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Murans G, Meska L, Gaurilcikas M, Jespersen SM, Lindberg-Larsen M. Patient-reported outcome from minimal invasive surgery compared with conventional open surgery for thoracolumbar fractures of the spine. BRAIN & SPINE 2024; 4:102782. [PMID: 38510609 PMCID: PMC10951746 DOI: 10.1016/j.bas.2024.102782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/12/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024]
Abstract
Study design retrospective cohort study of prospectively collected data. Objective The treatment guidelines for thoracolumbar spinal fractures are controversial although minimally invasive surgery (MIS) is a popular alternative to the traditional open approach (TOA). Limited data exists about outcomes after MIS fracture treatment. The main aim of our study was to evaluate self-reported disability, health-related quality of life, pain, and satisfaction after MIS compared with TOA. Methods Of 173 patients operated from 2014 to 2018, 64.7% patients completed the Oswestry Disability Index (ODI), the EQ-5D-5L, and a tailored clinical follow-up questionnaire on employment status, pain, activity level, and satisfaction with treatment. Results Of the 112 patients, 34 had MIS and 78 had TOA. Mean follow-up was 56 months. The two groups were comparable on demographic variables apart from mean age - MIS group was 10 years older. The MIS group had better ODI scores (p = 0.046), but the groups were similar regarding return to work and disability retirement. The EQ-5D-5L index for the MIS were very close (mean -0.033, median +0.049) to the Danish population score, while the TOA showed a greater deviation (mean - 0.125, median -0.040). The MIS used less pain medication than the TOA. Both groups were similarly satisfied with treatment results. Conclusion Our data indicates that MIS surgery for thoracolumbar spinal fractures can achieve acceptable self-reported outcomes in terms of disability, health-related quality of life, pain, and satisfaction with treatment. However, a randomized controlled trial is needed to determine whether the MIS approach is superior to TOA.
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Affiliation(s)
- Girts Murans
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Svendborg, Odense, Denmark
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Denmark
- University Center for Spine Surgery, Department of Neurosurgery, Odense University Hospital, Denamrk
| | - Laurynas Meska
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Svendborg, Odense, Denmark
- University Center for Spine Surgery, Department of Neurosurgery, Odense University Hospital, Denamrk
| | - Marius Gaurilcikas
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Svendborg, Odense, Denmark
- University Center for Spine Surgery, Department of Neurosurgery, Odense University Hospital, Denamrk
| | - Stig Mindedahl Jespersen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Svendborg, Odense, Denmark
- University Center for Spine Surgery, Department of Neurosurgery, Odense University Hospital, Denamrk
| | - Martin Lindberg-Larsen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Svendborg, Odense, Denmark
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Denmark
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2
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Yin N, Du L, Pan M, Xue F, Shen Y, Ding L. Minimally invasive technique of monoaxial percutaneous screws and instrumentational maneuvers in thoracolumbar and lumbar fractures. Injury 2022; 53:4028-4032. [PMID: 36184359 DOI: 10.1016/j.injury.2022.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 09/05/2022] [Accepted: 09/16/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Percutaneous pedicle screw fixation (PPSF) has been a common surgery for treating thoracolumbar and lumbar fractures. Many studies have reported PPSF is associated with poor reduction. We present a reliable method by using short-segment monoaxial percutaneous screws and instrumentational maneuvers to reduce the spine. This study aimed to evaluate radiological and clinical results of this method of reduction compared to traditional polyaxial screws method in treating thoracolumbar and lumbar fractures. METHODS From February 2015 to February 2021, 64 patients with thoracolumbar and lumbar fractures in our department were retrospectively reviewed and divided into experimental group and control group according to different treatment methods. The experimental group was treated with short-segment monoaxial percutaneous screws (which were inserted at the adjacent vertebrae one level above, one level below the fracture, and the fractured vertebra) and instrumentational maneuvers method, while the control group was treated with traditional polyaxial screws method. The operation time was recorded. Visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed as the clinical outcomes. The anterior height of the injured vertebra (AVH), the kyphosis cobb angle and the vertebral wedge angle were used to evaluate the fracture radiological reduction. RESULTS A total of 64 patients were enrolled including 31 in the experimental group and 33 in the control group. There were no significant difference in operation time, AVH, the kyphosis cobb angle,the wedge angle of injured vertebra,VAS and ODI score between the two groups in preoperation. In each group, there were significant differences in the AVH, the kyphosis cobb angle and wedge angle of injured vertebra between preoperation and immediate postoperation. In each group, there were significant differences in VAS and ODI score between the preoperation and last follow-up. The total correction rates of AVH,the kyphosis cobb angle and the wedge angle of injured vertebra were significantly higher in the experimental group than those in the control group, while the loss of correction was significantly lower than the control. CONCLUSIONS The reduction technique using monoaxial percutaneous screws and instrumentational maneuvers for thoracolumbar and lumbar fractures exhibited better radiological results and satisfying functional outcomes when compared to traditional polyaxial screws.
