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Patel BK, Bapat MR, Gujral A. Clinical and Radiological Outcomes after Reducing Adult Lytic High-Grade Spondylolisthesis Using a Hybrid Technique: Combination of Percutaneous Pedicle Screws with Midline Microscopic Transforaminal Decompression. Asian Spine J 2023; 17:1004-1012. [PMID: 37946335 PMCID: PMC10764137 DOI: 10.31616/asj.2023.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/10/2023] [Accepted: 06/11/2023] [Indexed: 11/12/2023] Open
Abstract
STUDY DESIGN Retrospective study. PURPOSE To analyze the results and effectiveness of percutaneous screws (PS) with midline microscopic transforaminal decompression (MTFD) technique in reducing adult stiff lytic high-grade spondylolisthesis (HGSL) and compare it with the conventional technique. OVERVIEW OF LITERATURE Pedicle screw cannulation and segmental kyphosis negotiation are surgical challenges in HGSL. Open reduction is the preferred approach. PS have the advantage of optimized trajectory and minimized soft tissue exposure. The role of minimally invasive surgery in HGSL remains unknown. We propose a hybrid technique combining PS with MTFD for lytic HGSL. METHODS This study included 25 patients with adult lytic HGSL (Meyerding grade III and IV) operated using a hybrid technique from 2012 to 2015. Data were compared with retrospective data on conventional open reduction (n=23) operated from 2000 to 2015. The minimum follow-up was 5 years. Clinical outcomes were assessed using the Visual Analog Scale (VAS) score and modified Oswestry Disability Index (m-ODI). The spinopelvic and perioperative parameters were recorded. The inter-body fusion and adjacent segment degeneration (ASD) were assessed on radiographs at the final follow-up. RESULTS The average age in the MTFD and open groups was 45.84±12.70 years (nine males and 16 females) and 49.26±13.33 years (eight males and 15 females), respectively. Further, 22 and three patients in the MTFD group and 19 and four in the open group had grade III and IV listhesis, respectively. The MTFD group demonstrated less operative time, blood loss, and hospital stays than the open group. Significant improvements were observed in VAS and m-ODI in subsequent follow-ups in both groups. The MTFD group fared better at 3 months but outcomes were comparable at the final follow-up. Both techniques were equally effective in restoring spinopelvic parameters. The incidence of ASD is comparable. CONCLUSIONS The technique was proven effective in reducing HGSL. The long-term clinical and radiological outcomes were favorable and comparable with the conventional approach.
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Affiliation(s)
- Bharat K. Patel
- Department of Spine Surgery, Nanavati Max Super Speciality Hospital, Mumbai,
India
| | - Mihir R. Bapat
- Minimally Invasive Spine Surgery Unit, Nanavati Max Super Speciality Hospital, Mumbai,
India
| | - Amandeep Gujral
- Department of Spine Surgery, Nanavati Max Super Speciality Hospital, Mumbai,
India
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Cattaneo S, Galante C, Biancardi E, Domenicucci M, Paderno M, Pianelli A, Milano G, Casiraghi A. Use of the iliac-outlet and iliac-inlet combined views in percutaneous posterior column retrograde screw fixation. Arch Orthop Trauma Surg 2023; 143:5713-5717. [PMID: 37284880 PMCID: PMC10449713 DOI: 10.1007/s00402-023-04939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/26/2023] [Indexed: 06/08/2023]
Abstract
Posterior column fractures are common acetabular injuries. Although displaced fractures require open reduction and fixation, undisplaced patterns may benefit from percutaneous screw fixation. The combination of iliac oblique with inlet and outlet views offers an intuitive and panoramic rendering of the bony corridor into the posterior column; lateral cross table view completes the sequence of fluoroscopic projections. Herein we describe the use of outlet/inlet iliac views and a detailed procedure for percutaneous retrograde posterior column screw fixation.
