1
|
Levy HA, Pinter ZW, Pumford A, Padilla S, Salmons HI, Townsley S, Katsos K, Clarke M, Bydon M, Fogelson JL, Elder BD, Currier B, Freedman BA, Nassr AN, Karamian BA, Sebastian AS. The effect of C2 screw type on perioperative outcomes and long-term stability after C2-T2 posterior cervical decompression and fusion. 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 2024:10.1007/s00586-024-08237-2. [PMID: 38563986 DOI: 10.1007/s00586-024-08237-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE To determine if C2 pedicle versus pars screw type predicts change in fusion status, C2 screw loosening, cervical alignment, and patient-reported outcomes measures (PROMs) after C2-T2 posterior cervical decompression and fusion (PDCF). METHODS All adult patients who underwent C2-T2 PCDF for myelopathy or myeloradiculopathy between 2013-2020 were retrospectively identified. Patients were dichotomized by C2 screw type into bilateral C2 pedicle and bilateral C2 pars screw groups. Preoperative and short- and long-term postoperative radiographic outcomes and PROMs were collected. Univariate and multivariate analysis compared patient factors, fusion status, radiographic measures, and PROMs across groups. RESULTS A total of 159 patients met the inclusion/exclusion criteria (76 bilateral pedicle screws, 83 bilateral pars screws). Patients in the C2 pars relative to C2 pedicle screw group were on average more likely to have bone morphogenic protein (p = 0.001) and four-millimeter diameter rods utilized intraoperatively (p = 0.033). There were no significant differences in total construct and C2-3 fusion rate, C2 screw loosening, or complication and revision rates between C2 screw groups in univariate and regression analysis. Changes in C2 tilt, C2-3 segmental lordosis, C0-2 Cobb angle, proximal junctional kyphosis, atlanto-dens interval, C1 lamina-occiput distance, C2 sagittal vertical axis, C2-7 lordosis, and PROMs at all follow-up intervals did not vary significantly by C2 screw type. CONCLUSION There were no significant differences in fusion status, hardware complications, and radiographic and clinical outcomes based on C2 screw type following C2-T2 PCDF. Accordingly, intraoperative usage criteria can be flexible based on patient vertebral artery positioning and surgeon comfort level.
Collapse
Affiliation(s)
- Hannah A Levy
- Department of Orthopedic Surgery, Mayo Clinic, 200 1 St. SW, Rochester, MN, 55905, USA.
| | - Zachariah W Pinter
- Department of Orthopedic Surgery, Mayo Clinic, 200 1 St. SW, Rochester, MN, 55905, USA
| | - Andrew Pumford
- Department of Orthopedic Surgery, Mayo Clinic, 200 1 St. SW, Rochester, MN, 55905, USA
| | - Sarah Padilla
- Department of Orthopedic Surgery, Mayo Clinic, 200 1 St. SW, Rochester, MN, 55905, USA
| | - Harold I Salmons
- Department of Orthopedic Surgery, Mayo Clinic, 200 1 St. SW, Rochester, MN, 55905, USA
| | - Sarah Townsley
- Department of Orthopedic Surgery, Mayo Clinic, 200 1 St. SW, Rochester, MN, 55905, USA
| | | | - Michelle Clarke
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Benjamin D Elder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bradford Currier
- Department of Orthopedic Surgery, Mayo Clinic, 200 1 St. SW, Rochester, MN, 55905, USA
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, 200 1 St. SW, Rochester, MN, 55905, USA
| | - Ahmad N Nassr
- Department of Orthopedic Surgery, Mayo Clinic, 200 1 St. SW, Rochester, MN, 55905, USA
| | - Brian A Karamian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Arjun S Sebastian
- Department of Orthopedic Surgery, Mayo Clinic, 200 1 St. SW, Rochester, MN, 55905, USA
| |
Collapse
|
2
|
Beucler N. The summit of the isthmic crest of the axis as a new entry point for C2 pedicle screw: an anatomical study. Neurosurg Rev 2024; 47:107. [PMID: 38456988 DOI: 10.1007/s10143-024-02346-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Nathan Beucler
- Neurosurgery department, Sainte-Anne Military Teaching Hospital, 2 boulevard Sainte-Anne, Toulon Cedex 9, 83800, France.
| |
Collapse
|
3
|
Bonello JP, Koucheki R, Abbas A, Lex J, Nucci N, Yee A, Ahn H, Finkelstein J, Lewis S, Larouche J, Toor J. Comparison of major spine navigation platforms based on key performance metrics: a meta-analysis of 16,040 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 2023; 32:2937-2948. [PMID: 37474627 DOI: 10.1007/s00586-023-07865-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/28/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE The objective of this meta-analysis is to compare available computer-assisted navigation platforms by key performance metrics including pedicle screw placement accuracy, operative time, neurological complications, and blood loss. METHODS A systematic review was conducted using major databases for articles comparing pedicle screw accuracy of computer-assisted navigation to conventional (freehand or fluoroscopy) controls via post-operative computed tomography. Outcome data were extracted and pooled by random-effects model for analysis. RESULTS All navigation platforms demonstrated significant reduction in risk of breach, with Stryker demonstrating the highest accuracy compared to controls (OR 0.16 95% CI 0.06 to 0.41, P < 0.00001, I2 = 0%) followed by Medtronic. There were no significant differences in accuracy or most surgical outcome measures between platforms; however, BrainLab demonstrated significantly faster operative time compared to Medtronic by 30 min (95% CI - 63.27 to - 2.47, P = 0.03, I2 = 74%). Together, there was significantly lower risk of major breach in the navigation group compared to controls (OR 0.42, 95% CI 0.27-0.63, P < 0.0001, I2 = 56%). CONCLUSIONS When comparing between platforms, Stryker demonstrated the highest accuracy, and Brainlab the shortest operative time, both followed by Medtronic. No significant difference was found between platforms regarding neurologic complications or blood loss. Overall, our results demonstrated a 60% reduction in risk of major breach utilizing computer-assisted navigation, coinciding with previous studies, and supporting its validity. This study is the first to directly compare available navigation platforms offering insight for further investigation and aiding in the institutional procurement of platforms. LEVEL 3 EVIDENCE: Meta-analysis of Level 3 studies.
