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Yamada T, Hasegawa T, Yamato Y, Yoshida G, Banno T, Arima H, Oe S, Mihara Y, Ushirozako H, Ide K, Watanabe Y, Nakai K, Kurosu K, Matsuyama Y. Characteristics of pedicle screw misplacement using freehand technique in degenerative scoliosis surgery. Arch Orthop Trauma Surg 2023; 143:1861-1867. [PMID: 35194658 DOI: 10.1007/s00402-022-04380-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 02/05/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to estimate the accuracy of pedicle screw (PS) placement in degenerative scoliosis surgery, characterize a patient population with PS misplacement, and analyze the association between misplaced PS vector and lumbar coronal curve. METHODS In this study, 122 patients (average age 68.6 years), who underwent corrective and decompression surgery, were selected retrospectively. PS accuracy was evaluated in the thoracic to lumbar spine. We identified characteristics of misplacement in each patient. Screw positions were categorized into grade A, entirely in the pedicle; grade B, < 2 mm breach; grade C, 2-4 mm breach; and grade D, > 4 mm breach using postoperative computed tomography. RESULTS The mean preoperative lumbar coronal curve was 32.3 ± 18.4°, and the number of fused vertebrae was 8.9 ± 2.8. A total of 2032 PS were categorized as follows: grade A, 1897 PS (93.3%); grade B, 67 (3.3%); grade C, 26 (1.3%); and grade D, 43 (2.1%). One PS (grade D), inserted at T5, needed surgery for removal due to neurological deficit. The misplacement group (grades C and D) had a significantly stronger lumbar coronal curve and apical vertebral rotation than the accuracy group (grades A and B). Misplaced PS vector (direction and degree) was significantly correlated with inserted vertebral rotation. Grade D misplacement was distributed mainly around the transitional vertebra of the lumbar curve. CONCLUSIONS The accuracy of PS insertion in the thoracic to lumbar spine was high in DS surgery, but the need for care was highlighted in the transitional vertebra.
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Affiliation(s)
- Tomohiro Yamada
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan.
| | - Tomohiko Hasegawa
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Yu Yamato
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Go Yoshida
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Tomohiro Banno
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Hideyuki Arima
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Shin Oe
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Yuki Mihara
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Hiroki Ushirozako
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Koichiro Ide
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Yuh Watanabe
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Keiichi Nakai
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Kenta Kurosu
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
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Guzek RH, Mitchell SL, Krakow AR, Harshavardhana NS, Sarkissian EJ, Flynn JM. Morphometric analysis of the proximal thoracic pedicles in Lenke II and IV adolescent idiopathic scoliosis: an evaluation of the feasibility for pedicle screw insertion. Spine Deform 2021; 9:1541-1548. [PMID: 34453700 DOI: 10.1007/s43390-021-00377-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/13/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Pedicles on the concave side of the proximal thoracic (PT) curve in adolescent idiopathic scoliosis (AIS) patients with Lenke II and IV deformities tend to be narrow and dysplastic, making pedicle screw (PS) insertion challenging. The aim of this study was to evaluate the feasibility for PS placement in these patients using pedicle chord length, diameter, and channel morphology. METHODS In this retrospective study, 56 consecutive AIS patients with Lenke II or IV curves who underwent instrumented posterior spinal fusion (PSF) were studied. The mean age at surgery was 14.8 years and the mean PT curve measured 45°. Two independent investigators evaluated all visible pedicles from T1 to T6 vertebral levels using axial images from intraoperative computed tomography-guided navigation recording the pedicle: (1) maximum transverse diameter 'd' at the isthmus, (2) maximum chord length 'l', and (3) qualitative assessment of the channel morphology (types A-D). RESULTS Two hundred and sixty-eight concave and 264 convex pedicles were measured. The mean 'd' of the concave pedicles at T3 and T4 was < 3.0 mm, compared to > 5.0 mm for the convex counterparts (p < 0.001). Of all concave pedicle channels, 48% had morphology characteristics that were riskier for PS cannulation (type C or D) compared to 2% of all convex pedicle channels (type A or B) (p < 0.001). CONCLUSION Almost half of all concave pedicles have morphologic characteristics that make them too small to accommodate a PS. Though PSs could be inserted using an in-out-in technique in these patients, alternative fixation anchors may improve strength and safety.
