle screw accuracy across different surgical experience levels. METHODS A spine fellowship-trained and board-certified attending neurosurgeon, postgraduate year 4 neurosurgery resident, and second-year medical student placed 32 FH and 32 AR-assisted thoracolumbar pedicle screws in 3 cadavers. A cableless, voice-activated AR system was paired with a headset. Accuracy was assessed using χ2 analysis and the Gertzbein-Robbins scale. Angular error, distance error, and time per pedicle screw were collected and compared. RESULTS The attending neurosurgeon had 91.6% (11/12) clinically acceptable (Gertzbein-Robbins scale A or B) insertion in both FH and AR groups; the resident neurosurgeon had 100% (9/9) FH and AR in both cases; the medical student had 72.3% (8/11) FH accuracy and 81.8% (9/11) AR accuracy. The medical student displayed significantly lower ideal (Gertzbein-Robbins scale A) FH accuracy compared with the resident neurosurgeon (P = 0.017) and attending neurosurgeon (P = 0.005), but no difference when using AR. FH screw placement was faster by both the attending neurosurgeon (median 46 seconds vs. 94.5 seconds, P = 0.0047) and the neurosurgery resident neurosurgeon (median 144 seconds vs. 140 seconds, P = 0.05). Total clinically acceptable AR and FH accuracy was 90.6% (29/32) and 87.5% (28/32), respectively (P = 0.69). CONCLUSIONS AR screw placement allowed an inexperienced medical student to double their accuracy in 1 training session. With subsequent iterations, this promising technology could serve as an important tool for surgical training.
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Affiliation(s)
- Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Arena
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Turlip
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Parr
- Novarad Corporation, Provo, Utah, USA
| | - Wendell Gibby
- Novarad Corporation, Provo, Utah, USA; Department of Radiology, University of California San Diego School of Medicine, San Diego, California, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Liebmann F, von Atzigen M, Stütz D, Wolf J, Zingg L, Suter D, Cavalcanti NA, Leoty L, Esfandiari H, Snedeker JG, Oswald MR, Pollefeys M, Farshad M, Fürnstahl P. Automatic registration with continuous pose updates for marker-less surgical navigation in spine surgery. Med Image Anal 2024; 91:103027. [PMID: 37992494 DOI: 10.1016/j.media.2023.103027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 10/29/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
Established surgical navigation systems for pedicle screw placement have been proven to be accurate, but still reveal limitations in registration or surgical guidance. Registration of preoperative data to the intraoperative anatomy remains a time-consuming, error-prone task that includes exposure to harmful radiation. Surgical guidance through conventional displays has well-known drawbacks, as information cannot be presented in-situ and from the surgeon's perspective. Consequently, radiation-free and more automatic registration methods with subsequent surgeon-centric navigation feedback are desirable. In this work, we present a marker-less approach that automatically solves the registration problem for lumbar spinal fusion surgery in a radiation-free manner. A deep neural network was trained to segment the lumbar spine and simultaneously predict its orientation, yielding an initial pose for preoperative models, which then is refined for each vertebra individually and updated in real-time with GPU acceleration while handling surgeon occlusions. An intuitive surgical guidance is provided thanks to the integration into an augmented reality based navigation system. The registration method was verified on a public dataset with a median of 100% successful registrations, a median target registration error of 2.7 mm, a median screw trajectory error of 1.6°and a median screw entry point error of 2.3 mm. Additionally, the whole pipeline was validated in an ex-vivo surgery, yielding a 100% screw accuracy and a median target registration error of 1.0 mm. Our results meet clinical demands and emphasize the potential of RGB-D data for fully automatic registration approaches in combination with augmented reality guidance.
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Affiliation(s)
- Florentin Liebmann
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Laboratory for Orthopaedic Biomechanics, ETH Zurich, Zurich, Switzerland.
| | - Marco von Atzigen
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Laboratory for Orthopaedic Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Dominik Stütz
- Computer Vision and Geometry Group, ETH Zurich, Zurich, Switzerland
| | - Julian Wolf
- Product Development Group, ETH Zurich, Zurich, Switzerland
| | - Lukas Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Daniel Suter
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Nicola A Cavalcanti
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Laura Leoty
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Hooman Esfandiari
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jess G Snedeker
- Laboratory for Orthopaedic Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Martin R Oswald
- Computer Vision and Geometry Group, ETH Zurich, Zurich, Switzerland; Computer Vision Lab, University of Amsterdam, Amsterdam, Netherlands
| | - Marc Pollefeys
- Computer Vision and Geometry Group, ETH Zurich, Zurich, Switzerland; Microsoft Mixed Reality and AI Zurich Lab, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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15
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Schwendner M, Ille S, Wostrack M, Meyer B. Evaluating a cutting-edge augmented reality-supported navigation system for spinal instrumentation. Eur Spine J 2024; 33:282-288. [PMID: 37962688 DOI: 10.1007/s00586-023-08011-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/27/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE Dorsal instrumentation using pedicle screws is a standard treatment for multiple spinal pathologies, such as trauma, infection, or degenerative indications. Intraoperative three-dimensional (3D) imaging and navigated pedicle screw placement are used at multiple centers. For the present study, we evaluated a new navigation system enabling augmented reality (AR)-supported pedicle screw placement while integrating navigation cameras into the reference array and drill guide. The present study aimed to evaluate its clinical application regarding safety, efficacy, and accuracy. METHODS A total of 20 patients were operated on between 06/2021 and 01/2022 using the new technique for intraoperative navigation. Intraoperative data with a focus on accuracy and patient safety, including patient outcome, were analyzed. The accuracy of pedicle screw placement was evaluated by intraoperative CT imaging. RESULTS A median of 8 (4-18) pedicle screws were placed in each case. Percutaneous instrumentation was performed in 14 patients (70%). The duration of pedicle screw placement (duration scan-scan) was 56 ± 26 (30-107) min. Intraoperative screw revision was necessary for 3 of 180 pedicle screws (1.7%). Intraoperatively, no major complications occurred-one case of delay due to software issues and one case of difficult screw placement were reported. CONCLUSION The current study's results could confirm the use of the present AR-supported system for navigated pedicle screw placement for dorsal instrumentation in clinical routine. It provides a reliable and safe tool for 3D imaging-based pedicle screw placement, only requires a minimal intraoperative setup, and provides new opportunities by integrating AR.
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Affiliation(s)
- Maximilian Schwendner
- Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Ille
- Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
- TUM Neuroimaging Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Maria Wostrack
- Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
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16
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Zhu Z, Hu S, Zeng W, Cen S, Liu Y, Zhang W, Shi B. Effect of L5 spinal canal type on pedicle screw placement based on CT imaging: a retrospective clinical study. Eur Spine J 2024; 33:298-306. [PMID: 37659047 DOI: 10.1007/s00586-023-07904-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/03/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The objective of this study was to investigate the optimal entry point and pedicle camber angle for L5 pedicle screws of different canal types. METHODS CT imaging data were processed by Mimics for simulated pedicle screw placement, and PD (Pedicle diameter), PCA (Pedicle camber angle), LD (Longitudinal distance), TD (Transverse distance), and PBG (Pedicle screw breach grade) were measured. Then they were divided into the Round group and Trefoil group according to the type of spinal canal. When comparing PD, PCA, LD, TD, and PBG, the two sides of the pedicle were compared separately, so they were first divided into the round-type pedicle group and the trefoil-type pedicle group. RESULTS In the round-type pedicle group (n = 134) and the trefoil-type pedicle group (n = 264), there was no significant difference in PD and LD, but there was a significant difference in PCA between the two groups (t = - 4.072, P < 0.05). A statistically significant difference in the distance of the Magerl point relative to the optimal entry point (t = - 3.792, P < 0.05), and the distance of the Magerl point relative to the optimal entry point was greater in the trefoil-type pedicle group than in the round-type pedicle group. CONCLUSION The optimal entry point for L5 is more outward than the Magerl point, and the Trefoil spinal canal L5 is more outwardly oriented than the Round spinal canal L5, with a greater angle of abduction during pedicle screw placement.
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Affiliation(s)
- Zhemin Zhu
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Shengxuan Hu
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Weibo Zeng
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Shuizhong Cen
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Yubin Liu
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Wei Zhang
- Department of Bone and Joint, Panyu Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China.
| | - Benchao Shi
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China.
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Feng F, Chen X, Liu Z, Han Y, Chen H, Li Q, Lao L, Shen H. Learning curve of junior surgeons in robot-assisted pedicle screw placement: a comparative cohort study. Eur Spine J 2024; 33:314-323. [PMID: 37964170 DOI: 10.1007/s00586-023-08019-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/07/2023] [Accepted: 10/21/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE Robot-assisted technology has been gradually applied to pedicle screw placement in spinal surgery. This study was designed to detailedly evaluate the learning curve of junior surgeons in robot-assisted spine surgery. METHODS From December 2020 to February 2022, 199 patients requiring surgical treatment with posterior pedicle screw fixation were prospectively recruited into the study. The patients were randomized to the robot-assisted group (the RA group) or the conventional freehand group (the CF group). Under the senior specialist's supervision, pedicle screws were placed by two junior fellows without prior experience. Cumulative summation (CUSUM) analysis was performed on the learning curve of pedicle screw placement for performing quantitative assessment based on the time of screw insertion. RESULTS In total, 769 and 788 pedicle screws were placed in the RA and CF groups. Compared with the CF group, the learning duration in the RA group was shorter in the upper thoracic region (57 vs. 70 screws), but longer in the lower thoracic (62 vs. 58 screws) and the lumbosacral region (56 vs. 48 screws). The slope of learning curve was lower in the RA group than in the CF group. The screw accuracy in the RA group was superior to that in the CF group, especially in upper thoracic region (89.4% vs. 76.7%, P < 0.001). This disparity of accuracy became wider in deformity cases. In the upper thoracic region, the mean placement time was 5.34 ± 1.96 min in the RA group and 5.52 ± 2.43 min in the CF groups, while in the lower thoracic and lumbosacral regions, the CF group's mean placement times were statistically shorter. Three screw-related neural complications occurred in the CF group. CONCLUSION Robot-assisted technique has its advantages in the upper thoracic region and deformity cases, which is easier and safer to insert pedicle screws. The robot-assisted technique allowed a short learning curve for junior surgeons and exhibited consistently excellent results even in the early application period.
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Affiliation(s)
- Fan Feng
- Department of Spine Surgery, Department of Orthopaedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200120, China
| | - Xiuyuan Chen
- Department of Spine Surgery, Department of Orthopaedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200120, China
| | - Zude Liu
- Department of Spine Surgery, Department of Orthopaedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200120, China
| | - Yingchao Han
- Department of Spine Surgery, Department of Orthopaedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200120, China
| | - Hao Chen
- Department of Spine Surgery, Department of Orthopaedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200120, China
| | - Quan Li
- Department of Spine Surgery, Department of Orthopaedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200120, China
| | - Lifeng Lao
- Department of Spine Surgery, Department of Orthopaedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200120, China.
| | - Hongxing Shen
- Department of Spine Surgery, Department of Orthopaedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200120, China.