Collapse
Affiliation(s)
- John-Peter Bonello
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| | - Robert Koucheki
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Aazad Abbas
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Johnathan Lex
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
| | - Nicholas Nucci
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Canada
| | - Albert Yee
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Department of Orthopaedic Surgery, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Henry Ahn
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Canada
| | - Joel Finkelstein
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Department of Orthopaedic Surgery, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Stephen Lewis
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Canada
| | - Jeremie Larouche
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Department of Orthopaedic Surgery, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Jay Toor
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
| |
Collapse
|
4
|
Rudy RF, Farber SH, Godzik J, Dugan RK, Gandhi SV, Turner JD, Uribe JS. Technique for Validation of Intraoperative Navigation in Minimally Invasive Spine Surgery. Oper Neurosurg (Hagerstown) 2023; 24:451-454. [PMID: 36812377 DOI: 10.1227/ons.0000000000000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 09/29/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Intraoperative 3-dimensional navigation is an enabling technology that has quickly become a commonplace in minimally invasive spine surgery (MISS). It provides a useful adjunct for percutaneous pedicle screw fixation. Although navigation is associated with many benefits, including improvement in overall screw accuracy, navigation errors can lead to misplaced instrumentation and potential complications or revision surgery. It is difficult to confirm navigation accuracy without a distant reference point. OBJECTIVE To describe a simple technique for validating navigation accuracy in the operating room during MISS. METHODS The operating room is set up in a standard fashion for MISS with intraoperative cross-sectional imaging available. A 16-gauge needle is placed within the bone of the spinous process before intraoperative cross-sectional imaging. The entry level is chosen such that the space between the reference array and the needle encompasses the surgical construct. Before placing each pedicle screw, accuracy is verified by placing the navigation probe over the needle. RESULTS This technique has identified navigation inaccuracy and led to repeat cross-sectional imaging. No screws have been misplaced in the senior author's cases since adopting this technique, and there have been no complications attributable to the technique. CONCLUSION Navigation inaccuracy is an inherent risk in MISS, but the described technique may mitigate this risk by providing a stable reference point.
Collapse
Affiliation(s)
- Robert F Rudy
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | | | | | | | | | | | | |
Collapse
|
5
|
Wu C, Deng J, Wang Q, Shen D, Qin B, Li T, Wang X, Zeng B. Comparison of Perpendicular to the Coronal Plane versus Medial Inclination for C2 Pedicle Screw Insertion Assisted by 3D Printed Navigation Template. Orthop Surg 2022; 15:563-571. [PMID: 36220773 PMCID: PMC9891962 DOI: 10.1111/os.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE C2 pedicle screw insertion is very important in posterior upper cervical surgery. The traditional screw placement technique requires us to consider both medial inclination and cephalad angle, it is difficult to operate intraoperatively. This paper is to explore a novel method of C2 pedicle screw placement compared with traditional C2 pedicle screw. METHODS A total of 44 patients diagnosed with atlantoaxial fracture or instability from May 2018 to November 2020 were involved in this retrospective study, and they were divided into C2-PPS group (perpendicular to the coronal plane C2 screw, 24 patients) and C2-TPS group (traditional C2 pedicle screw, 20 patients). The diameter of the maximum tangential circle, distance between geometric center and median sagittal plane and screw length of PPS and TPS were measured based on the 3D model of C2, respectively. Then the 3D printed navigation templated were designed and manufactured by 3D printing to assisted the PPS and TPS placement, respectively. The surgical time and radiation exposure times during operation were recorded; the post-operative grading criteria, deviation of screw entry point and deviation of screw angle of two groups were evaluated, respectively. RESULTS A total of 48 screws were inserted in the C2-PPS group, and 40 screws were inserted in the C2-TPS group. There were 46 screws with grade 0 (95.8%) in the PPS group and 31 screws with grade 0 (77.5%) in the TPS group, (P = 0.03). The radiation exposure times in the C2-PPS group and C2-TPS group were 4.7 ± 1.5 and 7.8 ± 3.8, respectively, (P = 0.045). The deviations of screw entry point in the C2-PPS group and C2-TPS group were 1.2 ± 0.8 mm and 3.2 ± 1.3 mm, respectively; the deviations of screw angle in the C2-PPS group and C2-TPS group were 2.1 ± 1.6° and 4.8 ± 2.0°, respectively, (P = 0.000). The diameters of the maximum tangential circle in the C2-PPS group and C2-TPS group were 5.5 ± 1.0 mm and 5.3 ± 0.9 mm, respectively. The distances between the geometric center and median sagittal plane in the C2-PPS group and C2-TPS group were 15.4 ± 2.3 mm and 18.0 ± 3.3 mm, respectively; The screw lengths in the C2-PPS group and C2-TPS group were 25.9 ± 3.2 mm and 27.6 ± 3.7 mm, respectively, (P = 0.000). CONCLUSION Eighty percent of C2-PPS corridor can accommodate a 3.5 mm diameter screw, and with an average screw length of 26 mm. Navigation templates assisted the C2-PPS placement is less surgical time, less radiation exposure times, more safe and more accurate than C2-TPS.
