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Meng X, Zhong J, Yang F, Peng J, Li J, Yuan Y. Percutaneous cement-augmented short-segment pedicle screw fixation plus percutaneous vertebroplasty for stage III Kummell's disease without neurological symptoms: A case report. Int J Surg Case Rep 2024; 118:109440. [PMID: 38581935 PMCID: PMC11015437 DOI: 10.1016/j.ijscr.2024.109440] [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: 01/17/2024] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 04/08/2024] Open
Abstract
INTRODUCTION The incidence of stage III Kummell's disease without neurological symptoms is increasing in elderly patients with osteoporotic thoracolumbar fractures. However, the surgical method is still controversial in this condition. This report presented a case of Kummell's disease in which percutaneous bone cement-augmented short-segment pedicle screw fixation combined with percutaneous vertebroplasty was performed, providing a reference for the surgical approach. CASE PRESENTATION The patient was a 72-year-old female who presented unexplained lower back pain accompanied with limited mobility for the past three months. Based on her medical history, physical examinations, and imaging studies, it was confirmed that she had Kummell's disease in stage III without neurological symptoms. We treated her with percutaneous bone cement-augmented short-segment pedicle screw fixation combined with percutaneous vertebroplasty on the symptomatic vertebrae. CLINICAL DISCUSSION The majority of patients with stage III Kummell's disease have severe osteoporosis, which result in failure of the internal fixation and a series of other complications. Maintaining the stability of the internal fixation system is crucial, especially after screwing and subsequent locking. When augmented with bone cement, the grip and pull-out resistance of the percutaneous pedicle screws enhance greatly. Simultaneously, percutaneous vertebroplasty on the symptomatic vertebrae can immediately support the spine unit's stability mechanically and maintain the shape of the vertebrae after reduction. CONCLUSIONS The percutaneous bone cement-augmented short-segment pedicle screw fixation combined with percutaneous vertebroplasty on the symptomatic vertebrae is an effective treatment for stage III Kummell's disease without neurological symptoms. It can effectively restore the vertebral height, correct the kyphotic deformities, improve spinal canal stenosis, and achieve satisfactory short-term clinical outcomes.
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Affiliation(s)
- Xudong Meng
- Orthopedics Department, Yueyang Hospital Affiliated to Hunan Normal University, Yueyang 414000, Hunan Province, China
| | - Jiongbiao Zhong
- Orthopedics Department, Yueyang Hospital Affiliated to Hunan Normal University, Yueyang 414000, Hunan Province, China.
| | - Fan Yang
- Orthopedics Department, Yueyang Hospital Affiliated to Hunan Normal University, Yueyang 414000, Hunan Province, China
| | - Jiarui Peng
- Orthopedics Department, Yueyang Hospital Affiliated to Hunan Normal University, Yueyang 414000, Hunan Province, China
| | - Jiafu Li
- Orthopedics Department, Yueyang Hospital Affiliated to Hunan Normal University, Yueyang 414000, Hunan Province, China
| | - Ye Yuan
- Orthopedics Department, Yueyang Hospital Affiliated to Hunan Normal University, Yueyang 414000, Hunan Province, China
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Zhu C, Liang J, Pan H, Zhang W. Biportal endoscopic-assisted cortical bone trajectory screw placement and lumbar interbody fusion. Acta Neurochir (Wien) 2024; 166:74. [PMID: 38332369 DOI: 10.1007/s00701-024-05986-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Endoscopically assisted screw fixation with lumbar interbody fusion is rarely performed. We succeeded in implanting the cortical bone trajectory (CBT) screws under the guidance of unilateral biportal endoscopy (UBE). METHOD We attempted endoscopically assisted screw fixation in a patient with degenerative spondylolisthesis. Through a third portal, ipsilateral CBT screws were implanted without complications. CONCLUSIONS We successfully performed unilateral biportal endoscopic lumbar interbody fusion (ULIF) with CBT and reversed CBT screws. Compared with percutaneous pedicle screw (PPS) placement, this procedure is a minimally invasive, endoscopic alternative that allows precise screw placement.
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Affiliation(s)
- Chengyue Zhu
- Department of Orthopaedics, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Tiyuchang Road No. 453, Hangzhou, 310007, China
- Institute of Orthopaedics and Traumatology, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Tiyuchang Road No. 453, Hangzhou, 310007, China
| | - Jiaming Liang
- Department of Orthopaedics, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Tiyuchang Road No. 453, Hangzhou, 310007, China
| | - Hao Pan
- Department of Orthopaedics, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Tiyuchang Road No. 453, Hangzhou, 310007, China
- Institute of Orthopaedics and Traumatology, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Tiyuchang Road No. 453, Hangzhou, 310007, China
| | - Wei Zhang
- Department of Orthopaedics, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Tiyuchang Road No. 453, Hangzhou, 310007, China.
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Masuda S, Shimizu T, Sono T, Tamaki Y, Onishi E, Takemoto M, Odate S, Kimura H, Izeki M, Tomizawa T, Tsubouchi N, Fujibayashi S, Otsuki B, Murata K, Matsuda S. Recurrence rate after posterior percutaneous screw fixation without anterior debridement for pyogenic spondylitis compared with conservative treatment: a propensity score-matched analysis. Eur Spine J 2023; 32:4265-4271. [PMID: 37278875 DOI: 10.1007/s00586-023-07800-7] [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: 03/27/2023] [Revised: 05/03/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE Previous studies have shown that percutaneous pedicle screw (PPS) posterior fixation without anterior debridement for pyogenic spondylitis can improve patient quality of life compared with conservative treatment. However, data on the risk of recurrence after PPS posterior fixation compared with conservative treatment is lacking. The aim of this study was to compare the recurrence rate of pyogenic spondylitis after PPS posterior fixation without anterior debridement and conservative treatment. METHODS The study was conducted under a retrospective cohort design in patients hospitalized for pyogenic spondylitis between January 2016 and December 2020 at 10 affiliated institutions. We used propensity score matching to adjust for confounding factors, including patient demographics, radiographic findings, and isolated microorganisms. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for recurrence of pyogenic spondylitis during the follow-up period in the matched cohort. RESULTS 148 patients (41 in the PPS group and 107 in the conservative group) were included. After propensity score matching, 37 patients were retained in each group. PPS posterior fixation without anterior debridement was not associated with an increased risk of recurrence compared with conservative treatment with orthosis (HR, 0.80; 95% CI, 0.18-3.59; P = 0.77). CONCLUSIONS In this multi-center retrospective cohort study of adults hospitalized for pyogenic spondylitis, we found no association in the incidence of recurrence between PPS posterior fixation without anterior debridement and conservative treatment.
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Affiliation(s)
- Soichiro Masuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Sono
- Department of Orthopaedic Surgery, Fukui Red Cross Hospital, Fukui, Japan
| | - Yasuyuki Tamaki
- Department of Orthopaedic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan
| | - Eijiro Onishi
- Department of Orthopaedic Surgery, Kobe Central General Hospital, Kobe, Japan
| | - Mitsuru Takemoto
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Seiichi Odate
- Department of Orthopaedic Surgery, Gakkentoshi Hospital, Kyoto, Japan
| | - Hiroaki Kimura
- Department of Orthopaedic Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Masanori Izeki
- Department of Orthopaedic Surgery, Kansai Electric Power Hospital, Osaka, Japan
| | - Takuya Tomizawa
- Department of Orthopaedic Surgery, Tenri Hospital, Nara, Japan
| | - Naoya Tsubouchi
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Ishihara M, Taniguchi S, Adachi T, Tani Y, Paku M, Ando M, Saito T. Surgical Approaches and Short-Term Results of Circumferential Minimally Invasive Correction Surgery for Adult Idiopathic Scoliosis. World Neurosurg 2023; 178:37-47. [PMID: 37419315 DOI: 10.1016/j.wneu.2023.06.131] [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: 05/10/2023] [Accepted: 06/27/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE We present the surgical approaches and short-term (2 years postoperative) results pertaining to circumferential minimally invasive spine surgery (CMIS) with lateral lumbar interbody fusion (LLIF) and percutaneous pedicle screw application for adult idiopathic scoliosis (AS). METHODS We enrolled eight patients with AS who underwent CMIS (2018-2020) and examined the number of fused levels, upper instrumented vertebra, lower instrumented vertebra, number of LLIF-treated segments, number of preoperative intervertebral fusions, intraoperative blood loss, operative time, various spinopelvic parameters, Oswestry Disability Index, low back pain, visual analog scale (VAS), leg VAS, bone fusion rate, and perioperative complications. RESULTS The upper instrumented vertebra was T4, T7, T8, and T9 in two cases, whereas lower instrumented vertebra was the pelvis in all the cases. The average numbers of fixed vertebrae and segments that underwent LLIF were 13.3 ± 2.0 and 4.6 ± 0.7, respectively. All spinopelvic parameters improved significantly after surgery (thoracic kyphosis: P < 0.05, lumbar lordosis, cobb angle, pelvic tilt, pelvic incidence-lumbar lordosis, sagittal vertical axis: P < 0.001), and good alignment was achieved. The Oswestry Disability Index and VAS scores improved significantly (P < 0.001). The bone fusion rates achieved in the lumbosacral and thoracic spine were 100% and 88%, respectively. Only 1 patient showed postoperative coronal imbalance. CONCLUSIONS The 2-year postoperative results of CMIS for AS were good, and spontaneous bone fusion was confirmed in the thoracic spine without bone grafting. In this procedure, sufficient intervertebral release with LLIF and a percutaneous pedicle screw device translation technique enabled adequate global alignment correction. Therefore, correcting the global imbalance of the coronal and sagittal planes is more crucial than correcting scoliosis.
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Affiliation(s)
- Masayuki Ishihara
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata City, Osaka, Japan.
| | - Shinichirou Taniguchi
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata City, Osaka, Japan
| | - Takashi Adachi
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata City, Osaka, Japan
| | - Yoichi Tani
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata City, Osaka, Japan
| | - Masaaki Paku
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata City, Osaka, Japan
| | - Muneharu Ando
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata City, Osaka, Japan
| | - Takanori Saito
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata City, Osaka, Japan
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Yamamoto K, Matsuoka H, Ohashi S, Yamashiro K, Kazami K, Hirokawa Y, Narikiyo M, Nagasaki H, Tsuboi Y. Retroperitoneal hematoma: A rare complication of percutaneous pedicle screw in an osteoporotic patient. Surg Neurol Int 2023; 14:345. [PMID: 37810303 PMCID: PMC10559495 DOI: 10.25259/sni_701_2023] [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: 08/22/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Background Percutaneous pedicle screw (PPS) placement is an established technique for minimally invasive surgery. However, life-threatening hematomas may occur in osteoporotic patients undergoing percutaneous screw placement. Case Description An 80-year-old female with an osteoporotic T10 chance fracture developed a life-threatening hematoma following a T8-L3 posterior fusion performed with PPS. Prompt angiography diagnosed a life-threatening hematoma attributed to laceration of the left third lumbar artery occurring following pedicle screw (PS) placement into an osteoporotically fractured left L3 transverse process. This was immediately and successfully embolized. Conclusion An 80-year-old female with multiple lumbar osteoporotic fractures developed a life-threatening hematoma during a T8-L3 PS fusion. When the lumbar computed tomography angiography diagnosed a laceration of the left L3 lumbar artery, immediate transarterial embolization proved life-saving.
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Affiliation(s)
- Kohei Yamamoto
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kanagawa, Japan
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Pereira L, Pinto V, Reinas R, Kitumba D, Alves OL. Long-Term Clinical and Radiological Evaluation of Low-Grade Lumbar Spondylolisthesis Stabilization with Rigid Percutaneous Pedicle Screws. Acta Neurochir Suppl 2023; 135:417-423. [PMID: 38153503 DOI: 10.1007/978-3-031-36084-8_64] [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] [Indexed: 12/29/2023]
Abstract
The armamentarium of surgical treatment options for lumbar spondylolisthesis (LS) includes decompression alone, stabilization with interlaminar devices, or instrumented fusion, through open or minimally invasive approaches. Despite its safe profuse use in distinctive lumbar spine disorders, using percutaneous pedicle screws (PPSs) alone to stabilize LS has never been described before. We performed a retrospective study of prospectively collected data, enrolling 24 patients with LS and scrutinizing clinical and radiological outcomes. A statistically significant decrease in visual analog scale (VAS) scores (p < 0.001) and Oswestry Disability Index (ODI) scores (p < 0.001) was observed, as was a reduction in the intake of acetaminophen after surgery (p = 0.022). In the long-term, PPS effectively reduced the index-level range of motion (p < 0.001), reduced preoperative slippage (p = 0.03), and maintained foraminal height, thus accounting for the positive clinical outcomes. It induced a significant segmental kyphotic effect (p < 0.001) that was compensated for by a favorable increase in the pelvic incidence minus lumbar lordosis (PI-LL) index (0.028).