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Oh BK, Son DW, Lee JS, Lee SH, Kim YH, Sung SK, Lee SW, Song GS, Yi S. A Single-Center Experience of Robotic-Assisted Spine Surgery in Korea : Analysis of Screw Accuracy, Potential Risk Factor of Screw Malposition and Learning Curve. J Korean Neurosurg Soc 2024; 67:60-72. [PMID: 38224963 PMCID: PMC10788558 DOI: 10.3340/jkns.2023.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/17/2023] [Accepted: 07/31/2023] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVE Recently, robotic-assisted spine surgery (RASS) has been considered a minimally invasive and relatively accurate method. In total, 495 robotic-assisted pedicle screw fixation (RAPSF) procedures were attempted on 100 patients during a 14-month period. The current study aimed to analyze the accuracy, potential risk factors, and learning curve of RAPSF. METHODS This retrospective study evaluated the position of RAPSF using the Gertzbein and Robbins scale (GRS). The accuracy was analyzed using the ratio of the clinically acceptable group (GRS grades A and B), the dissatisfying group (GRS grades C, D, and E), and the Surgical Evaluation Assistant program. The RAPSF was divided into the no-breached group (GRS grade A) and breached group (GRS grades B, C, D, and E), and the potential risk factors of RAPSF were evaluated. The learning curve was analyzed by changes in robot-used time per screw and the occurrence tendency of breached and failed screws according to case accumulation. RESULTS The clinically acceptable group in RAPSF was 98.12%. In the analysis using the Surgical Evaluation Assistant program, the tip offset was 2.37±1.89 mm, the tail offset was 3.09±1.90 mm, and the angular offset was 3.72°±2.72°. In the analysis of potential risk factors, the difference in screw fixation level (p=0.009) and segmental distance between the tracker and the instrumented level (p=0.001) between the no-breached and breached group were statistically significant, but not for the other factors. The mean difference between the no-breach and breach groups was statistically significant in terms of pedicle width (p<0.001) and tail offset (p=0.042). In the learning curve analysis, the occurrence of breached and failed screws and the robot-used time per screw screws showed a significant decreasing trend. CONCLUSION In the current study, RAPSF was highly accurate and the specific potential risk factors were not identified. However, pedicle width was presumed to be related to breached screw. Meanwhile, the robot-used time per screw and the incidence of breached and failed screws decreased with the learning curve.
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Affiliation(s)
- Bu Kwang Oh
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Busan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Busan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Jun Seok Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Busan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Su Hun Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Busan, Korea
| | - Young Ha Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Busan, Korea
| | - Soon Ki Sung
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Busan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Busan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Busan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Seoul, Korea
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
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19
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Ye SQ, Zhao LJ, Hou ZP, Zhang JH, Yu L, Gu YJ. Measurement of anatomical parameters of anterior transpedicular root screw intervertebral fusion system of cervical spine. BMC Musculoskelet Disord 2023; 24:905. [PMID: 37990231 PMCID: PMC10662538 DOI: 10.1186/s12891-023-06995-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/28/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE This study aims to investigate the feasibility of the anterior transpedicular root screw (ATPRS) intervertebral fusion system for the cervical spine and provide a basis for the design of the ATPRS intervertebral fusion system. METHODS A total of 60 healthy adult cervical spine CT images examined from our hospital were selected, including 30 males and 30 females, with an average age of 39.6 ± 4.8 years. The image data was imported into Mimics 21.0 software in DICOM format for 3D model reconstruction. Simulated screw insertion was performed on both sides of the midline of the intervertebral space. The entry point (P1) was determined when the upper and lower screw paths did not overlap. When the screw was tangent to the medial edge of the Luschka joint, the insertion point was determined as the entry point (P2). Measurements were taken and recorded for the following parameters: distance from the screw entry point to the midline of the intervertebral space (DPM), the simulated screw length, inclination angle, cranial/caudal tilted angle, the anterior-posterior (AP) and mediolateral (ML) diameters of the cervical intervertebral space, the heights of the anterior, middle, and posterior edges of the cervical intervertebral space, and the curvature diameter of the lower end plate of the cervical vertebral body. Statistical analysis was performed on the measurement results. RESULTS The screw entry area (P1P2) showed an increasing trend from C3-C7 in both male (2.92-6.08 mm) and female (2.32-5.12 mm) groups. There were statistical differences between men and women at the same level (P < 0.05). The average screw length of men and women was greater than 20 mm, and the upper and lower screw lengths showed an increasing trend from C3 to C7. In the area where screws could be inserted, the range of screw inclination was as follows: male group upper screw (47.73-66.76°), lower screw (48.05-65.35°); female group upper screw (49.15-65.66°) and lower screw (49.42-63.29°); The range of cranial/caudal tilted angle of the screw was as follows: male group upper screw (32.06-39.56°), lower screw (29.12-36.95°); female group upper screw (30.97-38.92°) and lower screw (27.29-37.20°). The anterior-posterior diameter and mediolateral diameter of the cervical intervertebral space showed an increasing trend from C3 to C7 in both male and female groups. The middle height (MH) of the cervical intervertebral space was greater than the anterior edge height (AH) and posterior edge height (PD), with statistical differences (P < 0.05). CONCLUSIONS Through the study of CT images of the cervical spine, it was determined that the ATPRS intervertebral fusion system has a feasible area for screw insertion in the cervical intervertebral space.
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Affiliation(s)
- Sen-Qi Ye
- Department of Spinal Surgery, Yuyao People's Hospital, Ningbo, 315499, Zhejiang Province, China
| | - Liu-Jun Zhao
- Department of Spinal Surgery, Ningbo No.6 hospital of Ningbo University, Ningbo, Zhejiang Province, 315040, China.
| | - Zhi-Peng Hou
- Health Science Center, Ningbo University, Ningbo, 315211, Zhejiang Province, China
| | - Ji-Hui Zhang
- Department of Spinal Surgery, Ningbo No.6 hospital of Ningbo University, Ningbo, Zhejiang Province, 315040, China
| | - Liang Yu
- Department of Spinal Surgery, Ningbo No.6 hospital of Ningbo University, Ningbo, Zhejiang Province, 315040, China
| | - Yong-Jie Gu
- Department of Spinal Surgery, Ningbo No.6 hospital of Ningbo University, Ningbo, Zhejiang Province, 315040, China
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Eastlack RK, Nunley PD, Poelstra KA, Vaccaro AR, Stone M, Miller LE, Legay P, Clin J, Agarwal A. Finite element analysis comparing a PEEK posterior fixation device versus pedicle screws for lumbar fusion. J Orthop Surg Res 2023; 18:855. [PMID: 37950318 PMCID: PMC10636999 DOI: 10.1186/s13018-023-04349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Pedicle screw loosening and breakage are common causes of revision surgery after lumbar fusion. Thus, there remains a continued need for supplemental fixation options that offer immediate stability without the associated failure modes. This finite element analysis compared the biomechanical properties of a novel cortico-pedicular posterior fixation (CPPF) device with those of a conventional pedicle screw system (PSS). METHODS The CPPF device is a polyetheretherketone strap providing circumferential cortical fixation for lumbar fusion procedures via an arcuate tunnel. Using a validated finite element model, we compared the stability and load transfer characteristics of CPPF to intact conditions under a 415 N follower load and PSS conditions under a 222 N preload. Depending on the instrumented levels, two different interbody devices were used: a lateral lumbar interbody device at L4-5 or an anterior lumbar interbody device at L5-S1. Primary outcomes included range of motion of the functional spinal units and anterior load transfer, defined as the total load through the disk and interbody device after functional motion and follower load application. RESULTS Across all combinations of interbody devices and lumbar levels evaluated, CPPF consistently demonstrated significant reductions in flexion (ranging from 90 to 98%), extension (ranging from 88 to 94%), lateral bending (ranging from 75 to 80%), and torsion (ranging from 77 to 86%) compared to the intact spine. Stability provided by the CPPF device was comparable to PSS in all simulations (range of motion within 0.5 degrees for flexion-extension, 0.6 degrees for lateral bending, and 0.5 degrees for torsion). The total anterior load transfer was higher with CPPF versus PSS, with differences across all tested conditions ranging from 128 to 258 N during flexion, 89-323 N during extension, 135-377 N during lateral bending, 95-258 N during torsion, and 82-250 N during standing. CONCLUSION Under the modeled conditions, cortico-pedicular fixation for supplementing anterior or lateral interbody devices between L4 and S1 resulted in comparable stability based on range of motion measures and less anterior column stress shielding based on total anterior load transfer measures compared to PSS. Clinical studies are needed to confirm these finite element analysis findings.
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Affiliation(s)
- Robert K Eastlack
- Department of Orthopaedic Surgery, Scripps Clinic, San Diego, CA, USA
| | | | - Kornelis A Poelstra
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Marcus Stone
- Spine Institute of Louisiana, Shreveport, LA, USA
| | - Larry E Miller
- Miller Scientific, 3101 Browns Mill Road, Ste 6, #311, Johnson City, TN, 37604, USA.
| | | | | | - Aakash Agarwal
- Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
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21
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Wu LC, Hsieh YY, Tsuang FY, Kuo YJ, Chen CH, Chiang CJ. Pullout strength of different pedicle screws after primary and revision insertion: an in vitro study on polyurethane foam. BMC Musculoskelet Disord 2023; 24:863. [PMID: 37932751 PMCID: PMC10629141 DOI: 10.1186/s12891-023-07015-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Surgeons are routinely required to remove loose or failed pedicle screws and insert a new screw in their place. However, inserting a new screw into an existing hole may compromise the holding capacity of the pedicle screw. The purpose of this study is to evaluate the pullout strength of pedicle screws with different thread designs after the primary insertion and revision surgery in a synthetic bone model. METHODS Four pedicle screws with different thread designs (single-lead-thread (SLT) screw, dual-lead-thread (DLT) screw, mixed-single-lead-thread (MSLT) screw, and proximal-unthreaded-dual-thread (PUDL) screw) were inserted into pre-drilled, untapped holes (ø 4.2 mm, length 35 mm) in Sawbone blocks of density 20 pcf. In the first sequence, a 6.0 mm screw was inserted into the predrilled foam block and the primary pullout strength of the screw was measured according to ASTM F543. In the second sequence, a 6.0 mm screw was inserted and removed, and then either a 6.5 mm screw of the same design or a different screw design was inserted into the same hole and the pullout strength recorded. RESULTS In the first sequence, the mean pullout strength of the MSLT screw was significantly (p < 0.05) greater than all other screw designs. In the second sequence, when the MSLT screw was the primary screw, using a larger MSLT screw (6.5 mm) as the revision screw did not lead to a higher pullout strength than if a 6.0 mm diameter PUDL screw was used for the revision. Using a larger DLT screw (6.5 mm) as the revision screw resulted in a significantly (p < 0.05) greater pullout strength than a 6.0 mm STL, DLT, MSLT, or PUDL screw. CONCLUSIONS Our results indicate that employing classic oversizing of the same screw design is a safe choice for maintaining screw purchase in the bone after revision. In cases where oversizing with the same screw design is not practical, opting for a PUDL screw with the same original diameter can provide enough purchase in the bone to maintain stability.
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Affiliation(s)
- Lien-Chen Wu
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan
| | - Yueh-Ying Hsieh
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan
| | - Fon-Yih Tsuang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, 10022, Taiwan
- Spine Tumor Center, National Taiwan University Hospital, Taipei City, 10022, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei City, 11696, Taiwan
| | - Chia-Hsien Chen
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan
| | - Chang-Jung Chiang
- Department of Orthopaedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, 23561, Taiwan.
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan.
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Pose-Díez-de-la-Lastra A, Ungi T, Morton D, Fichtinger G, Pascau J. Real-time integration between Microsoft HoloLens 2 and 3D Slicer with demonstration in pedicle screw placement planning. Int J Comput Assist Radiol Surg 2023; 18:2023-2032. [PMID: 37310561 PMCID: PMC10589185 DOI: 10.1007/s11548-023-02977-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE Up to date, there has been a lack of software infrastructure to connect 3D Slicer to any augmented reality (AR) device. This work describes a novel connection approach using Microsoft HoloLens 2 and OpenIGTLink, with a demonstration in pedicle screw placement planning. METHODS We developed an AR application in Unity that is wirelessly rendered onto Microsoft HoloLens 2 using Holographic Remoting. Simultaneously, Unity connects to 3D Slicer using the OpenIGTLink communication protocol. Geometrical transform and image messages are transferred between both platforms in real time. Through the AR glasses, a user visualizes a patient's computed tomography overlaid onto virtual 3D models showing anatomical structures. We technically evaluated the system by measuring message transference latency between the platforms. Its functionality was assessed in pedicle screw placement planning. Six volunteers planned pedicle screws' position and orientation with the AR system and on a 2D desktop planner. We compared the placement accuracy of each screw with both methods. Finally, we administered a questionnaire to all participants to assess their experience with the AR system. RESULTS The latency in message exchange is sufficiently low to enable real-time communication between the platforms. The AR method was non-inferior to the 2D desktop planner, with a mean error of 2.1 ± 1.4 mm. Moreover, 98% of the screw placements performed with the AR system were successful, according to the Gertzbein-Robbins scale. The average questionnaire outcomes were 4.5/5. CONCLUSIONS Real-time communication between Microsoft HoloLens 2 and 3D Slicer is feasible and supports accurate planning for pedicle screw placement.