Collapse
Affiliation(s)
- Chao Wu
- Department of OrthopedicsZigong Fourth People's HospitalZigongChina,Institute of Digital MedicineZigong Academy of Big Data for Medical Science and Artificial IntelligenceZigong643000China
| | - Jiayan Deng
- Institute of Digital MedicineZigong Academy of Big Data for Medical Science and Artificial IntelligenceZigong643000China
| | - Qing Wang
- Department of OrthopedicsHospital of Southwest Medical UniversityLuzhouChina
| | - Danwei Shen
- Institute of Digital MedicineZigong Academy of Big Data for Medical Science and Artificial IntelligenceZigong643000China
| | - Binwei Qin
- Department of OrthopedicsHospital of Southwest Medical UniversityLuzhouChina
| | - Tao Li
- Department of OrthopedicsZigong Fourth People's HospitalZigongChina
| | - Xiangyu Wang
- Department of OrthopedicsZigong Fourth People's HospitalZigongChina
| | - Baifang Zeng
- Department of OrthopedicsZigong Fourth People's HospitalZigongChina,Department of OrthopedicsHospital of Southwest Medical UniversityLuzhouChina
| |
Collapse
|
6
|
Singh DK, Shankar D, Singh N, Singh RK, Chand VK. C2 Screw fixation techniques in atlantoaxial instability: A technical review. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:368-377. [PMID: 36777907 PMCID: PMC9910137 DOI: 10.4103/jcvjs.jcvjs_128_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Atlantoaxial instability (AAI) is surgically a complex entity due to its proximity to vital neurovascular structures. C1-C2 fusion has been an established standard in its treatment for a considerable time now. Here, we have outlined the most common techniques for C2 screw fixation in practice at present such as C2 pedicle, C2 pars, C2 translaminar, C2 subfacetal, C2-C3 transfacetal, and C2 inferior facet screw. We have discussed in detail the technical as well as biomechanical aspects of each technique of C2 screw fixation in AAI and explored the intricacies of each technique.
Collapse
Affiliation(s)
- Deepak Kumar Singh
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Diwakar Shankar
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Neha Singh
- Department of Radiodiagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rakesh Kumar Singh
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vipin Kumar Chand
- Department of Neurosurgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
7
|
The medial window technique as a salvage method to insert C2 pedicle screw in the case of a high-riding vertebral artery or narrow pedicle: a technical note and case series. 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 2022; 31:1251-1259. [PMID: 35249142 DOI: 10.1007/s00586-022-07146-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/21/2021] [Accepted: 02/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe the safety and feasibility of C2 medial window screw (C2MWS) as an alternative salvage method for C2 pedicle screws in cases of high-riding vertebral artery (HRVA) or narrow pedicle. METHODS The C2MWS technique involves screw insertion by intentionally breaching the medial cortex of the pedicle to avoid vertebral artery injury. Twelve patients who underwent C2 screw insertion via the C2MWS were retrospectively reviewed. C2MWS was indicated in cases of high-riding vertebral artery (HRVA) or narrow pedicle (pedicle width ≤ 4 mm). The width of the canal breach by screw, vertebral artery groove (VAG) breach, solid fusion, neck pain visual analogue scale (VAS) score, and Japanese Orthopedic Association (JOA) score were assessed as outcome measurements. RESULTS C2MWS was indicated due to both HRVA and narrow pedicle for 11 screws, narrow pedicle for one screw, and HRVA for two screws. No screw VAG breach or vertebral artery injury was noted postoperatively. The mean width of canal breach was 2.9 ± 1.3 mm. There were no cases demonstrating neurologic deterioration, and 11 patients (91.7%) demonstrated solid fusion at 1-year follow-up. Furthermore, neck pain VAS and JOA scores significantly improved after the surgery. CONCLUSIONS The C2MWS technique can provide 3-column fixation while reliably avoiding VA injury. C2MWS could be considered as a salvage alternative method when the insertion of C2 pedicle screw is complicated by HRVA or a narrow pedicle, while there is a need to provide firmer fixation strength than that provided by pars or translaminar screws. LEVEL OF EVIDENCE: 4
Collapse
|
8
|
Tu P, Qin C, Guo Y, Li D, Lungu AJ, Wang H, Chen X. Ultrasound image guided and mixed reality-based surgical system with real-time soft tissue deformation computing for robotic cervical pedicle screw placement. IEEE Trans Biomed Eng 2022; 69:2593-2603. [PMID: 35157575 DOI: 10.1109/tbme.2022.3150952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cervical pedicle screw (CPS) placement surgery remains technically demanding due to the complicated anatomy with neurovascular structures. State-of-the-art surgical navigation or robotic systems still suffer from the problem of hand-eye coordination and soft tissue deformation. In this study, we aim at tracking the intraoperative soft tissue deformation and constructing a virtual physical fusion surgical scene, and integrating them into the robotic system for CPS placement surgery. Firstly, we propose a real-time deformation computation method based on the prior shape model and intraoperative partial information acquired from ultrasound images. According to the generated posterior shape, the structure representation of deformed target tissue gets updated continuously. Secondly, a hand tremble compensation method is proposed to improve the accuracy and robustness of the virtual-physical calibration procedure, and a mixed reality based surgical scene is further constructed for CPS placement surgery. Thirdly, we integrate the soft tissue deformation method and virtual-physical fusion method into our previously proposed surgical robotic system, and the surgical workflow for CPS placement surgery is introduced. We conducted phantom and animal experiments to evaluate the feasibility and accuracy of the proposed system. Our system yielded a mean surface distance error of 1.52 ± 0.43 mm for soft tissue deformation computing, and an average distance deviation of 1.04 ± 0.27 mm for CPS placement. Results demonstrated that our system involves tremendous clinical application potential. Our proposed system promotes the efficiency and safety of the CPS placement surgery.