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Affiliation(s)
- L Pereira
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Porto, Portugal
| | - V Pinto
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Porto, Portugal
| | - R Reinas
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Porto, Portugal
| | - D Kitumba
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Porto, Portugal
- Department of Neurosurgery, Hospital Américo Boavida, Angola, Portugal
| | - O L Alves
- Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Porto, Portugal
- Department of Neurosurgery, Hospital Lusíadas Porto, Porto, Portugal
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Zhang X, Guo Y, Li Y. Comparison of the clinical efficacy of two fixation methods combined with OLIF in the treatment of lumbar spondylolisthesis in adult patients. J Orthop Surg Res 2022; 17:115. [PMID: 35189897 PMCID: PMC8862256 DOI: 10.1186/s13018-022-02991-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 02/03/2022] [Indexed: 11/27/2022] Open
Abstract
Background To observe the clinical efficacy of an anterior single rob-screw fixation (ASRSF) combined with the oblique lumbar intervertebral fusion (OLIF) approach compared with a posterior percutaneous screw fixation (PPSF) combined with OLIF in the treatment of lumbar spondylolisthesis. Method This is a retrospective case–control study. Patients with degenerative lumbar spondylolisthesis (DLS) treated with either ASRSF combined with OLIF or PPSF combined with OLIF from January 2016 to January 2018 were enrolled in this study. None of the patients had posterior decompression. The visual analog scale (VAS) and Oswestry dysfunction index (ODI) were used for clinical efficacy assessment. The pre- and post-operational disc height, height of foramen, subsidence, and migration of cages, fusion rate and surgery-related complications were compared between the two groups. Results Fifty-three patients were included in this single-center study. According to the fixation methods, patients were divided into the ASRSF group (group A, 25 cases) and the PPSF group (group B, 28 cases). There was no statistical difference in surgery-related complications between groups. There was a significant difference in the VAS score at one-week post-surgery (2.3 ± 0.5 vs. 3.5 ± 0.4, P = 0.01), and three months post-operation (2.2 ± 0.3 vs. 3.0 ± 0.3, P = 0.01). Comparison of post-operative imaging data showed that there was a significant difference in the height of the foramen between groups at three months post-surgery(18.1 ± 2.3 mm vs. 16.9 ± 1.9 mm, P = 0.04). At 24 months post-surgery, the ODI was 12.65 ± 3.6 in group A and 19.1 ± 3.4 in group B (P = 0.01). Twelve months after surgery, the fusion rate in group A at 72.0% and 78.6% in group B was not statistically significant (P = 0.75). Fusion was identified in all patients at 24 months post-surgery. Conclusion When compared to PPSF, ASRSF combined with OLIF for DLS can reduce post-operative low back pain in the initial stages, maintain the height of the foramen and improve the performance of lumbar function.
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Affiliation(s)
- Xinliang Zhang
- Department of Spine Surgery, Xi'an Jiaotong University Affiliated Honghui Hospital, Xi'an, 710000, Shaanxi, China
| | - Yunshan Guo
- Department of Spine Surgery, Xi'an Jiaotong University Affiliated Honghui Hospital, Xi'an, 710000, Shaanxi, China
| | - Yibing Li
- Department of Spine Surgery, Xi'an Jiaotong University Affiliated Honghui Hospital, Xi'an, 710000, Shaanxi, China.
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Bodon G, Degreif J. Fluoroscopy-based percutaneous posterior screw placement in the lateral position using the tunnel view technique: technical note. Eur Spine J 2022; 31:2204-2211. [PMID: 35113237 DOI: 10.1007/s00586-022-07126-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 07/12/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Lumbar fusion using lateral single position surgery (LSPS) gained popularity during the last few years. While prone percutaneous pedicle screw placement is well described, placing percutaneous pedicle screws with the patient in the lateral position is considered the most complicated part of LSPS. In this article we describe the fluoroscopy navigated technique for lateral percutaneous screw placement using the tunnel view technique. METHODS The radiologic background and principles of the tunnel view technique are described. In addition, the special positioning of the patient, the C-arm and the surgical technique is discussed in detail. RESULTS This technique is used as the standard for percutaneous screw placement in the prone or lateral positions in our department since 2017. Since the introduction of this technique we have had 0% reoperation rate for symptomatic malpositioned pedicle screws. CONCLUSION The tunnel view technique simplifies pedicle screw placement while allowing for permanent observation of pedicle walls and the superior joint surface during placement of the Jamshidi needle. It also allows for confirmation of intrapedicular position of the screw after its implantation. This technique is safe and feasible in our clinical experience.
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Affiliation(s)
- Gergely Bodon
- Department of Orthopaedic Surgery and Traumatology, Klinikum Esslingen, Hirschlandstrasse 97, 73730, Esslingen, Germany. .,Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embriology, Semmelweis University, Budapest, Hungary.
| | - Juergen Degreif
- Department of Orthopaedic Surgery and Traumatology, Klinikum Esslingen, Hirschlandstrasse 97, 73730, Esslingen, Germany
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Li X, Guan Z, Chen X, Chen B, Kong L, Han J, Zhang W. Modified minimally invasive technique for decompression and reduction of thoracolumbar burst fracture with neurological symptoms: Technical Note. J Orthop Surg Res 2021; 16:626. [PMID: 34663409 PMCID: PMC8525019 DOI: 10.1186/s13018-021-02783-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/06/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose There are few reports about minimally invasive decompression and fixation for patients with thoracolumbar fracture and neurological symptoms. The previously reported method requires complete laminectomy, and removal of the medial part of the pedicle to expose the spinal canal for reduction. Thus, some approach-related damage to the bony structure and soft tissue still occurs. This study was performed to describe a modified minimally invasive tube technique for decompression and reduction of thoracolumbar fracture with neurological symptoms. This modified technique preserves most of the posterior structures of the spine as well as the muscle. Methods Percutaneous pedicle screws were placed on the vertebrae superior and inferior to the fracture and at the fracture segment on the side with less severe symptoms. After retraction, the tube for decompression was placed on the facet joint where the decompression was needed. Under microscopic vision, part of the lamina and ligamentum flavum were removed to expose the spinal canal, and an L-shaped probe was used to reduce the bone fragment. Results The modified method was successfully used in eight patients. Complete decompression was achieved and the bone fragment was safely reduced through the tube under microscopy in all cases. Fluoroscopy confirmed that the positioning of the percutaneous pedicle screw was good and the bone fragment was reduced. The neurological status was improved in all patients at last follow up. Conclusion The modified method of minimally invasive decompression and fusion is effective in treating thoracolumbar fractures with neurological symptoms and preserves most of the ligaments and bone structure.
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Affiliation(s)
- Xu Li
- Spine Center, Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, People's Republic of China
| | - Zhiyuan Guan
- Department of Orthopedics, The Shanghai Tenth People's Hospital of Tongji University, Shanghai, People's Republic of China
| | - Xiao Chen
- Spine Center, Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, People's Republic of China
| | - Buzhou Chen
- Spine Center, Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, People's Republic of China
| | - Lei Kong
- Spine Center, Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, People's Republic of China
| | - Jintao Han
- Peking University Third Hospital Intervention and Vascular Surgery N0, 38 Xueyuan Road, Beijing, 100083, People's Republic of China
| | - Wenzhi Zhang
- Spine Center, Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, People's Republic of China.
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Hiyama A, Katoh H, Nomura S, Sakai D, Watanabe M. Intraoperative computed tomography-guided navigation versus fluoroscopy for single-position surgery after lateral lumbar interbody fusion. J Clin Neurosci 2021; 93:75-81. [PMID: 34656265 DOI: 10.1016/j.jocn.2021.08.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 06/04/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 02/02/2023]
Abstract
There are no reports comparing fluoroscopy and intraoperative computed tomography (CT) navigation in lateral single-position surgery (SPS) in terms of surgical outcomes or implant-related complications. Therefore, the purpose of this study was to use radiological evaluation to compare the incidence of instrument-related complications in SPS of lateral lumbar interbody fusion (LLIF) using fluoroscopy with that using CT navigation techniques. We evaluated 99 patients who underwent lateral SPS. Twenty-six patients had a percutaneous pedicle screw (PPS) inserted under fluoroscopy (SPS-C group), and 73 patients had a PPS inserted under intraoperative CT navigation (SPS-O group). Average operation time was shorter in the SPS-C group than in the SPS-O group (88.4 ± 24.4 min versus 111.9 ± 35.3 min, respectively, P = 0.003). However, there was no significant difference between the two groups in postoperative thigh symptoms or reoperation rate. The screw insertion angle of the SPS-C group was smaller than that of the SPS-O group, but there was no significant difference in the rate of screw misplacement (4.6% versus 3.4%, respectively, P = 0.556). By contrast, facet joint violation (FJV) was significantly lower in the SPS-O group than in the SPS-C group (8.4% versus 21.3%, respectively, P < 0.001). While fluoroscopy was superior to intraoperative CT navigation in terms of mean surgery time, there was no significant difference in the accuracy of PPS insertion between fluoroscopy and intraoperative CT navigation. The advantage of intraoperative CT navigation over fluoroscopy is that it significantly decreases the occurrence of FJV in SPS.
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Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
| | - Satoshi Nomura
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
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Takahashi Y, Funao H, Yoshida K, Sasao Y, Nishiyama M, Isogai N, Ishii K. Sequential MRI Changes After Lateral Lumbar Interbody Fusion in Spondylolisthesis with Mild and Severe Lumbar Spinal Stenosis. World Neurosurg 2021; 152:e289-e296. [PMID: 34062297 DOI: 10.1016/j.wneu.2021.05.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/08/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We assessed the sequential magnetic resonance imaging changes of indirect neural decompression after minimally invasive lumbar lateral interbody fusion (LIF) combined with posterior percutaneous pedicle screw (PPS) fixation for degenerative spondylolisthesis (DS) according to the severity of preoperative lumbar spinal stenosis. METHODS A total of 43 patients (mean age, 68.7 years; 16 men and 27 women) with DS who had undergone LIF and closed reduction with PPS fixation were enrolled. The intervertebral levels were divided into the moderate stenosis (MS) group (preoperative cross-sectional area [CSA] of the thecal sac >50 mm2) and severe stenosis (SS) group (CSA ≤50 mm2). The CSA, ligamentum flavum thickness, and diameter of the thecal sac at the affected level were measured on cross-sectional magnetic resonance images at baseline, immediately postoperatively, and 2 years postoperatively. RESULTS For the 31 and 29 intervertebral levels in the MS and SS groups, the mean CSA at baseline, immediately postoperatively, and 2 years postoperatively was 76.9 mm2 and 35.8 mm2, 104.3 mm2 and 81.4 mm2, and 130.9 mm2 and 105.7 mm2, respectively. The mean ligamentum flavum thicknesses at 2 years postoperatively became thinner than that immediately after surgery in both groups (P < 0.01). The mean diameter of the thecal sac at 2 years was longer than that immediately after surgery in both groups (MS group, P < 0.05; SS group, P < 0.01) The expansion ratio of the CSA at 2 years postoperatively was significantly greater in the SS group than that in the MS group (P < 0.01). CONCLUSIONS Sequential enlargement of the spinal canal was obtained by the thinning of the ligamentum flavum after LIF and PPS fixation in patients with DS with both mild and severe stenosis. The effect of indirect neural decompression was equivalent even in those with severe lumbar spinal stenosis.
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Affiliation(s)
- Yoshiyuki Takahashi
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Otawara, Japan; Department of Orthopaedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare - Mita Hospital, Tokyo, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Otawara, Japan; Department of Orthopaedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare - Mita Hospital, Tokyo, Japan; Department of Orthopaedic Surgery, International University of Health and Welfare - Narita Hospital, Narita City, Japan
| | - Kodai Yoshida
- Department of Orthopaedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare - Mita Hospital, Tokyo, Japan
| | - Yutaka Sasao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Otawara, Japan; Department of Orthopaedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare - Mita Hospital, Tokyo, Japan
| | - Makoto Nishiyama
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Otawara, Japan; Department of Orthopaedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare - Mita Hospital, Tokyo, Japan
| | - Norihiro Isogai
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Otawara, Japan; Department of Orthopaedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare - Mita Hospital, Tokyo, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Otawara, Japan; Department of Orthopaedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare - Mita Hospital, Tokyo, Japan; Department of Orthopaedic Surgery, International University of Health and Welfare - Narita Hospital, Narita City, Japan.