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Affiliation(s)
| | - Tamas Ungi
- Laboratory for Percutaneous Surgery, School of Computing, Queen's University, Kingston, ON, K7M2N8, Canada
| | - David Morton
- Laboratory for Percutaneous Surgery, School of Computing, Queen's University, Kingston, ON, K7M2N8, Canada
| | - Gabor Fichtinger
- Laboratory for Percutaneous Surgery, School of Computing, Queen's University, Kingston, ON, K7M2N8, Canada
| | - Javier Pascau
- Departamento de Bioingeniería, Universidad Carlos III de Madrid, 28911, Leganés, Spain
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Zhai X, Li B, Chen K, Chen Z, Shao J, Chen K, Xu Q, Meng D, Fei Q, Jiang L, Bai Y, Li M. Spine Surgery with Electronic Conductivity Device: A Prospectively Multicenter Randomized Clinical Trial and Literature Review. Orthop Surg 2023; 15:2872-2880. [PMID: 37735987 PMCID: PMC10622289 DOI: 10.1111/os.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE Improving accuracy and safety of pedicle screw placement is of great clinical importance. Electronic conductivity device (ECD) can be a promising technique with features of affordability, portability, and real-time detection capabilities. This study aimed to validate the safety and effectiveness of a modified ECD. METHODS The ECD underwent a modification where six lamps of various colors, and it was utilized in a prospectively multicenter randomized controlled clinical trial involving 96 patients across three hospitals from June 2018 to December 2018. The trial incorporated a self-control randomization with an equal distribution of left or right side of vertebral pedicle among two groups: the free-hand group and the ECD group. A total of 496 pedicle screws were inserted, with 248 inserted in each group. The primary outcomes focused on the accuracy of pedicle screw placement and the frequency of intraoperative X-rays. Meanwhile, the secondary indicator measured the time required for pedicle screw placement. Results were presented as means ± SD. Paired samples t-test and χ2 -test were used for comparison. Furthermore, an updated review was conducted, which included studies published from 2006 onwards. RESULTS Baseline patient characteristics were recorded. The primary accuracy outcome revealed a 96.77% accuracy rate in the ECD group, compared to a 95.16% accuracy rate in the free-hand group, with no significant differences noted. In contrast, ECD demonstrated a significant reduction in radiation exposure frequency when compared to the free-hand group (1.11 ± 0.32 vs. 1.30 ± 0.53; p < 0.001), resulting in a 14.6% reduction. Moreover, ECD displayed a decrease of 30.38% in insertion time (70.88 ± 30.51 vs. 101.82 ± 54.00 s; p < 0.001). According to the results of the 21 studies, ECD has been utilized in various areas of the spine such as the atlas, thoracic and lumbar spine, as well as sacral 2-alar-iliac. The accuracy of ECD ranged from 85% to 100%. CONCLUSION The prospectively randomized trial and the review indicate that the use of ECD presents a secure and precise approach to the placement of pedicle screws, with the added benefit of reducing both procedure time and radiation exposure.
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Affiliation(s)
- Xiao Zhai
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Bo Li
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Kai Chen
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Ziqiang Chen
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Jie Shao
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Kai Chen
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Qintong Xu
- Department of Orthopaedic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Dehua Meng
- Department of Orthopaedic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Qinming Fei
- Department of Orthopaedic Surgery, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Leisheng Jiang
- Spine Center, Xinhua HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Yushu Bai
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
| | - Ming Li
- Department of Orthopaedics, Shanghai Changhai HospitalNavy Medical UniversityShanghaiChina
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Kondrashov DG, Piple AS, Ungurean V, Schlauch AM, Rowland A, Tran T, Denisov A, Zaborovskii N, Raji OR. Spinolaminar locking plates improve fixation strength compared to pedicle screws: a biomechanical analysis. Spine Deform 2023; 11:1335-1345. [PMID: 37329420 DOI: 10.1007/s43390-023-00716-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/27/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Pedicle screw loosening is a significant complication of posterior spinal fixation, particularly among osteoporotic patients and in deformity constructs. In orthopedic trauma surgery, locking plates and screws have revolutionized the fixation of osteoporotic fractures. We have combined the traumatology principle of fixed-angle locking plate fixation with the spine principles of segmental instrumentation. METHODS A novel spinolaminar locking plate was designed based on morphometric studies of human thoracolumbar vertebrae. The plates were fixed to cadaveric human lumbar spines and connected to form 1-level L1-L2 or L4-L5 constructs and compared to similar pedicle screw constructs. Pure moment testing was performed to assess range of motion before and after 30,000 cycles of cyclic fatigue. Post-fatigue fixture pullout strength was assessed by applying a continuous axial tensile force oriented to the principal axis of the pedicle until pullout was observed. RESULTS Spinolaminar plate fixation resulted in superior pullout strength compared to pedicle screws (1,065 ± 400N vs. 714 ± 284N, p = 0.028). Spinolaminar plates performed equivalently to pedicle screws in range of motion reduction during flexion/extension and axial rotation. Pedicle screws outperformed the spinolaminar plates in lateral bending. Finally, no spinolaminar constructs failed during cyclic fatigue testing, whereas one pedicle screw construct did. CONCLUSIONS The spinolaminar locking plate maintained adequate fixation post-fatigue, particularly in flexion/extension and axial rotation compared to pedicle screws. Moreover, spinolaminar plates were superior to pedicle screw fixation with respect to cyclic fatiguing and pullout strength. The spinolaminar plates offer a viable option for posterior lumbar instrumentation in the adult spine.
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Affiliation(s)
- Dimitriy G Kondrashov
- St. Mary's Spine Center, 1 Shrader St., Suite 600, San Francisco, CA, 94117, USA.
- The Taylor Collaboration, San Francisco, CA, USA.
- San Francisco Orthopaedic Residency Program, San Francisco, CA, USA.
| | - Amit S Piple
- The Taylor Collaboration, San Francisco, CA, USA
| | | | - Adam M Schlauch
- San Francisco Orthopaedic Residency Program, San Francisco, CA, USA
| | - Andrea Rowland
- San Francisco Orthopaedic Residency Program, San Francisco, CA, USA
| | - Tien Tran
- The Taylor Collaboration, San Francisco, CA, USA
| | - Anton Denisov
- Hospital Quirónsalud Valle del Henares, Madrid, Spain
- Hospital Quirónsalud San José, Madrid, Spain
- Hospital 12 de Octubre Health Research Institute, Madrid, Spain
| | - Nikita Zaborovskii
- Vreden National Medical Research Center of Traumatology and Orthopedics, Saint-Petersburg, Russia
- Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Oluwatodimu Richard Raji
- St. Mary's Spine Center, 1 Shrader St., Suite 600, San Francisco, CA, 94117, USA
- The Taylor Collaboration, San Francisco, CA, USA
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Lin JD, Schupper AJ, Matthew J, Lee N, Osorio JA, Marciano G, Lombardi JM, Sardar Z, Lehman RA, Lenke LG. A New Objective Radiographic Criteria for Diagnosis of Adult Idiopathic Scoliosis: Apical Pedicle Diameter Asymmetry. World Neurosurg 2023; 178:e141-e146. [PMID: 37437804 DOI: 10.1016/j.wneu.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE We sought to test the hypothesis that a difference of ≥1 mm in pedicle diameter between the convex and concave pedicles at the apex of a lumbar curve is a sensitive and/or specific criteria for adult idiopathic scoliosis (AdIS). METHODS Thirty-nine operative patients with adult deformity and lumbar major curves were identified. A chart review was performed. Radiographic measurements included lumbar Cobb, curve apex, and Cobb levels involved. Apical pedicle diameter at the concavity and convexity of the curve apex were measured. RESULTS Among these 39 patients, the average Cobb angle was 48.3 degrees. Curve apex averaged at L1/2 (range L1-L3). The curves spanned 4.7 levels (range 3-7). Twenty-five curves had the apex to the left, while 14 had the apex to the right. The average pedicle diameter at the apex was 6.1 mm. Fourteen patients had apical pedicle diameter asymmetry (APDA) >1 mm. Most (7 of 8, or 87.5%) of the patients with a history of adult idiopathic scoliosis had APDA >1 mm. A minority (7 of 31, 22.5%) of patients without known history of adult idiopathic scoliosis had APDA >1 mm (P < 0.01). CONCLUSIONS Apical pedicle diameter asymmetry is among the sensitive diagnostic criteria for AdIS and may be useful for differentiating lumbar major AdIS from degenerative lumbar scoliosis. The sensitivity of APDA >1 mm is 87.5%, with specificity of 77.4%. We propose a new, sensitive radiographic criterion for adult idiopathic scoliosis. A difference of ≥1 mm in pedicle diameter between the convex and concave pedicles at that apex of a lumbar curve has a sensitivity of 87.5% and specificity of 77.4% for patient-reported history of adolescent scoliosis. It can be a useful tool as exclusion criteria for studies on AdIS.
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Affiliation(s)
- James D Lin
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, New York, USA
| | | | - Justin Matthew
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Nathan Lee
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Joseph A Osorio
- Department of Neurosurgery, University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Gerard Marciano
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Joseph M Lombardi
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Zeeshan Sardar
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Ronald A Lehman
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Lawrence G Lenke
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
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26
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Ngoc QN, Riew KD, Lee SM, Park SM, Kim HJ, Chang BS, Lee SH, Lee JC, Yeom JS. The Feasibility of Multiple Fixation Points in C2. Asian Spine J 2023; 17:888-893. [PMID: 37443461 PMCID: PMC10622824 DOI: 10.31616/asj.2023.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/15/2023] Open
Abstract
STUDY DESIGN Analysis using three-dimensional simulation software for spinal screw placement and computed tomographic scan images. PURPOSE To assess the feasibility of achieving multiple (three or four) screw fixation points in C2 vertebra by using a combination of pedicle and laminar screws. OVERVIEW OF LITERATURE Secure C2 fixation using multiple screws is required or beneficial in some unique cases. However, to the best of our knowledge, there have been no reports analyzing the feasibility of multiple screw fixation in C2. METHODS We used 1.0-mm interval computed tomographic scan images of 100 patients (50 men and 50 women) and screw trajectory simulation software. The diameter of all screws was set at 3.5 mm, considering its common usage in real surgery. The anatomical feasibility of placing both pedicle and laminar screws on the same side was evaluated. For all feasible sides, the three-dimensional distance between the screw entry points was measured. RESULTS In 85% of cases, both pedicle and laminar screws could be placed on both sides, allowing for the insertion of 4 screws. In 11% of cases, 2 screws could be placed on one side, while only 1 screw was feasible on the other side, resulting in the placement of 3 screws. In all 181 sides where both types of screws could be inserted, the distance between their entry points exceeded 16.1 mm, which was sufficient to prevent the collision between the screw heads. CONCLUSIONS C2 vertebra can accommodate three (11%) or four (85%) screws in 96% of cases.