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Affiliation(s)
- Nuo Yin
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai Fengxian District Central Hospital. 6600 Nanfeng Road, Fengxian District, Shanghai, 201499, China
| | - Li Du
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai Fengxian District Central Hospital. 6600 Nanfeng Road, Fengxian District, Shanghai, 201499, China
| | - Mingmang Pan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai Fengxian District Central Hospital. 6600 Nanfeng Road, Fengxian District, Shanghai, 201499, China
| | - Feng Xue
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai Fengxian District Central Hospital. 6600 Nanfeng Road, Fengxian District, Shanghai, 201499, China
| | - Yuchun Shen
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai Fengxian District Central Hospital. 6600 Nanfeng Road, Fengxian District, Shanghai, 201499, China
| | - Liang Ding
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai Fengxian District Central Hospital. 6600 Nanfeng Road, Fengxian District, Shanghai, 201499, China.
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3
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Ozaki T, Yamada K, Nakamura H. Usefulness of Preoperative Planning by Three-Dimensional Planning Software for Pedicle Screw Placement in Thoracolumbar Surgeries: <i>Misplacement Rate and Associated Risk Factors</i>. Spine Surg Relat Res 2022; 6:279-287. [PMID: 35800631 PMCID: PMC9200427 DOI: 10.22603/ssrr.2021-0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/02/2021] [Indexed: 11/07/2022] Open
Abstract
Introduction A number of imaging technologies have been developed to reduce the risk of pedicle screw (PS) misplacement. For example, preoperative three-dimensional (3D) planning can reportedly enhance implant placement accuracy in some orthopedic surgeries. However, no study has investigated the effect of preoperative 3D planning on PS placement without intraoperative 3D navigation. Thus, in this study, we aim to examine the accuracy of PS placement and identify the risk factors for PS misplacement in thoracolumbar surgeries performed using preoperative 3D planning software with intraoperative fluoroscopic guidance in a retrospective study. Methods In total, 25 consecutive patients (197 PSs) underwent thoracic or lumbar spinal fusion surgeries using preoperative 3D planning with intraoperative fluoroscopic guidance. PS misplacement was graded based on the degree of perforation (Grade 0, no perforation; Grade 1, <2 mm; Grade 2, 2-4 mm; Grade 3, >4 mm) observed in postoperative computed tomography (CT). Deviations between planned and actual PSs were evaluated by matching preoperative and postoperative CT volume images for each vertebra. Results The overall PS misplacement rate was 6.6% (Grade 1: 4.0%, Grade 2: 1.5%, Grade 3: 1.0%). The median linear deviations of PS entry points between planned and actual locations were determined to be 3.3 mm and 3.3 mm for the horizontal and vertical axes, respectively. The median angular deviations of the PS axis were 6.2° and 4.5° for the transverse and sagittal planes, respectively. Multivariate analysis revealed that horizontal deviation of the PS entry point was the sole factor associated with Grade ≥1 PS misplacement (odds ratio=2.47, p<0.001). Conclusions Preoperative 3D planning software without intraoperative 3D navigation was able to achieve a relatively low PS misplacement ratio among the reported ratio of conventional techniques without navigation. Surgeons should carefully ensure that the entry point is consistent with preoperative planning, especially in the mediolateral direction to avoid misplacement in this method.
