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Papalia GF, Vadalà G, Russo F, Marcello G, Nardi N, Papalia R, Denaro V. Higher Accuracy and Better Clinical Outcomes in Navigated Thoraco-Lumbar Pedicle Screw Fixation Versus Conventional Techniques : A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2024; 49:1370-1380. [PMID: 39049509 PMCID: PMC11386964 DOI: 10.1097/brs.0000000000005105] [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: 02/21/2024] [Accepted: 06/03/2024] [Indexed: 07/27/2024]
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVE This study aims to compare pedicle screw accuracy, clinical outcomes, and complications between navigated and conventional techniques. SUMMARY OF BACKGROUND DATA In the last decades, intraoperative navigation has been introduced in spinal surgery to prevent risks and complications. MATERIALS AND METHODS The search was executed on Cochrane Central Library, PubMed, and Scopus on April 30, 2023. Randomized controlled trials, prospective and retrospective studies that compared pedicle screw accuracy in the thoracic-lumbar-sacral segments, blood loss, operative time, hospital stay, intraoperative and postoperative revision of screws, neurological and systemic complications, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI) between navigated and freehand or fluoroscopy-assisted techniques were included in this study. The meta-analysis was performed using Review Manager software. Clinical outcomes were assessed as continuous outcomes with mean difference, while pedicle screw accuracy and complications were assessed as dichotomous outcomes with odds ratio, all with 95% CIs. The statistical significance of the results was fixed at P <0.05. RESULTS This meta-analysis included 30 studies for a total of 17,911 patients and 24,600 pedicle screws. Statistically significant results in favor of the navigated technique were observed for the accuracy of pedicle screws ( P =0.0001), hospital stay ( P =0.0002), blood loss ( P <0.0001), postoperative revision of pedicle screws ( P <0.00001), and systemic complications ( P =0.0008). In particular, the positioning of the screws was clinically acceptable in 96.2% of the navigated group and 94.2% with traditional techniques. No significant differences were found in VAS, ODI, and operative time between the two groups. CONCLUSION Navigated pedicle screw fixation has been demonstrated to be a safe and effective technique with high improvement in clinical outcomes and accuracy in patients undergoing spinal fusion compared with conventional techniques. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Giuseppe F Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Roma, Italy
| | - Gianluca Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Roma, Italy
| | - Fabrizio Russo
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Roma, Italy
| | - Gianmarco Marcello
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Roma, Italy
| | - Niccolò Nardi
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Roma, Italy
| | - Rocco Papalia
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Roma, Italy
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, Roma, Italy
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Sarwahi V, Hasan S, Koutsogiannis P, Visahan K, Rao H, Patil A, Lo Y, Amaral T, DiMauro JP. Effect of Pedicle Screw Size on Surgical Outcomes Following Surgery for 412 Adolescent Idiopathic Scoliosis Patients. Spine (Phila Pa 1976) 2023; 48:1544-1551. [PMID: 37134132 DOI: 10.1097/brs.0000000000004700] [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: 01/18/2023] [Accepted: 04/12/2023] [Indexed: 05/04/2023]
Abstract
STUDY DESIGN Retrospective Review. OBJECTIVE The objective of this study was to determine differences in surgical and post-operative outcomes in AIS patients undergoing spinal deformity correction surgery using standard or large pedicle screw size. SUMMARY OF BACKGROUND Use of pedicle screw fixation in spinal deformity correction surgery is considered safe and effective. Still, the small size of the pedicle and the complex 3D anatomy of the thoracic spine makes screw placement challenging, with improper pedicle screw fixation leading to catastrophic complications including injuries to nerve roots, spinal cord, and major vessels. Thus, insertion of larger diameter screw sizes has raised concerns amongst surgeons, especially in the pediatric population. MATERIALS AND METHODS AIS patients undergoing PSF between 2013 and 2019 were included. Demographic, radiographic, and operative outcomes collected. Patients in the large screw size group (GpI) received 6.5 mm diameter screw sizes at all levels while standard screw size group (GpII) received 5.0 to 5.5 mm diameter screw sizes at all levels. Kruskall-Wallis and Fisher's exact test performed for continuous and categorical variables respectively.Subanalyses included (1) screw accuracy in patients with available CT scans, (2) stratified analysis of large- and standard-screw patients with ≥60% flexibility rate, (3) stratified analysis of large- and standard-screw patients with <60% flexibility rate, and (4) matched analysis of large- and standard-screw patients by surgeon and year of surgery. RESULTS GpI patients experienced significantly higher overall curve correction ( P <0.001), with 87.6% experiencing at least one grade reduction of apical vertebral rotation from preoperative to postoperative visit( P =0.008).Patients with larger screws displayed higher postoperative kyphosis. No patient experienced medial breaching. CONCLUSION Large screw sizes have similar safety profiles to standard screws without negatively impacting surgical and perioperative outcomes in AIS patients undergoing PSF. Additionally, coronal, sagittal, and rotational correction is superior for larger-diameter screws in AIS patients.
