1
|
Mengesha MG, Meena J, Ramachandran K, Shetty AP, Thippeswamy PB, Kanna RM, Shanmuganathan R. Correlation Analysis Between Computed Tomography and Magnetic Resonance Imaging for Assessing Thoracic Pedicle Morphology. World Neurosurg 2023; 180:e599-e606. [PMID: 37793609 DOI: 10.1016/j.wneu.2023.09.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE This study aimed to determine the accuracy and reliability of using magnetic resonance imaging (MRI) to characterize thoracic pedicle morphology in the normal population. METHODS Computed tomography (CT) and MRI datasets of 63 surgically treated patients were included in the study. Bilateral T3, T6, T9, and T12 vertebral levels were evaluated for the type of pedicle, pedicle chord length, and pedicle isthmic diameter on both MRI and CT scans. Pedicles were classified according to Sarwahi et al. into type A (normal pedicle), >4 mm cancellous channel; type B, 2-4 mm channel; type C, completely cortical channels >2 mm; and type D, <2 mm cortical bone channel. RESULTS Of 504 pedicles, 294 were classified as type A, 173 as type B, 24 as type C, and 13 as type D based on a CT scan. MRI had an overall accuracy rate of 92.86% for detecting type A, 96.53% for type B, and 100% for type C and type D compared with CT scans. Regarding the thoracic levels, MRI had an overall concordance of 97.98% at T3 level, 94.43% at T6 level, 98.11% at T9 level, and 99.3% at T12 level with CT readings. Comparing measurements between MRI and CT studies for pedicle isthmic diameter and pedicle chord length showed moderate to good reliability at all measured levels. CONCLUSIONS Pedicle measurements obtained by MRI may be used to estimate pedicle dimensions, allowing surgeons to preoperatively determine pedicle screw sizes based on MRI scans alone.
Collapse
Affiliation(s)
- Mengistu G Mengesha
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Jalaj Meena
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Karthik Ramachandran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India.
| | | | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, India
| | | |
Collapse
|
2
|
Hagan MJ, Syed S, Leary OP, Persad-Paisley EM, Lin Y, Zheng B, Shao B, Abdulrazeq H, Yu JYH, Telfeian AE, Gokaslan ZL, Fridley JS, Oyelese AA. Pedicle Screw Placement Using Intraoperative Computed Tomography and Computer-Aided Spinal Navigation Improves Screw Accuracy and Avoids Postoperative Revisions: Single-Center Analysis of 1400 Pedicle Screws. World Neurosurg 2022; 160:e169-e179. [PMID: 34990843 DOI: 10.1016/j.wneu.2021.12.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Intraoperative computed tomography and navigation (iCT-Nav) is increasingly used to aid spinal instrumentation. We aimed to document the accuracy and revision rate of pedicle screw placement across many screws placed using iCT-Nav. We also assess patient-level factors predictive of high-grade pedicle breach. METHODS Medical records of patients who underwent iCT-Nav pedicle screw placement between 2015 and 2017 at a single center were retrospectively reviewed. Screw placement accuracy was individually assessed for each screw using the 2-mm incremental grading system for pedicle breach. Predictors of high-grade (>2 mm) breach were identified using multiple logistic regression. RESULTS In total, 1400 pedicle screws were placed in 208 patients undergoing cervicothoracic (29; 13.9%), thoracic (30; 14.4), thoracolumbar (19; 9.1%) and lumbar (130; 62.5%) surgeries. iCT-Nav afforded high-accuracy screw placement, with 1356 of 1400 screws (96.9%) being placed accurately. In total, 37 pedicle screws (2.64%) were revised intraoperatively during the index surgery across 31 patients, with no subsequent returns to the operating room because of screw malpositioning. After correcting for potential confounders, males were less likely to have a high-grade breach (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.10-0.59, P = 0.003) whereas lateral (OR 6.21; 95% CI 2.47-15.52, P < 0.001) or anterior (OR 5.79; 95% CI2.11-15.88, P = 0.001) breach location were predictive of a high-grade breach. CONCLUSIONS iCT-Nav with postinstrumentation intraoperative imaging is associated with a reduced need for costly postoperative return to the operating room for screw revision. In comparison with studies of navigation without iCT where 1.5%-1.7% of patients returned for a second surgery, we report 0 revision surgeries due to screw malpositioning.