Collapse
|
9
|
Farber SH, Godzik J, Hlubek RJ, Zhou JJ, Walker CT, Kakarla UK, Uribe JS, Turner JD. Accuracy of Subaxial Cervical Pedicle Screw Placement Using Direct Visualization Versus Computed Tomography-Based Navigation. Clin Spine Surg 2022; 35:E104-E110. [PMID: 34379611 DOI: 10.1097/bsd.0000000000001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective analysis of operative data from cadaveric cervical spines. OBJECTIVE To evaluate the accuracy of neuronavigation compared with laminotomy with direct visualization (DV) of the pedicle for placement of subaxial pedicle screws. SUMMARY OF BACKGROUND DATA Subaxial pedicle screws provide superior fixation compared with other posterior cervical fixation strategies. However, high accuracy is required for safe placement, given the proximity of critical neurovascular structures. Computed tomography (CT)-based neuronavigation has increased in popularity for placement of spinal implants, including subaxial pedicle screws. However, the accuracy of the technique for this application has not been extensively evaluated. METHODS Six fresh-frozen cadaveric spines (occiput to T2) were prepared. Pedicle screws were placed from C3 to C7 on either side using either the DV or neuronavigation technique (alternating sides between specimens). Pedicles with diameters <4 mm were excluded. For the DV technique, a hemilaminotomy was performed for DV of pedicle borders and to determine appropriate screw medialization and trajectory. Neuronavigation screws were placed using CT-based navigation with a reference frame mounted on the C2 spinous process. Screw position was evaluated using postoperative CT, and breaches were classified using the Neo classification. RESULTS Fifty pedicle screws were placed at 25 levels in 6 cadaveric spines; 25 screws each were placed using neuronavigation or DV. No significant difference in accuracy was found between the 2 techniques. Three (12%) breaches occurred in the DV group, and 9 (36%) breaches occurred in the neuronavigation group (P=0.10). The breaches were evenly distributed across all levels. There were no high-grade breaches with DV and only 1 (4.0%) with neuronavigation (P>0.99). Average pedicle cortical and medullary bone widths were higher for levels with no breach (P=0.009 and P=0.02, respectively). CONCLUSIONS High accuracy can be achieved with both neuronavigation and DV for placement of subaxial cervical pedicle screws in cadavers.
Collapse
Affiliation(s)
- S Harrison Farber
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Evaluation of free-hand screw placement in cervical, thoracic, and lumbar spine by neurosurgical residents. Clin Neurol Neurosurg 2021; 204:106585. [PMID: 33813370 DOI: 10.1016/j.clineuro.2021.106585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/10/2021] [Accepted: 02/27/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Knowledge of free-hand screw technique remains critical to adequately train neurosurgical residents. The purpose of this study was to evaluate the accuracy of screw placement via the free-hand technique in lumbar, thoracic, and cervical spine by neurosurgical residents completing an enfolded spine fellowship. METHODS Medical records of all patients who underwent free-hand screw placement at all spinal levels over a 6-month period by senior neurosurgical residents enrolled in an in-folded spine fellowship were retrospectively reviewed. Postoperative CT images were assessed for presence and direction of cortical breach. RESULTS Twenty-six patients underwent 162 free-hand screw placements. The most commonly placed screws were cervical lateral mass screws (n = 69), thoracic (n = 41), and lumbar pedicle screws (n = 41). The most common indication for surgery was deformity (n = 22), followed by infection (n = 2) and trauma (n = 2). Fifty-five breaches were identified in 44 (27 %) screws placed in 21 patients (81 %). Anterior breach was identified in 22 cases (40.0 %), lateral in 12 (23.6 %), superior in 7 (12.7 %), and inferior in 7 (12.7 %), and medial in 6 (10.9 %). The most common level of breach was observed in cervical lateral mass screws (n = 19, 43 %) and least common in C2 pars screws (n = 1, 2%). With an average length of follow up of 12.1 ± 7.7 months of follow-up, no clinical sequalae of screw breach was observed. CONCLUSIONS Despite the high prevalence of screw breach using the free-hand technique by neurosurgical residents, the absence of clinical sequelae implies safety and emphasizes the importance of early exposure to this technique during neurosurgical residency training.