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Tanaka M, Singh M, Fujiwara Y, Uotani K, Arataki S, Yamauchi T, Nakanishi K. Minimally Invasive Thoracolumbar Corpectomy and Percutaneous Pedicle Screw Fixation with Computer-Assisted Rod-Bending System in Single Lateral Position: Technical Note. World Neurosurg 2021; 151:138-144. [PMID: 34020059 DOI: 10.1016/j.wneu.2021.05.028] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Thoracolumbar corpectomy and percutaneous pedicle screw (PPS) fixation is becoming the standard method for correcting and stabilizing malalignment of spine, as is often seen in osteoporotic vertebral fracture. Nowadays, this procedure can be performed in a single lateral position with navigation. For an osteoporotic spine, accurate rod bending is necessary to prevent screw back-out. We describe a new technique using the spinal rod-bending system in a single lateral position. METHODS A 71-year-old woman presented with severe back pain and impending paraplegia secondary to L1 osteoporotic vertebral fracture. We performed minimally invasive L1 corpectomy with an expandable vertebral cage and short-segment PPS with computer-assisted rod bending in a single lateral position under navigation guidance. RESULTS The patient was successfully treated with surgery, and her low back pain improved. Her clinical outcomes improved; the Oswestry Disability Index went from 54% to 26%, and her low back pain visual analog scale score went from 78 mm to 19 mm at the 2-year final follow-up. CONCLUSIONS Minimally invasive surgery thoracolumbar corpectomy using a computer-assisted spinal rod-bending system is a valuable technique to reduce screw back-out for osteoporotic vertebrae. With this new technique, the rod bending becomes easy, even for long PPS fusion with the severe osteoporotic or deformity patient in a single lateral position.
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Affiliation(s)
- Masato Tanaka
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan.
| | - Mahendra Singh
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Yoshihiro Fujiwara
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Koji Uotani
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Shinya Arataki
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Taro Yamauchi
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama, Japan
| | - Kazuo Nakanishi
- Department of Orthopaedic Surgery, Kawasaki Medical University, Kurashiki, Japan
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Maruo K, Arizumi F, Kusuyama K, Yoshie N, Tomoyuki K, Tachibana T. Comparison of Clinical Outcomes After Transforaminal Interbody Fusion Using Cortical Bone Trajectory versus Percutaneous Pedicle Screw Fixation. World Neurosurg 2021; 151:e821-e827. [PMID: 33964494 DOI: 10.1016/j.wneu.2021.04.130] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/15/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The study aim was to compare clinical outcomes between patients undergoing transforaminal lumbar interbody fusion (TLIF) using percutaneous pedicle screw (PPS) and cortical bone trajectory (CBT) by a single surgeon. METHODS This was a retrospective matched-cohort study of 77 patients (mean age, 71.7 years; 56% female) who underwent TLIF using CBT or PPS. Thirty-nine consecutive patients in the CBT group and 38 patients in the PPS group were matched for age, sex, and fused levels. All CBT screws were inserted by using a three-dimensional patient-specific guide (MySpine MC, Medacta). Perioperative outcomes of operative time, estimated blood loss, numeric rating scale scores, and serum concentration of creatine kinase were compared between the 2 groups. At 1 year postoperatively, clinical outcomes and radiographic outcomes, including cage subsidence, screw loosening, and fusion rates, were compared between the 2 groups. RESULTS The numeric rating scale scores on postoperative days 3 and 7 and serum creatine kinase levels on postoperative days 1 and 3 were significantly lower in the CBT group than in the PPS group (all P < 0.005). There were no significant intergroup differences in operation time and estimated blood loss. At postoperative 1 year, there were no significant differences in cage subsidence, screw loosening, and fusion rates between the CBT group and PPS group. Clinical outcomes were equivalent between the 2 groups. CONCLUSIONS The CBT technique using three-dimensional patient-specific guides resulted in lower perioperative pain and quicker recovery after surgery, which suggests that CBT is a less invasive procedure than PPS.
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Affiliation(s)
- Keishi Maruo
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Fumihiro Arizumi
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuki Kusuyama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Norichika Yoshie
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kusukawa Tomoyuki
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Hiyama A, Katoh H, Sakai D, Sato M, Tanaka M, Watanabe M. Accuracy of Percutaneous Pedicle Screw Placement after Single-Position versus Dual-Position Insertion for Lateral Interbody Fusion and Pedicle Screw Fixation Using Fluoroscopy. Asian Spine J 2021; 16:20-27. [PMID: 33934584 PMCID: PMC8874000 DOI: 10.31616/asj.2020.0526] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/19/2020] [Indexed: 11/23/2022] Open
Abstract
Study Design Retrospective study. Purpose The purpose of this study was to compare the accuracy of percutaneous pedicle screw (PPS) placement between prone and lateral decubitus positions during lateral lumbar interbody fusion (LLIF) and to evaluate the tendency of PPS positioning based on simple computed tomography measurements with patients in the lateral decubitus position. Overview of Literature There is insufficient information in the literature regarding the accuracy of inserting a PPS using fluoroscopy in patients in the lateral decubitus position. Methods We included 62 patients who underwent combined LLIF surgery and PPS fixation for degenerative lumbar spondylolisthesis with spinal canal stenosis. We compared the patient demographics and the accuracy of fluoroscopy-guided PPS placement between two groups: patients who remained in the lateral decubitus position for the pedicle screw fixation (single-position surgery [SPS] group) and those who were turned to the prone position (dual-position surgery [DPS] group). Results There were 40 patients in the DPS group and 22 in the SPS group. Of the 292 PPSs, only 12 were misplaced. In other words, 280/292 screws (95.9%) were placed correctly in the pedicle's cortical shell (grade 0). PPS insertion did not cause neurological, vascular, or visceral injuries in either group. The breach rates for the DPS and SPS groups were 4.1% (grade 1, 5 screws; grade 2, 3 screws; grade 3, 0 screw) and 4.1% (grade 1, 2 screws; grade 2, 2 screws; grade 3, 0 screw), respectively. Although there were no statistically significant differences, the downside PPS had more screw malpositioning than the upside PPS. Conclusions We found that PPS insertion with the patient in the decubitus position under fluoroscopic guidance might be as safe and reliable a technique as PPS insertion in the prone position, with a misplacement rate similar to that previously published.
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Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Hiroyuki Katoh
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Masato Sato
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Masahiro Tanaka
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Tokai University School of Medicine, Isehara, Japan
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Buckland AJ, Ashayeri K, Leon C, Manning J, Eisen L, Medley M, Protopsaltis TS, Thomas JA. Single position circumferential fusion improves operative efficiency, reduces complications and length of stay compared with traditional circumferential fusion. Spine J 2021; 21:810-820. [PMID: 33197616 DOI: 10.1016/j.spinee.2020.11.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [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: 07/07/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) with percutaneous posterior screw fixation are two techniques used to address degenerative lumbar pathologies. Traditionally, these anterior-posterior (AP) surgeries involve repositioning the patient from the supine or lateral decubitus position to prone for posterior fixation. To reduce operative time (OpTime) and subsequent complications of prolonged anesthesia, single-position lumbar surgery (SPLS) is a novel, minimally invasive alternative performed entirely from the lateral decubitus position. PURPOSE Assess the perioperative safety and efficacy of single position AP lumbar fusion surgery (SPLS). STUDY DESIGN Multicenter retrospective cohort study. PATIENT SAMPLE Three hundred and ninety patients undergoing AP surgery were included, of which 237 underwent SPLS and 153 were in the Flip group. OUTCOME MEASURES Outcome measures included levels fused, percentage of cases including L5-S1 fusion, fluoroscopy radiation dosage, OpTime, estimated blood loss (EBL), length of stay (LOS), and perioperative complications. Radiographic analysis included lumbar lordosis (LL), pelvic incidence, pelvic tilt, and segmental LL. METHODS Patients undergoing primary ALIF and/or LLIF surgery with bilateral percutaneous pedicle screw fixation between L2-S1 were included over a 4-year period. Patients were classified as either traditional repositioned "Flip" surgery or SPLS. Outcome measures included levels fused, percentage of cases including L5-S1 fusion, fluoroscopy radiation dosage, OpTime, EBL, LOS, perioperative complications. Radiographic analysis included LL, pelvic incidence, pelvic tilt, and segmental LL. All measures were compared using independent samples t-tests and chi-squared analyses as appropriate with significance set at p < .05. Propensity matching was completed where demographic differences were found. RESULTS Three hundred and ninety patients undergoing AP surgery were included, of which 237 underwent SPLS and 153 were in the Flip group. Age, gender, BMI, and CCI were similar between groups. Levels fused (1.47 SPLS vs 1.52 Flip, p = .468) and percent cases including L5-S1 (31% SPLS, 35% Flip, p = .405) were similar between cohorts. SPLS significantly reduced OpTime (103 min vs 306 min, p < .001), EBL (97 vs 313 mL, p < .001), LOS (1.71 vs 4.12 days, p < .001), and fluoroscopy radiation dosage (32 vs 88 mGy, p < .001) compared to Flip. Perioperative complications were similar between cohorts with the exception of postoperative ileus, which was significantly lower in the SPLS group (0% vs 5%, p < .001). There was no significant difference in wound, vascular injury, neurological complications, or Venous Thrombotic Event. There was no significant difference found in 90-day return to operating room (OR). CONCLUSIONS SPLS improves operative efficiency in addition to reducing blood loss, LOS and ileus in this large cohort study, while maintaining safety.
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Affiliation(s)
- Aaron J Buckland
- NYU Langone Orthopedic Hospital, New York, 530 1st Ave, Suite 8R, NY 10016, USA
| | - Kimberly Ashayeri
- Department of Neurosurgery, NYU Langone Medical Center, New York, 530 1st Ave, Suite 8R, NY 10016, USA.
| | - Carlos Leon
- NYU Langone Orthopedic Hospital, New York, 530 1st Ave, Suite 8R, NY 10016, USA
| | - Jordan Manning
- NYU Langone Orthopedic Hospital, New York, 530 1st Ave, Suite 8R, NY 10016, USA
| | - Leon Eisen
- NYU Langone Orthopedic Hospital, New York, 530 1st Ave, Suite 8R, NY 10016, USA
| | - Mark Medley
- Atlantic Neurosurgical and Spine Specialists, Wilmington, 2208 S 17th St, NC 28401, USA
| | | | - J Alex Thomas
- Atlantic Neurosurgical and Spine Specialists, Wilmington, 2208 S 17th St, NC 28401, USA
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Xu D, Han S, Wang C, Zhu K, Zhou C, Ma X. The technical feasibility and preliminary results of minimally invasive endoscopic-TLIF based on electromagnetic navigation: a case series. BMC Surg 2021; 21:149. [PMID: 33743668 PMCID: PMC7981827 DOI: 10.1186/s12893-021-01148-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/02/2020] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background Uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion (Endo-TLIF) with percutaneous pedicle screw fixation is a promising, minimally invasive method for the treatment of lumbar spondylolisthesis. However, repeated radiation exposure from X-rays and the steep learning curve remain to be improved. Methods This retrospective study explored the effects of electromagnetic navigation on improving Endo-TLIF with percutaneous pedicle screw fixation. Clinical information from 42 patients who had received Endo-TLIF with percutaneous pedicle screw fixation from May 2019 to November 2020 was analyzed retrospectively. The procedures were assisted under electromagnetic navigation. The rate of adjustment for guide wires, frequency of X-ray exposure, operative time, accuracy of pedicle screw location, and clinical outcomes were recorded. Results The mean follow-up for 42 patients was 11.9 ± 3.1 months. The mean age of the patients was 56.1 ± 9.26 years, with a female/male ratio of 25:17. According to postoperative CT scans and 3D reconstructions, the excellent and good rate of pedicle screws was 96.4%. The rate of adjustment for guide wires under the assistance of electromagnetic navigation was 1.78%, and the frequency of X-ray exposure was 8.27 ± 1.83. The operative time was 167.25 ± 28.16 min, including the duration of guide wire insertion (14.63 ± 5.45 min) and duration of decompression and cage placement (75.43 ± 13.97 min). The duration of hospitalization after operation was 2.59 ± 1.16 days. The preoperative VAS score was 7.51 ± 1.91, and the preoperative ODI was 82.42 ± 8.7%. At the last follow-up, the VAS score was 2.09 ± 0.59, and the ODI was 11.09 ± 3.2%. There were statistically significant improvements in the VAS score and ODI in all patients at the follow-up (p < 0.05). Conclusions Electromagnetic navigation can provide accurate positioning and guidance in real time, which improves the surgical efficiency of percutaneous pedicle screw placement and endoscopic decompression in Endo-TLIF with reduced radiation exposures. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01148-9.