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Affiliation(s)
- Ryan H Guzek
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stuart L Mitchell
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Arielle R Krakow
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Eric J Sarkissian
- Orthopedic Surgery, Washington DC VA Medical Center, Washington, DC, USA
| | - John M Flynn
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Egea-Gámez RM, Galán-Olleros M, Rodríguez Del Real T, González-Menocal A, González-Díaz R. Variations in the position of the aorta and vertebral safe zones in supine, prone, and lateral decubitus for adolescent idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1950-1958. [PMID: 33751236 DOI: 10.1007/s00586-021-06813-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 12/17/2020] [Accepted: 03/07/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Analyze the modifications in the "safe zones" of T4-L4 vertebral bodies relative to aorta according to patient positioning, as well as in the relationship between the aorta and the vertebrae. METHODS Patients with adolescent idiopathic scoliosis who underwent surgical treatment during 2017 were included. Preoperative whole spine MRI in supine, prone, and LD positions was performed. The safe zone right (SZR) was defined as the angle formed between X-axis (0º) and a line connecting the origin and the edge of the aorta, and the safe zone left (SZL) was the angle between the edge of the aorta to 180º (X-axis). RESULTS A total of 21 patients were studied, median age was 15.2 years, and 71.4% were female. The mean SZR lied from 0°-86.1º at T4 to 0°-76.9º at L4 in supine, from 0°-84.05º at T4 to 0º-78.5º at L4 in prone, and from 0° to 91.75º at T4 to 0°-80.4º at L4 in LD. While the mean SZL was located from 155.4º-180º at T4 to 107.9º-180º at L4 in supine, from 134°-180° at T4 to 103.9°-180° at L4 in prone, and from 143.8º-180º at T4 to 106º-180º at L4 in LD. Statistically significant differences were found almost at all levels when comparing supine versus prone and LD. CONCLUSIONS Patient positioning during spinal surgery significantly modifies T4-L4 vertebral safe zones relative to aorta. These variations should be taken into account when analyzing an MRI performed in supine if the patient is undergoing surgery in a different position, to avoid vascular-related injuries.
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Affiliation(s)
- Rosa M Egea-Gámez
- Orthopaedic Surgery, Spinal Unit, Hospital Universitario Niño Jesús, C/ Menéndez Pelayo 65, 28009, Madrid, Spain.
| | - María Galán-Olleros
- Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, Madrid, Spain
| | - Teresa Rodríguez Del Real
- Orthopaedic Surgery, Spinal Unit, Hospital Universitario Niño Jesús, C/ Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Alfonso González-Menocal
- Orthopaedic Surgery, Spinal Unit, Hospital Universitario Niño Jesús, C/ Menéndez Pelayo 65, 28009, Madrid, Spain
| | - Rafael González-Díaz
- Orthopaedic Surgery, Spinal Unit, Hospital Universitario Niño Jesús, C/ Menéndez Pelayo 65, 28009, Madrid, Spain
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Shepard N, Pham H, Natarajan V, Errico T, Rieger M. Use of a Novel Computerized Drill for Pedicle Screw Insertion in the Thoracic and Lumbar Spine: A Cadaveric Study. Int J Spine Surg 2019; 13:329-335. [PMID: 31534903 DOI: 10.14444/6045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background A variety of techniques have been utilized to improve the accuracy of pedicle screw instrumentation. Recently, a novel handheld computerized drill system, IntelliSense Drill Technology, has been used in orthopedic trauma to improve drilling accuracy and reduce radiation and iatrogenic injury. The specialized drill technology detects changes in cortical density to prevent inadvertent cortical violation. The aim of this study is to assess the ability of this system to identify pedicle trajectories in the thoracic and lumbar spine compared to a standard freehand technique. Methods Two spine surgeons, including 1 senior-level and 1 junior-level attending drilled pedicle screw tracts using a freehand technique and computerized drill technology in 4 cadaveric spines