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Affiliation(s)
| | - Kentaro Yamada
- Department of Orthopaedic Surgery, Osaka Metropolitan University
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University
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4
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Kohler FC, Schenk P, Bechstedt-Schimske M, Ullrich BW, Klauke F, Hofmann GO, Mendel T. Open versus minimally invasive fixation of thoracic and lumbar spine fractures in patients with ankylosing spinal diseases. Eur J Trauma Emerg Surg 2021; 48:2297-2307. [PMID: 34357408 PMCID: PMC9192405 DOI: 10.1007/s00068-021-01756-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/18/2021] [Indexed: 11/25/2022]
Abstract
Purpose Posterior multilevel fixation of traumatic instability in ankylosing spinal disease (ASD) can be performed by open surgery (OS) or minimally invasive surgery (MIS). We investigated whether both methods differ based on the reduction results and perioperative parameters. Methods In this retrospective cohort study, OS and MIS groups were investigated. The bisegmental Cobb angles and dislocation angles were measured using pre- and postoperative CT images, and the initial malalignment and achieved reduction were calculated. Cut-seam time, calculated blood loss, transfusion number, fluoroscopy time, pedicle screw placement accuracy, duration of ICU stay, in-patient stay, and complications (bleeding, postoperative thrombosis and embolism, and postoperative mortality) were recorded. Results Seventy-five ASD patients with spine fractures (Ø 75 ± 11 years, male: 52, female: 23) (MIS: 48; OS: 27) were included in this study. The extent of reduction did not differ in the OS and MIS groups (p = 0.465; MIS:− 1 ± 3°, OS:−2 ± 6°). The residual postoperative malalignment angle was not significantly different (p = 0.283). Seventy-eight of the implanted screws (11%) showed malpositioning. No difference was found between OS and MIS (MIS, 37 [7%]; OS, 41 [16%]; p = 0.095). MIS was associated with less blood loss (OS: 1.28 ± 0.78 l, MIS: 0.71 ± 0.57 l, p = 0.001), cut-seam time (MIS: 98 ± 44 min, OS: 166 ± 69 min, p < 0.001), and hospital stay (MIS: Ø14 ± 16 d, OS: Ø38 ± 49 d, p = 0.02) than OS. Conclusion OS and MIS show equally limited performance in terms of the fracture reduction achieved. The MIS technique was superior to OS based on the perioperative outcome. Therefore, MIS should be preferred over OS for unstable spinal injuries, excluding C-type fractures, in ASD patients without neurological impairment.
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Affiliation(s)
- Felix C Kohler
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Straße 165, 06112, Halle, Germany. .,Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany.
| | - P Schenk
- Research Executive Department, BG Klinikum Bergmannstrost Halle, Merseburger Straße 165, 06112, Halle, Germany
| | - M Bechstedt-Schimske
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Straße 165, 06112, Halle, Germany
| | - B W Ullrich
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Straße 165, 06112, Halle, Germany.,Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
| | - F Klauke
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Straße 165, 06112, Halle, Germany
| | - G O Hofmann
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Straße 165, 06112, Halle, Germany.,Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
| | - T Mendel
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Straße 165, 06112, Halle, Germany.,Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
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5
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Borni M, Belmabrouk H, Kammoun B, Boudawara MZ. Evaluation of functional outcomes of lumbar and lumbosacral isthmic and degenerative spondylolisthesis treated surgically. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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6
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Katsevman GA, Spencer RD, Daffner SD, Bhatia S, Marsh RA, France JC, Cui S, Dekeseredy P, Sedney CL. Robotic-Navigated Percutaneous Pedicle Screw Placement Has Less Facet Joint Violation Than Fluoroscopy-Guided Percutaneous Screws. World Neurosurg 2021; 151:e731-e737. [PMID: 33962072 DOI: 10.1016/j.wneu.2021.04.117] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To directly compare robotic-versus fluoroscopy-guided percutaneous pedicle screw (PPS) placement in thoracolumbar spine trauma with a focus on clinically acceptable pedicle screw accuracy and facet joint violation (FJV). METHODS A retrospective chart review assessed 37 trauma patients undergoing percutaneous thoracic and/or lumbar fixation. Postoperative computed tomography images were reviewed by authors blinded to surgical technique who assessed pedicle screw trajectory accuracy and FJV frequency. RESULTS Seventeen patients underwent placement of 143 PPS with robotic assistance (robot group), compared with 20 patients receiving 149 PPS using fluoroscopy assistance (control group). Overall, the robot cohort demonstrated decreased FJV frequency of 2.8% versus 14.8% in controls (P = 0.0003). When further stratified by level of surgery (i.e., upper thoracic, lower thoracic, lumbar spine), the robot group had FJV frequencies of 0%, 3.2%, and 3.7%, respectively, compared with 17.7% (P = 0.0209), 14.3% (P = 0.0455), and 11.9% (P = 0.2340) in controls. The robot group had 84.6% clinically acceptable screw trajectories compared with 81.9% in controls (P = 0.6388). Within the upper thoracic, lower thoracic, and lumbar regions, the robot group had acceptable screw trajectories of 66.7%, 87.1%, and 90.7%, respectively, compared with 58.8% (P = 0.6261), 91.1% (P = 0.5655), and 97.6% (P = 0.2263) in controls. CONCLUSIONS There was no significant difference in clinically acceptable screw trajectory accuracy between robotic versus fluoroscopy-guided PPS placement. However, the robot cohort demonstrated a statistically significantly decreased FJV overall and specifically within the thoracic spine region. Use of robotic technology may improve radiographic outcomes for a subset of patients or spine surgeries.