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Affiliation(s)
- Derong Xu
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Shuo Han
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Chao Wang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Kai Zhu
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Chuanli Zhou
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
| | - Xuexiao Ma
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
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Ishihara M, Taniguchi S, Adachi T, Kushida T, Paku M, Ando M, Saito T, Kotani Y, Tani Y. Rod contour and overcorrection are risk factors of proximal junctional kyphosis after adult spinal deformity correction surgery. Eur Spine J 2021; 30:1208-1214. [PMID: 33646420 DOI: 10.1007/s00586-021-06761-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 01/06/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the risk factors of proximal junctional kyphosis (PJK) after surgery for adult spinal deformity (ASD) focusing on rod contour. METHODS Sixty-three patients with ASD who underwent surgery using lateral lumbar interbody fusion and percutaneous pedicle screws were analyzed. Fixation range was from the lower thoracic spine to the pelvis in all cases. Patients were divided into two groups. The PJK group consisted of 16 patients with PJK. The non-PJK group had 47 patients without PJK. We examined various spinopelvic parameters and parameters related to rod contour. RESULTS Among the various spinal and pelvic parameters, those in the PJK group were significantly larger in terms of preoperative SVA and were significantly smaller in terms of postoperative "PI-LL." For parameters related to rod contour, the rod kyphotic curve at the thoracic spine in the PJK group was significantly less than that in the non-PJK group. The inclination of the pedicle screw at the upper instrumented vertebra (UIV) was significantly more cranial in the PJK group than in the non-PJK group. The kyphotic curve of the rod at the UIV was more parallel in the PJK group than in the non-PJK group. On logistic regression analysis, insufficient kyphotic curve at the thoracic spine along with UIV and overcorrection of the lumbar spine were identified as significant risk factors. CONCLUSIONS Insufficient kyphotic curve of the rod in the thoracic spine along with UIV and overcorrection of the lumbar spine were noted as significant risk factors of PJK.
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Affiliation(s)
- Masayuki Ishihara
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata, Japan.
| | | | - Takashi Adachi
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata, Japan
| | - Taketoshi Kushida
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata, Japan
| | - Masaaki Paku
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata, Japan
| | - Muneharu Ando
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata, Japan
| | - Takanori Saito
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata, Japan
| | - Yoshihisa Kotani
- Department of Orthopedic Surgery, Kansai Medical University Medical Center, Osaka, Japan
| | - Yoichi Tani
- Department of Orthopedic Surgery, Kansai Medical University, Hirakata, Japan
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Charles YP, Ntilikina Y, Collinet A, Schuller S, Garnon J, Godet J, Clavert P. Accuracy and technical limits of percutaneous pedicle screw placement in the thoracolumbar spine. Surg Radiol Anat 2021; 43:843-53. [PMID: 33449140 DOI: 10.1007/s00276-020-02673-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The two-dimensional fluoroscopic method of percutaneous pedicle screw instrumentation has been clinically described as reliable method in the caudal thoracic and lumbosacral spine. Its accuracy has not been clearly reported in the cranial thoracic spine. The aim of this in vitro study was to investigate percutaneous pedicle screw placement accuracy according to pedicle dimensions and vertebral levels. METHODS Six fresh-frozen human specimens were instrumented with 216 screws from T1 to S1. Pedicle isthmus widths, heights, transversal pedicles and screws were measured on computed tomography. Pedicle cortex violation ≥ 2 mm was defined as screw malposition. RESULTS The narrowest pedicles were at T3-T5. A large variability between transversal pedicle axes and percutaneous pedicle screw was present, depending on the spinal level. Screw malposition rates were 36.1% in the cranial thoracic spine (T1-T6), 16.7% in the caudal thoracic spine (T7-T12), and 6.9% in the lumbosacral spine (L1-S1). The risk for screw malposition was significantly higher at cranial thoracic levels compared to caudal thoracic (p = 0.006) and lumbosacral (p < 0.0001) levels. Cortex violation ≥ 2 mm was constantly present if the pedicle width was < 4.8 mm. CONCLUSION Percutaneous pedicle screw placement appears safe in the caudal thoracic and lumbosacral spine. The two-dimensional fluoroscopic method has a limited reliability above T7 because of smaller pedicle dimensions, difficulties in visualizing radiographic pedicle landmarks and kyphosis.
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Takami M, Taiji R, Okada M, Minamide A, Hashizume H, Yamada H. Lateral lumbar interbody fusion after reduction using the percutaneous pedicle screw system in the lateral position for Meyerding grade II spondylolisthesis: a preliminary report of a new lumbar reconstruction strategy. BMC Musculoskelet Disord 2021; 22:17. [PMID: 33402131 PMCID: PMC7786473 DOI: 10.1186/s12891-020-03935-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Utilization of a cage with a large footprint in lateral lumbar interbody fusion (LLIF) for the treatment of spondylolisthesis leads to a high fusion rate and neurological improvement owing to the indirect decompression effect and excellent alignment correction. However, if an interbody space is too narrow for insertion of an LLIF cage for cases of spondylolisthesis of Meyerding grade II or higher, LLIF cannot be used. Therefore, we developed a novel strategy, LLIF after reduction by the percutaneous pedicle screw (PPS) insertion system in the lateral position (LIFARL), for surgeons to perform accurate and safe LLIF with PPS in patients with such pathology. This study aimed to introduce the new surgical strategy and to present preliminary clinical and radiological results of patients with spondylolisthesis of Meyerding grade II. METHODS Six consecutive patients (four men and two women; mean age, 72.7 years-old; mean follow-up period, 15.3 months) with L4 spondylolisthesis of Meyerding grade II were included. Regarding the surgical procedure, first, PPSs were inserted into the L4 and L5 vertebrae fluoroscopically, and both rods were placed in the lateral position. The L5 set screws were fixed tightly, and the L4 side of the rod was floated. Second, the L4 vertebra was reduced by fastening the L4 set screws so that they expanded the anteroposterior width of the interbody space. At that time, the L4 set screws were not fully tightened to the rods to prevent the endplate injury. Finally, the LLIF procedure was started. After inserting the cage, a compression force was added to the PPSs, and the L4 set screws were completely fastened. RESULTS The mean operative time was 183 min, and the mean blood loss was 90.8 mL. All cages were positioned properly. Visual analog scale score and Oswestry disability index improved postoperatively. Bone union was observed using computed tomography 12 months after surgery. CONCLUSION For cases with difficulty in LLIF cage insertion for Meyerding grade II spondylolisthesis due to the narrow anteroposterior width of interbody space, LIFARL is an option to achieve LLIF combined with posterior PPS accurately and safely. TRIAL REGISTRATION UMIN-Clinical Trials Registry, UMIN000040268, Registered 29 April 2020, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000045938.
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Affiliation(s)
- Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
| | - Ryo Taiji
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Motohiro Okada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
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Inoue T, Mizutamari M, Hatake K. Surgical Invasiveness of Single-Segment Posterior Lumbar Interbody Fusion: Comparing Perioperative Blood Loss in Posterior Lumbar Interbody Fusion with Traditional Pedicle Screws, Cortical Bone Trajectory Screws, and Percutaneous Pedicle Screws. Asian Spine J 2020; 15:856-864. [PMID: 33371623 PMCID: PMC8696064 DOI: 10.31616/asj.2020.0296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/10/2020] [Accepted: 09/11/2020] [Indexed: 01/01/2023] Open
Abstract
Study Design Single-center retrospective study. Purpose This study aims to evaluate the surgical invasiveness of single-segment posterior lumbar interbody fusion (PLIF) by comparing perioperative blood loss in PLIF with traditional pedicle screws (PS), cortical bone trajectory screws (CBT), and percutaneous pedicle screws (PPS). Overview of Literature Intraoperative blood loss has often been used to evaluate surgical invasiveness. However, in patients undergoing spinal surgery, more blood loss is observed postoperatively than intraoperatively. Therefore, evaluating surgical invasiveness using only the intraoperative bleeding volume may result in considerable underestimation of the actual surgical invasiveness. Methods This study included patients who underwent single-segment PLIF between January 2012 and December 2017. In total, seven patients underwent PLIF with PS (PS-PLIF), nine underwent PLIF with CBT (CBT-PLIF), and 15 underwent PLIF with PPS (PPS-PLIF). Results No significant differences were noted in terms of operation time or intraoperative bleeding between the PS-PLIF, CBT-PLIF, and PPS-PLIF groups. However, the postoperative drainage volume in the PPS-PLIF group (210.1 mL; range, 50-367 mL) was determined to be significantly lower than that in the PS-PLIF (416.7 mL; range, 260-760 mL; p=0.002) and CBT-PLIF (421.1 mL; range, 180-890 mL; p=0.006) groups. In addition, the total amount of intraoperative bleeding and postoperative drainage was found to be significantly lower in the PPS-PLIF group (362.8 mL; range, 145-637 mL) than in the PS-PLIF (639.6 mL; range, 285-1,000 mL; p=0.01) and CBT-PLIF (606.7 mL; range, 270-950 mL; p=0.005) groups. Conclusions Based on our findings, evaluating surgical invasiveness using only intraoperative bleeding can result in the underestimation of actual surgical invasiveness. Even with single-segment PLIF, the amount of perioperative bleeding can vary depending on the way the posterior instrument is installed.
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Affiliation(s)
- Tetsuji Inoue
- Department of Orthopaedic Surgery, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Masaya Mizutamari
- Department of Orthopaedic Surgery, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Kuniaki Hatake
- Department of Orthopaedic Surgery, Kumamoto Chuo Hospital, Kumamoto, Japan
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Sasagawa T, Takeuchi Y, Aita I. Postoperative Blood Loss Including Hidden Blood Loss in Early and Late Surgery Using Percutaneous Pedicle Screws for Traumatic Thoracolumbar Fracture. Spine Surg Relat Res 2020; 5:171-175. [PMID: 34179554 PMCID: PMC8208959 DOI: 10.22603/ssrr.2020-0152] [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: 08/07/2020] [Accepted: 09/17/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Some reports revealed that hidden blood loss (HBL) during surgery for traumatic thoracolumbar fracture cannot be ignored, even when using a percutaneous approach. Using percutaneous pedicle screws (PPS) for traumatic thoracolumbar fracture, this study aimed to compare estimate blood loss (EBL), including HBL, between early and late fixation. Methods This investigation was a retrospective study. In the present study, data from 39 patients who underwent posterior spinal stabilization using PPS for single-level thoracolumbar fracture have been included. We divided the patients into an early group (group E) (n=20) in whom surgery was conducted within 3 days of fracture and a late group (group L) (n=19) in whom surgery was conducted more than 3 days after fracture. We evaluated hemoglobin (Hb) on the day of injury, and 1, 3 or 4, and 7 days after surgery, EBL, HBL, and transfusion requirement. Results Hb on day 1 (group E: 12.2±1.7 g/dL, group L: 12.3±1.6 g/dL) was significantly less than that on the injured day (group E: 14.2±1.7 g/dL, group L: 13.9±1.7 g/dL) in both groups. The values of Hb and EBL were not significantly different at any time between the two groups. HBL (group E: 487±266 mL, group L: 386±305 mL) was not significantly different between the two groups. No patients required transfusion in either group. Conclusions EBL in early fixation using PPS for traumatic thoracolumbar fracture is not significantly different compared with that in late surgery from days 1 to 7 postoperatively. Early fixation using PPS for traumatic thoracolumbar fracture does not result in negative outcomes any more than those in late surgery in terms of blood loss.
