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Wang X, Li HX, Zhu QS, Zhu YH. Effectiveness and safety of robot-assisted versus fluoroscopy-assisted cortical bone trajectory screw instrumentation in spinal surgery: a systematic review and meta-analysis. J Robot Surg 2024; 18:78. [PMID: 38358573 DOI: 10.1007/s11701-024-01866-1] [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: 11/27/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
Robot-assisted (RA) technology has been shown to be a safe aid in spine surgery, this meta-analysis aims to compare surgical parameters and clinical indexes between robot-assisted cortical bone trajectory (CBT) and fluoroscopy-assisted (FA) cortical bone trajectory in spinal surgery. We searched databases such as PubMed, Web of Science, the Cochrane Library, and the China National Knowledge Infrastructure. The study selection process was guided by the PICOS (Patient/Problem, Intervention, Comparison, Outcome, Study Design) strategy. The risk of bias in non-randomized comparative studies was assessed using the risk of bias in non-randomized studies of interventions (ROBINS-I) tool. We performed this meta-analysis using RevMan 5.3 software (Cochrane Collaboration, Copenhagen, Denmark), and the level of statistical significance was set at P < 0.05. Six articles involving 371 patients and 1535 screws were included in this meta-analysis. RA-CBT outperformed FA-CBT in terms of various parameters, such as accuracy of pedicle screw position (both Gertzbein-Robbins scale and Ding scale), avoidance of superior facet joint violation (FJV), and reduction of neurological injury. Our meta-analysis offered a thorough evaluation of the efficacy and safety of RA-CBT in spinal surgery. The findings revealed that RA-CBT produced statistically significant results in terms of pedicle screw position accuracy and superior facet joint violation prevention. In terms of surgical parameters and clinical indexes, future research and clinical practice should investigate the efficacy of RA-CBT further. The study was registered in the PROSPERO (CRD42023466280).
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Affiliation(s)
- Xu Wang
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, Jilin, China
| | - Hao-Xuan Li
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, Jilin, China
| | - Qing-San Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, Jilin, China.
| | - Yu-Hang Zhu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, Jilin, China.
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Mao H, Wang Z, Li Q. The effect of the cortical bone trajectory screw fixation and traditional pedicle screw fixation on surgical site wound infection in posterior lumbar fusion wound: A meta-analysis. Int Wound J 2023; 20:3241-3248. [PMID: 37264722 PMCID: PMC10502259 DOI: 10.1111/iwj.14203] [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: 03/27/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 06/03/2023] Open
Abstract
A meta-analysis investigation was performed to measure the influence of cortical bone trajectory screw fixation (CBTSF) and traditional pedicle screw fixation (TPSF) on surgical site wound infection (SSWI) in posterior lumbar fusion (PLF). A comprehensive literature inspection till February 2023 was applied and 1657 interrelated investigations were reviewed. The 13 chosen investigations enclosed 1195 individuals with PLF in the chosen investigations' starting point, 578 of them were using CBTSF, and 617 were using TPSF. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were utilised to compute the value of the effect of the CBTSF and TPSF on SSWI in PLF by the dichotomous approaches and a fixed or random model. No significant difference was found between individuals using CBTSF and TPSF in SSWI (OR, 0.68; 95% CI, 0.35-1.33, P = .26), superficial SSWI (OR, 0.62; 95% CI, 0.22-1.79, P = .38), and deep SSWI (OR, 0.30; 95% CI, 0.06-1.50, P = .14) in PLF. No significant difference was found between individuals using CBTSF and TPSF in SSWI, superficial SSWI, and deep SSWI in PLF. However, care must be exercised when dealing with its values because of the small sample sizes of several chosen investigations for this meta-analysis and the low number of selected investigations for a certain type of SSWI.
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Affiliation(s)
- Hanze Mao
- College of Acupuncture and OrthopedicsHubei University of Chinese MedicineWuhanChina
| | - Zhigang Wang
- Department of OrthopedicsAffiliated Hospital of Hubei University of Chinese Medicine, Hubei Provincial Hospital of Traditional Chinese MedicineWuhanChina
| | - Qiang Li
- Department of Orthopedics and TraumatologyShaanxi Traditional Chinese Medicine HospitalXi'anChina
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Huang Y, Maimaiti A, Tian Y, Li Z, Kahaer A, Rexiti P. Biomechanical investigation of the hybrid lumbar fixation technique with traditional and cortical bone trajectories in transforaminal lumbar interbody fusion: finite element analysis. J Orthop Surg Res 2023; 18:549. [PMID: 37525283 PMCID: PMC10388474 DOI: 10.1186/s13018-023-04027-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE To compare the biomechanical performance of the hybrid lumbar fixation technique with the traditional and cortical bone trajectory techniques using the finite element method. METHODS Four adult wet lumbar spine specimens were provided by the Department of Anatomy and Research of Xinjiang Medical University, and four L1-S1 lumbar spine with transforaminal lumbar interbody fusion (TLIF) models at L4-L5 segment and four different fixation techniques were established: bilateral traditional trajectory screw fixation (TT-TT), bilateral cortical bone trajectory screw fixation (CBT-CBT), hybrid CBT-TT (CBT screws at L4 and TT screws at L5) and TT-CBT (TT screws at L4 and CBT screws at L5). The range of motion (ROM) of the L4-L5 segment, von Mises stress of cage, internal fixation, and rod were compared in flexion, extension, left and right bending, and left and right rotation. RESULTS Compared with the TT-TT group, the TT-CBT group exhibited lower ROM of L4-L5 segment, especially in left-sided bending; the CBT-TT group had the lowest ROM of L4-L5 segment in flexion and extension among the four fixation methods. Compared with the CBT-CBT group, the peak cage stress in the TT-CBT group was reduced by 9.9%, 18.1%, 21.5%, 23.3%, and 26.1% in flexion, left bending, right bending, left rotation, and right rotation conditions, respectively, but not statistically significant (P > 0.05). The peak stress of the internal fixation system in the TT-CBT group was significantly lower than the other three fixation methods in all five conditions except for extension, with a statistically significant difference between the CBT-TT and TT-CBT groups in the left rotation condition (P = 0.017). In addition, compared with the CBT-CBT group, the peak stress of the rod in the CBT-TT group decreased by 34.8%, 32.1%, 28.2%, 29.3%, and 43.0% under the six working conditions of flexion, extension, left bending, left rotation, and right rotation, respectively, but not statistically significant (P > 0.05). CONCLUSIONS Compared with the TT-TT and CBT-CBT fixation methods in TLIF, the hybrid lumbar fixation CBT-TT and TT-CBT techniques increase the biomechanical stability of the internal fixation structure of the lumbar fusion segment to a certain extent and provide a corresponding theoretical basis for further development in the clinic.