Collapse
Affiliation(s)
- Matthew J Hagan
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Sohail Syed
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Owen P Leary
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | | | - Yang Lin
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Bryan Zheng
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Belinda Shao
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Hael Abdulrazeq
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - James Y H Yu
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Albert E Telfeian
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jared S Fridley
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Adetokunbo A Oyelese
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA.
| |
Collapse
|
3
|
Kulkarni R, Mesare V, Gursale A, Tiwari A, Kaware R. Accuracy of pedicle screw fixation in lumbar spine by freehand technique studied postoperatively by computed tomography. JOURNAL OF ORTHOPAEDICS AND SPINE 2022. [DOI: 10.4103/joasp.joasp_3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
4
|
Librianto D, Saleh I, Fachrisal, Utami WS, Hutami WD. Breach Rate Analysis of Pedicle Screw Instrumentation using Free-Hand Technique in the Surgical Correction of Adolescent Idiopathic Scoliosis. J Orthop Case Rep 2021; 11:38-44. [PMID: 34141640 PMCID: PMC8046465 DOI: 10.13107/jocr.2021.v11.i01.1956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Free-hand technique is one of the techniques used by spine surgeon during pedicle screw instrumentation of surgical correction of spinal deformities, including scoliosis. The previous studies showed that this technique is safe. However, some inherent factors may influence its outcomes, including screw breaching which is potentially violates spinal cord and other intimate structures. To confirm the safety and accuracy of this technique, additional study measuring the breach rate of pedicle screw placement in scoliosis is mandatory. Materials and Methods We performed a retrospective study of patients with adolescent idiopathic scoliosis (AIS) from Fatmawati General Hospital, Jakarta, treated for surgical correction during a period of 2017-2018 using free-hand technique for pedicle screw instrumentation. Post-operative computed tomography scan (CT scan) was analyzed to measure the medial and lateral breaches. P < 0.05 was deemed to be statistically significant. Results A total of 94 pedicle screws from six female patients with AIS were included in our study. Overall breach occurred in 33% instrumented screws, the majority of it was a low-grade breach. Of the breached screws, medial and lateral breach occurred in 20% and 12% of screws, respectively. There were no differences in the overall, medial, and lateral breaches between thoracic and lumbar vertebrae (P > 0.05). Medial breach was significantly higher in middle thoracic segment compared to other thoracic segments (P = 0.048). Risk of medial breach was 3 times higher in the convex side of deformity (P = 0.012), whereas risk of lateral breach was 4.6 times higher in the concave side of the deformity (P = 0.021). Conclusion The majority of breached screws were low-grade violation within the safe zone, with no neurological sequelae. Our study found that free-hand technique is safe and effective method of pedicle screw instrumentation for correction of AIS. Some inherent factors may influence the risk of pedicle screw breach.
Collapse
Affiliation(s)
- Didik Librianto
- Department of Orthopaedic and Traumatology, Fatmawati Hospital Jl. RS. Fatmawati Raya No.4, Cilandak, Kota Jakarta Selatan, Jakarta, Indonesia
| | - Ifran Saleh
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No. 71, Senen, Kota Jakarta Pusat, Jakarta, Indonesia
| | - Fachrisal
- Department of Orthopaedic and Traumatology, Fatmawati Hospital Jl. RS. Fatmawati Raya No.4, Cilandak, Kota Jakarta Selatan, Jakarta, Indonesia
| | - Widyastuti Srie Utami
- Department of Orthopaedic and Traumatology, Tarakan Hospital, Jl. Kyai Caringin No. 7, Cideng, Kota Jakarta Pusat, Jakarta, Indonesia
| | - Witantra Dhamar Hutami
- Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No. 71, Senen, Kota Jakarta Pusat, Jakarta, Indonesia
| |
Collapse
|
5
|