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Affiliation(s)
- Takeshi Sasagawa
- Department of Orthopedic Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Yosuke Takeuchi
- Department of Orthopedic Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Ikuo Aita
- Department of Orthopedic Surgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
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Ouchida J, Kanemura T, Satake K, Nakashima H, Segi N, Suzuki K, Imagama S. True accuracy of percutaneous pedicle screw placement in thoracic and lumbar spinal fixation with a CT-based navigation system: Intraoperative and postoperative assessment of 763 percutaneous pedicle screws. J Clin Neurosci 2020; 79:1-6. [PMID: 33070873 DOI: 10.1016/j.jocn.2020.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/01/2020] [Accepted: 07/05/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate intraoperative reinsertion of percutaneous pedicle screw (PPS) with intraoperative CT-based navigation and to evaluate the rate of deviation of PPS at postoperative radiographic examination. METHODS Seven hundred sixty-three screws were inserted in 138 patients. We investigated the rate of occurrence of intraoperative PPS reinsertion after the diagnosis of screw deviation by fluoroscopy and the causes of each screw deviation. The subsequent distribution of PPS deviation was evaluated by postoperative CT. We also assess the difference in variance between the group judged to be PPS misplaced intra-/postoperatively (IOD group/POD group) and appropriate PPS placement (ND group). RESULTS Among all the screws inserted, 10 (1.3%) were diagnosed as being deviated by fluoroscopy during surgery, and 74 (9.7%) screws were found to be deviated at postoperative CT evaluation. We found more pedicle screw mismatch in the POD group than in the ND group (52.7 vs 11.0%, P < 0.001). The distance between the screw and the reference was greater in the IOD group than that in the ND group (1.4 ± 1.2 vs 2.4 ± 1.1 vertebral levels, P = 0.016). In one patient in the IOD group, a motor function deficit was observed postoperatively. CONCLUSION PPS fixation under intraoperative CT-based navigation did not prevent screw deviation completely. It is necessary to consider errors that occur during surgery and to confirm placement with real-time assistance such as fluoroscopy even in a surgery performed under CT navigation assistance.
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Affiliation(s)
- Jun Ouchida
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, Aichi, Japan; Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan.
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Kotaro Satake
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Naoki Segi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Kanae Suzuki
- Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan
| | - Shiro Imagama
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, Aichi, Japan
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Ishii K, Isogai N, Shiono Y, Yoshida K, Takahashi Y, Takeshima K, Nakayama M, Funao H. Contraindication of Minimally Invasive Lateral Interbody Fusion for Percutaneous Reduction of Degenerative Spondylolisthesis: A New Radiographic Indicator of Bony Lateral Recess Stenosis Using I Line. Asian Spine J 2020; 15:455-463. [PMID: 33059436 PMCID: PMC8377220 DOI: 10.31616/asj.2020.0083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/18/2020] [Indexed: 11/24/2022] Open
Abstract
Study Design Retrospective cohort study. Purpose This study aimed to evaluate aggravated lateral recess stenosis and clarify the indirect decompression threshold by combined lateral interbody fusion and percutaneous pedicle screw fixation (LIF/PPS). Overview of Literature No previous reports have described an effective radiographic indicator for determining the surgical indication for LIF/PPS. Methods A retrospective review of 185 consecutive patients, who underwent 1- or 2-level lumbar fusion surgery for degenerative spondylolisthesis (DS). According to their symptomatic improvement, they were placed into either the “recovery” or “no-recovery” group. Preoperative computed tomography (CT) images were evaluated for the position of the superior articular processes at the slipping level, followed by a graded classification (grades 0–3) using the impingement line (I line), a new radiographic indicator. All 432 superior articular facets in 216 slipped levels were classified, and both groups’ characteristics were compared. Results There were 171 patients (92.4%) in the recovery group and 14 patients in the no-recovery group (7.6%). All patients in the no-recovery group were diagnosed with symptoms associated with deteriorated bony lateral recess stenosis. All superior articular processes of the lower vertebral body in affected levels reached and exceeded the I line (I line-; grade 2 and 3) on preoperative sagittal CT images. In the recovery group, most superior articular processes did not reach the I line (I line+; grade 0 and 1; p=0.0233). Conclusions In DS cases that are classified as grade 2 or greater, the risk of aggravated bony lateral recess stenosis due to corrective surgery is high; therefore, indirect decompression by LIF/PPS is, in principle, contraindicated.
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Affiliation(s)
- Ken Ishii
- Department of Orthopedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan.,Department of Orthopedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Narita & Mita Hospitals, Tokyo, Japan
| | - Norihiro Isogai
- Department of Orthopedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan.,Department of Orthopedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Narita & Mita Hospitals, Tokyo, Japan
| | - Yuta Shiono
- Department of Orthopedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Kodai Yoshida
- Department of Orthopedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Yoshiyuki Takahashi
- Department of Orthopedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Kenichiro Takeshima
- Department of Orthopedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Narita & Mita Hospitals, Tokyo, Japan
| | - Masanori Nakayama
- Department of Orthopedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Narita & Mita Hospitals, Tokyo, Japan
| | - Haruki Funao
- Department of Orthopedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan.,Department of Orthopedic Surgery, Spine and Spinal Cord Center, International University of Health and Welfare Narita & Mita Hospitals, Tokyo, Japan
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Abstract
Pediatric spine trauma presents unique management challenges. These injuries are often the result of high-energy mechanisms and are associated with other serious injuries that can complicate surgical and nonsurgical approaches. The pediatric population presents a host of challenges related to patient compliance, healing challenges, and patient tolerance of therapy. Percutaneous pedicle screw instrumentation, temporary fixation without fusion, continues to expand in its role of pediatric spine fracture treatment. Compared with open instrumentation and fusion, this technique addresses many of the previously mentioned challenges. Additional study is needed to evaluate the clinical utility of this approach in pediatric spinal fractures.
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Affiliation(s)
- Ryan S Bailey
- Department of Orthopaedic Surgery, Saint Louis University, 3635 Vista Avenue, 7th Floor-Desloge Tower, St Louis, MO 63110, USA
| | - Aki Puryear
- Department of Orthopaedic Surgery, Saint Louis University, 3635 Vista Avenue, 7th Floor-Desloge Tower, St Louis, MO 63110, USA.
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Funao H, Isogai N, Sasao Y, Nishiyama M, Ishii K. Vertebroplasty with posterior spinal fusion for osteoporotic vertebral fracture using computer-assisted rod contouring system: A new minimally invasive technique. Int J Surg Case Rep 2020; 72:301-305. [PMID: 32563090 PMCID: PMC7305354 DOI: 10.1016/j.ijscr.2020.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/09/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 11/25/2022] Open
Abstract
Surgical treatment of osteoporotic vertebral fracture (OVF) is challenging. A new minimally invasive technique of posterior spinal fusion was performed for OVF. This technique would be beneficial for elderly or immunocompromised patients.
Introduction Surgical treatment of osteoporotic vertebral fracture (OVF) has been challenging for spine surgeons, because there are potential risks of instrumentation failure; such as screw loosening, loss of correction, or pseudarthrosis, due to bone fragility in elderly patients with several comorbidities. Presentation of case A 68-year-old female presented with a severe low back pain and bilateral thigh pain. She had a history of systemic scleroderma, which was complicated by interstitial lung disease. Although she initially underwent non-surgical treatment with bracing for 7 months, her symptoms had progressively deteriorated, and her radiographs showed non-union at L1 and progressive kyphotic deformity at the thoracolumbar spine. Because an anterior approach was inadvisable due to interstitial lung disease, vertebroplasty with posterior spinal fusion was performed using percutaneous pedicle screws (PPS) at the upper most and lowest instrumented vertebra combined with sublaminar taping and computer-assisted rod contouring system. Good bony union was achieved with no screw loosening at 1-year follow-up. Discussion Various surgical procedures have been applied according to the fracture type or medical condition of the patient. Minimally invasive posterior spinal fusion would be a less invasive approach in patients with poor medical condition. PPS can prevent the excessive dissection of paravertebral muscles, and this is especially advantageous at the proximal and distal end of long constructs. A recent computer-assisted rod contouring system accurately matches each screw head resulting in reduced strength of the screw-bone interface. Conclusion This technique would be beneficial in the elderly or immunocompromised patients with OVF.
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Affiliation(s)
- Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Japan; Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Japan.
| | - Norihiro Isogai
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Japan; Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Japan
| | - Yutaka Sasao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Japan; Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Japan
| | - Makoto Nishiyama
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Japan; Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Japan; Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Japan
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Kanno H, Aizawa T, Hashimoto K, Itoi E. Novel augmentation technique of percutaneous pedicle screw fixation using hydroxyapatite granules in the osteoporotic lumbar spine: a cadaveric biomechanical analysis. Eur Spine J 2021; 30:71-8. [PMID: 32424638 DOI: 10.1007/s00586-020-06451-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/05/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Percutaneous pedicle screw (PPS) fixation has been commonly used for various spine surgeries. Rigid PPS fixation is necessary to decrease the incidence of screw loosening in osteoporotic spine. Recently, we have reported biomechanical advantages of augmentation technique using hydroxyapatite (HA) granules for PPS fixation in synthetic bone. However, its biomechanical performance in augmenting PPS fixation for osteoporotic spine has not been fully elucidated. The aim of the present study is to perform a cadaveric biomechanical analysis of PPS fixation augmented with HA granules. METHODS Thirty osteoporotic lumbar vertebrae (L1-L5) were obtained from 6 cadavers (3 men and 3 women; age 80 ± 9 years; bone mineral density 73 ± 9 mg/cm3). The maximal pullout strength and maximal insertion torque were compared between the screws inserted into the vertebrae with and without augmentation. In toggle testing, the number of craniocaudal toggle cycles and maximal load required to achieve the 2-mm screw head displacement were also compared. RESULTS The maximal pullout strength in the screws augmented with HA granules was significantly greater compared to those without augmentation (p < 0.05). The augmentation significantly increased the maximal insertion torque of the screws (p < 0.05). Moreover, the number of toggle cycles and the maximal load required to reach 2 mm of displacement were significantly higher in the augmented screws (p < 0.05). CONCLUSION The PPS fixation was significantly enhanced by the augmentation with HA granules in the osteoporotic lumbar spine. The PPS fixation augmented with HA granules might decrease the incidence of screw loosening and implant failure in patients with osteoporotic spine.
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Sumiya S, Numano F, Ogawa T, Yoshii T, Okawa A, Komori H. Accuracy of pedicle screw insertion for unilateral open transforaminal lumbar interbody fusion: a side-by-side comparison of percutaneous and conventional open techniques in the same patients. BMC Musculoskelet Disord 2020; 21:168. [PMID: 32171291 PMCID: PMC7071703 DOI: 10.1186/s12891-020-3180-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 02/28/2020] [Indexed: 11/16/2022] Open
Abstract
Background The aim of the study was to compare the accuracy of percutaneous pedicle screw (PPS) insertion (P-side) with that of conventional open screw insertion (O-side) during unilateral open transforaminal lumbar interbody fusion (TLIF) in the same patients. We also sought to determine the incidence of pedicle screw misplacement and to identify relevant risk factors. Methods The study was a retrospective analysis of prospectively collected data for 766 pedicle screws placed in 181 consecutive patients who underwent a unilateral open-TLIF procedure in the lumbosacral spine. Our minimally invasive TLIF was performed by unilateral open freehand insertion of pedicle screws for decompression on one side and PPS on the opposite side. Using this approach, we were able to compare the accuracy of PPS insertion with that of conventional open screw insertion in the same patients. There were 383 PPSs and 383 screws inserted by the open method. The accuracy of screw placement was evaluated on reconstructed computed tomography images obtained postoperatively, and screw misplacement was classified. Potential risk factors for screw misplacement were investigated in three-level mixed-effects logistic regression analysis. Results Thirty-four screws (8.9%) were misplaced on the P-side and 37 (9.5%) were misplaced on the O-side; the difference was not statistically significant (P = 0.803). Subclassification analysis revealed minor perforation of 28 screws (7.3%) on the P-side and 32 (8.4%) on the O-side, moderate perforation of 5 screws (1.3%) on the P-side and 4 (1.0%) on the O-side, and severe perforation of 1 screw (0.3%) on each side. Three-level mixed-effects logistic regression analysis identified body mass index as a significant risk factor for screw misplacement on the P-side (odds ratio 1.194, 95% confidence interval 1.066–1.338). Conclusions Accuracy of pedicle screw insertion was not significantly different between PPS insertion and conventional open screw insertion in the same patients. Body mass index had a significant influence on the risk of screw misplacement in PPS insertion.