from T2 to S1. A total of 134 pedicle screws were placed, including 70 by the senior surgeon and 64 by the junior surgeon. Cortical violations were assessed using computed tomography after instrumenting each pedicle tract, and procedure time for insertion of pedicle screws was recorded. Results A total of 15 (22.4%) and 12 (18.2%) pedicle violations were noted using the freehand and computerized drill technique, respectively (P = .767). Perforations using the computerized drill decreased from 31.1% in the first attempt to 5.9% in the second attempt (P = .027). Mean drill time per pedicle using the freehand and computerized drill techniques were comparable (12.2 ± 8.4 versus 12.1 ± 13.2, P = .871), and both surgeons had an improvement in procedure time using the computerized drill (surgeon 1: 12.3 ± 13.7-5.7 ± 3.8 [SD], P = .059; surgeon 2: 20.3 ± 20.0-10.4 ± 5.6 [SD], P = .063). Conclusions We demonstrate the use of a novel drill technology for placement of pedicle screws in the thoracic and lumbar spine. After an initial learning curve, this technology is comparable to use of a freehand technique by both a senior-level and a junior-level attending surgeon in a cadaveric model. Further investigation is needed to identify the clinical role of this technology in spine surgery.
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Affiliation(s)
- Nicholas Shepard
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - Hien Pham
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - Vivek Natarajan
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - Thomas Errico
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
| | - Mark Rieger
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York
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Duchaussoy T, Lacoste M, Norberciak L, Decaudain J, Verclytte S, Budzik JF. Preoperative assessment of idiopathic scoliosis in adolescent and young adult with three-dimensional T2-weighted spin-echo MRI. Diagn Interv Imaging 2019; 100:371-379. [PMID: 30878467 DOI: 10.1016/j.diii.2019.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/10/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare tridimensional (3D) T2-weighted spin-echo MRI and CT for minimal pedicle width measurements in the preoperative assessment of adolescent idiopathic scoliosis (AIS) in adolescent and young patients. MATERIALS AND METHODS A total of 22 adolescents/young patients suffering from AIS were retrospectively included. There were 18 females and 4 males with a mean age of 15.3±2.3 (SD) years (range: 11-21years). Preoperative lumbar spine MRI and CT examinations of the 22 patients were reviewed by two independent readers who measured the minimal width of 259 pedicles. Inter-reader agreement for CT and MRI was assessed using intra-class correlation coefficient (ICC). Intra-reader agreement and relative differences in measurements between MRI and CT were also assessed for each reader. RESULTS Inter-reader agreement was excellent (ICC≥0.8) for both CT and MRI. Relative differences in measurements between CT and MRI was 10.3% for reader 1 and 9.4% for reader 2. CONCLUSION 3D T2-weighted spin-echo MRI underestimates minimal pedicle width by only 9.4 - 10.3% compared to CT. 3D T2-weighted MRI appears as a valuable alternative to CT for preoperative measurements of vertebral pedicles in AIS.
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Affiliation(s)
- T Duchaussoy
- Lille Catholic Hospitals, Imaging Department, 59000 Lille, France
| | - M Lacoste
- Lille Catholic Hospitals, Imaging Department, 59000 Lille, France
| | - L Norberciak
- Lille Catholic Hospitals, Clinical Research and Innovation Department, 59000 Lille, France
| | - J Decaudain
- Lille Catholic Hospitals, Orthopedic Surgery Department, 59000 Lille, France; Lille Catholic University, 59000 Lille, France
| | - S Verclytte
- Lille Catholic Hospitals, Imaging Department, 59000 Lille, France; Lille Catholic University, 59000 Lille, France
| | - J-F Budzik
- Lille Catholic Hospitals, Imaging Department, 59000 Lille, France; Lille Catholic University, 59000 Lille, France; PMOI Physiopathology of Inflammatory Bone Diseases, EA 4490, 59000 Lille, France.
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