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Affiliation(s)
- Stefano Cattaneo
- Department of Bone and Joint Surgery, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, BS, Italy.
| | - Claudio Galante
- Department of Bone and Joint Surgery, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, BS, Italy
| | - Elena Biancardi
- Department of Bone and Joint Surgery, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, BS, Italy
| | - Marco Domenicucci
- Department of Bone and Joint Surgery, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, BS, Italy
| | - Marco Paderno
- Department of Bone and Joint Surgery, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, BS, Italy
| | - Antonio Pianelli
- Department of Bone and Joint Surgery, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, BS, Italy
| | - Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Viale Europa 11, 25123, Brescia, BS, Italy
| | - Alessandro Casiraghi
- Department of Bone and Joint Surgery, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123, Brescia, BS, Italy
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Jarragh A, Lari A, Shaikh M. A computed tomography (CT) based morphometric study of superior pubic ramus anatomy among Arabs to determine safe intramedullary pubic rami screw insertion. Surg Radiol Anat 2023; 45:603-609. [PMID: 36964777 DOI: 10.1007/s00276-023-03128-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/10/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE To assess the morphometric variables of the superior pubic ramus in an Arab/ Middle Eastern population to establish a safe pubic screw fixation technique. METHODS Cross-sectional retrospective analysis of computed tomography (CT) pelvic images. Morphometric data were extracted including; on pubic ramus length, insertion angles, potential danger zones and ramus diameters. The correlation between pubic rami diameter and patient demographics was also analyzed. RESULTS A total of 231 participants were included (45% female). The mean pubic ramus length was 104 mm in females and 127 mm in males. The narrowest canal diameters at the para-symphyseal area were; 7.35 mm (males) and 4.75 mm (females). The mediolateral insertion angle was 49.4° in females and 41.8° in males. The cephalic-caudal angle was 49.9° in males and 42.1° in females. The mean distance from the lateral ilium entry point to the joint articular surface was 23.5 mm in males and 19.9 mm in females. The symphysis pubis to tubercle exit point was higher in females than males (24.2 mm vs 16.6 mm, respectively). There was a significant positive correlation between age and pubic ramus diameters in all age groups. CONCLUSION The results from this study suggest that percutaneous pubic rami screw fixation using the standard 6.5 or 7.3 mm cannulated screw system may potentially be unsafe in female Arab patients. This subset of patients may require alternative non-cannulated screws (3.5-4.5 mm) or plate options. Further, female patients may have a higher risk of acetabular joint penetration, while males have a potentially higher risk of pudendal nerve injury.
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Affiliation(s)
- Ali Jarragh
- Department of Surgery, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
| | - Ali Lari
- Department of Orthopedic Surgery, AlRazi Orthopedic Hospital, Kuwait City, Kuwait
| | - Mehraj Shaikh
- Department of Radiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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Takaesu M, Nakasone S, Miyata Y, Nishida K. Real-time three-dimensional fluoroscopy-navigated percutaneous pelvic screw placement for fragility fractures of the pelvis in the hybrid operating room. BMC Musculoskelet Disord 2022; 23:1057. [PMID: 36463151 PMCID: PMC9719204 DOI: 10.1186/s12891-022-06026-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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The prognosis of conservative treatment for fragility fracture of the pelvis (FFP) in the older patients remains poor. Percutaneous pelvic screw placement (PPSP), which aids in the treatment of FFP, can be challenging to perform using fluoroscopy alone because of the proximity of blood vessels and neuroforamina. Hence, this study aimed to investigate the accuracy and clinical outcomes of PPSP using real-time 3D fluoroscopic navigation for FFP in the hybrid operating room. METHODS This study included 41 patients with FFP who underwent PPSP in a hybrid operating room between April 2016 and December 2020. Intraoperative C-arm cone-beam CT was performed under general anesthesia. Guidewire trajectory was planned using a needle guidance system. The guidewire was inserted along the overlaid trajectory using 3D fluoroscopic navigation, and a 6.5 mm cannulated cancellous screw (CCS) was placed. The clinical outcomes and accuracy of the screw placement were then investigated. RESULTS A total of 121 screws were placed. The mean operative time was 84 ± 38.7 minutes, and the mean blood loss was 7.6 ± 3.8 g. The mean time to wheelchair transfer was 2 days postoperatively. Pain was relieved in 35 patients. Gait ability from preoperative and latest follow-up after surgery was maintained in 30 (73%) patients. All 41 patients achieved bone union. Of the 121 screws, 119 were grade 0 with no misplacement; only 2 patients had grade 1 perforations. CONCLUSION PPSP using real-time 3D fluoroscopic navigation in a hybrid operating room was accurate and useful for early mobilization and pain relief among older patients with FFP with an already-installed needle biopsy application.