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Affiliation(s)
- Vishal Sarwahi
- Department of Pediatric Orthopaedics, Cohen Children's Medical Center, New Hyde Park, NY
| | - Sayyida Hasan
- Department of Pediatric Orthopaedics, Cohen Children's Medical Center, New Hyde Park, NY
| | - Petros Koutsogiannis
- Department of Pediatric Orthopaedics, Cohen Children's Medical Center, New Hyde Park, NY
| | - Keshin Visahan
- Department of Pediatric Orthopaedics, Cohen Children's Medical Center, New Hyde Park, NY
| | - Himanshu Rao
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY
| | - Aravind Patil
- Department of Pediatric Orthopaedics, Cohen Children's Medical Center, New Hyde Park, NY
| | - Yungtai Lo
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Terry Amaral
- Department of Pediatric Orthopaedics, Cohen Children's Medical Center, New Hyde Park, NY
| | - Jon-Paul DiMauro
- Department of Pediatric Orthopaedics, Cohen Children's Medical Center, New Hyde Park, NY
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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.
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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
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Li T, He H, Zhang T, Li X, Xie W, Huang B, Xu F, Xiong C. Comprehensive comparison of three techniques for the treatment of adjacent segment degeneration after lumbar fusion. Front Surg 2023; 10:1096483. [PMID: 37066013 PMCID: PMC10097961 DOI: 10.3389/fsurg.2023.1096483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/07/2023] [Indexed: 04/01/2023] Open
Abstract
PurposeAdjacent segment degeneration (ASD) following lumbar fusion is technically challenging for spine surgeons. Posterolateral open fusion surgery with pedicle screw fixation is an effective way to treat symptomatic ASD with favorable clinical outcomes; however, it is associated with an increased morbidity rate. Therefore, minimally invasive spine surgery is advocated. This study was designed to compare clinical outcomes among patients with symptomatic ASD who underwent percutaneous transforaminal endoscopic discectomy (PTED) with the transforaminal approach, posterior lumbar interbody fusion (PLIF) with cortical bone trajectory screw fixation (CBT-PLIF), and PLIF with traditional trajectory screw fixation (TT-PLIF).MethodsA retrospective study was conductedon 46 patients (26 men and 20 women; average age 60.8 ± 6.78 years) with symptomatic ASD. The patients were treated with three approaches. The operation time, incision length, time to return to work, complications, and the like were compared among three groups. Intervertebral disc (IVD) space height, angular motion, and vertebral slippage were obtained to assess spine biomechanical stability following surgery. The visual analog scale (VAS) score and Oswestry disability index were evaluated at preoperation and 1-week, 3-month, and the latest follow-ups. Clinical global outcomes were also estimated using modified MacNab criteria.ResultsThe operation time, incision length, intraoperative blood loss, and time to return to work for the PTED group were significantly decreased compared with those for the other two groups (P < 0.05). The radiological indicators in the CBT-PLIF group and TT-PLIF group had better biomechanical stability compared with those in the PTED groups at the latest follow-up (P < 0.05). The back pain VAS score in the CBT-PLIF group was significantly decreased compared with those in the other two groups at the latest follow-up (P < 0.05). The good-to-excellent rate was 82.35% in the PTED group, 88.89% in the CBT-PLIF group, and 85.00% in the TT-PLIF group. No serious complications were encountered. Two patients experienced dysesthesia in the PTED group; screw malposition was found in one patient in the CBT-PLIF group. One case with a dural matter tear was observed in the TT-PLIF group.ConclusionAll three approaches can treat patients with symptomatic ASD efficiently and safely. Functional recovery was more accelerated in the PTED group compared with the other approaches in the short term; CBT-PLIF and TT-PLIF can provide superior biomechanical stability to the lumbosacral spine following decompression compared with PTED; however, compared with TT-PLIF, CBT-PLIF can significantly reduce back pain caused by iatrogenic muscle injury and improve functional recovery. Therefore, superior clinical outcomes were achieved in the CBT-PLIF group compared with the PTED and TT-PLIF groups in the long term.