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Affiliation(s)
- Ying Huang
- Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | | | | | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University), Ministry of Education, Urumqi, China.
- Xinjiang Clinical Research Center for Orthopedics, Urumqi, China.
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Petrone S, Ajello M, Marengo N, Bozzaro M, Pesaresi A, Allevi M, Fiumefreddo A, Denegri F, Cogoni M, Garnero A, Tartara F, Di Perna G, Armocida D, Pesce A, Frati A, Zenga F, Garbossa D, Cofano F. Clinical outcomes, MRI evaluation and predictive factors of indirect decompression with lateral transpsoas approach for lumbar interbody fusion: a multicenter experience. Front Surg 2023; 10:1158836. [PMID: 37077862 PMCID: PMC10106706 DOI: 10.3389/fsurg.2023.1158836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
IntroductionEvaluating the effects of indirect decompression obtained through lateral lumbar interbody fusion (LLIF) by clinical improvements and radiological parameters on MRI scans. Identifying predictors of better decompression and clinical outcome.Materials and methodsFrom 2016 to 2019, patients who underwent single- or double-level indirect decompression LLIF were consecutively reviewed. Radiological signs of indirect decompression were evaluated in preoperative and follow-up MRI studies and were subsequently correlated to clinical data, expressed as axial/radicular pain (VAS back/leg), index of disability (Oswestry Disability Index) and clinical severity of lumbar stenosis (Swiss Spinal Stenosis Questionnaire).Results72 patients were enrolled. The mean follow-up was 24 months. Differences in vertebral canal area (p < 0.001), height of the foramina (p < 0.001), thickness of the yellow ligament (p = 0.001) and anterior height of the interbody space (p = 0.02) were observed. Older age (p = 0.042), presence of spondylolisthesis (p = 0.042), presence of intra-articular facet effusion (p = 0.003) and posterior height of the implanted cage (p = 0.020) positively affected the increase of the canal area. Change in root canal area (p < 0.001), height of the implanted cage (p = 0.020) and younger age (p = 0.035) were predictive factors of root pain relief, while increased vertebral canal area (p = 0.020) and height of the interbody fusion cage (p = 0.023) positively affected the severity of clinical stenosis.ConclusionsLLIF indirect decompression showed both clinical and radiological improvements. Presence and degree of spondylolisthesis, presence of intra-articular facet effusion, age of the patient and height of the cage were predictive factors of major clinical improvements.
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Affiliation(s)
- Salvatore Petrone
- Spine Surgery Unit, Humanitas Gradenigo Turin, Turin, Italy
- Neurosurgery Unit, University of Turin Department of Neurosciences Rita Levi Montalcini, Turin, Italy
- Correspondence: Salvatore Petrone
| | - Marco Ajello
- Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Nicola Marengo
- Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Marco Bozzaro
- Spine Surgery Unit, Humanitas Gradenigo Turin, Turin, Italy
| | - Alessandro Pesaresi
- Neurosurgery Unit, University of Turin Department of Neurosciences Rita Levi Montalcini, Turin, Italy
| | - Mario Allevi
- Neurosurgery Unit, University of Turin Department of Neurosciences Rita Levi Montalcini, Turin, Italy
| | | | - Federica Denegri
- Neuroradiology Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Maurizio Cogoni
- Neuroradiology Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Andrea Garnero
- Neuroradiology Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Fulvio Tartara
- Spine Surgery Unit, Humanitas Gradenigo Turin, Turin, Italy
| | - Giuseppe Di Perna
- Neurosurgery Unit, University of Turin Department of Neurosciences Rita Levi Montalcini, Turin, Italy
- Spine Surgery Unit, Casa di Cura Città di Bra, Bra, Italy
| | - Daniele Armocida
- Neurosurgery Unit, Department of Human Neuroscience, University Sapienza of Rome, Rome, Italy
| | | | - Alessandro Frati
- Neurosurgery Unit, Department of Human Neuroscience, University Sapienza of Rome, Rome, Italy
| | - Francesco Zenga
- Skull Base and Pituitary Surgery Unit, AOU Città Della Salute e Della Scienza, Turin, Italy
| | - Diego Garbossa
- Neurosurgery Unit, University of Turin Department of Neurosciences Rita Levi Montalcini, Turin, Italy
- Neurosurgery Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Fabio Cofano
- Spine Surgery Unit, Humanitas Gradenigo Turin, Turin, Italy
- Neurosurgery Unit, University of Turin Department of Neurosciences Rita Levi Montalcini, Turin, Italy
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Burkhard MD, Cornaz F, Spirig JM, Wanivenhaus F, Fasser MR, Widmer J, Farshad M. Residual motion of cortical versus pedicle screw constructs after decompression, interbody fusion and cross-link augmentation. 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; 32:1401-1410. [PMID: 36877366 DOI: 10.1007/s00586-023-07596-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE To compare the residual range of motion (ROM) of cortical screw (CS) versus pedicle screw (PS) instrumented lumbar segments and the additional effect of transforaminal interbody fusion (TLIF) and cross-link (CL) augmentation. METHODS ROM of thirty-five human cadaver lumbar segments in flexion/extension (FE), lateral bending (LB), lateral shear (LS), anterior shear (AS), axial rotation (AR), and axial compression (AC) was recorded. After instrumenting the segments with PS (n = 17) and CS (n = 18), ROM in relation to the uninstrumented segments was evaluated without and with CL augmentation before and after decompression and TLIF. RESULTS CS and PS instrumentations both significantly reduced ROM in all loading directions, except AC. In undecompressed segments, a significantly lower relative (and absolute) reduction of motion in LB was found with CS 61% (absolute 3.3°) as compared to PS 71% (4.0°; p = 0.048). FE, AR, AS, LS, and AC values were similar between CS and PS instrumented segments without interbody fusion. After decompression and TLIF insertion, no difference between CS and PS was found in LB and neither in any other loading direction. CL augmentation did not diminish differences in LB between CS and PS in the undecompressed state but led to an additional small AR reduction of 11% (0.15°) in CS and 7% (0.05°) in PS instrumentation. CONCLUSION Similar residual motion is found with CS and PS instrumentation, except of slightly, but significantly inferior reduction of ROM in LB with CS. Differences between CS and PS in diminish with TLIF but not with CL augmentation.