Chen X, Gao X, Zhang G, Zheng F, Wang Y, Huang W, Lin H. Design, application, and evaluation of a novel method for determining optimal trajectory of thoracic pedicle screws. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1012. [PMID: 32953812 PMCID: PMC7475455 DOI: 10.21037/atm-20-5426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background This is an experimental study performed on 15 adult cadavers. In this cadaveric study, we designed and evaluated a novel methodology for determining the optimal trajectory for the placement of thoracic pedicle screws. The accuracy of thoracic pedicle screw placement is critical to the spinal surgery. The concept, implement method, and significance of the optimal thoracic pedicle trajectory have not been reported. Methods The experimental study was performed on 15 adult cadavers. The Mimics software was used to design optimal trajectory through the pedicle central axis. Using three-dimensional (3D) printing, a navigation module with a locating facet and a stabilizing facet was developed. The thoracic pedicle screws were inserted with the help of the navigation module. The three-dimensional coordinates for the entry and the exit points of the screws were compared between the planned trajectories and the postoperative trajectories. The differences in coordinates were analyzed to evaluate the precision of the screw placement. Results The trajectories through the pedicle central axis showed an excellent symmetry between the single segments and for all thoracic vertebrae. Out of a total of 358 screws that were inserted, 15 (4.2%) screws breached the pedicle cortex with a breach distance of <2 mm. The qualifying rate was 98.6% (353/358) for the entry point precision of ≥3.2 mm, and 98.9% (354/358) for the exit point precision of ≥6.4 mm. In comparison to the designed qualified rate of 100% (358/358), the χ2 was 3.22 and 2.26, respectively (P>0.05). Conclusions The optimal trajectory was obtained through the pedicle central axis, which significantly reduced the risk of cortex breach. A high degree of precision was obtained for the entry and the exit points of the screws when the postoperative trajectory was compared with the designed trajectory.
Collapse
Affiliation(s)
- Xuanhuang Chen
- Department of Orthopedics, the Affiliated Hospital of Putian University, Putian, China
| | - Xiaoqiang Gao
- Department of Orthopedics, the Affiliated Hospital of Putian University, Putian, China
| | - Guodong Zhang
- Department of Orthopedics, the Affiliated Hospital of Putian University, Putian, China
| | - Feng Zheng
- Department of Orthopedics, the Affiliated Hospital of Putian University, Putian, China
| | - Ya Wang
- National Key Discipline of Human Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Wenhua Huang
- National Key Discipline of Human Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Haibin Lin
- Department of Orthopedics, the Affiliated Hospital of Putian University, Putian, China
| |
Collapse
|
6
|
Shah K, Gadiya A, Shah M, Vyas D, Patel P, Bhojraj S, Nene A. Does Three-Dimensional Printed Patient-Specific Templates Add Benefit in Revision Surgeries for Complex Pediatric Kyphoscoliosis Deformity with Sublaminar Wires in Situ? A Clinical Study. Asian Spine J 2020; 15:46-53. [PMID: 32213799 PMCID: PMC7904488 DOI: 10.31616/asj.2019.0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 10/15/2019] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Case-control study. PURPOSE To evaluate the accuracy of three-dimensional (3D) printed patient-specific templates (PSTs) for placement of pedicle screws (PAs) in patients undergoing revision surgeries for complex kyphoscoliosis deformity with sublaminar wires in situ. OVERVIEW OF LITERATURE Revision kyphoscoliosis correction surgery in pediatric patients is a challenging task for the treating surgeon. In patients with sublaminar wires in situ, the native anatomical landmarks are obscured, thus making the freehand screw placement technique a highly specialized task. Hence, the concept of using PSTs for insertion of PAs in such surgeries is always intriguing and attractive. METHODS Five consecutive patients undergoing revision deformity correction with sublaminar wires in situ were included in this study. Patients were divided in two groups based on the technique of PA insertion. A total of 91 PAs were inserted using either a freehand technique (group A) or 3D printed templates (group B) (34 vs. 57). The placement of PAs was classified according to a postoperative computed tomography scan using Neo's classification. Perforation beyond class 2 (>2 mm) was termed as a misplaced screw. The average time required for the insertion of screws was also noted. RESULTS Mean age, surgical time, and blood loss were recorded. The change in mean Cobb's angle in both groups was also recorded. The difference in rates of misplaced screws was noted in group A and group B (36.21% vs. 2.56%); however, the mean number of misplaced PAs per patient in group A and group B was statistically insignificant (6.5±3.54 vs. 4.67±1.53, p =0.4641). The mean time required to insert a single PA was also statistically insignificant (120±28.28 vs. 90±30 seconds, p =0.3456). CONCLUSIONS Although 3D printed PSTs help to avoid the misplacement of PAs in revision deformity correction surgeries with sublaminar wires in situ, the mean number of misplaced screws per patient using this technique was found to be statistically insignificant when compared with the freehand technique in this study.