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Affiliation(s)
- Quyen Nguyen Ngoc
- Spine Surgery Unit, Polyclinic and Premier Healthcare Center, 108 Military Central Hospital, Hanoi,
Socialist Republic of Vietnam
| | - K. Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, NY,
USA
- Department of Neurological Surgery, Weill Cornell Medical School, New York, NY,
USA
| | - So Min Lee
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Sang-Min Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Bong-Soon Chang
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Sang-Hun Lee
- Department of Orthopaedic Surgery, Johns Hopkins University, School of Medicine, Baltimore, MD,
USA
| | - Jae Chul Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul,
Korea
| | - Jin S. Yeom
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
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Weber M, Kernich N, Scheyerer MJ, Prescher A, Walter S, Heck VJ, Eysel P, Sircar K. Does index-level pedicle screw instrumentation affect cage subsidence after vertebral body replacement? - A biomechanical study in human cadaveric osteoporotic specimens. Clin Biomech (Bristol, Avon) 2023; 109:106075. [PMID: 37651900 DOI: 10.1016/j.clinbiomech.2023.106075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Vertebral body replacement is a common surgical procedure for treatment of disorders associated with spinal instability. Therefore, pedicle screws are usually inserted in adjacent vertebrae for stabilization of the posterior column, however, there is lack of evidence whether implantation of index-level pedicle screws is beneficial or not. This biomechanical study aims to investigate the effect of pedicle screw instrumentation on axial stability following vertebral body replacement. METHODS Unstable fracture at L3 level was simulated in lumbar spines from six human cadaveric specimens. Then instrumentation was performed one level above / one level below index level in three specimens and further, three specimens were instrumented at index-level (L3) additionaly. Then we used a testing protocol for biomechanical evaluation of axial loading on human cadaveric lumbar spines until cage subsidence occurred. FINDINGS Our results show that index-level instrumented spines endured significantly higher load until cage subsidence occurred compared to non-index-level instrumented specimens (p = 0.05). INTERPRETATION Our results demonstrate pedicle screw instrumentation at index-level vertebra should be considered when possbile as it may have a protective effect against cage subsidence in patients undergoing vertebral body replacement surgery.
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Affiliation(s)
- Maximilian Weber
- University of Cologne, Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Nikolaus Kernich
- University of Cologne, Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, Kerpener Str. 62, 50937 Cologne, Germany
| | - Max J Scheyerer
- Department of Trauma and Spine Surgery, Heinrich Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy (MOCA), Wendlingweg 2, 52074 Aachen, Germany
| | - Sebastian Walter
- University of Cologne, Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, Kerpener Str. 62, 50937 Cologne, Germany
| | - Vincent J Heck
- University of Cologne, Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, Kerpener Str. 62, 50937 Cologne, Germany
| | - Peer Eysel
- University of Cologne, Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, Kerpener Str. 62, 50937 Cologne, Germany
| | - Krishnan Sircar
- University of Cologne, Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, Kerpener Str. 62, 50937 Cologne, Germany
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Oppermann M, Karapetyan V, Gupta S, Ramjist J, Oppermann P, Yang VXD. The pedicle screw accuracy using a robotic system and measured by a novel three-dimensional method. J Orthop Surg Res 2023; 18:706. [PMID: 37730623 PMCID: PMC10510280 DOI: 10.1186/s13018-023-04206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/13/2023] [Indexed: 09/22/2023] Open
Abstract
Robotics in medicine is associated with precision, accuracy, and replicability. Several robotic systems are used in spine surgery. They are all considered shared-control systems, providing "steady-hand" manipulation instruments. Although numerous studies have testified to the benefits of robotic instrumentations, they must address their true accuracy. Our study used the Mazor system under several situations and compared the spatial accuracy of the pedicle screw (PS) insertion and its planned trajectory. We used two cadaveric specimens with intact spinal structures from C7 to S1. PS planning was performed using the two registration methods (preopCT/C-arm or CT-to-fluoroscopy registration). After planning, the implant spatial orientation was defined based on six anatomic parameters using axial and sagittal CT images. Two surgical open and percutaneous access were used to insert the PS. After that, another CT acquisition was taken. Accuracy was classified into optimal, inaccurate and unacceptable according to the degree of screw deviation from its planning using the same spatial orientation method. Based on the type of spatial deviation, we also classified the PS trajectory into 16 pattern errors. Seven (19%) out of 37 implanted screws were considered unacceptable (deviation distances > 2.0 mm or angulation > 5°), and 14 (38%) were inaccurate (> 0.5 mm and ≤ 2.0 mm or > 2.5° and ≤ 5°). CT-to-fluoroscopy registration was superior to preopCT/C-arm (average deviation in 0.9 mm vs. 1.7 mm, respectively, p < 0.003), and percutaneous was slightly better than open but did not reach significance (1.3 mm vs. 1.7 mm, respectively). Regarding pattern error, the tendency was to have more axial than sagittal shifts. Using a quantitative method to categorize the screw 3D position, only 10.8% of the screws were considered unacceptable. However, with a more rigorous concept of inaccuracy, almost half were non-optimal. We also identified that, unlike some previous results, the O-arm registration delivers more accurate implants than the preopCT/C-arm method.
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Affiliation(s)
- Marcelo Oppermann
- Department of Clinical Neurological Science, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
- Department of Electrical Computer and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada.
| | - Vahagan Karapetyan
- Department of Clinical Neurological Science, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Shaurya Gupta
- Department of Electrical Computer and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Joel Ramjist
- Department of Electrical Computer and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Priscila Oppermann
- Department of Clinical Neurological Science, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Victor X D Yang
- Department of Clinical Neurological Science, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Electrical Computer and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
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29
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Biswas JK, Mondal N, Choudhury S, Malas A, Rana M. A finite element study and mathematical modeling of lumbar pedicle screw along with various design parameters. J Orthop Sci 2023; 28:992-1003. [PMID: 36175251 DOI: 10.1016/j.jos.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/04/2022] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Lumbar pedicle screw is one of the most common and important elements in the field of lumbar surgery. It plays a great role in rectifying the spinal alignment and stabilization providing strength and stability to the affected area of spine. In spinal surgery, minimally invasive techniques and minor incisions are made which makes it less painful for the patients than the traditional methods. Moreover, the screws are not needed to be removed after the surgery which is yet another great advantage of the pedicle screw. METHOD In this study, 3D Finite Element (FE) model of human L4 vertebrae is taken for analysis using image processing tool. Pedicle screw design with varying mechanical and geometrical properties has been carried out at different applied loads on it along with considering the effect of frictional forces between all contact surfaces. RESULT Mathematical relationship among stress, strain, pitch of the screw and diameter have been developed for different thread profiles which will be beneficial for researchers for further development of pedicle screw implants. CONCLUSION Results from the different analysis shows that bending stress on the screw for different loads at triangular pitch is higher than the trapezoidal. Hence, trapezoidal thread is efficacious than triangular thread. In case of vertebral bone, the magnitude of stress is less for trapezoidal screw than triangular and stress has a linear relationship with pitch length. In term of strain, triangular thread develops more strain than trapezoidal thread. A set of mathematical relation has been developed for different thread profile based on pitch length, stress and strain which gives the idea about von Mises stress and strain.
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Affiliation(s)
- Jayanta Kumar Biswas
- Department of Mechanical Engineering, National Institute of Technology, Patna, Bihar - 800005, India
| | - Nitesh Mondal
- Department of Mechanical Engineering, Ghani Khan Choudhury Institute of Engineering & Technology, Narayanpur, Malda - 732141, India
| | - Sandeep Choudhury
- Department of Aerospace Engineering and Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, Howrah - 711103, India
| | - Anindya Malas
- Department of Mechanical Engineering, National Institute of Technology, Patna, Bihar - 800005, India
| | - Masud Rana
- Department of Aerospace Engineering and Applied Mechanics, Indian Institute of Engineering Science and Technology, Shibpur, Howrah - 711103, India.
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30
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Maruo K, Arizumi F, Kishima K, Yoshie N, Kusukawa T, Tachibana T. Patient-specific guide systems decrease the major perforation rate of pedicle screw placement in comparison to the freehand technique for adolescent idiopathic scoliosis. Eur Spine J 2023; 32:3105-3112. [PMID: 37289252 DOI: 10.1007/s00586-023-07802-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/03/2023] [Accepted: 05/27/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE This study aimed to compare the accuracy of pedicle screw (PS) placement between a low-profile three-dimensional (3D) printed patient-specific guide system and freehand technique for adolescent idiopathic scoliosis (AIS) surgery. METHODS Patients with AIS who underwent surgery between 2018 and 2023 at our hospital were included in the study. The 3D-printed patient-specific guide was used since 2021 (guide group). PS perforation was classified using Rao and Neo's classification (grade 0, no violation; grade 1, < 2 mm; grade 2, 2-4 mm; grade 3, > 4 mm). Major perforations were defined as grades 2 or 3. The major perforation rate of PS, operative time, estimated blood loss (EBL), and correction rate were compared between the two groups. RESULTS A total of 576 PSs were inserted in 32 patients (20 patients in the freehand (FH) group and 12 patients in the guide group). The major perforation rate was significantly lower in the guide group than in the FH group (2.1% vs. 9.1%, p < 0.001). Significantly fewer major perforations were observed in the guide group than in the FH group in the upper thoracic (T2-4) region (3.2% vs. 20%, p < 0.001) and lower thoracic (T10-12) region (0% vs. 13.8%, p = 0.001). The operative time, EBL, and correction rate were equivalent between the two groups. CONCLUSION The 3D-printed patient-specific guide notably reduced the major perforation rate of PS without increasing EBL and operative time. Our findings indicate that this guide system is reliable and effective for AIS surgery.
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Affiliation(s)
- Keishi Maruo
- Department of Orthopedic Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Fumihiro Arizumi
- Department of Orthopedic Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Kazuya Kishima
- Department of Orthopedic Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Norichika Yoshie
- Department of Orthopedic Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tomoyuki Kusukawa
- Department of Orthopedic Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Toshiya Tachibana
- Department of Orthopedic Surgery, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, 663-8501, Japan
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31
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Li C, Wang Z, Li D, Tian Y, Yuan S, Wang L, Liu X. Safety and accuracy of cannulated pedicle screw placement in scoliosis surgery: a comparison of robotic-navigation, O-arm-based navigation, and freehand techniques. Eur Spine J 2023; 32:3094-3104. [PMID: 37273031 DOI: 10.1007/s00586-023-07710-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 03/28/2023] [Accepted: 04/06/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE To compare the safety and accuracy of cannulated pedicle screw placement using a robotic-navigation technique, O-arm-based navigation technique, or freehand technique. METHODS This study analyzed 106 consecutive patients who underwent scoliosis surgery. Thirty-two patients underwent robotic-navigation-assisted pedicle screw insertion (Group 1), 34 patients underwent O-arm-based navigation-guided pedicle screw insertion (Group 2), and 40 patients underwent freehand pedicle screw insertion (Group 3). The primary outcome measure was the accuracy of screw placement. Secondary outcome parameters included operation time, blood loss, radiation exposure, and postoperative stay. RESULTS A total of 2035 cannulated pedicle screws were implanted in 106 patients. The accuracy rate of the first pedicle screw placement during operation was significantly greater in Group 1 (94.7%) than in Group 2 (89.2%; P < 0.001). The accuracy rate of pedicle screw placement postoperatively decreased in the order of Group 1 (96.7%) > Group 2 (93.0%) > Group 3 (80.4%; P < 0.01). There were no significant differences in blood loss or postoperative stay among the three groups (P > 0.05). The operation times of Group 1 and Group 2 were significantly longer than that of Group 3 (P < 0.05). CONCLUSION The robotic-navigation and O-arm-based navigation techniques effectively increased the accuracy and safety of pedicle screw insertion alternative to the freehand technique in scoliosis surgery. Compared with the O-arm-based navigation technique, the robotic-navigation technique increases the mean operation time, but also increases the accuracy of pedicle screw placement. A three-dimensional scan after insertion of the K-wire may increase the accuracy of pedicle screw placement in the O-arm-based navigation technique.