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Affiliation(s)
- Marco D Burkhard
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Frédéric Cornaz
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - José Miguel Spirig
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Florian Wanivenhaus
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Marie-Rosa Fasser
- Institute for Biomechanics, Balgrist Campus, ETH Zurich, Lengghalde 5, 8008, Zurich, Switzerland.,Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jonas Widmer
- Institute for Biomechanics, Balgrist Campus, ETH Zurich, Lengghalde 5, 8008, Zurich, Switzerland.,Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Di Perna G, Marengo N, Matsukawa K, Mahieu G, Baldassarre BM, Petrone S, De Marco R, Zeppa P, Ajello M, Fiumefreddo A, Zenga F, Garbossa D, Cofano F. Three-Dimensional Patient-Matched Template Guides Are Able to Increase Mean Diameter and Length and to Improve Accuracy of Cortical Bone Trajectory Screws: A 5-Year International Experience. World Neurosurg 2023; 170:e542-e549. [PMID: 36402304 DOI: 10.1016/j.wneu.2022.11.066] [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: 10/18/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze whether significant differences exist between free-hand three-dimensional (3D) planning-guided cortical bone trajectory (CBT) screw placement and 3D-printed template-guided CBT screw positioning in terms of accuracy, size of screws, and potential complications. METHODS In this retrospective study, data of adult patients in whom CBT screws were placed for lumbar degenerative pathologies were extracted from a prospectively collected database and analyzed. Patients in whom screws were placed using free-hand 3D planning-guided technique were compared with patients in whom screws were positioned using customized 3D-printed templates. Size of the screws, accuracy, clinical outcomes, and complications were analyzed. RESULTS The study evaluated 251 patients (1004 screws). The free-hand 3D planning-guided group included 158 patients (632 screws), and the 3D-printed template-guided group included 93 patients (372 screws). The 3D-printed template-guided group involved screws of larger size from L3 to S1. Differences between the 2 groups in terms of accuracy parameters reached statistical significance (P ≤ 0.05). CONCLUSIONS With the use of 3D patient-matched template guides, mean diameter and length of CBT screws could be safely increased due to improved accuracy of screw placement. Based on previous evidence regarding CBT biomechanical properties, these advantages could allow increased fixation strength over traditional convergent pedicle screw trajectories. Further biomechanics studies are needed.
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Affiliation(s)
- Giuseppe Di Perna
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; Spine Surgery Unit, "Casa di Cura Clinica Città di Bra", Bra, Italy
| | - Nicola Marengo
- Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Keitaro Matsukawa
- Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan
| | - Geert Mahieu
- Orthopaedic Surgery Department, ORTHOCA - AZ Monica Hospital, Antwerp, Belgium
| | | | | | - Raffaele De Marco
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.