Collapse
Affiliation(s)
- Kunal Shah
- "We Are Spine" Centre, Aarav Polyclinic, Mumbai, India
| | - Akshay Gadiya
- Department of Spine Surgery, Wockhardt Hospital, Mumbai, India
| | - Munjal Shah
- Department of Orthopedic Surgery, Lilavati Hospital and Research Center, Mumbai, India
| | | | - Priyank Patel
- Department of Orthopedic Surgery, Jupiter Hospital, Thane, India
| | - Shekhar Bhojraj
- Department of Spine Surgery, Lilavati Hospital, Mumbai, India
| | - Abhay Nene
- Department of Spine Surgery, Wockhardt Hospital, Mumbai, India
| |
Collapse
|
7
|
Khorshidi A, Abdollahi A, Pirouzi A, Hosseini SH. Band pass filter plan in fluoroscopy for high energy range. SN APPLIED SCIENCES 2020. [DOI: 10.1007/s42452-019-1885-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
8
|
Salama AA, Amin MA, Soliman AY, El-Tantaway A. Postoperative 320 multi-slice computed tomography in assessment of pedicle screw insertion in thoraco-lumbar fixation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0050-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pedicle screw instrumentation is used widely in lumbar spine for stabilization to enhance arthrodesis and has been accepted in the thoracic spine in recent years. The purpose of this study was to assess the value of postoperative 320 multi-slice computed tomography (MSCT) in assessment of pedicle screw placement in patients with spinal fixation with clinical and surgical correlation.
Results
A total of 340 pedicular screws were inserted to 70 cases. 286 (84.12%) were in, 54 screws (15.88%) were violated, and revision surgeries were required for 5 displaced screws. On axial, coronal reconstruction and three-dimensional (3D) reformatted CT images 36, 47, and 54 displaced screws were detected, respectively. Both sensitivity and specificity for 3D reformatted images were 100%. For axial image, they were 97.6% and 89.4%, respectively, compared with surgical findings in 5 revised screws.
Conclusion
Multi-slice CT scan is a valuable and valid postoperative assessment tool of accuracy of spinal pedicle screw placement.
Collapse
|
9
|
Junaid M, Afzal A, Kalsoom A, Bukhari SS. Freehand pedicle screw fixation: A safe recipe for dorsal, lumbar and sacral spine. Pak J Med Sci 2019; 35:680-684. [PMID: 31258575 PMCID: PMC6572961 DOI: 10.12669/pjms.35.3.981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To determine outcome of freehand pedicle screw fixation for dorsal, lumbar and sacral fractures at a tertiary care centre in the developing world. Methods: A retrospective review was performed of 150 consecutive patients who underwent pedicle screw fixation from January 1, 2012 to 31st December 2017. A total of 751 pedicle screws were placed. Incidence and extent of cortical breach by misplaced pedicle screw was determined by review of intra-operative and post-operative radiographs and/or computed tomography. Results: Among the total 751 free hand placed pedicle screws, four screws (0.53%) were repositioned due to a misdirected trajectory towards the disc space. six screws (0.79%) were identified to have cause moderate breach while four screws (0.53%) cause severe breach. There was no occurrence of iatrogenic nerve root damage or violation of the spinal canal. Conclusion: Free hand pedicle screw placement based on external landmarks showed remarkable safety and accuracy in our center. The authors conclude that assiduous adherence to technique and preoperative planning is vital to success.