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Affiliation(s)
- Satoshi Sumiya
- Department of Orthopaedic and Spine Surgery, Yokohama-City Minato Red Cross Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama City, Kanagawa, 231-8682, Japan. .,Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Fujiki Numano
- Department of Orthopaedic and Spine Surgery, Yokohama-City Minato Red Cross Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama City, Kanagawa, 231-8682, Japan.,Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahisa Ogawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiromichi Komori
- Department of Orthopaedic and Spine Surgery, Yokohama-City Minato Red Cross Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama City, Kanagawa, 231-8682, Japan
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O'Donohoe TJ, Dawes BH, Thien C, Wang YY. Accuracy of K-Wireless Insertion of Percutaneous Pedicle Screws Using Computer-Assisted Spinal Navigation: A Systematic Review and Single-Center Experience. World Neurosurg 2020; 138:e267-74. [PMID: 32105880 DOI: 10.1016/j.wneu.2020.02.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study sought to 1) describe the use K-wireless pedicle screw insertion among adults (age ≥18 years) undergoing a minimally invasive fusion and 2) perform a systematic review (SR) of all studies that describe a navigated, K-wireless technique with 3-dimensional fluoroscopy. METHODS Patients undergoing a minimally invasive fusion requiring pedicle screw fixation for any indication were prospectively enrolled in the observational component of this study. An assessment of pedicle breach was performed independently and in duplicate based on a modification of the Belmont grading scale. Articles for the SR were identified from a structured search of Medline from inception to May 8, 2019, without restriction of language. RESULTS A total of 82 pedicle screws were placed in 20 patients who underwent surgery between January and June 2014. There was no significant difference in mean operative time between the cases included in this study and a matched cohort of 20 patients undergoing surgery with 2-dimensional fluoroscopy and K-wire-assisted pedicle screw placement (95 ± 13 vs. 87 ± 20 minutes, respectively; P > 0.05). There were 2 major pedicle breaches (Belmont grade 3) in a single patient, yielding a major breach rate of 2.44%. A total of 6 papers that described the placement of 700 pedicle screws in 160 patients between May 2011 and March 2017 were included in the SR. The overall breach rate was 7.00% (n = 37). CONCLUSIONS Percutaneous pedicle screws can be placed accurately and safely using 3-dimensional navigation without the use of K-wires and may confer benefits to patients and clinicians by reducing K-wire-associated complications and radiation exposure.
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Abstract
PURPOSE OF REVIEW The goal of the review is to discuss the common general applications of navigation in the context of minimally invasive spine surgery and assess its value in the published literature comparing against non-navigated or navigated techniques. RECENT FINDINGS There is increasing utilization of computer navigation in minimally invasive spine surgery. There is synergy between navigation and minimally invasive technologies, such that one enhances or facilitates the other, thus leading to wider applications for both. Specifically, navigation has been shown to improve performance of percutaneous pedicle screw placement, vertebral augmentation, and minimally invasive fusion procedures. Overall, clinical studies have shown better accuracy and less radiation exposure with the use of navigation in spine surgery. The use of navigation in minimally invasive spine surgery enhances the accuracy of instrumentation and decreases radiation exposure. It is yet to be determined whether patient-reported outcomes will differ. Further research on its effect on clinical outcomes may further define the future impact of navigation in minimally invasive spine surgery.
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Affiliation(s)
- Jonathan N Sembrano
- Department of Orthopaedic Surgery, University of Minnesota Medical School, 2450 Riverside Ave S R200, Minneapolis, MN, 55454, USA.
| | - Sharon C Yson
- Department of Orthopaedic Surgery, University of Minnesota Medical School, 2450 Riverside Ave S R200, Minneapolis, MN, 55454, USA
| | - Jeffrey J Theismann
- Department of Orthopaedic Surgery, University of Minnesota Medical School, 2450 Riverside Ave S R200, Minneapolis, MN, 55454, USA
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30
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Yang JS, Chu L, Deng R, Chen CM, Wang XF, Xie PG, Yu KX, Rong LM, Hao DJ, Wei JM, Deng ZL. Treatment of Single-Level Thoracic Tuberculosis by Percutaneous Endoscopic Débridement and Allograft via the Transforaminal Approach Combined with Percutaneous Pedicle Screw Fixation: A Multicenter Study with a Median Follow-Up of 36 Months. World Neurosurg 2018; 122:e1472-e1481. [PMID: 30465947 DOI: 10.1016/j.wneu.2018.11.087] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 10/14/2018] [Revised: 11/08/2018] [Accepted: 11/10/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine effects of percutaneous endoscopic débridement and allograft via the transforaminal approach combined with percutaneous pedicle screw fixation as treatment for single-level thoracic tuberculosis. METHODS This multicenter retrospective analysis included 75 patients with single-level thoracic tuberculosis who underwent percutaneous endoscopic débridement and allograft via the transforaminal approach combined with percutaneous pedicle screw fixation and were followed for >36 months between January 2012 and December 2014. RESULTS Follow-up was 36-48 months (average 41.1 ± 2.2 months). Intraoperative blood loss was low (average 30.5 ± 7.9 mL), and bed rest time was short (average 1.5 ± 0.3 days). No recurrence was observed in all 75 patients. Except for 3 patients, almost all patients (96%) achieved grade I or II fusion in interbody bone grafting. Segmental Cobb angle was 13.5° ± 4.1° before surgery, 10.5° ± 3.7° immediately after surgery, and 11.7° ± 3.9° at 36 months of follow-up. All patients achieved complete recovery of neurologic function (American Spinal Injury Association grade E), including 15 patients with spinal cord injury (American Spinal Injury Association grade D) before surgery. The visual analog scale and 36-Item Short-Form Health Survey scores significantly improved at 1, 3, 12, and 36 months of follow-up. No complications related to internal fixation occurred within the follow-up period; complication rate was 9.0%. CONCLUSIONS Median follow-up clinical experience with percutaneous endoscopic débridement and allograft via the transforaminal approach combined with percutaneous pedicle screw fixation indicates that the technique is safe, effective, feasible, and minimally invasive.
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Affiliation(s)
- Jun-Song Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Lei Chu
- Department of Orthopaedics, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Rui Deng
- Department of Orthopaedics, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Chien-Min Chen
- Department of Neurosurgery, Changhua Christian Hospital, Changhua City, Taiwan, China; School of Medicine, Kaohsiung Medical University, Kaohsiung, China; College of Nursing and Health Sciences, Dayeh University, Changhua City, Taiwan, China
| | - Xiang-Fu Wang
- Department of Spinal Minimally Invasive Surgery, Gansu Provincial Hospital of Traditional Chinese Medicine, Gansu, China
| | - Pei-Gen Xie
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ke-Xiao Yu
- Department of Orthopaedics, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Li-Min Rong
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Shaanxi, China.
| | - Jian-Min Wei
- Department of Spine Surgery, Baoji City Hospital of Traditional Chinese Medicine, Shaanxi, China
| | - Zhong-Liang Deng
- Department of Orthopaedics, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Li X, Zhang W, Zhang R, Shang X, Deng C, Kong L, Han J. Marked Guidewire Technique Prevents Complications of Percutaneous Pedicle Screws and Precisely Controls Depth: Technical Note. World Neurosurg 2018; 118:81-85. [PMID: 30017756 DOI: 10.1016/j.wneu.2018.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/18/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We sought to describe a novel modified guidewire technique used in the placement of percutaneous pedicle screws (PPSs), which enables safe and precise control of the depth of screw placement and prevents excessive advancement of the guidewire with low radiation exposure. PPSs have been widely used and have many advantages. However, inadvertent advancement of the guidewire may damage peripheral tissue or viscera, and repeated confirmation of the depth of screw and guidewire leads to extensive radiation exposure. METHODS A modified guidewire with markers was used intraoperatively. The reading of the mark on the guidewire increased as the PPS advanced into the pedicle. The depth of the screw in the pedicle was calculated as the mark reading after each screw was rotated into the pedicle minus the initial mark reading. After all pedicle screws were placed, the positions of the screws were checked by C-arm or G-arm fluoroscopy. RESULTS The modified guidewire was applied in 41 thoracic-lumbar fracture patients. The depths of the percutaneous screws were precisely controlled as planned. There were no inadvertent breaches of the anterior cortices of the vertebrae. No patients reported neurologic symptoms, and there was no screw misplacement detected. Surgeons had no radiation exposure, and patients were only exposed once to the radiation. CONCLUSIONS The modified guidewire with markers is an effective device to precisely control the depth of PPSs and prevent complications of the guidewire in the placement of pedicle screws.
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Affiliation(s)
- Xu Li
- Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Hefei, China
| | - Wenzhi Zhang
- Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Hefei, China.
| | - Rui Zhang
- Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Hefei, China
| | - Xifu Shang
- Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Hefei, China
| | - Chen Deng
- Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Hefei, China
| | - Lei Kong
- Spine Center, Department of Orthopedics, Anhui Provincial Hospital, The First Affiliated Hospital of USTC, Hefei, China
| | - Jintao Han
- Peking University Third Hospital Intervention and Vascular Surgery, Beijing, China
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Harrison Farber S, Nayar G, Desai R, Reiser EW, Byrd SA, Chi D, Idler C, Isaacs RE. Radiation exposure to the surgeon during minimally invasive spine procedures is directly estimated by patient dose. Eur Spine J 2018; 27:1911-1917. [PMID: 29948320 DOI: 10.1007/s00586-018-5653-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 05/10/2018] [Accepted: 06/01/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Radiation exposure is a necessary component of minimally invasive spine procedures to augment limited visualization of anatomy. The surgeon's exposure to ionizing radiation is not easily recognizable without a digital dosimeter-something few surgeons have access to. The aim of this study was to identify an easy alternative method that uses the available radiation dose data from the C-arm to accurately predict physician exposure. METHODS The senior surgeon wore a digital dosimeter during all minimally invasive spine fusion procedures performed over a 12-month period. Patient demographics, procedure information, and radiation exposure throughout the procedure were recorded. RESULTS Fifty-five minimally invasive spine fusions utilizing 330 percutaneous screws were included. Average radiation dose was 0.46 Rad/screw to the patient. Average radiation exposure to the surgeon was 1.06 ± 0.71 μSv/screw, with a strong positive correlation (r = 0.77) to patient dose. The coefficient of determination (r2) was 0.5928, meaning almost two-thirds of the variability in radiation exposure to the surgeon is explained by radiation exposure to the patient. CONCLUSIONS Intra-operative radiation exposure to the patient, which is easily identifiable as a continuously updated fluoroscopic monitor, is a reliable predictor of radiation exposure to the surgeon during percutaneous screw placement in minimally invasive spinal fusion surgery and therefore can provide an estimate of exposure without the use of a dosimeter. With this, a surgeon can better understand the magnitude of their exposure on a case-by-case basis rather than on a quarterly basis, or more likely, not at all. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- S Harrison Farber
- Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC, 27710, USA
| | - Gautam Nayar
- Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC, 27710, USA
| | - Rupen Desai
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Elizabeth W Reiser
- Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC, 27710, USA
| | - Sarah A Byrd
- Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC, 27710, USA
| | - Deborah Chi
- Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC, 27710, USA
| | - Cary Idler
- Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC, 27710, USA
| | - Robert E Isaacs
- Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC, 27710, USA.
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Piazzolla A, Solarino G, Bizzoca D, Parato C, Monteleone G, Dicuonzo F, Moretti B. The pedicle instrumentation and percutaneous elevation (Pi.Pe): a new cementless surgical technique in type A post-traumatic vertebral fractures. Eur Spine J 2018; 27:182-9. [PMID: 29679136 DOI: 10.1007/s00586-018-5602-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/09/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate if bone substitutes are strictly necessary to restore the vertebral body height and improve the clinical outcome, in patients with thoracolumbar or lumbar AO type A post-traumatic vertebral fractures, managed with balloon kyphoplasty combined with posterior screw and rod system. METHODS 105 patients with post-traumatic thoracolumbar spine fracture were recruited. At baseline, the patients underwent a CT and an MRI of the spine. Clinical evaluation was performed, using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI), at baseline, 48 h after surgery, at 3-month follow-up (FU), 6-month FU, 48 h after the instrumentation removal and at 24-month FU. At each FU, VK, regional kyphosis (RK), central wall (MH/PH) and anterior wall (AH/PH) heights were assessed on lateral spine X-rays. At 6-month FU, a CT scan of the spine was performed to investigate the fracture healing. The posterior instrumentation was removed 7 months after surgery (range 6-10 months). RESULTS A significant reduction of mean VAS (p < 0.05) and ODI (p < 0.05) was observed after surgery; no impairment of these scores was observed after the instrumentation removal. A significant correction of VK, RK, AH/PH and MH/PH was recorded after surgery; no significant changes of these values were noticed at subsequent FU. After the instrumentation removal, only an RK impairment was recorded, but it was not significant. CONCLUSIONS PMMA or bone substitutes are not necessary to keep the reduction of the endplate obtained with the balloon tamp, when BK is performed in the association with posterior percutaneous pedicle screws instrumentation. These slides can be retrieved under Electronic Supplementary Material.