| | - Pietro Zeppa
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Marco Ajello
- Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Alessandro Fiumefreddo
- Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Francesco Zenga
- Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Diego Garbossa
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Fabio Cofano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
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Katsevman GA, Morgan CD, Uribe JS. Commentary: Lumbar Fixation Using the Cortical Bone Trajectory Fixation: A Single Surgeon Experience With 3-Year Follow-up. Oper Neurosurg (Hagerstown) 2022; 23:e207-e208. [PMID: 35972119 DOI: 10.1227/ons.0000000000000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Gennadiy A Katsevman
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Analysis of Fast-Track Surgery with Pain Care on Postoperative Pain Improvement and Complication Prevention in Perioperative Spine Surgery Patients. Emerg Med Int 2022; 2022:9291583. [PMID: 36034483 PMCID: PMC9410989 DOI: 10.1155/2022/9291583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022] Open
Abstract
Objective The study aimed to analyze the effect of fast-track surgery with pain care on the improvement of postoperative pain and the prevention of postoperative complications in perioperative spinal surgery patients. Methods A total of 126 patients undergoing spinal surgery from January 2021 to September 2021 were chosen as the study population, and the patients were classified into the regular group, the FTS group, and the combined group by random grouping, with 42 cases in each group. Patients in the regular group used routine perioperative care in spine surgery, patients in the FTS group used the FTS care model, and patients in the combined group combined special pain care on the basis of the FTS group. We compared the numeric rating scale (NRS) and pain severity of patients in the three groups post-op, 30 min, 1 h, 3 h, 6 h, and 24 h after surgery; we compared the time to get out of bed, length of stay, and occurrence of postoperative adverse effects in the three groups, compared the incidence of complications in the three groups, and compared the satisfaction of care in the three groups. Results The NRS scores at 12 h, 24 h, 48 h, and 72 h post-op in the combined group and FTS group were lower than those in the regular group, and the NRS scores at 12 h and 24 h post-op in the combined group were lower than those in the FTS group (all P < 0.05); the post-op bed activity time, post-op hospitalization time, post-op adverse reaction rate, and post-op complication rate in the combined group and FTS group were shorter or lower than those of the regular group. Nursing satisfaction was higher than that of the regular group, the post-op time to bed activity in the combined group was shorter than that of the FTS group, and nursing satisfaction was higher than that of the FTS group (all P < 0.05). Conclusion The use of FTS with pain care interventions helps relieve postoperative pain in perioperative patients in spine surgery, reduce the incidence of post-op adverse effects and complications in patients, accelerate their postoperative recovery, and improve nursing satisfaction.
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Cofano F, Perna GD, Bongiovanni D, Roscigno V, Baldassarre BM, Petrone S, Tartara F, Garbossa D, Bozzaro M. Obesity and Spine Surgery: A Qualitative Review About Outcomes and Complications. Is It Time for New Perspectives on Future Researches? Global Spine J 2022; 12:1214-1230. [PMID: 34128419 PMCID: PMC9210241 DOI: 10.1177/21925682211022313] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Literature review. OBJECTIVES An increasing number of obese patients requires operative care for degenerative spinal disorders. The aim of this review is to analyze the available evidence regarding the role of obesity on outcomes after spine surgery. Peri-operative complications and clinical results are evaluated for both cervical and lumbar surgery. Furthermore, the contribution of MIS techniques for lumbar surgery to play a role in reducing risks has been analyzed. METHODS Only articles published in English in the last 10 years were reviewed. Inclusion criteria of the references were based on the scope of this review, according to PRISMA guidelines. Moreover, only paper analyzing obesity-related complications in spine surgery have been selected and thoroughly reviewed. Each article was classified according to its rating of evidence using the Sacket Grading System. RESULTS A total number of 1636 articles were found, but only 130 of them were considered to be relevant after thorough evaluation and according to PRISMA checklist. The majority of the included papers were classified according to the Sacket Grading System as Level 2 (Retrospective Studies). CONCLUSION Evidence suggest that obese patients could benefit from spine surgery and outcomes be satisfactory. A higher rate of peri-operative complications is reported among obese patients, especially in posterior approaches. The use of MIS techniques plays a key role in order to reduce surgical risks. Further studies should evaluate the role of multidisciplinary counseling between spine surgeons, nutritionists and bariatric surgeons, in order to plan proper weight loss before elective spine surgery.
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Affiliation(s)
- Fabio Cofano
- Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy,Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Turin, Italy
| | - Giuseppe Di Perna
- Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Turin, Italy
| | - Daria Bongiovanni
- Division of Endocrinology, Andrology and Metabolism, Humanitas Gradenigo Hospital, Turin, Italy
| | - Vittoria Roscigno
- Division of Endocrinology, Andrology and Metabolism, Humanitas Gradenigo Hospital, Turin, Italy
| | - Bianca Maria Baldassarre
- Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Turin, Italy
| | - Salvatore Petrone
- Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Turin, Italy,Salvatore Petrone, Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Via Cherasco 15, Turin 10126, Italy.
| | - Fulvio Tartara
- Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
| | - Diego Garbossa
- Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Turin, Italy
| | - Marco Bozzaro
- Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
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10
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Goldberg JL, Härtl R, Elowitz E. Minimally Invasive Spine Surgery: An Overview. World Neurosurg 2022; 163:214-227. [PMID: 35729823 DOI: 10.1016/j.wneu.2022.03.114] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 12/29/2022]
Abstract
Spinal surgery is undergoing a major transformation toward a minimally invasive paradigm. This shift is being driven by multiple factors, including the need to address spinal problems in an older and sicker population, as well as changes in patient preferences and reimbursement patterns. Increasingly, minimally invasive surgical techniques are being used in place of traditional open approaches due to significant advancements and implementation of intraoperative imaging and navigation technologies. However, in some patients, due to specific anatomic or pathologic factors, minimally invasive techniques are not always possible. Numerous algorithms have been described, and additional efforts are underway to better optimize patient selection for minimally invasive spinal surgery (MISS) procedures in order to achieve optimal outcomes. Numerous unique MISS approaches and techniques have been described, and several have become fundamental. Investigators are evaluating combinations of MISS techniques to further enhance the surgical workflow, patient safety, and efficiency.
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Affiliation(s)
- Jacob L Goldberg
- Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Roger Härtl
- Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Eric Elowitz
- Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA.