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Affiliation(s)
- Chao Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, 250012, Shandong, People's Republic of China
| | - Zheng Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, 250012, Shandong, People's Republic of China
| | - Donglai Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, 250012, Shandong, People's Republic of China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, 250012, Shandong, People's Republic of China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, 250012, Shandong, People's Republic of China
| | - Lianlei Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, 250012, Shandong, People's Republic of China.
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Road 107#, Jinan, 250012, Shandong, People's Republic of China.
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Song Z, Zhou Q, Jin X, Zhang J. Cement-augmented pedicle screw for thoracolumbar degenerative diseases with osteoporosis: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:631. [PMID: 37641101 PMCID: PMC10464480 DOI: 10.1186/s13018-023-04077-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Cement-augmentation pedicle screws have been widely used in spinal internal fixation surgery combined with osteoporosis in recent years, which can significantly improve the fixation strength, but compared with conventional methods, whether it has more advantages is still inconclusive of evidencebased medicine. To systematically evaluate the efficacy and safety of cement-augmented pedicle screw in the treatment of thoracolumbar degenerative diseases with osteoporosis. METHODS We searched PubMed, Embase, and Cochrane Library for studies published from the establishment of the database up until June 2023. We included studies that concerning the cement-augmented pedicle screw and the traditional pedicle screw placement for thoracolumbar degenerative diseases with osteoporosis. We excluded repeated publication, researches without full text, incomplete information or inability to conduct data extraction and animal experiments, case report, reviews and systematic reviews. STATA 15.1 software was used to analyze the data. RESULTS A total of 12 studies were included in this meta-analysis. The sample size of patients were totally 881, of which, 492 patients in cement-augmented screw group and 389 patients in conventional screw group. Meta-analysis results showed that Japanese Orthopaedic Association (JOA) score (WMD = 1.69, 95% CI 1.15 to 2.22), intervertebral space height (WMD = 1.66, 95% CI 1.03 to 2.29) and post-operation fusion rate (OR = 2.80, 95% CI 1.49 to 5.25) were higher in the cement-augmented screw group than those in the conventional screw group. Operation time was longer in the cement-augmented screw group than that in the conventional screw group (WMD = 15.47, 95% CI 1.25 to 29.70). Screw loosening rate was lower in the cement-augmented screw group than those in the conventional screw group (OR = 0.13, 95% CI 0.07 to 0.22). However, hospitalization time, intraoperative blood loss and Visual analog scale (VAS) score were not significantly different between the two groups (P > 0.05). CONCLUSION Compared with conventional pedicle screw placement, cement-augmented pedicle screw is more effective in the treatment of osteoporotic thoracolumbar degenerative disease by improving fusion rate and interbody height, reducing the incidence of screw loosening, and elevating long-term efficacy.
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Affiliation(s)
- Zhoufeng Song
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Post and Telegraph Road Uptown, Hangzhou, 310000, China
| | - Qiujun Zhou
- Department of First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310000, China
| | - Xiaoliang Jin
- Department of First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310000, China
| | - Jinjie Zhang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Post and Telegraph Road Uptown, Hangzhou, 310000, China.
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Liu Z, Zheng JH, Yuan N, Miao J. Comparison of the clinical effects of lamina replantation and screw fixation after laminectomy in the treatment of intraspinal tumours. J Orthop Surg Res 2023; 18:617. [PMID: 37612752 PMCID: PMC10464039 DOI: 10.1186/s13018-023-04066-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION Intraspinal tumours are common diseases in neurosurgery and spinal surgery. Due to the fact that most of them are benign tumours, surgical resection is usually effective, and it is also the main treatment for these tumours. To maintain the stability of the spine and to reduce the incidence of kyphosis, pedicle screw fixation is required after traditional laminectomy, but there are many complications. In recent years, tumour resection and laminectomy have become increasingly favoured by clinicians. However, the comparison of the clinical effects of lamina complex replantation and pedicle screw fixation after laminectomy in the treatment of intraspinal tumours is still unknown. This paper systematically compared the two methods from many aspects and discussed their advantages and disadvantages to obtain better clinical guidance. MATERIALS AND METHODS In this study, a retrospective analysis was conducted to select 58 patients who underwent posterior approach tumour resection in the spinal surgery department of our hospital from January 2017 to January 2020. Among them, 32 patients underwent tumour resection and laminoplasty, and 26 patients underwent tumour resection and screw internal fixation. The age, sex, body mass index (BMI), smoking status, duration of symptoms, operation time, length of hospital stay, postoperative complications, amount of bleeding and other data were summarized, calculated and compared. RESULTS 1. The age, sex, BMI, smoking status and symptom duration of the two groups were compared. The abovementioned results were not statistically significant. 2. The operation time, hospital stay, postoperative complications, intraoperative bleeding and adjacent segment degeneration (ASD) were counted and compared between the two groups. There was no significant difference in hospital stay or intraoperative bleeding between the two groups; in addition, the operation time, postoperative complications and incidence of ASD were statistically significant. 3. The visual analog scale (VAS) score, Oswestry Disability Index (ODI) score of thoracic and lumbar spines and Neck Disability Index (NDI) score of cervical spine patients in the two groups were counted, and the preoperative and postoperative data, as well as their changes, were counted and compared between groups and within groups. There was no statistical significance between the two groups; moreover, the postoperative scores were all significantly lower than preoperative in the group. 4. According to the spinal cord function ASIA grade, the preoperative, final follow-up and change values of the two groups were counted, and intragroup and intergroup comparisons were made. There was no significant difference between the two groups; in addition, the scores of the final follow-up were significantly higher than preoperative in the group. 5. The spinal mobility was measured and recorded before the operation and at the final follow-up. There was no significant difference between preoperative and postoperative cervical mobility, and there was no statistical significance observed; furthermore, the range of flexion, extension, rotation and lateral bending of the thoracic and lumbar spines in the screw fixation group was significantly lower than that in the lamina replantation group. CONCLUSIONS Lamina replantation can be used as splendid methods for the treatment of Intraspinal tumour. Lamina replantation can reduce the operation time, as well as reduce the occurrence of postoperative cerebrospinal fluid leakage, iatrogenic spinal stenosis, posterior soft tissue adhesion and ASD. These complications are reduced in comparison to the other mode of management and better preserve the mobility of the spine.
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Affiliation(s)
- Zhen Liu
- Department of Spinal Surgery, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, 31 Huanghe Road, Cangzhou, 061000, People's Republic of China.
| | - Ji-Hui Zheng
- Graduate School, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, People's Republic of China
| | - Na Yuan
- Department of Spinal Surgery, Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine, 31 Huanghe Road, Cangzhou, 061000, People's Republic of China
| | - Jun Miao
- Department of Spine Surgery, Tianjin Hospital Affiliated to Tianjin University, No. 406 Jiefang South Road, Hexi District, Tianjin, 300210, People's Republic of China.
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Ding B, Zhou T, Ma H, Zhao J. A novel radiographic analysis system for subaxial cervical spine pedicle screw placement. J Orthop Surg Res 2023; 18:581. [PMID: 37553693 PMCID: PMC10408217 DOI: 10.1186/s13018-023-03999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Precise pedicle screw placement of the subaxial cervical spine is difficult. Not every hospital is equipped with a guidance system that can provide effective help. Computed tomography (CT) scanning is almost a routine preoperative examination for cervical spine surgery in all hospitals. Appropriate measurement and analysis of the CT images could assist optimal cervical pedicle screw placement. The purpose of this study is to propose a new and universal method using computed tomography (CT) morphological parameters analysis to assist optimal cervical pedicle screw placement from C3 to C7. METHODS A localization system with six parameters was designed based on preoperative CT reconstruction to guide subaxial cervical spine pedicle screw placement. The six parameters were distance from the starting point to the midline [D1], distance from the starting point to the lower edge of the inferior articular process [D2], transverse section angle [TSA], sagittal section angle [SSA], pedicle width [PW], and pedicle height [PH]. The six parameters were analyzed in 53 participants. RESULTS Combining D1 and D2 could localize the entrance of the pedicle screw, and we concluded that D1 and TSA and D2 and SSA could be a new standard for determination of the transverse and sagittal orientation of the pedicle screw. The six parameters were closely related to the patient's gender, height, and weight. PH and PW were linearly correlated and could guide selection of the appropriate pedicle screw. SSA was an independent parameter of the relevant vertebral body, and changes in SSA had nothing to do with the curvature or posture of the cervical spine. CONCLUSIONS Understanding and applying the six-parameter localization system are essential for achieving accurate and optimal pedicle screw placement in subaxial cervical spine, regardless of cervical sagittal alignment.
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Affiliation(s)
- Baozhi Ding
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai, People's Republic of China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China
| | - Tangjun Zhou
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai, People's Republic of China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China
| | - Hui Ma
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai, People's Republic of China.
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China.
| | - Jie Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai, People's Republic of China.
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China.
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Wang S, Aikeremu D, Kahaer A, Maimaiti A, Xiao Y, Tuoheti A, Zhang R, Maimaiti X, Guo H, Rexiti P. Anatomical and imaging measurements of the angle between the axis of the lumbar pedicle and lateral isthmus margin and its clinical significance. J Orthop Surg Res 2023; 18:509. [PMID: 37464385 DOI: 10.1186/s13018-023-03983-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND This study aims to explore the measurement of the angle between the axis of the pedicle and the lateral margin of the isthmus on the lumbar spine, and investigate its clinical significance. METHODS The angle was measured on 120 normal adults' X-ray and 25 dry anatomical specimens. 60 screws were placed by junior residents on 6 wet specimens through the freehand technique. 30 screws were placed on one side with their original experience. After learning the techniques mentioned in the study, 30 screws were placed on the other side. The specimens were examined by X-ray and CT, and the angles of the screw paths and the integrity of the pedicle were evaluated. RESULTS The angles of 120 subjects and 25 anatomical specimens show a gradually increasing trend. The differences among each segment were statistically significant (P < 0.05), but the difference in the same segment between the X-ray and the anatomical specimens was not statistically significant (P > 0.05). Furthermore, the differences in L1, L2, and L3 between the two genders were not statistically significant (P > 0.05). However, the angles were larger in female group than in male group in L4 and L5, and the differences were statistically significant (P < 0.05). The difference in the deviation rate of screw placement before and after the learning was statistically significant only in the L5 segment (P < 0.05). The difference in overall excellence rate was statistically significant (P < 0.05). CONCLUSIONS The measurement of the angle between the axis of the pedicle and the lateral margin of the isthmus on the lumbar can improve the accuracy of the lumbar sagittal screw angle.