Collapse
Affiliation(s)
- Muhammad Junaid
- Dr. Muhammad Junaid, FCPS IFAANS, Department of Neurosurgery, PNS Shifa Hospital, Karachi, Pakistan
| | - Ali Afzal
- Dr. Ali Afzal, FCPS, Department of Neurosurgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Anisa Kalsoom
- Dr. Anisa Kalsoom, FCPS, Department of Radiology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Syed Sarmad Bukhari
- Dr. Syed Sarmad Bukhari, MBBS, Department of Neurological Surgery, Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
10
|
Perdomo-Pantoja A, Ishida W, Zygourakis C, Holmes C, Iyer RR, Cottrill E, Theodore N, Witham TF, Lo SFL. Accuracy of Current Techniques for Placement of Pedicle Screws in the Spine: A Comprehensive Systematic Review and Meta-Analysis of 51,161 Screws. World Neurosurg 2019; 126:664-678.e3. [PMID: 30880208 DOI: 10.1016/j.wneu.2019.02.217] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Pedicle screws (PSs) are routinely used for stabilization to enhance fusion in a variety of spinal diseases. Although the accuracy of different PS placement methods has been previously reported, most of these studies have been limited to 1 or 2 techniques. The purpose was to determine the current accuracy of PS placement among 4 modalities of PS insertion (freehand [FH], fluoroscopy-assisted [FA], computed tomography navigation-guided [CTNav], and robot-assisted [RA]) and analyze variables associated with screw misplacement. METHODS A systematic review was performed of peer-reviewed articles reporting PS accuracy of 1 technique from January 1990 to June 2018. Accuracy of PS placement, PS insertion technique, and pedicle breach (PB) data were collected. A meta-analysis was performed to estimate the overall pooled (OP) rates of PS accuracy as a primary outcome, stratified by screw insertion techniques. Potential determinants were analyzed via meta-regression analyses. RESULTS Seventy-eight studies with 7858 patients, 51,161 PSs, and 3614 cortical PBs were included. CTNav showed the highest PS placement accuracy compared with other techniques: OP accuracy rates were 95.5%, 93.1%, 91.5%, and 90.5%, via CTNav, FH, FA, and RA techniques, respectively. RA and CTNav were associated with the highest PS accuracy in the thoracic spine, compared with FH. CONCLUSIONS The OP data show that CTNav has the highest PS accuracy rates. Thoracic PSs were associated with lower accuracy rates; however, RA showed fewer breaches in the thoracic spine compared with FH and FA. Given the heterogeneity among studies, further standardized and comparative investigations are required to confirm our findings.
Collapse
Affiliation(s)
| | - Wataru Ishida
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Corinna Zygourakis
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christina Holmes
- Florida A&M University-Florida State University College of Engineering, Tallahassee, Florida, USA
| | - Rajiv R Iyer
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ethan Cottrill
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sheng-Fu L Lo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| |
Collapse
|
11
|
Aslanbaş Ö, Oktay K, Özsoy KM, Çetinalp NE, Tuna M. Torakolumbosakral omurgada pedikül vidası malpozisyon oranlarının değerlendirilmesi: 100 hastanın postoperatif bilgisayarlı tomografi sonuçları. CUKUROVA MEDICAL JOURNAL 2018. [DOI: 10.17826/cumj.376307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
12
|
Park SM, Shen F, Kim HJ, Kim H, Chang BS, Lee CK, Yeom JS. How Many Screws Are Necessary to Be Considered an Experienced Surgeon for Freehand Placement of Thoracolumbar Pedicle Screws?: Analysis Using the Cumulative Summation Test for Learning Curve. World Neurosurg 2018; 118:e550-e556. [DOI: 10.1016/j.wneu.2018.06.236] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 11/29/2022]
|
13
|
Paredes I, Panero I, Cepeda S, CastaÑo-Leon AM, Jimenez-Roldan L, Perez-NuÑez Á, AlÉn JA, Lagares A. Accuracy of percutaneous pedicle screws for thoracic and lumbar spine fractures compared with open technique. J Neurosurg Sci 2018; 65:38-46. [PMID: 29905430 DOI: 10.23736/s0390-5616.18.04439-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to compare the accuracy of screw placement between open pedicle screw fixation and percutaneous pedicle screw fixation (MIS) for the treatment of thoracolumbar spine fractures (TSF). METHODS forty-nine patients with acute TSF who were treated with transpedicular screw fixation from January 2013 to December 2016 were retrospectively reviewed. The patients were divided into Open and MIS groups. Laminectomy was performed in either group if needed. The accuracy of the screw placement, the evolution of the Cobb sagittal angle postoperatively and at 12-month follow-up and the neurological status were recorded. AO type of fracture and TLICS score were also recorded. RESULTS Mean age was 42 years old. Mean TLICS score was 6.29 and 5.96 for open and MIS groups respectively. Twenty-five MIS and 24 open surgeries were performed, and 350 (175 in each group) screws were inserted (7.14 per patient). Twenty-four and 13 screws were considered "out" in the open and MIS groups respectively (Odds ratio 1.98. 0.97-4,03 P=0.056). The Cobb sagittal angle went from 13.3º to 4.5º and from 14.9º to 8.2º in the Open and MIS groups respectively (both P<0.0001). Loss of correction at 12-month follow-up was 3.2º and 4.2º for the open and MIS groups, respectively. No neurological worsening was observed. CONCLUSIONS For the treatment of acute thoracolumbar fractures, the MIS technique seems to achieve similar results to the open technique in relation to neurological improvement and deformity correction, while placing the screws more accurately.