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Affiliation(s)
- Gennadiy A Katsevman
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA.
| | - Raven D Spencer
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Scott D Daffner
- Department of Orthopaedic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Sanjay Bhatia
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
| | - Robert A Marsh
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
| | - John C France
- Department of Orthopaedic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Shari Cui
- Department of Orthopaedic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Patricia Dekeseredy
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
| | - Cara L Sedney
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
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7
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Chung WH, Eu WC, Chiu CK, Chan CYW, Kwan MK. Minimally invasive reduction of thoracolumbar burst fracture using monoaxial percutaneous pedicle screws: Surgical technique and report of radiological outcome. J Orthop Surg (Hong Kong) 2020; 28:2309499019888977. [PMID: 31876259 DOI: 10.1177/2309499019888977] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To describe the reduction technique of thoracolumbar burst fracture using percutaneous monoaxial screws and its radiological outcomes compared to polyaxial screws. METHODS All surgeries were performed by minimally invasive technique with either percutaneous monoaxial or percutaneous polyaxial screws inserted at adjacent fracture levels perpendicular to both superior end plates. Fracture reduction is achieved with adequate rod contouring and distraction maneuver. Radiological parameters were measured during preoperation, postoperation, and follow-up. RESULTS A total of 21 patients were included. Eleven patients were performed with monoaxial pedicle screws and 10 patients performed with polyaxial pedicle screws. Based on AO thoracolumbar classification system, 10 patients in the monoaxial group had A3 fracture type and 1 had A4. In the polyaxial group, six patients had A3 and four patients had A4. Total correction of anterior vertebral height (AVH) ratio was 0.30 ± 0.10 and 0.08 ± 0.07 in monoaxial and polyaxial groups, respectively (p < 0.001). Total correction of posterior vertebral height (PVH) ratio was 0.11 ± 0.05 and 0.02 ± 0.02 in monoaxial and polyaxial groups, respectively (p < 0.001). Monoaxial group achieved more correction of 13° (62.6%) in local kyphotic angle compared to 8.2° (48.0%) in polyaxial group. Similarly, in regional kyphotic angle, 16.5° (103.1%) in the monoaxial group and 8.1° (76.4%) in the polyaxial group were achieved. CONCLUSIONS Monoaxial percutaneous pedicle screws inserted at adjacent fracture levels provided significantly better fracture reduction compared to polyaxial screws in thoracolumbar fractures.
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Affiliation(s)
- Weng Hong Chung
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wei Cheong Eu
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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8
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Biomechanics and clinical outcome after posterior stabilization of mid-thoracic vertebral body fractures: a systematic literature review. Eur J Trauma Emerg Surg 2020; 47:1389-1398. [PMID: 33263816 PMCID: PMC8476456 DOI: 10.1007/s00068-020-01560-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022]
Abstract
Purpose The aim of this review is to systematically screen the literature for clinical and biomechanical studies dealing with posterior stabilization of acute traumatic mid-thoracic vertebral fractures in patients with normal bone quality. Methods This review is based on articles retrieved by a systematic search in the PubMed and Web of Science database for publications up to December 2018 dealing with the posterior stabilization of fractures of the mid-thoracic spine. Results Altogether, 1012 articles were retrieved from the literature search. A total of 960 articles were excluded. A total of 16 articles were dealing with the timing of surgery in polytraumatized patients, patients suffering of neurologic deficits after midthoracic fractures, and the impact of concomitant thoracic injuries and were excluded. Thus, 36 remaining original articles were included in this systematic review depicting the topics biomechanics, screw insertion, and outcome after posterior stabilization. The overall level of evidence of the vast majority of studies is low. Conclusion High quality studies are lacking. Long-segmental stabilization is indicated in unstable midthoracic fractures with concomitant sternal fractures. Generally, long-segmental constructs seem to be the safer treatment strategy considering the relative high penetration rate of pedicle screws in this region. Thereby, navigated insertion techniques and intraoperative 3D-imaging help to improve pedicle screw placement accuracy.