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Affiliation(s)
- Shuiquan Wang
- Department of Anatomy, College of Basic Medicine, Xinjiang Medical University, Urumqi, China
| | - Dilimulati Aikeremu
- Department of 2nd Spine Surgery, People's Hospital of Xinjiang, Urumqi, China
| | - Alafate Kahaer
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yang Xiao
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abudusalamu Tuoheti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Rui Zhang
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xieraili Maimaiti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Paerhati Rexiti
- Departments of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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Kanna RM, Shetty AP, Rajasekaran S. "Satellite pedicle screws" - A novel technique of pedicle screw insertion in obese patients undergoing lumbar fusion. World Neurosurg X 2023; 19:100198. [PMID: 37168418 PMCID: PMC10165253 DOI: 10.1016/j.wnsx.2023.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/19/2023] [Indexed: 05/13/2023] Open
Abstract
The presence of thick sub-cutaneous fat and bulky paraspinal musculature mandates extensive surgical dissection in obese patients undergoing open Transforaminal lumbar interbody fusion surgery. Securing a 'converging' pedicle screw trajectory becomes difficult by the counterforces of the erector spinae muscles and thick sub-cutaneous fat in obese patients, especially at the L5-S1 level. We describe the use of a limited standard posterior midline exposure and a separate, far lateral 'satellite' incision to insert pedicle screws in an optimal trajectory in obese patients. Through proper pre-operative planning of the axial and sagittal MRI, the appropriate entry site is determined which is executed intra-operatively to insert pedicle screws freehand. Through a single 1.5 cm incision, both L5-S1 screws were inserted. Fourteen obese patients (mean BMI was 30.5 ± 1.1) received 56 satellite pedicle screws for TLIF at L5-S1 level. The mean age was 48.3 ± 9.7 years. The mean blood loss was 244.8 ± 114 ml and the mean operative time was 126.7 ± 82.8 min. In all patients, the screws were inserted as per pre-operative planning without any difficulties. All wounds healed well without wound complications. There were no screw related complications, and in the antero-posterior and lateral radiographs, there were no screw breaches. Satellite free-hand pedicle screws are safe and easily reproducible. They enable limited dissection of the main surgical wound and well-medialised converging pedicle screws in obese patients.
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Wu C, Deng J, Hu H, Shen D, Qin B, Wang X, Gao T, Xu L. Operative Effect Comparison of Flexible Drill Guiding vs. Traditional Drill Guiding Template for Lower Cervical Pedicle Screw Insertion: A Retrospective Analysis. Orthop Surg 2023. [PMID: 37345457 DOI: 10.1111/os.13773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/24/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
OBJECTIVE Accurately inserting pedicle screws is the key point of posterior pedicle screw fixation for lower cervical spine (C3-C7) instability. 3D printing technology can improve the accuracy of screw placement. This study compared the safety of 3D-printed flexible drill guiding template vs. traditional rigid drill guiding template for lower cervical pedicle screw insertion. METHODS This was a retrospective study. A total of 34 patients who underwent lower cervical pedicle screw fixation from March 2018 to May 2021 were enrolled in this study, and they were divided into the flexible drill flexible drill group and the traditional drill group. A total of 18 patients in the flexible drill flexible drill group underwent pedicle screw fixation assisted by 3D printed flexible drill guiding templates for the lower cervix, and 16 patients in the traditional drill group underwent pedicle screw fixation assisted by 3D printed regular drill guiding templates for the lower cervix. The length of the incision and intraoperative blood loss during surgery were recorded and compared for the two groups. The grade, deviation of the screw entry point, deviation of the screw medial angle and screw length were measured and compared after surgery for the two groups by independent-sample tests. RESULTS There was a significant difference in the length of the incision and blood loss between the two groups (P < 0.05). There was a significant difference between the two groups for grade (P = 0.016). The deviation of the screw entry point was 0.65 ± 0.50 mm in the flexible drill group and 0.78 ± 0.83 mm in the traditional drill group. The deviation of the screw medial angle was 2.14 ± 1.78 in the flexible drill group and 4.23 ± 2.51 in the traditional drill group, with a significant difference between the two groups (P < 0.05). CONCLUSION Compared with regular guiding techniques, lower cervical pedicle screw placement assisted by multistep navigation templates and flexible K-wires results in less trauma and better safety.
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Affiliation(s)
- Chao Wu
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong, China
- Institute of Digital Medicine, Zigong Academy of Big Data for Medical Science and Artificial Intelligence, Zigong, China
| | - Jiayan Deng
- Institute of Digital Medicine, Zigong Academy of Big Data for Medical Science and Artificial Intelligence, Zigong, China
| | - Haigang Hu
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong, China
| | - Danwei Shen
- Institute of Digital Medicine, Zigong Academy of Big Data for Medical Science and Artificial Intelligence, Zigong, China
| | - Binwei Qin
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong, China
- Department of Orthopaedics, Hospital of Southwest Medical University, Luzhou, China
| | - Xiangyu Wang
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong, China
| | - Tao Gao
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong, China
| | - Lian Xu
- Department of Orthopaedics, Zigong Fourth People's Hospital, Zigong, China
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Shahi P, Maayan O, Shinn D, Dalal S, Song J, Araghi K, Melissaridou D, Vaishnav A, Shafi K, Pompeu Y, Sheha E, Dowdell J, Iyer S, Qureshi SA. Floor-Mounted Robotic Pedicle Screw Placement in Lumbar Spine Surgery: An Analysis of 1,050 Screws. Neurospine 2023; 20:577-586. [PMID: 37401076 PMCID: PMC10323346 DOI: 10.14245/ns.2346070.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE To analyze the usage of floor-mounted robot in minimally invasive lumbar fusion. METHODS Patients who underwent minimally invasive lumbar fusion for degenerative pathology using floor-mounted robot (ExcelsiusGPS) were included. Pedicle screw accuracy, proximal level violation rate, pedicle screw size, screw-related complications, and robot abandonment rate were analyzed. RESULTS Two hundred twenty-nine patients were included. Most surgeries were primary single-level fusion. Sixty-five percent of surgeries had intraoperative computed tomography (CT) workflow, 35% had preoperative CT workflow. Sixty-six percent were transforaminal lumbar interbody fusion, 16% were lateral, 8% were anterior, and 10% were a combined approach. A total of 1,050 screws were placed with robotic assistance (85% in prone position, 15% in lateral position). Postoperative CT scan was available for 80 patients (419 screws). Overall pedicle screw accuracy rate was 96.4% (prone, 96.7%; lateral, 94.2%; primary, 96.7%; revision, 95.3%). Overall poor screw placement rate was 2.8% (prone, 2.7%; lateral, 3.8%; primary, 2.7%; revision, 3.5%). Overall proximal facet and endplate violation rates were 0.4% and 0.9%. Average diameter and length of pedicle screws were 7.1 mm and 47.7 mm. Screw revision had to be done for 1 screw (0.1%). Use of the robot had to be aborted in 2 cases (0.8%). CONCLUSION Usage of floor-mounted robotics for the placement of lumbar pedicle screws leads to excellent accuracy, large screw size, and negligible screw-related complications. It does so for screw placement in prone/lateral position and primary/revision surgery alike with negligible robot abandonment rates.
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Affiliation(s)
| | - Omri Maayan
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | | | | | - Junho Song
- Hospital for Special Surgery, New York, NY, USA
| | | | | | | | - Karim Shafi
- Hospital for Special Surgery, New York, NY, USA
| | - Yuri Pompeu
- Hospital for Special Surgery, New York, NY, USA
| | - Evan Sheha
- Hospital for Special Surgery, New York, NY, USA
| | | | - Sravisht Iyer
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Sheeraz A. Qureshi
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
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Song F, Liu Y, Fu R, Gao X, Iqbal K, Yang D, Liu Y, Yang H. Craniocaudal toggling increases the risk of screw loosening in osteoporotic vertebrae. Comput Methods Programs Biomed 2023; 238:107625. [PMID: 37263117 DOI: 10.1016/j.cmpb.2023.107625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Screw loosening remains a prominent problem for osteoporotic patients undergoing pedicle screw fixation surgeries but its underlying mechanisms are not fully understood. This study sought to examine the interactive effect of craniocaudal or axial cyclic loading (toggling) and osteoporosis on screw fixation. METHODS QCT-based finite element models of normal (n = 7; vBMD = 156 ± 13 mg/cm3) and osteoporotic vertebrae (n = 7; vBMD = 72 ± 6 mg/cm3) were inserted with pedicle screws and loaded with or without craniocaudal toggling. Among them, a representative normal vertebra (age: 55; BMD: 140 mg/cm3) and an osteoporotic vertebra (age: 64; BMD: 79 mg/cm3) were also loaded with or without axial toggling. The individual and interactive effects of craniocaudal toggling and osteoporosis on screw fixation strength (the force when the pull-up displacement of the screw head reached 1 mm) and bone tissue failure (characterized by equivalent plastic strain) were examined by repeated measure ANOVA. RESULTS A significant interactive effect between craniocaudal toggling and osteoporosis on screw fixation strength was detected (p = 0.008). Specifically, craniocaudal toggling led to a marked decrease in the fixation strength (68%, p < 0.05) and stiffness (83%, p < 0.05) only in the osteoporotic vertebrae but had no effect on screw fixation strength and stiffness of the normal vertebrae (p > 0.05). Likewise, most of the bone tissues around the screw in the osteoporotic vertebrae yielded following craniocaudal toggling whereas this result was not seen in the normal vertebrae. The axial toggling had no significant effect on bone tissue failure as well as pedicle screw fixation in normal or osteoporotic vertebrae. CONCLUSIONS Craniocaudal toggling substantially reduces the screw fixation strength of the osteoporotic vertebrae by progressively increasing tissue failure around the screw, and therefore may contribute to the higher rates of screw loosening in osteoporotic compared to normal patients, whereas axial toggling is not a risk factor for pedicle screw loosening in normal or osteoporotic patients.
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Affiliation(s)
- Fei Song
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Yang Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Ruisen Fu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Xing Gao
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Kamran Iqbal
- Key Laboratory of Urban Security and Disaster Engineering of Ministry of Education, Beijing University of Technology, Beijing, China
| | - Dongyue Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Yuxuan Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Haisheng Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China.
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Wang Y, Kahaer A, Maimaiti A, Guo H, Rexiti P. Complication, fusion, and revision rate in the lumbar cortical bone trajectory and pedicle screw fixation techniques: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:382. [PMID: 37226223 DOI: 10.1186/s13018-023-03820-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/02/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND To obtain the complication rate, fusion rate, and revision rate of the lumbar cortical bone trajectory technique and pedicle screw fixation technique in lumbar interbody fusion surgery by single-arm meta-analysis and lay a basis for orthopedic surgeons to select the fixation techniques and perioperative management. METHODS PubMed, Ovid Medline, Web of Science, CNKI, and Wanfang databases were searched comprehensively. Data extraction, content analysis, and quality assessment of the literature were performed by two independent reviewers according to the Cochrane Collaboration guidelines using R and STATA software for single-arm meta-analysis. RESULTS The total complication rate of the lumbar cortical bone trajectory technique was 6%, including a hardware complication rate of 2%, ASD (adjacent segment degeneration) rate of 1%, wound infection rate of 1%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 1%. Lumbar pedicle screw fixation techniques had a total complication rate of 9%, with a hardware complication rate of 2%, ASD rate of 3%, wound infection rate of 2%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 5%. This study was registered with PROSPERO, CRD42022354550. CONCLUSION Lumbar cortical bone trajectory was associated with a lower total complication rate, ASD rate, wound infection rate, and revision rate than pedicle screw fixation. The cortical bone trajectory technique reduces the incidence of intraoperative and postoperative complications and can be an alternative in lumbar interbody fusion surgery.
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Affiliation(s)
- Yixi Wang
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University), China Ministry of Education, Urumqi, China.
- Xinjiang Clinical Research Center for Orthopedics, Xinjiang Medical University, Urumqi, China.