Collapse
Affiliation(s)
- Igor Paredes
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain -
| | - Irene Panero
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Santiago Cepeda
- Department of Neurosurgery, Rio Hortega University Hospital, Valladolid, Spain
| | - Ana M CastaÑo-Leon
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Luis Jimenez-Roldan
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Ángel Perez-NuÑez
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Jose A AlÉn
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
| |
Collapse
|
14
|
Unilateral Spinous Process Noncovering Hook Type Patient-specific Drill Template for Thoracic Pedicle Screw Fixation: A Pilot Clinical Trial and Template Classification. Spine (Phila Pa 1976) 2017; 42:E1050-E1057. [PMID: 28092341 DOI: 10.1097/brs.0000000000002067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective clinical pilot study. OBJECTIVE To confirm the accuracy of thoracic pedicle screw placement by using the unilateral spinous noncovering hook type patient-specific drill template (PSDT) made through rapid prototyping (RP) and to analyze previously reported PSDT designs and their characteristics. SUMMARY OF BACKGROUND DATA Pedicle screw fixation is the most common form of the posterior instrumentation of the thoracic and lumbar spine. Various techniques have been introduced to improve pedicle screw placement. Among them PSDT with a preplanned trajectory has been considered a promising solution; however, we don't have consensus on proper character of the template. METHODS Preoperative spiral three-dimensional (3D) computed tomography (CT) was performed on the thoracic spine. The images were stored in DICOM format and transferred to a workstation running MIMICS 17.0 software to generate a 3D reconstruction template for the desired thoracic vertebra. The accurate trajectory and screw diameter and length were calculated with UG Imageware 12.1. The guide template was sterilized and used intraoperatively to assist with the placement of thoracic pedicle screws. After all pedicle trajectory screws had been inserted. We reviewed 12 previous reports and classified them according to the shape and system of PSDT that met the inclusion criteria of the review. RESULTS Ten screws were placed by using the PSDT without violating the single laminar cortex. There was no violation of the spinal canal or the cortex of pedicle on postoperative CT scans. The results of 13 PSDT types included in the current study suggested that there is no significant difference in accuracy between the PSDTs. CONCLUSION The unilateral spinous process noncovering hook type PSDT made through RP provided an accurate trajectory for the thoracic vertebra, and the classification of PSDT in this study could be helpful for further studies. LEVEL OF EVIDENCE 5.