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9
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Spiegl UJA, Schnake KJ, Hartmann F, Katscher S, Riehle M, Scheyerer MJ, Schmeiser G, Siekmann H, Osterhoff G. Traumatic Fractures of the Thoracic Spine. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:373-382. [PMID: 32392598 DOI: 10.1055/a-1144-3846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The majority of traumatic vertebral fractures occur at the thoracolumbar junction and the lumbar spine and less commonly at the mid-thoracic and upper thoracic spine. In accordance, a high number of articles are dealing with thoracolumbar fractures focusing on the thoracolumbar junction. Nonetheless, the biomechanics of the thoracic spine differ from the thoracolumbar junction and the lumbar vertebral spine. The aim of this review is to screen the literature dealing with acute traumatic thoracic vertebral fractures in patients with normal bone quality. Thereby, the diagnostic of thoracic vertebral body fractures should include a CT examination. Ideally, the CT should include the whole thoracic cage particularly in patients suffering high energy accidents or in those with clinical suspicion of concomitant thoracic injuries. Generally, concomitant thoracic injuries are frequently seen in patients with thoracic spine fractures. Particularly sternal fractures cause an increase in fracture instability. In case of doubt, long segment stabilization is recommended in patients with unstable mid- und upper thoracic fractures, particularly in those patients with a high grade of instability.
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Affiliation(s)
- Ulrich J A Spiegl
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital Leipzig
| | | | - Frank Hartmann
- Centre for Trauma and Orthopaedic Surgery, Ev. Stift St. Martin, Community Hospital Mittelrhein, Koblenz
| | | | - Marion Riehle
- Orthopaedic and Trauma Centre, Alb Fils Hospitals, Göppingen
| | - Max J Scheyerer
- Clinic and Outpatient Department for Orthopaedic and Trauma Surgery, Cologne University Hospital
| | | | | | - Georg Osterhoff
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital Leipzig
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10
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Tamburrelli FC, Perna A, Proietti L, Zirio G, Santagada DA, Genitiempo M. The Feasibility of Long-Segment Fluoroscopy-guided Percutaneous Thoracic Spine Pedicle Screw Fixation, and the Outcome at Two-year Follow-up. Malays Orthop J 2019; 13:39-44. [PMID: 31890109 PMCID: PMC6915314 DOI: 10.5704/moj.1911.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction: Posterior percutaneous instrumentation may represent a challenge when multiple levels need to be instrumentated, especially when including the upper thoracic spine. The aim of the present study was to evaluate the technical feasibility and the long-term outcome of such long constructs in different surgical conditions. Materials and Methods: This investigation was a retrospective cohort study which included patients who underwent thoraco-lumbar percutaneous fixations. We collected clinical, surgical and radiological data, with a minimum follow-up of 24 months. Health-related quality-of-life, residual pain, instrumentation placement, and complications were studied. Results: A total of 18 procedures were enrolled, in which 182 screws were implanted, (170 positioned in thoracic and 12 in lumbar pedicles, respectively). No surgical complications or hardware failure occurred in our series, 6 out of 182 (3,2%) screws had a partial pedicle breach, without neurological impairment or need for surgical revision. Conclusion: According to our results, a fully posterior percutaneous approach for long thoraco-lumbar spine instrumentation can be considered safe and reproducible, although an adequate training is strictly required.