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Yuan J, Zhang XJ, Huang XG, Dai L, Liu C. [Treatment of spinal burst fractures with pedicle screw fixation at high altitude area]. Zhongguo Gu Shang 2023; 36:450-3. [PMID: 37211938 DOI: 10.12200/j.issn.1003-0034.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE According to the characteristics of spinal burst fractures in high-altitude areas and the local medical conditions, to explore the clinical efficacy of short-segment fixation with pedicle screws combined with screw placement in injured vertebrae in the treatment of thoracolumbar burst fractures. METHODS From August 2018 to December 2021, 12 patients with single-vertebral thoracolumbar burst fractures without neurological symptoms were treated with injured vertebral screw placement technique, including 7 males and 5 females;aged 29 to 54 years old, with an average of(42.50±7.95) years old;6 cases of traffic accident injury, 4 cases of high fall injury, 2 cases of heavy object injury;2 cases of T11, 4 cases of T12, 3 cases of L1, 2 cases of L2, and 1 case of L3. In the operation, screws were first placed in the upper and lower vertebrae of the fracture, pedicle screws were placed in the injured vertebra, and connecting rods were installed, and the fractured vertebral body was reset by positioning and distraction. Visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) scoring were used to evaluate the changes in pain and quality of life of patients, and the kyphotic correction rate and correction loss rate of the injured segment were measured by X-ray. RESULTS All operations were successful without significant intraoperative complications. All 12 patients were followed up, the duration ranged from 9 to 27 months, with an mean of (17.75±5.79) months. VAS at 3 days after operation was significantly higher than that at admission (t=6.701, P=0.000). There was significant difference in JOA score between 9 months after operation and at admission (t=5.085, P=0.000). Three days after operation, Cobb angle was (4.42±1.16)°, and the correction rate was (82±5)% compared with (25.67±5.71)° at admission. Cobb angle was (5.08±1.24) °at 9 months after operation, with a corrected loss rate of (16±13)%. No loosening or breakage of internal fixation was found. CONCLUSION Under the high-altitude hypobaric and hypoxic environment, the effect of the operation should be ensured while reducing the trauma. The application of the technique of placing screws on the injured vertebra can effectively restore and maintain the height of the injured vertebra, with less bleeding and shorter fixed segments, which is an effective method.
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Affiliation(s)
- Jun Yuan
- Dingri County People's Hospital, Shigatse 858200, Xizang Zizhiqu, China; Songjiang District Sijing Hospital, Shanghai 201601, China
| | - Xin-Jun Zhang
- Dingri County People's Hospital, Shigatse 858200, Xizang Zizhiqu, China; Songjiang District Sijing Hospital, Shanghai 201601, China
| | - Xiao-Gang Huang
- Dingri County People's Hospital, Shigatse 858200, Xizang Zizhiqu, China; Songjiang District Sijing Hospital, Shanghai 201601, China
| | - Lei Dai
- Dingri County People's Hospital, Shigatse 858200, Xizang Zizhiqu, China; Songjiang District Central Hospital, Shanghai 201600, China
| | - Chao Liu
- Dingri County People's Hospital, Shigatse 858200, Xizang Zizhiqu, China; Songjiang District Central Hospital, Shanghai 201600, China
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Zhang R, Kahaer A, Niu H, Wang J, Jumahan A, Qiu Y, Guo H, Rexiti P. Biomechanical evaluation of the hybrid pedicle screw-cortical bone trajectory technique in transforaminal lumbar interbody fusion to adjacent segment degeneration-finite element analysis. BMC Musculoskelet Disord 2023; 24:409. [PMID: 37221546 DOI: 10.1186/s12891-023-06411-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 04/07/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Transforaminal lumbar interbody fusion is an effective surgical treatment of intervertebral disk herniation. However, its clinical efficacy for adjacent segment disk degeneration (ASDD) after hybrid bilateral pedicle screw - bilateral cortical screw (pedicle screw at L4 and cortical bone trajectory screw at L5) and hybrid bilateral cortical screw - bilateral pedicle screw (bilateral cortical screw at L4 and bilateral pedicle screw at L5) remains undiscovered. Therefore, the aim of this study is to evaluate the effect of the hybrid bilateral pedicle screw - bilateral cortical screw and hybrid bilateral cortical screw - bilateral pedicle screw on the adjacent segment via a 3-dimensional (3D) finite element (FE) analysis. METHODS Four human cadaveric lumbar spine specimens were provided by the anatomy teaching and research department of Xinjiang Medical University. Four finite element models of L1-S1 lumbar spine segment were generated. For each of these, four lumbar transforaminal lumbar interbody fusion models at L4-L5 segment with the following instruments were created: hybrid bilateral pedicle screw - bilateral cortical screw, bilateral cortical screw - bilateral cortical screw (bilateral cortical screw at both L4 and L5 segments), bilateral pedicle screw - bilateral pedicle screw (bilateral pedicle screw at both L4 and L5 segments), and hybrid bilateral cortical screw - bilateral pedicle screw. A 400-N compressive load with 7.5 Nm moments was applied for the simulation of flexion, extension, lateral bending, and rotation. The range of motion of L3-L4 and L5-S1 segments and von Mises stress of the intervertebral disc at the adjacent segment were compared. RESULTS Hybrid bilateral pedicle screw - bilateral cortical screw has the lowest range of motion at L3-L4 segment in flexion, extension, and lateral bending, and the highest disc stress in all motions, while the range of motion at L5-S1 segment and disc stress was lower than bilateral pedicle screw - bilateral pedicle screw in flexion, extension, and lateral bending, and higher than bilateral cortical screw - bilateral cortical screw in all motions. The range of motion of hybrid bilateral cortical screw - bilateral pedicle screw at L3-L4 segment was lower than bilateral pedicle screw - bilateral pedicle screw and higher than bilateral cortical screw - bilateral cortical screw in flexion, extension, and lateral bending, and the range of motion at L5-S1 segment was higher than bilateral pedicle screw - bilateral pedicle screw in flexion, lateral bending, and axial rotation. The disc stress at L3-L4 segment was lowest and more dispersed in all motions, and the disc stress at L5-S1 segment was higher than bilateral pedicle screw - bilateral pedicle screw in lateral bending and axial rotation, but more dispersed. CONCLUSION Hybrid bilateral cortical screw - bilateral pedicle screw decreases the impact on adjacent segments after spinal fusion, reduces the iatrogenic injury to the paravertebral tissues, and provides throughout decompression of the lateral recess.
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Affiliation(s)
- Rui Zhang
- Second Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, China
| | - Hanqian Niu
- Fifth Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Jingwen Wang
- Second Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Ayididaer Jumahan
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Yanning Qiu
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, China.
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan South Road, Urumqi, China.
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Yuan YF, Ren ZX, Zhang C, Li GJ, Liu BZ, Li XD, Miao J, Li JF. Multitrack and multianchor point screw technique combined with the Wiltse approach for lesion debridement for lumbar tuberculosis. World J Clin Cases 2023; 11:3167-3175. [PMID: 37274032 PMCID: PMC10237128 DOI: 10.12998/wjcc.v11.i14.3167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/01/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND The incidence of lumbar tuberculosis is high worldwide, and effective treatment is a continuing problem.
AIM To study the safety and efficacy of the multitrack and multianchor point screw technique combined with the contralateral Wiltse approach for lesion debridement to treat lumbar tuberculosis.
METHODS The C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) score, oswestry disability index (ODI) and American Spinal Injury Association (ASIA) grade were recorded and analysed pre- and postoperatively.
RESULTS The CRP level and ESR returned to normal, and the VAS score and ODI were decreased at 3 mo postoperatively, with significant differences compared with the preoperative values (P < 0.01). Neurological dysfunction was relieved, and the ASIA grade increased, with no adverse events.
CONCLUSION The multitrack, multianchor point screw fixation technique combined with the contralateral Wiltse approach for debridement is an effective and safe method for the treatment of lumbar tuberculosis.
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Affiliation(s)
- Yu-Fei Yuan
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Zhi-Xin Ren
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Cun Zhang
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Guan-Jun Li
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Bing-Zhi Liu
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Xiao-Dong Li
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Jie Miao
- Department of Orthopedic Surgery, Handan Central Hospital, Handan 056001, Hebei Province, China
| | - Jian-Fei Li
- Department of CT, Handan Central Hospital, Handan 056001, Hebei Province, China
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Li Y, Wang Y, Ma X, Ma J, Dong B, Yang P, Sun Y, Zhou L, Shen J. Comparison of short-term clinical outcomes between robot-assisted and freehand pedicle screw placement in spine surgery: a meta-analysis and systematic review. J Orthop Surg Res 2023; 18:359. [PMID: 37189203 DOI: 10.1186/s13018-023-03774-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/01/2023] [Indexed: 05/17/2023] Open
Abstract
STUDY DESIGN Meta-analysis and systematic review. BACKGROUND Robot-assisted pedicle screw placement technique offers greater accuracy than the traditional freehand screw placement technique. However, it is controversial whether there is a difference between the two procedures in terms of improved clinical outcomes. MATERIALS AND METHODS We systematically searched PubMed, EMBASE, Cochrane, and Web of Science to identify potentially eligible articles. Indispensable data such as the year of publication, study type, age, number of patients, sex distribution, and outcomes were extracted. The outcome indicators of interest included Oswestry disability index (ODI), visual analog scale (VAS) score, operative time, intraoperative blood loss, and post-operative length of stay. RevMan 5.4.1 was used for the meta-analysis. RESULTS A total of eight studies with 508 participants were included. Eight were related to ΔVAS, six were related to ΔODI, seven were related to operative time, five were related to intraoperative blood loss, and seven were related to the length of hospitalization. The results showed that, in terms of ΔVAS (95% CI, -1.20 to -0.36, P = 0.0003) and ΔODI (95% CI, -2.50 to -0.48, P = 0.004), robot-assisted pedicle screw placement technique scored higher than traditional freehand technique. Additionally, the intraoperative blood loss (95% CI, -140.34 to -10.94, P = 0.02) and the length of hospitalization (95% CI, -2.59 to -0.31, P = 0.01) for patients who underwent robotic-assisted pedicle screw placement were less than that of those who underwent the conventional freehand screw placement. No significant difference was found between robot-assisted techniques and conventional freehand techniques in pedicle screw placement in surgical time (95% CI, -2.24 to 26.32, P = 0.10). CONCLUSIONS Robot-assisted technique helps improve short-term clinical outcomes, reduce intraoperative blood loss and patient suffering, and shorten recovery time compared to the freehand technique.
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Affiliation(s)
- Yiyang Li
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
| | - Yan Wang
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
| | - Xinlong Ma
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China.
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China.
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China.
| | - Jianxiong Ma
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China.
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China.
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China.
| | - Benchao Dong
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
| | - Peichuan Yang
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
| | - Yadi Sun
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
| | - Liyun Zhou
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
| | - Jiahui Shen
- Tianjin Hospital of Tianjin University (Tianjin Hospital), Tianjin, 300211, People's Republic of China
- Tianjin Orthopedic Institute, Tianjin, 300050, People's Republic of China
- Tianjin Key Laboratory of Orthopedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
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Benito R, Bertelsen Á, de Ramos V, Iribar-Zabala A, Innocenti N, Castelli N, Lopez-Linares K, Scorza D. Fast and versatile platform for pedicle screw insertion planning. Int J Comput Assist Radiol Surg 2023:10.1007/s11548-023-02940-z. [PMID: 37160582 DOI: 10.1007/s11548-023-02940-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/24/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Computer-assisted surgical planning methods help to reduce the risks and costs in transpedicular fixation surgeries. However, most methods do not consider the speed and versatility of the planning as factors that improve its overall performance. In this work, we propose a method able to generate surgical plans in minimal time, within the required safety margins and accounting for the surgeon's personal preferences. METHODS The proposed planning module takes as input a CT image of the patient, initial-guess insertion trajectories provided by the surgeon and a reduced set of parameters, delivering optimal screw sizes and trajectories in a very reduced time frame. RESULTS The planning results were validated with quantitative metrics and feedback from surgeons. The whole planning pipeline can be executed at an estimated time of less than 1 min per vertebra. The surgeons remarked that the proposed trajectories remained in the safe area of the vertebra, and a Gertzbein-Robbins ranking of A or B was obtained for 95 % of them. CONCLUSIONS The planning algorithm is safe and fast enough to perform in both pre-operative and intra-operative scenarios. Future steps will include the improvement of the preprocessing efficiency, as well as consideration of the spine's biomechanics and intervertebral rod constraints to improve the performance of the optimisation algorithm.