Collapse
|
11
|
Farah K, Meyer M, Prost S, Dufour H, Blondel B, Fuentes S. Cirq® Robotic Assistance for Minimally Invasive C1-C2 Posterior Instrumentation: Report on Feasibility and Safety. Oper Neurosurg (Hagerstown) 2020; 19:730-734. [PMID: 32710770 DOI: 10.1093/ons/opaa208] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Accurate screw placement remains very challenging especially in the upper cervical spine. OBJECTIVE To present our first experience of a percutaneous posterior C1-C2 fixation for a traumatic fracture. METHODS This is a case report of a non-neurological patient, harboring a type II odontoid fracture. She underwent a posterior percutaneous fixation using Cirq® Robotic Assistance coupled to the AIRO® intraoperative computed tomography (iCT)-scan and BrainLab® navigation system (all by BrainLab AG). Routine CT was performed on postoperative day 2 to evaluate pedicle screw placement. The effective dose was calculated. RESULTS The C1-C2 posterior percutaneous fixation was performed with cannulated VERTEX® Reconstruction System (Medtronic). Overall, 4 screws were placed. All of them were rated as acceptable (100%). Radiation dose received by the patient was 4.13 mSv. Radiation dose received by the surgical staff was 0 mSv. Postoperative course was excellent. CONCLUSION Posterior percutaneous fixation using Cirq® Robotic Assistance coupled with iCT navigation system is a major innovation that can improve pedicle screw positioning's accuracy with acceptable patient radiation and reduced surgical team exposure.
Collapse
Affiliation(s)
- Kaissar Farah
- Department of neurosurgery, La Timone university hospital, APHM, Marseille, France.,Spine unit, La Timone university hospital, APHM, Marseille, France
| | - Mikael Meyer
- Department of neurosurgery, La Timone university hospital, APHM, Marseille, France.,Spine unit, La Timone university hospital, APHM, Marseille, France
| | - Solene Prost
- Department of orthopedic surgery, La Timone university hospital, APHM, Marseille, France.,Spine unit, La Timone university hospital, APHM, Marseille, France
| | - Henry Dufour
- Department of neurosurgery, La Timone university hospital, APHM, Marseille, France.,Spine unit, La Timone university hospital, APHM, Marseille, France
| | - Benjamin Blondel
- Department of orthopedic surgery, La Timone university hospital, APHM, Marseille, France.,Spine unit, La Timone university hospital, APHM, Marseille, France
| | - Stephane Fuentes
- Department of neurosurgery, La Timone university hospital, APHM, Marseille, France.,Spine unit, La Timone university hospital, APHM, Marseille, France
| |
Collapse
|
12
|
3D-printed navigation template in cervical spine fusion: a systematic review and meta-analysis. 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 2020; 30:389-401. [DOI: 10.1007/s00586-020-06601-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 06/28/2020] [Accepted: 09/05/2020] [Indexed: 12/19/2022]
|
13
|
Azimi P, Yazdanian T, Benzel EC, Aghaei HN, Azhari S, Sadeghi S, Montazeri A. Accuracy and safety of C2 pedicle or pars screw placement: a systematic review and meta-analysis. J Orthop Surg Res 2020; 15:272. [PMID: 32690035 PMCID: PMC7372824 DOI: 10.1186/s13018-020-01798-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/14/2020] [Indexed: 11/25/2022] Open
Abstract
Study design Systematic review and meta-analysis. Aim The purpose of this study was to compare the safety and accuracy of the C2 pedicle versus C2 pars screws placement and free-hand technique versus navigation for upper cervical fusion patients. Methods Databases searched included PubMed, Scopus, Web of Science, and Cochrane Library to identify all papers published up to April 2020 that have evaluated C2 pedicle/pars screws placement accuracy. Two authors individually screened the literature according to the inclusion and exclusion criteria. The accuracy rates associated with C2 pedicle/pars were extracted. The pooled accuracy rate estimated was performed by the CMA software. A funnel plot based on accuracy rate estimate was used to evaluate publication bias. Results From 1123 potentially relevant studies, 142 full-text publications were screened. We analyzed data from 79 studies involving 4431 patients with 6026 C2 pedicle or pars screw placement. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Overall, funnel plot and Begg’s test did not indicate obvious publication bias. The pooled analysis reveals that the accuracy rates were 93.8% for C2 pedicle screw free-hand, 93.7% for pars screw free-hand, 92.2% for navigated C2 pedicle screw, and 86.2% for navigated C2 pars screw (all, P value < 0.001). No statistically significant differences were observed between the accuracy of placement C2 pedicle versus C2 pars screws with the free-hand technique and the free-hand C2 pedicle group versus the navigated C2 pedicle group (all, P value > 0.05). Conclusion Overall, there was no difference in the safety and accuracy between the free-hand and navigated techniques. Further well-conducted studies with detailed stratification are needed to complement our findings.
Collapse
Affiliation(s)
- Parisa Azimi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, 19839-63113, Iran.