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Fujino S, Miyagi M, Tajima S, Imura T, Tazawa R, Inoue G, Nakazawa T, Saito W, Shirasawa E, Minehara H, Matsuura T, Kawamura T, Uchida K, Takahira N, Takaso M. Surgical treatment for suicidal jumper's fracture (unstable sacral fracture) with thoracolumbar burst fracture: a report of three cases. Spine Surg Relat Res 2017; 1:100-106. [PMID: 31440620 PMCID: PMC6698561 DOI: 10.22603/ssrr.1.2016-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/05/2016] [Accepted: 02/04/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Suicidal jumper's fracture (unstable sacral fracture) is characterized not only by multiple fractures including thoracolumbar fractures, but also major chest and abdominal injuries. Early stabilization of these fractures and early ambulation are required for the treatment and management of chest and abdominal injuries. We present 3 cases of suicidal jumper's fracture with thoracolumbar burst fracture, treated with minimally invasive posterior fixation surgery, which is a combination of percutaneous pedicle screws (PPS) and the mini-open Galveston technique. Case reports Case 1. A 50-year-old woman was injured by a fall from the 5th floor of a building as the result of a suicide attempt. Computed tomography revealed an H-shaped unstable sacral fracture and thoracolumbar fractures with major chest and abdominal injuries. For early stabilization of spinopelvic instability and early ambulation, we treated the patient with PPS and the mini-open Galveston technique. Her early postoperative emergence from bedrest contributed to the improvement of her general condition. One year after surgery at the final follow-up, she was able to walk with a T-cane without any motor, bladder, or bowel dysfunction (BBD) and achieved almost complete healing of the fractures. Cases 2 and 3. A 25-year-old woman (Case 2) and a 43-year-old woman were injured in falls. They had multiple injuries including unstable sacral fractures, and thoracolumbar fractures with major chest and abdominal injuries. We treated these patients with PPS and the mini-open Galveston technique. One year after surgery, they were able to walk with a T-cane and achieved almost complete healing of thoracolumbar fractures, but delayed healing of an unstable sacral fracture in Case 2, and remaining BBD in Case 3. Conclusion PPS and the mini-open Galveston technique is a good approach to fixation because they are minimally invasive and provide moderately rigid fixation, especially in patients with multiple trauma whose general condition is poor.
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Affiliation(s)
- Shotaro Fujino
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Shuichiro Tajima
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Takayuki Imura
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Ryo Tazawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Toshiyuki Nakazawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Wataru Saito
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Eiki Shirasawa
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Hiroaki Minehara
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Terumasa Matsuura
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Tadashi Kawamura
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Kentaro Uchida
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
| | - Naonobu Takahira
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan.,Departments of Biomedical Engineering and Rehabilitation, Kitasato University School of Allied Health Sciences, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, Japan
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Guo J, Guo L, Gao J, Ling Q, Yin Z, He E. Does a deep seated L5 vertebra position with respect to the iliac crests affect the accuracy of percutaneous pedicle screw placement at lumbosacral junction? BMC Musculoskelet Disord 2017; 18:180. [PMID: 28476112 PMCID: PMC5420121 DOI: 10.1186/s12891-017-1537-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Significant prominence of iliac crests with a deep seated L5 vertebra can potentially interfere with the screw trajectory when placing percutaneous pedicle screws (PPS) at the lumbosacral segment. The objective of this study was to investigate the influence of L5 position in relation to the iliac crests on the accuracy of percutaneous placement of lumbosacral pedicle screws. METHODS From Oct 2012 to Sep 2014, 54 patients who underwent PPS placement at L5-S1 segment were recruited. Patients were divided into 2 groups: the L5-Seated Group (L5-S Group, n = 34) including patients with intercrest lines passing through the L4 vertebra or L4/5 intervertebral disc; whereas the L5-Non-Seated Group (L5-NS Group, n = 20) including patients with intercrest lines passing through the L5 vertebra. Postoperative computerized tomography was obtained in all patients, and PPS accuracy was evaluated by grading pedicle breach (Grade 0, no breach; Grade 1, ≤2mm; Grade 2, >2mm without neurological compromise; Grade 3, with complications). Screw convergence angle (SCA), defined as the angle subtended by the screw axis and vertebral midline, was also recorded. RESULTS In the L5-S Group, 82.4% (56/68) screws were measured as Grade 0 at L5, and 66.2% (45/68) were Grade 0 at S1; meanwhile, in the L5-NS Group, 77.5% (31/40) and 75.0% (30/40) screws were Grade 0 at L5 and S1, respectively. Misplacement rate was numerically higher at S1 in the L5-S Group (P > 0.05). There were significantly more medial pedicle violations at S1 in the L5-S Group as compared to the L5-NS Group (25.0% vs 7.5%, P = 0.024). No statistical difference was found in L5 SCA between the 2 groups (L5-S Group 23.7° ± 7.4° vs L5-NS Group 23.4° ± 10.6°, P = 0.945); however, S1 SCA was significantly smaller in the L5-S Group (14.7° ± 5.8°) when compared with the L5-NS Group (20.8° ± 5.2°) (P = 0.036). CONCLUSIONS A deep seated L5 vertebra with respect to the iliac crests might compromise the accuracy of PPS placement at S1 vertebra. Severe iliac prominence may interfere with the screw trajectory and limit the medial angulation of pedicle screw for percutaneous S1 fixation.
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Affiliation(s)
- Jing Guo
- Spine Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Orthopaedic Institute, Guangzhou, China
| | - Lianjin Guo
- Spine Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Juzhou Gao
- Spine Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qinjie Ling
- Spine Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Orthopaedic Institute, Guangzhou, China
| | - Zhixun Yin
- Spine Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Orthopaedic Institute, Guangzhou, China
| | - Erxing He
- Spine Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. .,Guangzhou Orthopaedic Institute, Guangzhou, China. .,The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang West Road, 510000, Guangzhou, China.
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Dai JH, Lin HB, Li X, Wu YY, Zhang HZ, Yu ZX. [Clinical effect of minimally-Invasive surgical-transforaminal lumbar interbody fusion technique associated with percutaneous pedicle screws in micro endoscopy discectomy]. Zhonghua Yi Xue Za Zhi 2017; 97:864-868. [PMID: 28355744 DOI: 10.3760/cma.j.issn.0376-2491.2017.11.014] [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: 11/05/2022]
Abstract
Objective: To evaluate the clinical efficacy between the minimally-Invasive surgical (MIS)-transforaminal lumbar interbody fusion (TLIF) technique associated with percutaneous pedicle screws in micro endoscopy discectomyand MIS-TLIF technique associated with both sides of the lower lumbar spine Wiltse approach in Quadrant channel with treatment of single segment herniation associated with lumbar instability syndrome. Methods: From January 2012 to January 2015, 75 cases that meet the inclusion and exclusion criteria were treated by retrospective study method, which were divided into two groups in Department of Orthopedics, the Affiliated Hospital of Putian University.Experimental group(30 patients) were treated with MIS-TLIF technique associated with percutaneous pedicle screws in microendoscopy discectomy, control group were treated with MIS-TLIF technique associated with both sides of the lower lumbar spine Wiltse approach in Quadrant Chanel.Compare operation time, blood loss, postoperativehospital stay, clinical efficacy, nailing accuracy, fusion rate, postoperative pain scoring of two groups. Results: The blood loss[(102.1±5.5) min vs(103.7±7.7) min, t=-0.586, P>0.05], postoperative blood loss, hospital stay[(44.6±5.2) ml and(57.2±5.3) ml, (7.3±1.6) d and(9.3±1.9) d; t=-5.813, -2.774, P<0.05], JOA score before and after surgery in same group were statistically significant(P<0.05), respectively.Patients of two groups compared with operation time, clinical efficacy, nailing accuracy[group A: 97.5%, group B: 95.7%; χ(2)=3.00, P>0.05.Postoperative 3 month , group A: 96.7%(29/30), group B: 94.3%(33/35; χ(2)=0.79, P>0.05], fusion rate[group A: 96.7%(29/30), group B: 94.3%(33/35), χ(2)=0.79, P>0.05], preoperative JOA score[(20.4±2.4)score and(7.9±1.0), (19.1±2.7)score and(7.8±1.2)score], postoperative JOA score were no statistically significant respectively, P>0.05. JOA score of both groups were statistically significant respectively Before and after operate.Excellent rate: group A; 84.4%(25/30), group B: 80.0%(28/35), χ(2)=0.43, P>0.05. Conclusion: MIS-TLIF technique associated with percutaneous pedicle screws in micro endoscopy discectomy relative to conventional minimally invasive spine surgery had many advantages: minimal damage, operation conveniently, precisely clinical effect, that is a kind of feasible and reliable minimally invasive surgery which is worth promoting.
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Affiliation(s)
- J H Dai
- Department of Orthopedics, the Affiliated Hospital of Putian University, Fujian 351100, China
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Abstract
Minimally invasive techniques aimed at minimizing surgery-associated risk and morbidity of spinal surgery have increased in popularity in recent years. Their potential advantages include reduced length of hospital stay, blood loss, and requirement for post-operative analgesia and earlier return to work. One such minimally invasive technique is the use of percutaneous pedicle screw fixation, which is paramount for promoting rigid and stable constructs and fusion in the context of trauma, tumors, deformity and degenerative disease. Percutaneous pedicle screw insertion can be an intimidating prospect for surgeons who have only been trained in open techniques. One of the ongoing challenges of this percutaneous system is to provide the surgeon with adequate access to the pedicle entry anatomy and adequate tactile or visual feedback concerning the position and anatomy of the rod and set-screw construct. This review article discusses the history and evolution of percutaneous pedicle screw retractor technologies and outlines the advances over the last decade in the rapidly expanding field of minimal access surgery for posterior pedicle screw based spinal stabilization. As indications for percutaneous pedicle screw techniques expand, the nuances of the minimally invasive surgery techniques and associated technologies will also multiply. It is important that experienced surgeons have access to tools that can improve access with a greater degree of ease, simplicity and safety. We here discuss the technical challenges of percutaneous pedicle screw retractor technologies and a variety of systems with a focus on the pros and cons of various retractor systems.
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Affiliation(s)
- Ralph J Mobbs
- NeuroSpine Surgery Research Group, Sydney, Australia.,NeuroSpine Clinic, Prince of Wales Private Hospital, Sydney, Australia.,Department of Neurosurgery, University of New South Wales (UNSW), Randwick, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group, Sydney, Australia.,NeuroSpine Clinic, Prince of Wales Private Hospital, Sydney, Australia.,Department of Neurosurgery, University of New South Wales (UNSW), Randwick, Australia
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Ikeuchi H, Ikuta K. Accuracy of pedicle screw insertion in the thoracic and lumbar spine: a comparative study between percutaneous screw insertion and conventional open technique. Arch Orthop Trauma Surg 2016; 136:1195-1202. [PMID: 27402214 DOI: 10.1007/s00402-016-2502-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 10/25/2015] [Indexed: 02/09/2023]
Abstract
INTRODUCTION In the last decade, posterior instrumented fusion using percutaneous pedicle screws (PPSs) had been growing in popularity, and its safety and good clinical results have been reported. However, there have been few previous reports of the accuracy of PPS placement compared with that of conventional open screw insertion in an institution. This study aimed to evaluate the accuracy of PPS placement compared with that of conventional open technique. MATERIALS AND METHODS One hundred patients were treated with posterior instrumented fusion of the thoracic and lumbar spine from April 2008 to July 2013. Four cases of revised instrumentation surgery were excluded. In this study, the pedicle screws inserted below Th7 were investigated, therefore, a total of 455 screws were enrolled. Two hundred and ninety-three pedicle screws were conventional open-inserted screws (O-group) and 162 screws were PPSs (P-group). We conducted a comparative study about the accuracy of placement between the two groups. Postoperative computed tomography scans were carried out to all patients, and the pedicle screw position was assessed according to a scoring system described by Zdichavsky et al. (Eur J Trauma 30:241-247, 2004; Eur J Trauma 30:234-240, 2004) and a classification described by Wiesner et al. (Spine 24:1599-1603, 1999). RESULTS Based on Zdichavsky's scoring system, the number of grade Ia screws was 283 (96.6 %) in the O-group and 153 (94.4 %) in the P-group, whereas 5 screws (1.7 %) in the O-group and one screw (0.6 %) in the P-group were grade IIIa/IIIb. Meanwhile, the pedicle wall penetrations based on Wiesner classification were demonstrated in 20 screws (6.8 %) in the O-group, and 12 screws (7.4 %) in the P-group. No neurologic complications were observed and no screws had to be replaced in both groups. CONCLUSIONS The PPSs could be ideally inserted without complications. There were no statistically significant differences about the accuracy between the conventional open insertion and PPS placement.