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Affiliation(s)
- Mika Takaesu
- Department of Orthopaedic Surgery, Chubu Tokushukai Hospital, 801 Higa, Kitanakagusuku, Nakagami-gun, Okinawa, 901-2393 Japan
| | - Satoshi Nakasone
- grid.267625.20000 0001 0685 5104Department of Orthopaedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Aza-Uehara, Nishihara, Nakagami-gun, Okinawa, 903-0215 Japan
| | - Yoshihide Miyata
- Department of Orthopaedic Surgery, Chubu Tokushukai Hospital, 801 Higa, Kitanakagusuku, Nakagami-gun, Okinawa, 901-2393 Japan
| | - Kotaro Nishida
- grid.267625.20000 0001 0685 5104Department of Orthopaedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Aza-Uehara, Nishihara, Nakagami-gun, Okinawa, 903-0215 Japan
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Calis M, Kaplan GO, Küçük KY, Altunbulak AY, Akgöz Karaosmanoğlu A, Işıkay Aİ, Mavili ME, Tunçbilek G. Algorithms for the management of frontal sinus fractures: A retrospective study. J Craniomaxillofac Surg 2022; 50:S1010-5182(22)00144-5. [PMID: 36220677 DOI: 10.1016/j.jcms.2022.09.007] [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: 01/06/2022] [Revised: 08/17/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023] Open
Abstract
The aim of this study was to evaluate the long-term results and to evaluate the validity of the treatment algorithm that can be safely applied in dfrontal sinus fractures. All patients were evaluated in terms of late-term contour deformity and further craniometric analysis for measurement of maximum amount of displacement, fracture surface area (mm2) and the maximum angulation of the fracture (degree) were done. 125 patients (101 male, 24 female) with frontal sinus fractures with an average age of 22.4 years (range,17-66 years) were reviewed. All patients with isolated anterior table fractures without displacement were followed up on conservative basis. 33 patients with anterior table fractures with displacement and 39 patients with anterior and posterior table fractures were also followed on conservative basis without surgical intervention. The cut-off value of the maximum amount of displacement was confirmed to be 4.5 mm in prediction of late-term contour deformities (p < 0.001). The maximum amount of displacement was decreased by an average of 1.8 mm at late-term. Apart from the standard protocols, within the limitations of the study it seems that isolated anterior table fractures with a maximum amount of displacement of less than 4.5 mm can be treated conservatively without leading to contour deformities. CSF leakage in the acute setting might not always require cranialization and this may spontaneously resolve within 10 days. Cranialization should be considered whenever CSF leakage lasts longer than 10 days.
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Affiliation(s)
- Mert Calis
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Ankara, Turkey.