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Controversies in Spine Surgery: Is a Cortical Bone Trajectory Superior to Traditional Pedicle Screw Trajectory? Clin Spine Surg 2022; 35:225-228. [PMID: 32205518 DOI: 10.1097/bsd.0000000000000965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Li Y, Chen L, Liu Y, Ding H, Lu H, Pan A, Zhang X, Hai Y, Guan L. Accuracy and safety of robot-assisted cortical bone trajectory screw placement: a comparison of robot-assisted technique with fluoroscopy-assisted approach. BMC Musculoskelet Disord 2022; 23:328. [PMID: 35387621 PMCID: PMC8988323 DOI: 10.1186/s12891-022-05206-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 03/04/2022] [Indexed: 11/26/2022] Open
Abstract
Objective To compare the safety and accuracy of cortical bone trajectory screw placement between the robot-assisted and fluoroscopy-assisted approaches. Methods This retrospective study was conducted between November 2018 and June 2020, including 81 patients who underwent cortical bone trajectory (CBT) surgery for degenerative lumbar spine disease. CBT was performed by the same team of experienced surgeons. The patients were randomly divided into two groups—the fluoroscopy-assisted group (FA, 44 patients) and the robot-assisted group (RA, 37 patients). Robots for orthopedic surgery were used in the robot-assisted group, whereas conventional fluoroscopy-guided screw placement was used in the fluoroscopy-assisted group. The accuracy of screw placement and rate of superior facet joint violation were assessed using postoperative computed tomography (CT). The time of single screw placement, intraoperative blood loss, and radiation exposure to the surgical team were also recorded. The χ2 test and Student’s t-test were used to analyze the significance of the variables (P < 0.05). Results A total of 376 screws were inserted in 81 patients, including 172 screws in the robot-assisted group and 204 pedicle screws in the fluoroscopy-assisted group. Screw placement accuracy was higher in the RA group (160, 93%) than in the FA group (169, 83%) (P = 0.003). The RA group had a lower violation of the superior facet joint than the FA group. The number of screws reaching grade 0 in the RA group (58, 78%) was more than that in the FA group (56, 64%) (P = 0.041). Screw placement time was longer in the FA group (7.25 ± 0.84 min) than in the RA group (5.58 ± 1.22 min, P < 0.001). The FA group had more intraoperative bleeding (273.41 ± 118.20 ml) than the RA group (248.65 ± 97.53 ml, P = 0.313). The radiation time of the FA group (0.43 ± 0.07 min) was longer than the RA group (0.37 ± 0.10 min, P = 0.001). Furthermore, the overall learning curve tended to decrease. Conclusions Robot-assisted screw placement improves screw placement accuracy, shortens screw placement time, effectively improves surgical safety and efficiency, and reduces radiation exposure to the surgical team. In addition, the learning curve of robot-assisted screw placement is smooth and easy to operate.
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Affiliation(s)
- Yue Li
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Long Chen
- Department of Orthopedics, Guangzhou Red Cross Hospital Affiliated To Jinan University, No. 396, Mid Tongfu Road, Haizhu District, Guangzhou, 510000, Guangdong, P. R. China
| | - Yuzeng Liu
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China.
| | - Hongtao Ding
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Hongyi Lu
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Aixing Pan
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Xinuo Zhang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
| | - Li Guan
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chaoyang District, Beijing, 100020, China
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Himstead AS, Shahrestani S, Brown NJ, Produturi G, Shlobin NA, Al Jammal O, Choi EH, Ransom SC, Daniel Diaz-Aguilar L, Sahyouni R, Abraham M, Pham MH. Bony fixation in the era of spinal robotics: A systematic review and meta-analysis. J Clin Neurosci 2022; 97:62-74. [DOI: 10.1016/j.jocn.2022.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 01/01/2022] [Accepted: 01/08/2022] [Indexed: 01/02/2023]
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Cofano F, Langella F, Petrone S, Baroncini A, Cecchinato R, Redaelli A, Garbossa D, Berjano P. Clinical and radiographic performance of indirect foraminal decompression with anterior retroperitoneal lumbar approach for interbody fusion (ALIF). Clin Neurol Neurosurg 2021; 209:106946. [PMID: 34555799 DOI: 10.1016/j.clineuro.2021.106946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/06/2021] [Accepted: 09/12/2021] [Indexed: 01/31/2023]
Abstract
STUDY DESIGN Retrospective study BACKGROUND: Indirect decompression with ALIF allows the restoration of the disk and foraminal height with limited soft tissue damage. However, it does not offer a direct view of the neural structure and a direct intraoperative assessment of the results of the decompression is not possible. For this reason, ALIF is often accompanied by posterior, direct decompression. So far, there is no consensus on the effects of indirect decompression alone for L5-S1 foraminal stenosis. OBJECTIVE Evaluation of the clinical and mechanical performance of indirect decompression with anterior lumbar interbody fusion (ALIF) in L5-S1 foraminal stenosis. METHODS All patients who underwent ALIF at our institution and had a minimum follow-up of six months were assessed for inclusion. Radiographic parameters (anterior and posterior disc height, foraminal height and surface, L5-S1 angle, pelvic incidence, pelvic tilt and lumbar lordosis) and clinical data (Oswestry Disability Index - ODI and Numeric Rating Scale - NRS) before ALIF and at the last follow-up were compared. A regression analysis was performed to investigate the correlation between radiographic and clinical outcomes. RESULTS Thirty-four patients were available for the study (55.9% female, mean age 53.4±11.5 years), mean follow-up was 26.4±11.1 months. At the last follow-up, a significant increase in foraminal height (14.6±4.0 vs. 17.9±3.9 mm, p<0.001), posterior disc height (6.5±2 vs. 9.1±2 mm, p<0.001) was observed. ODI and NRS back and leg improved significantly. The NRS leg correlated with foraminal height (r=-0.45), foraminal surface (r=-0.36) and anterior (r=-0.41) and posterior disc height (r=-0.43). CONCLUSION ALIF provided significant indirect foraminal decompression and improvement of radicular pain. The increase of foraminal height, surface, and posterior disc height is directly associated with radicular pain improvement. LEVEL OF EVIDENCE IV AVAILABILITY OF DATA AND MATERIAL: The datasets used and/or analyzed in the present study are available from the corresponding author on reasonable request.