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Affiliation(s)
- Hiroko Ikeuchi
- Department of Orthopaedic Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka, 802-0077, Japan.
| | - Ko Ikuta
- Department of Orthopaedic Surgery, Japanese Red Cross Karatsu Hospital, 1-5-1 Futago, Karatsu, Saga, 847-0861, Japan
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Cao L, Tan L, Lin X, Wu C. [SHORT-TERM EFFECTIVENESS OF PERCUTANEOUS PEDICLE SCREW GUIDED WITH PHOTOELECTRIC NAVIGATION FOR THORACOLUMBAR FRACTURES]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2016; 30:726-731. [PMID: 29786267 DOI: 10.7507/1002-1892.20160148] [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: 11/03/2022]
Abstract
OBJECTIVE To investigate the short-term effectiveness of percutaneous pedicle screw (PPS) guided with photoelectric navigation for thoracolumbar fractures. METHODS Between May 2013 and June 2015, the clinical data of 39 patients with thoracolumbar fractures in accordance with the selection criteria were retrospectively analyzed. The patients were divided into photoelectric navigation PPS group (trial group, 20 cases) and C-arm X-ray guidance PPS group (control group, 19 cases). There was no significant difference in gender, age, injury cause, fracture vertebrae, AO classification, operation time after injury, visual analogue scale (VAS) score, and vertebral compression ratio (VCR) between 2 groups (P > 0.05). The operation time, bleeding amount, perspective times, VAS score, and one-time success rate (OSR) of screw placement were recorded; VCR and endplate-screw angle (ESA) were measured; and pedicle-screw relationship (PSR) was assessed by Ringel's method in radiographic result. RESULTS Differences in operation time and bleeding amount were not significant between 2 groups (P > 0.05); perspective times of control group was significantly more than t hat of trial group (t=-15.658, P=0.000). The OSR of trial group (95.60%, 87/91) was significantly better than that of control group (86.75%, 72/83) (χ2=4.323, P=0.038). The patients were followed up 6-11 months (mean, 7.6 months) in trial group, and 7-11 months (mean, 7.8 months) in control group. No neurovascular complications associated with screw insertion occurred. Difference was not significant in VAS score at 7 days and 6 months after operation between 2 groups (P > 0.05), but VAS scores at 7 days and 6 months were significantly improved when compared with preoperative score in 2 groups (P < 0.05), and significant difference in VAS score was shown between at 7 days and 6 months in 2 groups (P < 0.05). VCR of trial group and control group were significantly improved to 94.75%±5.10% and 92.40%±5.09% at 6 months after operation from preoperative 71.97%±5.66% and 73.50%±5.97% (t=11.865, P=0.000; t=11.359, P=0.000), but there was no significant difference between 2 groups (t=1.442, P=0.158). ESA of trial group and control group were (1.82±1.13)° and (3.36±2.43)° at 6 months after operation, showing significant difference (t=5.421, P=0.000). At 6 months after operation, according to PSR classification, 83 screws rated as grade I, 6 as grade II, and 2 as grade III, and excellent and good rate of screw replacement was 97.80% in trial group; 54 screws were rated as grade I, 19 as grade II, 7 as grade III, and 3 as grade IV, and excellent and good rate of screw replacement was 87.95% in control group; difference was significant between 2?groups (χ2=18.347, P=0.000). CONCLUSIONS Application of photoelectric navigation can guide screws placement by the two-dimensional multi pl ane dynamic image, has better accuracy of screws position in thoracolumbar fractures, reduces the introperative X-ray perspective times, maintains good reduction of vertebral body, and achieves satisfactory effectiveness.
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Affiliation(s)
- Linhu Cao
- Department of Orthopedics, Chongqing Orthopedics Hospital of Traditional Chinese Medicine, Chongqing, 400012, P.R.China.,Department of Orthopedics, the Fourth People's Hospital of Zigong City
| | - Lun Tan
- Department of Orthopedics, the Fourth People's Hospital of Zigong City
| | - Xu Lin
- Department of Orthopedics, the Fourth People's Hospital of Zigong City
| | - Chao Wu
- Department of Orthopedics, the Fourth People's Hospital of Zigong City
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Kwan MK, Lee CK, Chan CY. Minimally Invasive Spinal Stabilization Using Fluoroscopic-Guided Percutaneous Screws as a Form of Palliative Surgery in Patients with Spinal Metastasis. Asian Spine J 2016; 10:99-110. [PMID: 26949465 DOI: 10.4184/asj.2016.10.1.99] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 05/25/2015] [Accepted: 06/14/2015] [Indexed: 01/08/2023] Open
Abstract
Study Design Prospective cohort study. Purpose To report the outcome of 50 patients with spinal metastases treated with minimally invasive stabilization (MISt) using fluoroscopic guided percutaneous pedicle screws with/without minimally invasive decompression. Overview of Literature The advent of minimally invasive percutaneous pedicle screw stabilization system has revolutionized the treatment of spinal metastasis. Methods Between 2008 and 2013, 50 cases of spinal metastasis with pathological fracture(s) with/without neurology deficit were treated by MISt at our institution. The patients were assessed by Tomita score, pain score, operation time, blood loss, neurological recovery, time to ambulation and survival. Results The mean Tomita score was 6.3±2.4. Thirty seven patients (74.0%) required minimally invasive decompression in addition to MISt. The mean operating time was 2.3±0.5 hours for MISt alone and 3.4±1.2 hours for MISt with decompression. Mean blood loss for MISt alone and MISt with decompression was 0.4±0.2 L and 1.7±0.9 L, respectively. MISt provided a statistically significant reduction in visual analog scale pain score with mean preoperative score of 7.9±1.4 that was significantly decreased to 2.5±1.2 postoperatively (p=0.000). For patients with neurological deficit, 70% displayed improvement of one Frankel grade and 5% had an improvement of 2 Frankel grades. No patient was bed-ridden postoperatively, with the average time to ambulation of 3.4±1.8 days. The mean overall survival time was 11.3 months (range, 2–51 months). Those with a Tomita score <8 survived significantly longer than those a Tomita score ≥8 with a mean survival of 14.1±12.5 months and 6.8±4.9 months, respectively (p=0.019). There were no surgical complications, except one case of implant failure. Conclusions MISt is an acceptable treatment option for spinal metastatic patients, providing good relief of instability back pain with no major complications.
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Mobbs RJ, Park A, Maharaj M, Phan K. Outcomes of percutaneous pedicle screw fixation for spinal trauma and tumours. J Clin Neurosci 2015; 23:88-94. [PMID: 26422600 DOI: 10.1016/j.jocn.2015.05.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 02/14/2015] [Revised: 04/22/2015] [Accepted: 05/01/2015] [Indexed: 11/30/2022]
Abstract
We investigated the clinical and radiological results of percutaneous pedicle screw fixation in the management of spinal trauma and metastatic tumours. A retrospective analysis was performed on a series of 14 patients who were operated on from March 2009 to November 2011 by a single surgeon (RJM). Following a radiological review (CT scan/MRI), six patients underwent short segment fixation, while the remaining underwent long segment fixation. All patients had routine follow-ups at 4, 6, 12months, and annually thereafter. Clinical examinations were conducted preoperatively and postoperatively, and the length of operation, blood loss, and postoperative pain relief were recorded. There was a single patient with an incision site complication. The mean blood loss was 269mL. All of the parameters demonstrated no significant differences between the trauma and the tumour groups (p=0.10). The neurological power scores improved for all patients, with the largest increase being from a score of 2 to 4. At follow-up, the majority of patients had returned to their previous activities and had reduced pain scores. One patient suffered high pain levels from other medical conditions that were not related to the operation. Minimally invasive pedicle screw fixation is a suitable option for patients with spinal tumours and fractures, with acceptable safety and efficacy in this small retrospective patient series. We have seen favourable results in our patients, who have experienced an increased quality of life following their surgery.
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Affiliation(s)
- Ralph J Mobbs
- NeuroSpineClinic, Suite 7, Level 7, Prince of Wales Private Hospital, Barker Street, Randwick, NSW 2031, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; NeuroSpine Surgery Research Group, Sydney, NSW, Australia.
| | - Ashley Park
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Monish Maharaj
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kevin Phan
- NeuroSpineClinic, Suite 7, Level 7, Prince of Wales Private Hospital, Barker Street, Randwick, NSW 2031, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; NeuroSpine Surgery Research Group, Sydney, NSW, Australia
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Han SH, Kang SH, Cho YJ, Cho TG. Single incision percutaneous pedicle screw fixation for transforaminal lumbar interbody fusion. Korean J Spine 2012; 9:92-7. [PMID: 25983795 PMCID: PMC4432367 DOI: 10.14245/kjs.2012.9.2.92] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 06/22/2012] [Accepted: 06/25/2012] [Indexed: 11/19/2022]
Abstract
Objective Percutaneous pedicle screw fixation (PPSF) offers some of the advantages of minimally invasive surgery. However, an additional skin incision is necessary in order to gain these advantages. The author recently performed a modified PPSF through a single skin incision and it yielded good results. Here, we report the single incision percutaneous pedicle screw fixation (SIPPSF). Methods The medical records of 51 patients who underwent single segment transforaminal lumbar interbody fusion (TLIF) with pedicle screw fixation (PSF) between December 2009 and December 2011 were reviewed. The patients were divided into 3 groups according to the PSF technique used; conventional group (Group C), SIPPSF (Group S) and PPSF through multiple skin incisions (Group M). Operation time, estimated blood loss (EBL) and pain intensity before and after the operation using a numeric rating scale (NRS) were evaluated. Results The number of patients in Group S, Group C and Group M was 25, 17 and 9, respectively. The NRS demonstrated a reduction in pain intensity in all the patients, and there were no differences in NRS scoring between the three groups. Group S showed a reduction in the EBL compared to Group C (p=0.001) and a reduction in the operation time compared to Group M(p=0.003). Conclusion The author supposes that the type of skin incision does not correlate significantly with the clinical results of TLIF with PPSF. However, it can be considered that SIPPSF offers the advantage of avoiding an additional paramedian skin incision.
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Affiliation(s)
- Sung Hoon Han
- Department of Neurosurgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Suk-Hyung Kang
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Yong-Jun Cho
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Tack Geun Cho
- Department of Neurosurgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Agrawal A, Mizuno J, Kato Y, Inoue T, Sano H. Minimally invasive pedicle screw placement in a case of L4 fracture: case report with review of literature. Asian J Neurosurg 2010; 5:64-9. [PMID: 22028760 PMCID: PMC3201084] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Pedicle screw instrumentation provides a rigid construct to promote fusion in cases of spinal trauma and degenerative diseases. Minimally invasive percutaneous technique in lumbar spine is a safe and reliable procedure as compared to the well established Magerl technique. It is a straight forward alternative to open approaches or minimally invasive ones and the accuracy of screw placement is also similar to that reported for other techniques. CASE REPORT A 16 year old high school boy presented to us with accidental fall from third floor. He was suffering from common cold with resulting high fever. He developed low back ache with bilateral radiculopathy and weakness of dorsiflexors. Neuro-imaging revealed a burst fracture of L4 vertebral body (type A 3.3 according to Magerl/AO spine classification), with bone fragments compromising the spinal canal. Delayed surgery was planned in view of anticipated excessive bleeding from the wound site in addition to poor general condition. Using a bone impactor, the bony fragments were impacted back into the original vertebral body space. Sextant (Medtronic Sofamor Danek, Tennessee, USA) percutaneous pedicle screw and rod fixation device was then used as a rigid construct to stabilize the lumbar spine. Post-operative CT scan and MRI revealed accurate pedicle screw fixation with adequately decompressed spinal canal. CONCLUSION Short segment fusion with minimally invasive pedicle screwing following decompression of cauda equina was considered to be a minimally invasive approach for this case.
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Affiliation(s)
- Abhishek Agrawal
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan,Correspondence: Dr Abhishek Agrawal, Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo Kutsukake Toyoake, Aichi, 470-1192, Japan Tel: +81-562-93-9253 Fax: +81-562-93-3118 E-mail:
| | - Junichi Mizuno
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan
| | - Tatsushi Inoue
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan
| | - Hirotoshi Sano
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan
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