| | - Güven Ozan Kaplan
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Ankara, Turkey
| | - Kutluhan Yusuf Küçük
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Ankara, Turkey
| | | | | | - Ahmet İlkay Işıkay
- Hacettepe University Faculty of Medicine, Department of Neurosurgery, Ankara, Turkey
| | - Mehmet Emin Mavili
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Ankara, Turkey
| | - Gökhan Tunçbilek
- Hacettepe University Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Ankara, Turkey
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Liu ZJ, Gu Y, Jia J. The Kocher-Langenbeck approach combined with robot-aided percutaneous anterior column screw fixation for transverse-oriented acetabular fractures: a retrospective study. BMC Musculoskelet Disord 2022; 23:345. [PMID: 35410204 PMCID: PMC8996653 DOI: 10.1186/s12891-022-05313-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 04/06/2022] [Indexed: 11/19/2022] Open
Abstract
Objective Transverse-oriented acetabular fractures (TOAFs), including transverse, transverse with posterior wall and T-shaped fractures, are always challenging for double-column reduction and fixation with minimally invasive method. The purpose of this study is to compare the therapeutic effects of robot-aided percutaneous anterior column screw fixation versus minimally invasive anterior plate fixation for TOAFs based on the Kocher-Langenbeck (K-L) approach. Methods Patients suffering TOAFs that were fixed by robot-aided percutaneous anterior column screw fixation or minimally invasive anterior plate fixation associated with posterior fixation via the K-L approach were divided into two groups: group A (screw fixation) and group B (plate fixation). Surgical time, blood loss, incision length for anterior fixation and complications were recorded. Fracture reduction quality was evaluated using criteria described by Matta. Fracture healing was assessed on the series of pelvic radiographs at each follow-up. Functional outcomes were investigated using the modified Postel Merle D’Aubigne score at the final follow-up. Results Twenty-nine patients with TOAFs, including 12 patients in group A and 17 patients in group B, were evaluated for study eligibility. The mean surgical time of anterior fracture fixation was 18.7 ± 4.6 min in group A and 33.4 ± 5.0 min in group B (P < 0.001). The amount of intraoperative blood loss was 615.6 ± 178.7 ml in group A and 719.3 ± 199.0 ml in group B (P < 0.001). Incision length for anterior fixation was 9.0 ± 1.8 mm in group A and 81.2 ± 7.3 mm in group B (P < 0.001). The complications related to the surgery of anterior column only occurred in group B (lateral femoral cutaneous nerve palsy in 1 patient and groin discomfort in 1 patient). No significant differences in reduction quality, hospital stay, fracture healing time and functional results were noted between the two groups. Conclusion The K-L approach combined with robot-aided anterior column screw fixation is a safe and effective option for TOAFs. Compared with minimally invasive anterior plate fixation, robot-aided screw fixation has obvious advantages on surgical time, blood loss, and invasiveness. The K-L approach combined with minimally invasive anterior plate fixation can also be a reliable alternative for TOAFs, with the similar reduction quality and functional results.
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Affiliation(s)
- Zhao-Jie Liu
- Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211, China
| | - Ya Gu
- Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211, China
| | - Jian Jia
- Department of Orthopaedics, Tianjin Hospital, 406 Jiefangnan Road, Tianjin, 300211, China.
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Ebrahimpour A, Kord MHC, Sadighi M, Chehrassan M, Najafi A, Sajjadi MM. Percutaneous reduction and screw fixation for all types of intra-articular calcaneal fractures. Musculoskelet Surg 2021; 105:97-103. [PMID: 31907753 DOI: 10.1007/s12306-019-00635-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION This study compares the outcomes of consecutive of patients with Sanders II and III and IV calcaneal fractures that were stabilized by either close reduction and internal fixation (CRIF) or open reduction and internal fixation (ORIF). MATERIALS AND METHODS Group I (N = 49) underwent close reduction internal fixation (CRIF). Group II (N = 39) underwent open reduction internal fixation (ORIF). The clinical outcomes included time to operation, operative duration, visual analog score (VAS), length of hospital stay, wound-related complications and AOFAS SF-36 score. Preoperative and postoperative radiographic measures also were compared. RESULTS The duration of operation in the CRIF group was considerably shorter than in ORIF group (P = 0.0001). Postoperatively, at seventh day, the VAS in the CRIF group (4.2 ± 1.1) was meaningfully lower than those of the ORIF patients group (4.7 ± 1.2, P = 0.04). Totally, the prevalence of wound complications in CRIF group was significantly lower than in ORIF group. In final follow-up visit after one year, AOFAS scores and SF-36 scores between groups were comparable. Comparable radiographic measures were found in both groups. There was no significant difference between groups regarding preoperative radiographic measures (P > 0.05), while in postoperative imaging acceptable calcaneal fracture reduction was found in both groups. CONCLUSION We believed that for treatment of various types of calcaneal fracture compared with ORIF the percutaneous reduction and screw fixation may lead to shorter hospital stay, decreased subtalar joint stiffness and earlier weight bearing along with much favorable patients' satisfaction.