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Affiliation(s)
- F C Tamburrelli
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Institute of Orthopedic Clinic, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Perna
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - L Proietti
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy.,Institute of Orthopedic Clinic, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Zirio
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - D A Santagada
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - M Genitiempo
- UOC Vertebral Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
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11
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Hiyama A, Sakai D, Sato M, Watanabe M. The analysis of percutaneous pedicle screw technique with guide wire-less in lateral decubitus position following extreme lateral interbody fusion. J Orthop Surg Res 2019; 14:304. [PMID: 31488181 PMCID: PMC6729011 DOI: 10.1186/s13018-019-1354-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 08/29/2019] [Indexed: 11/18/2022] Open
Abstract
Background Lateral lumbar interbody fusion (LLIF) and bilateral percutaneous pedicle fixation are valuable, minimally invasive lateral approaches used to treat symptomatic degenerative disc disease. In the current procedure, the patient’s position on the operating table is changed after LLIF surgery from the lateral decubitus to the prone position. The ability to perform both approaches with the patient in the same position should reduce operation time. Use of a guide wire is problematic during percutaneous pedicle screw (PPS) insertion using fluoroscopy with the patient in the lateral decubitus position. A new guide wire-less PPS system may solve this problem and reduce operation time. Here, we evaluated the operative data and efficacy for this technique. Methods This study included 30 patients (aged 70.8 ± 8.5 years; 17 men, 13 women) who underwent a combined operation (indirect decompression) using extreme lateral interbody fusion (XLIF) with only a single level for lumbar spinal canal stenosis and lumbar degenerative spondylolisthesis. Patient demographics and operative data were compared between two groups: patients who remained in the lateral decubitus position for pedicle screw fixation (L group) and those turned to the prone position (P group). Radiographic assessment was performed using pre- and postoperative anteroposterior and lateral lumbar films with measurement of lumbar lordosis, segmental lordosis, and segmental translation. Results We analyzed 18 patients in the P group and 12 in the L group. Age, sex, height, body weight, body mass index, estimated blood loss, and length of stay did not differ between groups. The operation time was 34 min shorter for the L group (P group 111.9 ± 25.0 vs. L group 77.5 ± 22.2 min, p < 0.01). Pre- and postoperative lordosis, segmental lordosis, and segmental translation did not differ significantly between groups. Conclusions A single position after XLIF surgery is a feasible modification to the standard procedure when used with fluoroscopy and a guide wire-less PPS system. The time saved is the main advantage of inserting the PPS with the patient in the lateral decubitus position without repositioning. Use of the lateral PPS with a guide wire-less technique may help improve operative efficiency and reduce cost.
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Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masato Sato
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
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Garg S, Palmer C, Whitmore W, Cyr M, Michael N, Kim E, Boucharel W. Triggered EMG (T-EMG) Values of Pedicle Screws with a Powered Screwdriver vs A Standard Probe in Adolescent Idiopathic Scoliosis Do Not Agree: A Prospective Validation Study. Neurodiagn J 2019; 59:152-162. [PMID: 31251123 DOI: 10.1080/21646821.2019.1630211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Triggered electromyography (t-EMG) is a common technique used during spinal instrumentation in surgery for adolescent idiopathic scoliosis. This study tests the validity of t-EMG values obtained with a standard ball-tipped probe after completion of screw placement versus t-EMG values obtained during screw insertion with a powered screwdriver. t-EMG values were collected for screws spanning T7-L5 using both a standard probe and a powered screwdriver. A power analysis determined that a sample size of 300 screws would provide enough precision to estimate limits of agreement within ±2 mA. A monopolar constant current stimulation technique (0.2 ms duration and 3.11 Hz stimulation rate) was used at each level. EMG was acquired with placement of bipolar pairs of subdermal needle electrodes. A Bland-Altman plot was used to assess agreement between threshold readings from the two techniques. Twenty-nine patients were enrolled in this study with 305 screws. t-EMG values measured using a powered screwdriver were on average 1 mA lower than values from a standard probe. When readings less than or equal to 20 mA were considered, the limits of agreement were approximately 4 and 7 mA overall. In total, 28/305 (9%) screws were removed and reinserted, 9/305 (3%) screws were redirected, and 3/305 (1%) screws were aborted based on t-EMG readings. Despite a small overall difference in t-EMG value between the standard probe and screwdriver, there was still large variability in agreement between the two techniques. t-EMG values obtained with a powered screwdriver during screw insertion are not interchangeable with values measured by a probe.