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Affiliation(s)
- Fabio Cofano
- Neurosurgery Department of Neuroscience "Rita Levi Montanlcini", University of Torino, Turin, Italy.
| | | | - Salvatore Petrone
- Neurosurgery Department of Neuroscience "Rita Levi Montanlcini", University of Torino, Turin, Italy.
| | - Alice Baroncini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Department of Orthopaedics, RWTH Uniklinik Aachen, Aachen, Germany.
| | | | | | - Diego Garbossa
- Neurosurgery Department of Neuroscience "Rita Levi Montanlcini", University of Torino, Turin, Italy.
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Wangsawatwong P, Sawa AGU, de Andrada Pereira B, Lehrman JN, O'Neill LK, Turner JD, Uribe JS, Kelly BP. Adjacent-segment effects of lumbar cortical screw-rod fixation versus pedicle screw-rod fixation with and without interbody support. J Neurosurg Spine 2021:1-7. [PMID: 34144524 DOI: 10.3171/2020.11.spine20977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cortical screw-rod (CSR) fixation has emerged as an alternative to the traditional pedicle screw-rod (PSR) fixation for posterior lumbar fixation. Previous studies have concluded that CSR provides the same stability in cadaveric specimens as PSR and is comparable in clinical outcomes. However, recent clinical studies reported a lower incidence of radiographic and symptomatic adjacent-segment degeneration with CSR. No biomechanical study to date has focused on how the adjacent-segment mobility of these two constructs compares. This study aimed to investigate adjacent-segment mobility of CSR and PSR fixation, with and without interbody support (lateral lumbar interbody fusion [LLIF] or transforaminal lumbar interbody fusion [TLIF]). METHODS A retroactive analysis was done using normalized range of motion (ROM) data at levels adjacent to single-level (L3-4) bilateral screw-rod fixation using pedicle or cortical screws, with and without LLIF or TLIF. Intact and instrumented specimens (n = 28, all L2-5) were tested using pure moment loads (7.5 Nm) in flexion, extension, lateral bending, and axial rotation. Adjacent-segment ROM data were normalized to intact ROM data. Statistical comparisons of adjacent-segment normalized ROM between two of the groups (PSR followed by PSR+TLIF [n = 7] and CSR followed by CSR+TLIF [n = 7]) were performed using 2-way ANOVA with replication. Statistical comparisons among four of the groups (PSR+TLIF [n = 7], PSR+LLIF [n = 7], CSR+TLIF [n = 7], and CSR+LLIF [n = 7]) were made using 2-way ANOVA without replication. Statistical significance was set at p < 0.05. RESULTS Proximal adjacent-segment normalized ROM was significantly larger with PSR than CSR during flexion-extension regardless of TLIF (p = 0.02), or with either TLIF or LLIF (p = 0.04). During lateral bending with TLIF, the distal adjacent-segment normalized ROM was significantly larger with PSR than CSR (p < 0.001). Moreover, regardless of the types of screw-rod fixations (CSR or PSR), TLIF had a significantly larger normalized ROM than LLIF in all directions at both proximal and distal adjacent segments (p ≤ 0.04). CONCLUSIONS The use of PSR versus CSR during single-level lumbar fusion can significantly affect mobility at the adjacent segment, regardless of the presence of TLIF or with either TLIF or LLIF. Moreover, the type of interbody support also had a significant effect on adjacent-segment mobility.
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Kumar KK, Parikh B, Jabarkheel R, Dirlikov B, Singh H. Fluoroscopic versus CT-guided cortical bone trajectory pedicle screw fixation: Comparing trajectory related complications. J Clin Neurosci 2021; 89:354-359. [PMID: 34088578 DOI: 10.1016/j.jocn.2021.05.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/23/2021] [Accepted: 05/23/2021] [Indexed: 01/02/2023]
Abstract
Cortical bone trajectory (CBT) pedicle screw fixation is an emerging technique for treatment of degenerative spine disease which requires either intraoperative fluoroscopy or intraoperative CT guidance (iCT). To date, there has been no direct comparison of these two navigation modalities; here we compare fluoroscopic versus iCT navigation for CBT pedicle screw fixation. We retrospectively reviewed all patients who underwent CBT screw fixation with either fluoroscopic or iCT guidance for lumbar degenerative disease by the senior author. Trajectory-related complications such as medial or lateral breach were compared on postoperative CT, in addition to the incidence of trajectory-related dural tear. We also compared general surgical complications such as postoperative infection and decompression related durotomies. Thirty-eight patients (19 fluoroscopic, 19 CT-guided) who underwent placement of 182 cortical screws (88 fluoroscopic, 94 CT-guided) were identified. In terms of trajectory-related complications, the iCT cohort had fewer medial breaches (1/94) compared to the fluoroscopic cohort (6/88) (p = 0.05). Each group had one lateral breach (p = 0.73). There was one case of CSF leak from screw placement in the fluoroscopic cohort, but none in the iCT cohort (p = 0.48). Overall, there were eight trajectory-related complications in the fluoroscopic cohort versus two in the iCT cohort (p = 0.04). Our data suggests statistically significant decreased trajectory-related complications with iCT-guided CBT screw fixation as compared to fluoroscopically guided. In terms of general surgical complications, while we observed increased postoperative infections in our fluoroscopic cohort, there was no statistically significant difference.
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Affiliation(s)
- Kevin K Kumar
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Bhavya Parikh
- School of Medicine, Meharry Medical College, Nashville, TN, USA
| | - Rashad Jabarkheel
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin Dirlikov
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Harminder Singh
- Department of Neurosurgery, Stanford University, Stanford, CA, USA; Division of Neurosurgery, Santa Clara Valley Medical Center, San Jose, CA, USA.