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Long T, Li KN, Gao JH, Liu TH, Mu JS, Wang XJ, Peng C, He ZY. Comparative Study of Percutaneous Sacroiliac Screw with or without TiRobot Assistance for Treating Pelvic Posterior Ring Fractures. Orthop Surg 2019; 11:386-396. [PMID: 31077570 PMCID: PMC6595115 DOI: 10.1111/os.12461] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 01/22/2019] [Revised: 03/11/2019] [Accepted: 03/27/2019] [Indexed: 12/15/2022] Open
Abstract
Objectives To analyze the curative effect of TiRobot surgical robotic navigation and location system‐assisted percutaneous sacroiliac screw fixation and percutaneous sacroiliac screw by traditional fluoroscopy, and to summarize the safety and benefits of TiRobot. Methods A total of 91 patients with pelvic posterior ring fractures from December 2015 to February 2018 were included in this study. According to the surgical methods selected by the patients, the patients were divided into a TiRobot surgical robotic navigation and location system group (TiRobot group) and a percutaneous sacroiliac screw fixation group (traditional group). Statistical indicators included the number of sacroiliac screws, the time of planning the sacroiliac screw path, fluoroscopy frequency, fluoroscopy time, operation time, length of incision, blood loss, anesthesia time, the healing process of skin incisions, and fracture healing time. Fracture reduction was evaluated according to the maximum displacement degree at the inlet and outlet view X‐ray or CT. Matta standard was used to evaluate fracture reduction. At the last follow‐up, the Majeed function system was used to evaluate the function. Results All patients were followed up for 8 to 32 months. A total of 66 sacroiliac screws were implanted in the TiRobot group. A total of 43 sacroiliac screws were implanted in the traditional group. There were statistically significant differences in terms of fluoroscopy frequency, fluoroscopy time, operation time, incision length, anesthesia time, and blood loss between the two groups; the TiRobot group was superior to the traditional group. The healing time of the TiRobot group and the traditional group was 4.61 ± 0.68 months (range, 3.5–6.3 months) and 4.56 ± 0.78 months (range, 3.4–6.2 months), respectively, and there was no statistical difference. Postoperatively, by Matta standard, the overall excellent and good rate of fracture reduction was 89.28% and 88.57%, respectively. At the last follow‐up, by Majeed function score, the overall excellent and good rate was 91.07% and 91.43%. There was no statistical difference between the two groups. Conclusion Sacroiliac screw implantation assisted by TiRobot to treat the posterior pelvic ring fractures has the characteristics of less trauma, shorter operation time, and less blood loss. TiRobot has the characteristics of high safety and accuracy and has great clinical application value.
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Affiliation(s)
- Tao Long
- Department of Orthopaedic Surgery, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Kai-Nan Li
- Department of Orthopaedic Surgery, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Jin-Hua Gao
- Department of Orthopaedic Surgery, The First People's Hospital of Anqing, Anqing, China
| | - Tian-Hu Liu
- Department of Orthopaedic Surgery, The People's Hospital of Pixian, Chengdu, China
| | - Jian-Song Mu
- Department of Orthopaedic Surgery, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Xue-Jun Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Chao Peng
- Department of Orthopaedic Surgery, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Zhi-Yong He
- Department of Orthopaedic Surgery, Affiliated Hospital of Chengdu University, Chengdu, China
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Tsuang FY, Chen CH, Kuo YJ, Tseng WL, Chen YS, Lin CJ, Liao CJ, Lin FH, Chiang CJ. Percutaneous pedicle screw placement under single dimensional fluoroscopy with a designed pedicle finder-a technical note and case series. Spine J 2017. [PMID: 28645672 DOI: 10.1016/j.spinee.2017.