Collapse
|
15
|
Pedicle screw insertion accuracy in terms of breach and reposition using a new intraoperative cone beam computed tomography imaging technique and evaluation of the factors associated with these parameters of accuracy: a series of 695 screws. 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 2017. [DOI: 10.1007/s00586-017-5195-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
16
|
Farshad M, Betz M, Farshad-Amacker NA, Moser M. Accuracy of patient-specific template-guided vs. free-hand fluoroscopically controlled pedicle screw placement in the thoracic and lumbar spine: a randomized cadaveric study. 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 2016; 26:738-749. [DOI: 10.1007/s00586-016-4728-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/01/2016] [Accepted: 08/01/2016] [Indexed: 01/05/2023]
|
17
|
Liu H, Chen W, Wang Z, Lin J, Meng B, Yang H. Comparison of the accuracy between robot-assisted and conventional freehand pedicle screw placement: a systematic review and meta-analysis. Int J Comput Assist Radiol Surg 2016; 11:2273-2281. [DOI: 10.1007/s11548-016-1448-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/13/2016] [Indexed: 11/28/2022]
|
18
|
Avila MJ, Baaj AA. Freehand Thoracic Pedicle Screw Placement: Review of Existing Strategies and a Step-by-Step Guide Using Uniform Landmarks for All Levels. Cureus 2016; 8:e501. [PMID: 27014535 PMCID: PMC4803536 DOI: 10.7759/cureus.501] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Pedicle screw fixation in the thoracic spine presents certain challenges due to the critical regional neurovascular anatomy as well as the narrow pedicular corridor that typically exists. With increased awareness of the dangers of intraoperative radiation, the ability to place pedicle screws with anatomic landmarks alone is paramount. In this study, we reviewed the literature from 1990 to 2015 for studies that included freehand pedicle screw placement in the thoracic spine with special emphasis on entry points and the trajectories of the screws. We excluded studies that used fluoroscopy guidance, navigation techniques, cadaveric and biomechanical articles, case reports, and experimental studies on animals. The search retrieved 40 articles, and after careful selection, seven articles were analyzed. Over 8,000 screws were placed in the different studies. The mean accuracy for placement of the thoracic screws was 93.3%. However, there is little consensus between studies in entry points, sagittal, and axial trajectories of the screws. We complete this review by presenting our step-by-step technique for the placement of freehand pedicle screws in the thoracic spine.
Collapse
Affiliation(s)
| | - Ali A Baaj
- Neurological Surgery, NewYork-Presbyterian/Weill Cornell Medical College
| |
Collapse
|
19
|
Larson AN, Polly DW, Ackerman SJ, Ledonio CGT, Lonner BS, Shah SA, Emans JB, Richards BS, _ _. What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US? J Neurosurg Spine 2016; 24:116-23. [DOI: 10.3171/2015.4.spine131119] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
There is substantial heterogeneity in the number of screws used per level fused in adolescent idiopathic scoliosis (AIS) surgery. Assuming equivalent clinical outcomes, the potential cost savings of using fewer pedicle screws were estimated using a medical decision model with sensitivity analysis.
METHODS
Descriptive analyses explored the annual costs for 5710 AIS inpatient stays using discharge data from the 2009 Kids’ Inpatient Database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), which is a national all-payer inpatient database. Patients between 10 and 17 years of age were identified using the ICD-9-CM code for idiopathic scoliosis (737.30). All inpatient stays were assumed to represent 10-level fusions with pedicle screws for AIS. High screw density was defined at 1.8 screws per level fused, and the standard screw density was defined as 1.48 screws per level fused. The surgical return for screw malposition was set at $23,762. A sensitivity analysis was performed by varying the cost per screw ($600–$1000) and the rate of surgical revisions for screw malposition (0.117%–0.483% of screws; 0.8%–4.3% of patients). The reported outcomes include estimated prevented malpositioned screws (set at 5.1%), averted revision surgeries, and annual cost savings in 2009 US dollars, assuming similar clinical outcomes (rates of complications, revision) using a standard- versus high-density pattern.
RESULTS
The total annual costs for 5710 AIS hospital stays was $278 million ($48,900 per patient). Substituting a high for a standard screw density yields 3.2 fewer screws implanted per patient, with 932 malpositioned screws prevented and 21 to 88 revision surgeries for implant malposition averted, and a potential annual cost savings of $11 million to $20 million (4%–7% reduction in the total cost of AIS hospitalizations).
CONCLUSIONS
Reducing the number of screws used in scoliosis surgery could potentially decrease national AIS hospitalization costs by up to 7%, which may improve the safety and efficiency of care. However, such a screw construct must first be proven safe and effective.
Collapse
Affiliation(s)
- A. Noelle Larson
- 1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - David W. Polly
- 2Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | | | | | - Baron S. Lonner
- 4Mount Sinai Beth Israel Hospital, Department of Orthopedic Surgery, New York, New York
| | - Suken A. Shah
- 5Department of Orthopaedic Surgery, Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - John B. Emans
- 6Department of Orthopaedic Surgery, Children’s Hospital, Boston, Massachusetts; and
| | - B. Stephens Richards
- 7Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | | |
Collapse
|