| | | | - Edward C Benzel
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Hossein Nayeb Aghaei
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, 19839-63113, Iran
| | - Shirzad Azhari
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, 19839-63113, Iran
| | - Sohrab Sadeghi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Arabi Ave, Daneshjoo Blvd, Velenjak, Tehran, 19839-63113, Iran
| | - Ali Montazeri
- Population Health Research Group, Mental Health Research Group, Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| |
Collapse
|
14
|
Kovalenko RA, Rudenko VV, Kashin VA, Cherebillo VY, Ptashnikov DA. [Assessment of the safety and accuracy of implantation of screws into the C2 vertebra using individual 3D-navigation matrices]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:42-50. [PMID: 32412193 DOI: 10.17116/neiro20208402142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Individual 3D-navigation matrices are valuable to increase the safety of screw implantation into the axis. Objective To analyze safety and accuracy of screw deployment into the axis using individual 3D-navigation matrices compared to free hand technique. Material and methods A retrospective analysis included 23 patients (group 1) who underwent implantation of 44 screws into the axis using the «free hand» technique. The screws were installed along the transpedicular or pars trajectory. A prospective analysis enrolled 17 patients (group 2) who underwent installation of 34 screws using individual navigation matrices. 3D-printing technology was applied for manufacturing these matrices. Implantation results were evaluated considering postoperative CT data and SGT (Screw Guide Template) system. Results In the 1st group («free hand»), grade 0 and 1 (no malposition or less than 50% of screw diameter) were recorded for 29 (65.91%) screws, grade 2 - for 13 (29.55%) screws, grade 3 - for 2 (4.45%) screws. Intraoperative injury of the vertebral artery without postoperative neurological deficit occurred in 4 (8.89%) patients. In the 2nd group, 97% of screws were implanted in accordance with grades 1 and 2. Deviation grade 2 was registered in 11 cases (32.35%). Mean deviation was 1.8 ± 1.0 mm. In the 2nd group, 28 (82.35%) out of 34 screws were completely within the bone structures (grade 0), 4 (11.76%) screws perforated pedicles for less than 50% of their diameter (grade 1). There were 2 cases of malposition grade 2 and 3 without vertebral artery injury. Conclusion Individual 3D navigation matrix is an effective method for screw installation into the axis. This approach exceeds fluoroscopy-assisted "free hand" technique in terms of safety of implantation.
Collapse
Affiliation(s)
- R A Kovalenko
- V.A. Almazov Medical Research Center, Saint Petersburg, Russia
| | - V V Rudenko
- R.R. Vreden Russian Scientific Research Institute of Traumatology and Orthopedics, Saint Petersburg, Russia
| | - V A Kashin
- V.A. Almazov Medical Research Center, Saint Petersburg, Russia
| | - V Yu Cherebillo
- V.A. Almazov Medical Research Center, Saint Petersburg, Russia
| | - D A Ptashnikov
- R.R. Vreden Russian Scientific Research Institute of Traumatology and Orthopedics, Saint Petersburg, Russia
| |
Collapse
|
15
|
Du YQ, Yin YH, Qiao GY, Yu XG. C2 medial pedicle screw: a novel "in-out-in" technique as an alternative option for posterior C2 fixation in cases with a narrow C2 isthmus. J Neurosurg Spine 2020; 33:281-287. [PMID: 32357339 DOI: 10.3171/2020.2.spine191517] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors describe a novel "in-out-in" technique as an alternative option for posterior C2 screw fixation in cases that involve narrow C2 isthmus. Here, they report the preliminary radiological and clinical outcomes in 12 patients who had a minimum 12-month follow-up period. METHODS Twelve patients with basilar invagination and atlantoaxial dislocation underwent atlantoaxial reduction and fixation. All patients had unilateral hypoplasia of the C2 isthmus that prohibited insertion of pedicle screws. A new method, the C2 medial pedicle screw (C2MPS) fixation, was used as an alternative. In this technique, the inner cortex of the narrow C2 isthmus was drilled to obtain space for screw insertion, such that the lateral cortex could be well preserved and the risk of vertebral artery injury could be largely reduced. The C2MPS traveled along the drilled inner cortex into the anterior vertebral body, achieving a 3-column fixation of the axis with multicortical purchase. RESULTS Satisfactory C2MPS placement and reduction were achieved in all 12 patients. No instance of C2MPS related vertebral artery injury or dural laceration was observed. There were no cases of implant failure, and solid fusion was demonstrated in all patients. CONCLUSIONS This novel in-out-in technique can provide 3-column rigid fixation of the axis with multicortical purchase. Excellent clinical outcomes with low complication rates were achieved with this technique. When placement of a C2 pedicle screw is not possible due to anatomical constraints, the C2MPS can be considered as an efficient alternative.
Collapse
|
16
|
Lee JS, Son DW, Lee SH, Ki SS, Lee SW, Song GS. Comparative Analysis of Surgical Outcomes of C1-2 Fusion Spine Surgery between Intraoperative Computed Tomography Image Based Navigation-Guided Operation and Fluoroscopy-Guided Operation. J Korean Neurosurg Soc 2020; 63:237-247. [PMID: 32120457 PMCID: PMC7054113 DOI: 10.3340/jkns.2019.0172] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/15/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Fixation of the C1-2 segment is challenging because of the complex anatomy in the region and the need for a high degree of accuracy to avoid complications. Preoperative 3D-computed tomography (CT) scans can help reduce the risk of complications in the vertebral artery, spinal cord, and nerve roots. However, the patient may be susceptible to injury if the patient's anatomy does not match the preoperative CT scans. The intraoperative 3D image-based navigation systems have reduced complications in instrument-assisted techniques due to greater accuracy. This study aimed to compare the radiologic outcomes of C1-2 fusion surgery between intraoperative CT image-guided operation and fluoroscopy-guided operation. METHODS We retrospectively reviewed the radiologic images of 34 patients who underwent C1-2 fusion spine surgery from January 2009 to November 2018 at our hospital. We assessed 17 cases each of degenerative cervical disease and trauma in a study population of 18 males and 16 females. The mean age was 54.8 years. A total of 139 screws were used and the surgical procedures included 68 screws in the C1 lateral mass, 58 screws in C2 pedicle, nine screws in C2 lamina and C2 pars screws, four lateral mass screws in sub-axial level. Of the 34 patients, 19 patients underwent screw insertion using intraoperative mobile CT. Other patients underwent atlantoaxial fusion with a standard fluoroscopy-guided device. RESULTS A total of 139 screws were correctly positioned. We analyzed the positions of 135 screws except for the four screws that performed the lateral mass screws in C3 vertebra. Minor screw penetration was observed in seven cases (5.2%), and major pedicle screw penetration was observed in three cases (2.2%). In one case, the malposition of a C2 pedicle screw was confirmed, which was subsequently corrected. There were no complications regarding vertebral artery injury or onset of new neurologic deficits. The screw malposition rate was lower (5.3%) in patients who underwent intraoperative CT-based navigation than that for fluoroscopy-guided cases (10.2%). And we confirmed that the operation time can be significantly reduced by surgery using intraoperative O-arm device. CONCLUSION Spinal navigation using intraoperative cone-beam CT scans is reliable for posterior fixation in unstable C1-2 pathologies and can be reduced the operative time.