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Affiliation(s)
- Rafael Benito
- Digital Health and Biomedical Applications, Vicomtech, San Sebastián, Basque Country, Spain.
| | - Álvaro Bertelsen
- Digital Health and Biomedical Applications, Vicomtech, San Sebastián, Basque Country, Spain
- Bioengineering Area, Biodonostia Health Research Institute, San Sebastián, Basque Country, Spain
| | - Verónica de Ramos
- Digital Health and Biomedical Applications, Vicomtech, San Sebastián, Basque Country, Spain
| | - Amaia Iribar-Zabala
- Digital Health and Biomedical Applications, Vicomtech, San Sebastián, Basque Country, Spain
| | - Niccoló Innocenti
- Functional Neurosurgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Nicoló Castelli
- Functional Neurosurgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Karen Lopez-Linares
- Digital Health and Biomedical Applications, Vicomtech, San Sebastián, Basque Country, Spain
- Bioengineering Area, Biodonostia Health Research Institute, San Sebastián, Basque Country, Spain
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Lin Y, Xu J, Zheng W. The Fusion Rate of Cortical Bone Trajectory Screw Fixation and Pedicle Screw Fixations in L4-5 Interbody Fusion: A Retrospective Cohort Study. Orthop Surg 2023; 15:1281-1288. [PMID: 37073082 PMCID: PMC10157714 DOI: 10.1111/os.13704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVE Although cortical bone trajectory (CBT) screw fixation has been used for several years, the number of studies on its fusion effects is limited. Furthermore, several studies report conflicting outcomes. We aimed to compare the fusion rates and clinical efficacy of CBT screw fixation and pedicle screw (PS) fixation for L4-L5 interbody fusion. METHODS This study was a retrospective cohort control study. Patients with lumbar degenerative disease who underwent L4-L5 oblique lumbar interbody fusion (OLIF) or posterior decompression using CBT screws between February 2016 and February 2019 were included. Patients in whom PS was used were matched for age, sex, height, weight, and BMI. Record the operation time, blood loss. All enrolled patients underwent lumbar CT imaging at one-year follow-up to evaluate the fusion rate. At the two-year follow-up the visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopaedic Association scores (JOA) were used to identify symptom improvement. Independent t-test was used for the comparison, and score data were analyzed using the χ2 and exact probability tests. RESULTS A total of 144 patients with were included. All patients were followed-up postoperatively for 25-36 months (average 32.42 ± 10.55 months). Twenty-eight patients underwent OLIF and CBT screw fixation, 36 underwent OLIF and PS fixation, 32 underwent posterior decompression and CBT screw fixation, and 48 underwent posterior decompression and PS fixation. The fusion rates following CBT screw and PS fixations in OLIF were 92.86% (26/28) and 91.67% (33/36), respectively (P = 1). The fusion rates following CBT screw and PS fixations in posterior decompression were 93.75% (30/32) and 93.75% (45/48), respectively (P > 0.05). Regardless of OLIF or posterior decompression, there were no significant differences in the VAS, ODI, and JOA scores between patients treated with CBT and PS (P > 0.05). CONCLUSION CBT screw fixation can achieve a satisfactory interbody fusion rate with a clinical efficacy similar to that of PS in patients with lumbar degenerative disease, regardless of whether OLIF or posterior decompression was performed.
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Affiliation(s)
- Yuhe Lin
- Department of Orthopedic, Fujian Provincial Hospital, Fuzhou, China
| | - Jie Xu
- Department of Orthopedic, Fujian Provincial Hospital, Fuzhou, China
| | - Wu Zheng
- Department of Orthopedic, Fujian Provincial Hospital, Fuzhou, China
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Kahaer A, Zhang R, Wang Y, Luan H, Maimaiti A, Liu D, Shi W, Zhang T, Guo H, Rexiti P. Hybrid pedicle screw and modified cortical bone trajectory technique in transforaminal lumbar interbody fusion at L4-L5 segment: finite element analysis. BMC Musculoskelet Disord 2023; 24:288. [PMID: 37055739 PMCID: PMC10099636 DOI: 10.1186/s12891-023-06385-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/30/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Investigate the biomechanical properties of the hybrid fixation technique with bilateral pedicle screw (BPS) and bilateral modified cortical bone trajectory screw (BMCS) in L4-L5 transforaminal lumbar interbody fusion (TLIF). METHODS Three finite element (FE) models of the L1-S1 lumbar spine were established according to the three human cadaveric lumbar specimens. BPS-BMCS (BPS at L4 and BMCS at L5), BMCS-BPS (BMCS at L4 and BPS at L5), BPS-BPS (BPS at L4 and L5), and BMCS-BMCS (BMCS at L4 and L5) were implanted into the L4-L5 segment of each FE model. The range of motion (ROM) of the L4-L5 segment, von Mises stress of the fixation, intervertebral cage, and rod were compared under a 400-N compressive load with 7.5 Nm moments in flexion, extension, bending, and rotation. RESULTS BPS-BMCS technique has the lowest ROM in extension and rotation, and BMCS-BMCS technique has the lowest ROM in flexion and lateral bending. The BMCS-BMCS technique showed maximal cage stress in flexion and lateral bending, and the BPS-BPS technique in extension and rotation. Compared to the BPS-BPS and BMCS-BMCS technique, BPS-BMCS technique presented a lower risk of screw breakage and BMCS-BPS technique presented a lower risk of rod breakage. CONCLUSION The results of this study support that the use of the BPS-BMCS and BMCS-BPS techniques in TLIF surgery for offering the superior stability and a lower risk of cage subsidence and instrument-related complication.
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Affiliation(s)
- Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, China
| | - Rui Zhang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, China
| | - Yixi Wang
- First Clinical Medical Institution, Xinjiang Medical University, Urumqi, China
| | - Haopeng Luan
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, China
| | - Dongshan Liu
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, China
| | - Wenjie Shi
- First Clinical Medical Institution, Xinjiang Medical University, Urumqi, China
| | - Tao Zhang
- Digital Orthopaedic Center of Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, China.
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Miyazaki M, Abe T, Sako N, Kanezaki S, Tsumura H. Analysis of accuracy of pedicle screw placement in dysplastic pedicles in adolescent idiopathic scoliosis using the pedicle expansion technique with CT-based navigation. J Orthop Sci 2023:S0949-2658(23)00089-1. [PMID: 37045687 DOI: 10.1016/j.jos.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/27/2023] [Accepted: 03/30/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND This study aimed to study the accuracy of pedicle screw (PS) insertion into dysplastic pedicles in adolescent idiopathic scoliosis (AIS) comparing cannulated screw using the pedicle expansion technique (PET) versus conventional technique. METHODS Forty-two AIS patients with 766 PSs were evaluated. In total, 236 screws were inserted into dysplastic pedicles: 138 and 98 screws were inserted using the PET (PET group) and standard technique (conventional group), respectively. Both methods used CT-based navigation to determine the insertion point. In the PET, a rigid ball tip feeler was tapped with a mallet to create an insertion route, a guide wire was passed through the tap, the pedicle was enlarged, and then a cannulated PS with a diameter of 4.35 mm was inserted. Postoperative CT was used to compare the accuracy of PS insertion. RESULTS In total, 23/236 (9.7%) perforations occurred. Regarding overall perforation, there were six (4.3%) and 17 (17.3%) cases in the PET and conventional group, respectively (P = 0.008). In terms of medial perforation, the PET group (n = 2, 1.4%) was significantly better than the conventional group (n = 7, 7.1%) (P = 0.021). In terms of lateral perforation, the PET group (n = 4, 2.9%) was significantly better than conventional group (n = 10, 10.2%) (P = 0.030). Only grade 1 perforation had occurred in the PET group, whereas grades 2 and 3 perforation occurred in the conventional group. CONCLUSION Use of the PET with CT-based navigation significantly increased the accuracy and safety of PS insertion in dysplastic pedicles in AIS.
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Affiliation(s)
- Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan.
| | - Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Noriaki Sako
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Yamada T, Hasegawa T, Yamato Y, Yoshida G, Banno T, Arima H, Oe S, Mihara Y, Ushirozako H, Ide K, Watanabe Y, Nakai K, Kurosu K, Matsuyama Y. Characteristics of pedicle screw misplacement using freehand technique in degenerative scoliosis surgery. Arch Orthop Trauma Surg 2023; 143:1861-1867. [PMID: 35194658 DOI: 10.1007/s00402-022-04380-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 02/05/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to estimate the accuracy of pedicle screw (PS) placement in degenerative scoliosis surgery, characterize a patient population with PS misplacement, and analyze the association between misplaced PS vector and lumbar coronal curve. METHODS In this study, 122 patients (average age 68.6 years), who underwent corrective and decompression surgery, were selected retrospectively. PS accuracy was evaluated in the thoracic to lumbar spine. We identified characteristics of misplacement in each patient. Screw positions were categorized into grade A, entirely in the pedicle; grade B, < 2 mm breach; grade C, 2-4 mm breach; and grade D, > 4 mm breach using postoperative computed tomography. RESULTS The mean preoperative lumbar coronal curve was 32.3 ± 18.4°, and the number of fused vertebrae was 8.9 ± 2.8. A total of 2032 PS were categorized as follows: grade A, 1897 PS (93.3%); grade B, 67 (3.3%); grade C, 26 (1.3%); and grade D, 43 (2.1%). One PS (grade D), inserted at T5, needed surgery for removal due to neurological deficit. The misplacement group (grades C and D) had a significantly stronger lumbar coronal curve and apical vertebral rotation than the accuracy group (grades A and B). Misplaced PS vector (direction and degree) was significantly correlated with inserted vertebral rotation. Grade D misplacement was distributed mainly around the transitional vertebra of the lumbar curve. CONCLUSIONS The accuracy of PS insertion in the thoracic to lumbar spine was high in DS surgery, but the need for care was highlighted in the transitional vertebra.
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Affiliation(s)
- Tomohiro Yamada
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan.
| | - Tomohiko Hasegawa
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Yu Yamato
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Go Yoshida
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Tomohiro Banno
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Hideyuki Arima
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Shin Oe
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Yuki Mihara
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Hiroki Ushirozako
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Koichiro Ide
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Yuh Watanabe
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Keiichi Nakai
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Kenta Kurosu
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
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Yamout T, Orosz LD, Good CR, Jazini E, Allen B, Gum JL. Technological Advances in Spine Surgery: Navigation, Robotics, and Augmented Reality. Orthop Clin North Am 2023; 54:237-246. [PMID: 36894295 DOI: 10.1016/j.ocl.2022.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Accurate screw placement is critical to avoid vascular or neurologic complications during spine surgery and to maximize fixation for fusion and deformity correction. Computer-assisted navigation, robotic-guided spine surgery, and augmented reality surgical navigation are currently available technologies that have been developed to improve screw placement accuracy. The advent of multiple generations of new technologies within the past 3 decades has presented surgeons with a diverse array of choices when it comes to pedicle screw placement. Considerations for patient safety and optimal outcomes must be paramount when selecting a technology.
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Affiliation(s)
- Tarek Yamout
- Virginia Spine Institute, 11800 Sunrise Valley Drive, Suite 800, Reston, VA 20191, USA
| | - Lindsay D Orosz
- National Spine Health Foundation, 11800 Sunrise Valley Drive, Suite 330, Reston, VA 20191, USA
| | - Christopher R Good
- Virginia Spine Institute, 11800 Sunrise Valley Drive, Suite 800, Reston, VA 20191, USA
| | - Ehsan Jazini
- Virginia Spine Institute, 11800 Sunrise Valley Drive, Suite 800, Reston, VA 20191, USA
| | - Brandon Allen
- National Spine Health Foundation, 11800 Sunrise Valley Drive, Suite 330, Reston, VA 20191, USA
| | - Jeffrey L Gum
- Norton Leatherman Spine Center, 210 East Gray Street Suite 900, Louisville, KY 40202, USA.
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