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Cortical screw fixation using CT-navigation coupled with real-time electrophysiological monitoring of individual screw placement for unstable degenerative lumbar spondylolisthesis. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Cofano F, Di Perna G, Bozzaro M, Longo A, Marengo N, Zenga F, Zullo N, Cavalieri M, Damiani L, Boges DJ, Agus M, Garbossa D, Calì C. Augmented Reality in Medical Practice: From Spine Surgery to Remote Assistance. Front Surg 2021; 8:657901. [PMID: 33859995 PMCID: PMC8042331 DOI: 10.3389/fsurg.2021.657901] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/08/2021] [Indexed: 11/19/2022] Open
Abstract
Background: While performing surgeries in the OR, surgeons and assistants often need to access several information regarding surgical planning and/or procedures related to the surgery itself, or the accessory equipment to perform certain operations. The accessibility of this information often relies on the physical presence of technical and medical specialists in the OR, which is increasingly difficult due to the number of limitations imposed by the COVID emergency to avoid overcrowded environments or external personnel. Here, we analyze several scenarios where we equipped OR personnel with augmented reality (AR) glasses, allowing a remote specialist to guide OR operations through voice and ad-hoc visuals, superimposed to the field of view of the operator wearing them. Methods: This study is a preliminary case series of prospective collected data about the use of AR-assistance in spine surgery from January to July 2020. The technology has been used on a cohort of 12 patients affected by degenerative lumbar spine disease with lumbar sciatica co-morbidities. Surgeons and OR specialists were equipped with AR devices, customized with P2P videoconference commercial apps, or customized holographic apps. The devices were tested during surgeries for lumbar arthrodesis in a multicenter experience involving author's Institutions. Findings: A total number of 12 lumbar arthrodesis have been performed while using the described AR technology, with application spanning from telementoring (3), teaching (2), surgical planning superimposition and interaction with the hologram using a custom application for Microsoft hololens (1). Surgeons wearing the AR goggles reported a positive feedback as for the ergonomy, wearability and comfort during the procedure; being able to visualize a 3D reconstruction during surgery was perceived as a straightforward benefit, allowing to speed-up procedures, thus limiting post-operational complications. The possibility of remotely interacting with a specialist on the glasses was a potent added value during COVID emergency, due to limited access of non-resident personnel in the OR. Interpretation: By allowing surgeons to overlay digital medical content on actual surroundings, augmented reality surgery can be exploited easily in multiple scenarios by adapting commercially available or custom-made apps to several use cases. The possibility to observe directly the operatory theater through the eyes of the surgeon might be a game-changer, giving the chance to unexperienced surgeons to be virtually at the site of the operation, or allowing a remote experienced operator to guide wisely the unexperienced surgeon during a procedure.
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Affiliation(s)
- Fabio Cofano
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini," University of Torino, Turin, Italy.,Spine Surgery Unit, Humanitas Gradenigo, Turin, Italy
| | - Giuseppe Di Perna
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini," University of Torino, Turin, Italy
| | - Marco Bozzaro
- Spine Surgery Unit, Humanitas Gradenigo, Turin, Italy
| | | | - Nicola Marengo
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini," University of Torino, Turin, Italy
| | - Francesco Zenga
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini," University of Torino, Turin, Italy
| | - Nicola Zullo
- Spine Surgery Unit, Casa di Cura Città di Bra, Bra, Italy
| | | | - Luca Damiani
- Intravides SRL, Palazzo degli Istituti Anatomici, Turin, Italy.,LD Consulting, Chiavari, Italy
| | - Daniya J Boges
- Intravides SRL, Palazzo degli Istituti Anatomici, Turin, Italy.,BESE Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Marco Agus
- College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience "Rita Levi Montalcini," University of Torino, Turin, Italy
| | - Corrado Calì
- Neuroscience Institute Cavalieri Ottolenghi, Orbassano, Italy.,Department of Neuroscience "Rita Levi Montalcini," University of Torino, Turin, Italy
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Shi W, Aierken G, Wang S, Abuduwali N, Xia Y, Rezhake R, Zhao S, Zhou M, Jianabuli, Sheng W, Rexiti P. Application study of three-dimensional printed navigation template between traditional and novel cortical bone trajectory on osteoporosis lumbar spine. J Clin Neurosci 2021; 85:41-48. [PMID: 33581788 DOI: 10.1016/j.jocn.2020.11.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/08/2020] [Accepted: 11/23/2020] [Indexed: 01/02/2023]
Abstract
To investigate the safety, accuracy and indications of traditional and novel cortical bone screws placement for osteoporosis lumbar spine, 4 lumbar vertebra specimens (2 males and 2 females) were used for this study. After the computed tomography scanning data of the above anatomical specimens were three-dimensional (3D) reconstructed, one side of each anatomical specimen was randomly chosen to place traditional cortical bone screws, and the other side received novel technical placement. The safety screw trajectory was designed, and a 3D navigation template complementary to the surface anatomical structure of lumbar isthmus lateral margin-vertebral plate-spinous process part was established. The designed supporting navigation template was substantialized, and the navigation template replicated different cortical bone screw trajectory at different sides of the same one lumbar vertebra. Forty cortical bone screws were firstly placed in 3D printed vertebra and then 40 were placed in real anatomical specimens. In 3D printed specimens, the success rates of screw placement with navigation template using traditional and novel techniques were both 100%. While in anatomical specimens, the success rate of screw placement using traditional and novel navigation template was 97.5% (one out of 40 went wrong). Therefore, it is safe, accurate and reliable to place traditional and novel cortical bone screws on osteoporosis lumbar spine using 3D printed navigation template. Traditional and novel screw placement methods should be flexibly applied or combined according to specific sequence and form of vertebra.