Collapse
Affiliation(s)
- Jun Seok Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Hun Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung Soon Ki
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| |
Collapse
|
17
|
The efficacy of immersive virtual reality surgical simulator training for pedicle screw placement: a randomized double-blind controlled trial. INTERNATIONAL ORTHOPAEDICS 2020; 44:927-934. [PMID: 32047963 DOI: 10.1007/s00264-020-04488-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/15/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To verify whether the pedicle screw placement (PSP) skills of young surgeons receiving immersive virtual reality surgical simulator (IVRSS) training could be improved effectively and whether the IVRSS-PSP training mode could produce a real clinical value in clinical surgery. METHODS Twenty-four young surgeons were equally randomized to a VR group and a NON-VR group. Participants in VR group received IVRSS-PSP training, and those in NON-VR group used the conventional model of observing a spinal model first and then watching a teaching video of spinal surgery for 40 minutes x five. The nailing outcome of the participants before and after training was evaluated by statistical analysis in both groups. RESULTS Post-training data analysis showed that the success rate and accuracy rate of screw placement in VR group and NON-VR group were 82.9% and 69.6% vs. 74.2% and 55.4%, respectively, showing statistically significant differences between the two groups by chi-square test (P < 0.05). CONCLUSION The present study demonstrated that IVRSS-PSP was helpful to improve the success rate of PSP for young surgeons, and may provide valuable reference for PSP training of young surgeons. In addition, our study also showed a promising potential of the VR technology in surgical simulation training.
Collapse
|
18
|
Tian Y, Zhang J, Liu T, Tang S, Chen H, Ding K, Hao D. A Comparative Study of C2 Pedicle or Pars Screw Placement with Assistance from a 3-Dimensional (3D)-Printed Navigation Template versus C-Arm Based Navigation. Med Sci Monit 2019; 25:9981-9990. [PMID: 31907341 PMCID: PMC6944189 DOI: 10.12659/msm.918440] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Since C2 is adjacent to important nerves and blood vessels, the implantation risk of C2 internal fixation in this area is high and requires high accuracy. This study mainly discussed the application value of 3-dimensional (3D)-printed navigation template in C2 screw placement. Material/Methods A retrospective study compared 3D-printed navigation template-assisted screw placement (group A, n=32) and the C-arm based navigation-assisted screw placement group (group B, n=32). Group A was divided into 2 subgroups: A1 (C2 pedicle screw placement) and A2 (C2 pars screw placement); group B was divided into B1 (C2 pedicle screw placement) and B2 (C2 pars screw placement). The accuracy and safety of screw placement and clinical outcomes were evaluated. Results There were 64 C2 screws placed in group A, and 95.31% achieved a grade A accuracy rating, including 52 screws in group A1 (96.15% grade A) and 12 screws in group A2 (91.67% grade A). A total of 64 C2 screws were placed in group B, and 84.38% achieved a grade A accuracy rating, including 50 screws in group B1 (84.00% grade A) and 14 screws in group B2 (85.71% grade A). The accuracy of screw placement differed significantly between groups A and B (P=0.041) and between groups A1 and B1 (P=0.039) but not between groups A2 and B2 (P=0.636). The postoperative efficacy of the 2 groups was satisfactory. And there were no complications of blood vessels or nerves related to screw placement in either group. Conclusions Although 3D-printed navigation template-assisted and C-arm based navigation-assisted C2 pedicle and pars screw placement provided similar safety and clinical efficacy, 3D-printed navigation template technology achieved more accurate C2 pedicle screw placement.
Collapse
Affiliation(s)
- Ye Tian
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Jianan Zhang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Tuanjiang Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Shi Tang
- Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China (mainland)
| | - Hao Chen
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Keyuan Ding
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| |
Collapse
|
19
|
Park JH, Lee JB, Lee HJ, Kim IS, Hong JT. Accuracy evaluation of placements of three different alternative C2 screws using the freehand technique in patients with high riding vertebral artery. Medicine (Baltimore) 2019; 98:e17891. [PMID: 31725634 PMCID: PMC6867729 DOI: 10.1097/md.0000000000017891] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
An observational study.To evaluate the safeties of placing three different alternative C2 screws using the freehand technique under high riding vertebral artery (HRVA) and to analyze the C2 morphometry in patients with HRVA.A retrospective analysis of radiologic data was performed on patients that underwent C2 instrumentation from September 2004 to December 2017. Two hundred fifty-one patients were included, and 90 of these patients (35.9%) had a unilateral or bilateral HRVA. We placed three alternative C2 screws including superior pars, inferior pars, and translaminar screws. Computed tomography was used to assess cortical breeches of screw placement and obtain morphometric measurements of C2 pars and lamina, that is, superior pars height/length, inferior pars length, and laminar thickness/length. We used the modification of the all India Institute of Medical Sciences outcome to define cortical breach.In total, 117 alternative C2 screws were inserted in 90 patients; 7 superior pars screws (6%), 69 inferior pars screws (59.0%), and 41 translaminar (35%) screws. Although cortical breaches occurred during 31 screw placements (26.5%), these were unacceptable in only two cases (1.7%). No symptomatic neurovascular complication was observed after screw placement in any case. Mean height of C2 superior pars was 3.8 ± 1.8 mm and mean thickness of C2 lamina was 5.2 ± 1.1 mm. Mean lengths of superior pars, inferior pars, and lamina were 17.8 ± 3.0 mm, 13.6 ± 2.2 mm, and 26.7 ± 3.3 mm, respectively. Superior pars height and lamina thickness < 3.5 mm that was a minimal diameter of cervical screw were 49.6% and 6.8%, alternative C2 screw was not available in these cases.Placements of alternative C2 screws using the freehand technique were achieved accurately and safely in patients with HRVA. However, preoperative morphometric evaluation is essential to determine the best option for C2 instrumentation and C2 screw length to avoid neurovascular complications.