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Affiliation(s)
- Tao Li
- Department of Orthopaedics, Affiliated Hospital of Wuhan Sports University, Wuhan, China
| | - Hang He
- Department of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Tonghui Zhang
- Department of Orthopaedics, Affiliated Hospital of Wuhan Sports University, Wuhan, China
| | - Xugui Li
- Department of Orthopaedics, Affiliated Hospital of Wuhan Sports University, Wuhan, China
| | - Wei Xie
- Department of Orthopaedics, Affiliated Hospital of Wuhan Sports University, Wuhan, China
| | - Biwang Huang
- Department of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Feng Xu
- Department of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China
- Correspondence: Feng Xu Chengjie Xiong
| | - Chengjie Xiong
- Department of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China
- Correspondence: Feng Xu Chengjie Xiong
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Alomari S, Lubelski D, Lehner K, Tang A, Wolinsky JP, Theodore N, Sciubba DM, Larry Lo SF, Belzberg A, Weingart J, Witham T, Gokaslan ZL, Bydon A. Safety and Accuracy of Freehand Pedicle Screw Placement and the Role of Intraoperative O-Arm: A Single-Institution Experience. Spine (Phila Pa 1976) 2023; 48:180-188. [PMID: 36190990 DOI: 10.1097/brs.0000000000004497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/02/2022] [Indexed: 11/05/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim was to investigate the accuracy of pedicle screw placement by freehand technique and to compare revision surgery rates among three different imaging verification pathways. SUMMARY OF BACKGROUND DATA Studies comparing different imaging modalities in freehand screw placement surgery are limited. MATERIALS AND METHODS A single-institution retrospective chart review identified adult patients who underwent freehand pedicle screw placement in the thoracic, lumbar or sacral levels. Patients were stratified into three cohorts based on the intraoperative imaging modality used to assess the accuracy of screw position: intraoperative X-rays (cohort 1); intraoperative O-arm (cohort 2); or intraoperative computed tomography (CT)-scan (cohort 3). Postoperative CT scans were performed on all patients in cohorts 1 and 2. Postoperative CT scan was not required in cohort 3. Screw accuracy was assessed using the Gertzbein-Robbins grading system. RESULTS A total of 9179 pedicle screws were placed in the thoracic or lumbosacral spine in 1311 patients. 210 (2.3%) screws were identified as Gertzbein-Robbins grades C-E on intraoperative/postoperative CT scan, 137 thoracic screws, and 73 lumbar screws ( P <0.001). Four hundred and nine patients underwent placement of 2754 screws followed by intraoperative X-ray (cohort 1); 793 patients underwent placement of 5587 screws followed by intraoperative O-arm (cohort 2); and 109 patients underwent placement of 838 screws followed by intraoperative CT scan (cohort 3). Postoperative CT scans identified 65 (2.4%) and 127 (2.3%) malpositioned screws in cohorts 1 and 2, respectively. Eleven screws (0.12%) were significantly malpositioned and required a second operation for screw revision. Nine patients (0.69%) required revision operations: eight of these patients were from cohort 1 and one patient was from cohort 2. CONCLUSION When compared to intraoperative X-ray, intraoperative O-arm verification decreased the revision surgery rate for malpositioned screws from 0.37% to 0.02%. In addition, our analysis suggests that the use of intraoperative O-arm can obviate the need for postoperative CT scans.