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Affiliation(s)
- Sumeet Garg
- Orthopedics, Children's Hospital Colorado , Aurora , Colorado
| | - Claire Palmer
- Department of Pediatrics, School of Medicine University of Colorado , Aurora , Colorado
| | - Wayne Whitmore
- Orthopedics, Children's Hospital Colorado , Aurora , Colorado
| | - Micaela Cyr
- Orthopedics, Children's Hospital Colorado , Aurora , Colorado
| | - Nicole Michael
- Orthopedics, Children's Hospital Colorado , Aurora , Colorado
| | - Eun Kim
- Orthopedics, Children's Hospital Colorado , Aurora , Colorado
| | - Willy Boucharel
- Orthopedics, Children's Hospital Colorado , Aurora , Colorado
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Blizzard DJ, Thomas JA. MIS Single-position Lateral and Oblique Lateral Lumbar Interbody Fusion and Bilateral Pedicle Screw Fixation: Feasibility and Perioperative Results. Spine (Phila Pa 1976) 2018; 43:440-446. [PMID: 28704331 DOI: 10.1097/brs.0000000000002330] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data of the first 72 consecutive patients treated with single-position one- or two-level lateral (LLIF) or oblique lateral interbody fusion (OLLIF) with bilateral percutaneous pedicle screw and rod fixation by a single spine surgeon. OBJECTIVE To evaluate the clinical feasibility, accuracy, and efficiency of a single-position technique for LLIF and OLLIF with bilateral pedicle screw and rod fixation. SUMMARY OF BACKGROUND DATA Minimally-invasive lateral interbody approaches are performed in the lateral decubitus position. Subsequent repositioning prone for bilateral pedicle screw and rod fixation requires significant time and resources and does not facilitate increased lumbar lordosis. METHODS The first 72 consecutive patients (300 screws) treated with single-position LLIF or OLLIF and bilateral pedicle screws by a single surgeon between December 2013 and August 2016 were included in the study. Screw accuracy and fusion were graded using computed tomography and several timing parameters were recorded including retractor, fluoroscopy, and screw placement time. Complications including reoperation, infection, and postoperative radicular pain and weakness were recorded. RESULTS Average screw placement time was 5.9 min/screw (standard deviation, SD: 1.5 min; range: 3-9.5 min). Average total operative time (interbody cage and pedicle screw placement) was 87.9 minutes (SD: 25.1 min; range: 49-195 min). Average fluoroscopy time was 15.0 s/screw (SD: 4.7 s; range: 6-25 s). The pedicle screw breach rate was 5.1% with 10/13 breaches measured as < 2 mm in magnitude. Fusion rate at 6-months postoperative was 87.5%. Two (2.8%) patients underwent reoperation for malpositioned pedicle screws with subsequent resolution of symptoms. CONCLUSION The single-position, all-lateral technique was found to be feasible with accuracy, fluoroscopy usage, and complication rates comparable with the published literature. This technique eliminates the time and staffing associated with intraoperative repositioning and may lead to significant improvements in operative efficiency and cost savings. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Daniel J Blizzard
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC
| | - J Alex Thomas
- Atlantic Neurosurgical and Spine Specialists, Wilmington, NC
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Rienmüller A, Buchmann N, Kirschke JS, Meyer EL, Gempt J, Lehmberg J, Meyer B, Ryang YM. Accuracy of CT-navigated pedicle screw positioning in the cervical and upper thoracic region with and without prior anterior surgery and ventral plating. Bone Joint J 2017; 99-B:1373-1380. [PMID: 28963160 DOI: 10.1302/0301-620x.99b10.bjj-2016-1283.r1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/03/2017] [Indexed: 11/05/2022]
Abstract
AIMS We aimed to retrospectively assess the accuracy and safety of CT navigated pedicle screws and to compare accuracy in the cervical and thoracic spine (C2-T8) with (COMB) and without (POST) prior anterior surgery (anterior cervical discectomy or corpectomy and fusion with ventral plating: ACDF/ACCF). PATIENTS AND METHODS A total of 592 pedicle screws, which were used in 107 consecutively operated patients (210 COMB, 382 POST), were analysed. The accuracy of positioning was determined according to the classification of Gertzbein and Robbins on post-operative CT scans. RESULTS High accuracy was achieved in 524 screws (88.5%), 192 (87.7%) in the cervical spine and 332 (89%) in the thoracic spine, respectively. The results in the two surgical groups were compared and a logistic regression mixed model was performed to analyse the risk of low accuracy. Significantly lower accuracy was found in the COMB group with 82.9% versus 91.6% in the POST group (p = 0.036). There were no neurological complications, but two vertebral artery lesions were recorded. Three patients underwent revision surgery for malpositioning of a screw. Although the risk of malpositioning of a screw after primary anterior surgery was estimated to be 2.4-times higher than with posterior surgery alone, the overall rates of complication and revision were low. CONCLUSION We therefore conclude that CT navigated pedicle screws can be positioned safely although greater caution must be taken in patients who have previously undergone anterior surgery. Cite this article: Bone Joint J 2017;99-B:1373-80.