Collapse
Affiliation(s)
- Jong-Hyeok Park
- Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul
| | - Jong Beom Lee
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju
| | - Ho Jin Lee
- Department of Neurosurgery, St. Vincent's Hospital
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent's Hospital
| | - Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
20
|
Zhao J, Yang L, Zheng S, Qu Y, Zhang X, Kang M, Dong R, Zhao X, Yu T. A novel screw view model of 3D navigation for upper cervical pedicle screw placement: A case report. Medicine (Baltimore) 2019; 98:e15291. [PMID: 31083161 PMCID: PMC6531100 DOI: 10.1097/md.0000000000015291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The purpose of this study is to introduce the technique of screw view model of navigation (SVMN) for upper cervical pedicle screw (UCPS) insertion. With the assistance of SVMN technology, the difficulty of screw placement manipulation can be diminished and the accuracy of placement can be improved. PATIENT CONCERNS A 49-year-old man presented with numbness of extremities and limited activity for 2 years. DIAGNOSES He was diagnosed with old fracture of C1 vertebra and atlantoaxial subluxation. INTERVENTIONS We used SVMN to assist UCPS insertion and lateral mass screw insertion in this patient. OUTCOMES A total of 2 pedicle screws and 2 lateral mass screws were inserted, all screws were defined as excellent position according to postoperative computer tomography (CT). The neurological function was intact postoperatively. The operation time was 293 minutes, the total fluoroscopic time was 4.1 minutes and the bleeding volume was 302 ml. There were no complications during the 48 months follow-up period. CONCLUSIONS The application of SVMN in UCPS insertion could achieve satisfactory effect of internal fixation for upper cervical spine and avoid neurovascular damage. The utilization of SVMN for UCPS insertion is a safe and efficacious method. Besides, it also increased the patients' hospital cost, and the surgeon must be quite familiar with the functional state of computer navigation.
Collapse
Affiliation(s)
| | | | | | | | - Xiwen Zhang
- Department of Gynaecology, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | | | | | | | | |
Collapse
|
21
|
Xin B, Chen G, Wang Y, Bai G, Gao X, Chu J, Xiao J, Liu T. The Efficacy of Immersive Virtual Reality Surgical Simulator Training for Pedicle Screw Placement: A Randomized Double-Blind Controlled Trial. World Neurosurg 2018; 124:S1878-8750(18)32913-9. [PMID: 30597280 DOI: 10.1016/j.wneu.2018.12.090] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE To assess efficacy of immersive virtual reality (VR) surgical simulator training for pedicle screw placement (PSP) in surgical graduate students. METHODS Sixteen inexperienced surgical graduate students were equally randomly assigned to an experimental group (VR group) and a control group (non-VR group). Students in the VR group performed PSP on the immersive VR surgical simulator, and students in the non-VR group were given a traditional introductory teaching session before a cadaver test. Eight adult fresh cadavers, 6 male and 2 female, were collected and randomly allocated to the 2 groups. Each group performed bilateral T11-L4 PSP on the cadavers independently, and the outcomes of PSP in terms of accuracy, success rate, and efficiency were assessed by computed tomography and compared between the 2 groups statistically. RESULTS Accuracy rate of PSP in the VR group was 89.6% versus 60.4% in the non-VR group (P < 0.05), success rate was 100% versus 79.2% (P < 0.05), and mean time was 2.8 ± 1 minutes versus 4.9 ± 1 minutes (P < 0.05), all showing significant differences between the 2 groups. CONCLUSIONS The immersive VR surgical simulator for PSP training model is superior to the traditional training model in terms of accuracy, success rate, and efficiency, showing potential in training new orthopedic spine surgeons.
Collapse
Affiliation(s)
- Baoquan Xin
- Taishan Medical University, Taian, ShanDong, China
| | - Guanghui Chen
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Yang Wang
- Department of Spine, Hefei Orthopaedic Hospital, Hefei, Anhui, China
| | | | - Xin Gao
- Orthopaedic Oncology Center, Department of Orthopaedics, Changzheng Hospital, Shanghai, China
| | - Jianjun Chu
- Department of Spine, Hefei Orthopaedic Hospital, Hefei, Anhui, China
| | - Jianru Xiao
- Orthopaedic Oncology Center, Department of Orthopaedics, Changzheng Hospital, Shanghai, China
| | - Tielong Liu
- Orthopaedic Oncology Center, Department of Orthopaedics, Changzheng Hospital, Shanghai, China.
| |
Collapse
|