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Affiliation(s)
- Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kurt Lehner
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anthony Tang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jean-Paul Wolinsky
- Department of Neurological Surgery, Northwestern University, Chicago, IL
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY
| | - Allan Belzberg
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jon Weingart
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Timothy Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Ivanov M, Radatz M. Role of Navigation in the Surgery of Spine Tumours. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:173-178. [PMID: 38153467 DOI: 10.1007/978-3-031-36084-8_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Computer-assisted navigation has emerged in neurosurgery as an approach to improve intraoperative orientation and achieve better surgical results with lower complication rates. While the initial use was focused around precise identification of the surgical target, the current applications are much wider and continue to rapidly expand.Here we report our review of the main applications of navigation in spine surgery with a focus on the surgery of spine tumours operated in Sheffield Teaching Hospitals in the past 10 years (2010-2020). In our unit, intraoperative navigation became a helpful and routine adjunct to the modern armamentarium of a spinal surgeon and is currently used not just for accurate placement of the implants but also for precise demarcation of the tumour margins, as well as for identification of important anatomical structures that must be preserved.Conclusion: Intraoperative navigation is a technology that helped us to improve intraoperative orientation to the unexposed anatomy and reduce the risk of iatrogenic complications; achieve better tumour resection; improve the spinal biomechanical construction; provide a safer learning environment for the spinal surgical trainees; minimise radiation exposure of the surgical team and shorten the operating time. In our opinion, it was helpful not only to reduce the risk of complications but also to perform procedures, which without navigation would have been considered inoperable or very high risk.
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He J, Luo F, Wang H, Xu J, Zhang Z. SAP Principle Guided Free Hand Technique: A Secret for T1 to S1 Pedicle Screw Placement. Orthop Surg 2022; 14:2995-3002. [PMID: 36208012 DOI: 10.1111/os.13513] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/31/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Existing freehand techniques of screw placement mainly emphasized on various entry points and complex trajectory reference. The aim of this study is to illustrate a standardized and reliable freehand technique of pedicle screw insertion for open pedicle screw fixation with a universal entry point and a stereoscopic trajectory reference system and report the results from a single surgeon's clinical experience with the technique. METHOD In this study, the author respectively reviewed a total of 200 consecutive patients who had undergone open freehand pedicle screw fixation with Superior Articular Process (SAP) technique from January 2019 to May 2020. For accuracy and safety, all 200 cases had undergone postoperative X-ray while 33 cases including spinal deformity, infection, and tumor had received additional CT-scan. Screw accuracy was analyzed via a CT-based classification system with Student's t test. RESULTS A total of 1126 screws had been placed from T1-S1 with SAP-guided freehand technique and the majority had been confirmed safe in X-ray without the need of CT scan. A total of 316 screws in deformity or infectious or tumor cases had undergone additional CT scan with 95.5% (189 of 198 screws) accuracy in thoracic group and 94.9% (112 of 118 screws) in lumbar group. The accuracy had been 90.5% (114 of 126 screws) in deformity group and 95.8% (182 of 190 screws) in non-deformity group. All perforation cases had been rated Grade B (<2 mm) without significant difference between the medial and the lateral (p < 0.05). No cases had been detected with significant neurological deficiencies. The mean intraoperative X-ray shots were 0.73 per screw. CONCLUSION SAP-guidance is a reliable freehand technique for thoracic and lumbar pedicle screw instrument. It allows accurate and safe screw insertion in both non-deformity and deformity cases with less radiation exposure.
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Affiliation(s)
- Jinyue He
- Department of Orthopedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Fei Luo
- Department of Orthopedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Hao Wang
- Department of Orthopedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Jianzhong Xu
- Department of Orthopedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - ZeHua Zhang
- Department of Orthopedics, Southwest Hospital, Army Medical University, Chongqing, China
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