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Minimally invasive spine surgery has become increasingly popular in clinical practice, and it offers patients the potential benefits of reduced blood loss, wound pain, and infection risk, and it also diminishes the loss of working time and length of hospital stay. However, surgeons require more intraoperative fluoroscopy and ionizing radiation exposure during minimally invasive spine surgery for localization, especially for guidance in instrumentation placement. In addition, computer navigation is not accessible in some facility-limited institutions. PURPOSE This study aimed to demonstrate a method for percutaneous screws placement using only the anterior-posterior (AP) trajectory of intraoperative fluoroscopy. STUDY DESIGN A technical report (a retrospective and prospective case series) was carried out. PATIENT SAMPLE Patients who received posterior fixation with percutaneous pedicle screws for thoracolumbar degenerative disease or trauma comprised the patient sample. METHOD We retrospectively reviewed the charts of consecutive 670 patients who received 4,072 pedicle screws between December 2010 and August 2015. Another case series study was conducted prospectively in three additional hospitals, and 88 consecutive patients with 413 pedicle screws were enrolled from February 2014 to July 2016. The fluoroscopy shot number and radiation dose were recorded. In the prospective study, 78 patients with 371 screws received computed tomography at 3 months postoperatively to evaluate the fusion condition and screw positions. RESULTS In the retrospective series, the placement of a percutaneous screw required 5.1 shots (2-14, standard deviation [SD]=2.366) of AP fluoroscopy. One screw was revised because of a medialwall breach of the pedicle. In the prospective series, 5.8 shots (2-16, SD=2.669) were required forone percutaneous pedicle screw placement. There were two screws with a Grade 1 breach (8.6%), both at the lateral wall of the pedicle, out of 23 screws placed at the thoracic spine at T9-T12. Forthe lumbar and sacral areas, there were 15 Grade 1 breaches (4.3%), 1 Grade 2 breach (0.3%), and 1 Grade 3 breach (0.3%). No revision surgery was necessary. CONCLUSION This method avoids lateral shots of fluoroscopy during screw placement and thus decreases the operation time and exposes surgeons to less radiation. At the same time, compared with the computer-navigated procedure, it is less facility-demanding, and provides satisfactory reliability and accuracy.
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Affiliation(s)
- Fon-Yih Tsuang
- Institute of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan No. 1, Sec. 1, Jen-Ai Road, Taipei City, 100, Taiwan; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan No. 7, Chung-Shan South Road, Taipei City 100, Taiwan; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan No. 579, Yun-Lin Road, Diou-Liu City, Yun-Lin County, 640, Taiwan; Kinmen Hospital, Ministry of Health and Welfare, Kinmen County, Taiwan No. 2, Fu-Xing Road, Kin-Hu Township, Kin-Men County, 891, Taiwan
| | - Chia-Hsien Chen
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, 23561, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedics, Taipei Medical University Hospital, Taipei City, Taiwan No. 252, Wu-Xing Street, Taipei City, 110, Taiwan; Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan No. 250, Wu-Xing Street, Taipei City, 110, Taiwan
| | - Wei-Lung Tseng
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan No. 7, Chung-Shan South Road, Taipei City 100, Taiwan; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan No. 579, Yun-Lin Road, Diou-Liu City, Yun-Lin County, 640, Taiwan
| | - Yuan-Shen Chen
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan No. 579, Yun-Lin Road, Diou-Liu City, Yun-Lin County, 640, Taiwan
| | - Chin-Jung Lin
- Kinmen Hospital, Ministry of Health and Welfare, Kinmen County, Taiwan No. 2, Fu-Xing Road, Kin-Hu Township, Kin-Men County, 891, Taiwan
| | - Chun-Jen Liao
- Industry Technology Research Institute, Hsinchu County, Taiwan No. 195, Sec. 4, Chung-Hsing Road., Chutung, Hsinchu County, 310, Taiwan
| | - Feng-Huei Lin
- Institute of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan No. 1, Sec. 1, Jen-Ai Road, Taipei City, 100, Taiwan; Division of Medical Engineering, National Health Research Institute, Miaoli County, Taiwan No. 35, Keyan Road, Zhunan, Miaoli County, 35053, Taiwan
| | - Chang-Jung Chiang
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, 23561, Taiwan; Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan No. 250, Wu-Xing Street, Taipei City, 110, Taiwan.
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Tonetti J, van Overschelde J, Sadok B, Vouaillat H, Eid A. Percutaneous ilio-sacral screw insertion. fluoroscopic techniques. Orthop Traumatol Surg Res 2013; 99:965-72. [PMID: 24238905 DOI: 10.1016/j.otsr.2013.08.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2013] [Indexed: 02/02/2023]
Affiliation(s)
- J Tonetti
- Service Orthopédie-Traumatologie, BP 217, 38043 Grenoble cedex 09, France.
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