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Affiliation(s)
- A Rienmüller
- Medical University Vienna General Hospital, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - N Buchmann
- Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - J S Kirschke
- Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - E L Meyer
- Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - J Gempt
- Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - J Lehmberg
- Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - B Meyer
- Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Y M Ryang
- Klinikum rechts der Isar, Technical University Munich, Ismaninger Straße 22, 81675 Munich, Germany
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Comparison Between Minimally Invasive Surgery and Conventional Open Surgery for Patients With Spinal Metastasis: A Prospective Propensity Score-Matched Study. Spine (Phila Pa 1976) 2017; 42:789-797. [PMID: 27584676 DOI: 10.1097/brs.0000000000001893] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective propensity score-matched study. OBJECTIVE To compare the outcomes of minimal invasive surgery (MIS) and conventional open surgery for spinal metastasis patients. SUMMARY OF BACKGROUND DATA There is lack of knowledge on whether MIS is comparable to conventional open surgery in treating spinal metastasis. METHODS Patients with spinal metastasis requiring surgery from January 2008 to December 2010 in two spine centers were recruited. The demographic, preoperative, operative, perioperative and postoperative data were collected and analyzed. Thirty MIS patients were matched with 30 open surgery patients using propensity score matching technique with a match tolerance of 0.02 based on the covariate age, tumor type, Tokuhashi score, and Tomita score. RESULTS Both groups had significant improvements in Eastern Cooperative Oncology Group (ECOG), Karnofsky scores, visual analogue scale (VAS) for pain and neurological status postoperatively. However, the difference comparing the MIS and open surgery group was not statistically significant. MIS group had significantly longer instrumented segments (5.5 ± 3.1) compared with open group (3.8 ± 1.7). Open group had significantly longer decompressed segment (1.8 ± 0.8) than MIS group (1.0 ± 1.0). Open group had significantly more blood loss (2062.1 ± 1148.0 mL) compared with MIS group (1156.0 ± 572.3 mL). More patients in the open group (76.7%) needed blood transfusions (with higher average units of blood transfused) compared with MIS group (40.0%). Fluoroscopy time was significantly longer in MIS group (116.1 ± 63.3 s) compared with open group (69.9 ± 42.6 s). Open group required longer hospitalization (21.1 ± 10.8 days) compared with MIS group (11.0 ± 5.0 days). CONCLUSION This study demonstrated that MIS resulted in comparable outcome to open surgery for patients with spinal metastasis but has the advantage of less blood loss, blood transfusions, and shorter hospital stay. LEVEL OF EVIDENCE 3.
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Kwan MK, Chiu CK, Gani SMA, Wei CCY. Accuracy and Safety of Pedicle Screw Placement in Adolescent Idiopathic Scoliosis Patients: A Review of 2020 Screws Using Computed Tomography Assessment. Spine (Phila Pa 1976) 2017; 42:326-335. [PMID: 27310021 DOI: 10.1097/brs.0000000000001738] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of CT scan. OBJECTIVE To investigate the accuracy and safety of pedicle screws placed in adolescent idiopathic scoliosis (AIS) patients. SUMMARY OF BACKGROUND DATA The reported pedicle screws perforation rates for corrective AIS surgery vary widely from 1.2% to 65.0%. Knowledge regarding the safety of pedicle screws in scoliosis surgery is very important in preventing complications. METHODS This study investigates the accuracy and safety of pedicle screws placed in 140 AIS patients. CT scans were used to assess the perforations that were classified according to Rao et al (2002): grade 0, grade 1 (<2 mm), grade 2 (2-4 mm), and grade 3 (>4 mm). Anterior perforations were classified into grade 0, grade 1 (<4 mm), grade 2 (4-6 mm), and grade 3 (>6 mm). Grade 2 and 3 (excluding lateral grade 2 and 3 perforation over thoracic vertebrae) were considered as critical perforations. RESULTS A total of 2020 pedicle screws from 140 patients were analyzed. The overall total perforation rate was 20.3% (410 screws) with 8.2% (166 screws) grade 1, 2.9% (58 screws) grade 2 and 9.2% (186 screws) grade 3 perforations. Majority of the perforations was because of lateral perforation occurring over the thoracic region, as a result of application of extrapedicular screws at this region. When the lateral perforations of the thoracic region were excluded, the perforation rate was 6.4% (129 screws), grade 2, 1.4% (28 screws) and grade 3, 0.8% (16 screws). There were only two symptomatic left medial grade 2 perforations: one screw at T12 presented with postoperative iliac crest numbness and another screw at L2 presented with radicular pain that subsided with conservative treatment. There were six anterior perforations abutting the right lung, four anterior perforations abutting the aorta, two anterior perforations abutting the esophagus, and one abutting the trachea was noted. CONCLUSION Pedicle screws insertion in AIS has a total perforation rate of 20.3%. After exclusion of lateral thoracic perforations, the overall perforation rate was 8.6% with a critical perforation rate of 2.2% (44/2020). The rate of symptomatic screw perforation leading to radicular symptoms was 0.1%. There was no spinal cord, aortic, esophageal, or lung injuries caused by malpositioned screws in this study. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Mun Keong Kwan
- Department of Orthopedic Surgery, National Orthopedic Center of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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