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Affiliation(s)
- Wenjie Shi
- Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Gulixian Aierken
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Shuiquan Wang
- Department of Anatomy, College of Basic Medicine, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Nueraihemaiti Abuduwali
- Department of Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Yudong Xia
- Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Reyazuli Rezhake
- Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Shuwen Zhao
- Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Mingbin Zhou
- Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Jianabuli
- Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Weibin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China.
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China.
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Cofano F, Giambra C, Costa P, Zeppa P, Bianconi A, Mammi M, Monticelli M, Di Perna G, Junemann CV, Melcarne A, Massaro F, Ducati A, Tartara F, Zenga F, Garbossa D. Management of Extramedullary Intradural Spinal Tumors: The Impact of Clinical Status, Intraoperative Neurophysiological Monitoring and Surgical Approach on Outcomes in a 12-Year Double-Center Experience. Front Neurol 2020; 11:598619. [PMID: 33391161 PMCID: PMC7775672 DOI: 10.3389/fneur.2020.598619] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/19/2020] [Indexed: 12/15/2022] Open
Abstract
Objective: Intradural Extramedullary (IDEM) tumors are usually treated with surgical excision. The aim of this study was to investigate the impact on clinical outcomes of pre-surgical clinical conditions, intraoperative neurophysiological monitoring (IONM), surgical access to the spinal canal, histology, degree of resection and intra/postoperative complications. Methods: This is a retrospective observational study analyzing data of patients suffering from IDEM tumors who underwent surgical treatment over a 12 year period in a double-center experience. Data were extracted from a prospectively maintained database and included: sex, age at diagnosis, clinical status according to the modified McCormick Scale (Grades I-V) at admission, discharge, and follow-up, tumor histology, type of surgical access to the spinal canal (bilateral laminectomy vs. monolateral laminectomy vs. laminoplasty), degree of surgical removal, use and type of IONM, occurrence and type of intraoperative complications, use of Ultrasonic Aspirator (CUSA), radiological follow-up. Results: A total number of 249 patients was included with a mean follow-up of 48.3 months. Gross total resection was achieved in 210 patients (84.3%) mostly in Schwannomas (45.2%) and Meningiomas (40.4%). IONM was performed in 162 procedures (65%) and D-wave was recorded in 64.2% of all cervical and thoracic locations (99 patients). The linear regression diagram for McCormick grades before and after surgery (follow-up) showed a correlation between preoperative and postoperative clinical status. A statistically significant correlation was found between absence of worsening of clinical condition at follow-up and use of IONM at follow-up (p = 0.01) but not at discharge. No associations were found between the choice of surgical approach and the extent of resection (p = 0.79), the presence of recurrence or residual tumor (p = 0.14) or CSF leakage (p = 0.25). The extent of resection was not associated with the use of IONM (p = 0.91) or CUSA (p = 0.19). Conclusion: A reliable prediction of clinical improvement could be made based on pre-operative clinical status. The use of IONM resulted in better clinical outcomes at follow-up (not at discharge), but no associations were found with the extent of resection. The use of minimally invasive approaches such as monolateral laminectomy showed to be effective and not associated with worse outcomes or increased complications.
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Affiliation(s)
- Fabio Cofano
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy.,Ospedale Humanitas Gradenigo, Turin, Italy
| | | | - Paolo Costa
- Section of Clinical Neurophysiology, Centro Traumatologico Ortopedico Hospital, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Pietro Zeppa
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Andrea Bianconi
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Marco Mammi
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Matteo Monticelli
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Giuseppe Di Perna
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Carola Vera Junemann
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Antonio Melcarne
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Fulvio Massaro
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | | | - Fulvio Tartara
- Unit of Neurosurgery, Istituto Clinico Città Studi (ICCS), Milan, Italy
| | - Francesco Zenga
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
| | - Diego Garbossa
- Unit of Neurosurgery, University Hospital of the City of Health and Science of Turin, Turin, Italy
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21
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The C2 Cortical Screw, an Alternative Fixation Technique for the C2 Segment During High Cervical Spine Surgery: Technical Note. World Neurosurg 2020; 142:24-28. [PMID: 32599192 DOI: 10.1016/j.wneu.2020.06.160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND For posterior fixation of C2 vertebra (the axis), several fixation techniques such as pedicle screw, laminar screw, and pars screw have been reported. A pedicle screw (PS) is considered the strongest among the techniques, but certain situations make PS fixation impossible or difficult. These include patients with a narrow C2 pedicle or high-riding vertebral artery. We introduced an alternative screw technique for C2 that addressed the aforementioned problems with safely placing it, which we termed a cortical screw (CS) for C2. METHODS Among a total of 28 cases using C2 CS for high cervical spine surgery, 2 cases using C2 CS were described. One patient was a 76-year old woman with a gait disturbance and myelopathic symptoms and diagnosed with C1-C2 myelopathy and translational instability. The other case was 54-year old man with posterior neck pain after traffic accident and diagnosed with C1-C2 fracture-dislocation. We used the C2 CS as an alternative technique for high cervical spine surgery in these patients and describe the ideal entry point and trajectory. RESULTS A postoperative computed tomography scan confirmed proper positioning of the C1 posterior arch screw and C2 CS, with satisfactory reduction of the C2 dens and adequate restoration of the C1-C2 spinal canal. The patient experienced no screw-related postoperative complications, and postoperative 1-year computed tomography images showed that solid union and good alignment of C1-2 segment was achieved. CONCLUSIONS C2 CS can be suitable alternative for C2 screw fixation technique in posterior high cervical spine fusion surgery.
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