scholarly journals Treatment of Upper Cervical Spinal Cord Injury (Unstable C1-C2) by Direct Visualization and Nailing Technique and the Advantages of Early MRI

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Jamal Alshorman ◽  
Lian Zeng ◽  
Yulong Wang ◽  
Fengzhao Zhu ◽  
Kaifang Chen ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Pedicle Screw ◽  
Posterior Approach ◽  
Cervical Spinal Cord ◽  
Pedicle Screws ◽  
Atlantoaxial Joint ◽  
Direct Visualization ◽  
Neck Movement ◽  
Screw Insertion ◽  
Cord Injury

Background. The treatment of C1-C2 fractures mainly depends on fracture type and the stability of the atlantoaxial joint. Disruption of the C1-C2 combination is a big challenge, especially in avoiding vertebral artery, nerve, and vein sinus injury during the operation. Purpose. This study aims to show the benefit of using the posterior approach and pedicle screw insertion by nailing technique and direct visualization to treat unstable C1-C2 and, moreover, to determine the advantages of performing early MRI in patients with limited neck movement after trauma. Method. Between Jan 2017–Feb 2019, we present 21 trauma patients who suffered from C1, C2, or unstable atlantoaxial joint. X-ray, computed tomography (CT), and magnetic resonance image (MRI) were performed preoperatively. All the patients underwent our surgical procedure (posterior approach and pedicle screw placement by direct visualization and nailing technique). Result. The mean age was 41.1 years old, 8 females and 14 males. The average follow-up time was 2.6 years. Four patients were with C1 fracture, seven with C2 fracture, six with atlantoaxial dislocation, and four with C1 and C2 fractures. The time of MRI was between 12 hours and 48 hours; neck movement symptoms appeared between 2 days and 2 weeks. Conclusion. The posterior approach to treat the C1 and C2 fractures or dislocation by direct visualization and nailing technique can reduce the risk of the vertebral artery, vein sinus, and nerve root injuries with significant improvement. It can show a better angle view while inserting the pedicle screws. An early MRI (12–48 hours) is essential even if no symptoms appear at the time of admission, and if it is normal, it is necessary to repeat it. The presence of skull bleeding can be associated with upper neck instability.

Augmented reality–assisted pedicle screw insertion: a cadaveric proof-of-concept study

2019 ◽  
Vol 31 (1) ◽  
pp. 139-146 ◽  
Author(s):  
Camilo A. Molina ◽  
Nicholas Theodore ◽  
A. Karim Ahmed ◽  
Erick M. Westbroek ◽  
Yigal Mirovsky ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Pedicle Screw ◽  
User Experience ◽  
Pedicle Screws ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Insertion Method ◽  
Comparative Accuracy ◽  
Placement Accuracy ◽  
Surgical Field

OBJECTIVEAugmented reality (AR) is a novel technology that has the potential to increase the technical feasibility, accuracy, and safety of conventional manual and robotic computer-navigated pedicle insertion methods. Visual data are directly projected to the operator’s retina and overlaid onto the surgical field, thereby removing the requirement to shift attention to a remote display. The objective of this study was to assess the comparative accuracy of AR-assisted pedicle screw insertion in comparison to conventional pedicle screw insertion methods.METHODSFive cadaveric male torsos were instrumented bilaterally from T6 to L5 for a total of 120 inserted pedicle screws. Postprocedural CT scans were obtained, and screw insertion accuracy was graded by 2 independent neuroradiologists using both the Gertzbein scale (GS) and a combination of that scale and the Heary classification, referred to in this paper as the Heary-Gertzbein scale (HGS). Non-inferiority analysis was performed, comparing the accuracy to freehand, manual computer-navigated, and robotics-assisted computer-navigated insertion accuracy rates reported in the literature. User experience analysis was conducted via a user experience questionnaire filled out by operators after the procedures.RESULTSThe overall screw placement accuracy achieved with the AR system was 96.7% based on the HGS and 94.6% based on the GS. Insertion accuracy was non-inferior to accuracy reported for manual computer-navigated pedicle insertion based on both the GS and the HGS scores. When compared to accuracy reported for robotics-assisted computer-navigated insertion, accuracy achieved with the AR system was found to be non-inferior when assessed with the GS, but superior when assessed with the HGS. Last, accuracy results achieved with the AR system were found to be superior to results obtained with freehand insertion based on both the HGS and the GS scores. Accuracy results were not found to be inferior in any comparison. User experience analysis yielded “excellent” usability classification.CONCLUSIONSAR-assisted pedicle screw insertion is a technically feasible and accurate insertion method.

scholarly journals Does the application of Robotics improve outcomes of pedicle screw insertion in spine surgery compared to conventional fluoroscopy guidance? A protocol for Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Vishal Kumar ◽  
Vishnu Baburaj ◽  
Prasoon Kumar ◽  
Sarvdeep Singh Dhatt
Keyword(s):  
Systematic Review ◽  
Pedicle Screw ◽  
Clinical Outcomes ◽  
Spine Surgery ◽  
Meta Analysis ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Fluoroscopy Guidance

AbstractBackgroundPedicle screw insertion is routinely carried out in spine surgery that has traditionally been performed under fluoroscopy guidance. Robotic guidance has recently gained popularity in order to improve the accuracy of screw placement. However, it is unclear whether the use of robotics alters the accuracy of screw placement or clinical outcomes.ObjectivesThis systematic review aims to compare the results of pedicle screws inserted under fluoroscopy guidance, with those inserted under robotic guidance, in terms of both short-term radiographic outcomes, as well as long-term clinical outcomes.MethodsThis systematic review will be conducted according to the PRISMA guidelines. A literature search will be conducted on the electronic databases of PubMed, Embase, Scopus, and Ovid with a pre-determined search strategy. A manual bibliography search of included studies will also be done. Original articles in English that directly compare pedicle screw insertion under robotic guidance to those inserted under fluoroscopy guidance will be included. Data on outcomes will be extracted from included studies and analysis carried out with the help of appropriate software.

scholarly journals Preoperative Assessment of the Feasibility of Pedicle Screw Insertion at the Proximal Thoracic Curve in Lenke Type 2 Idiopathic Scoliosis

2019 ◽  
Vol 10 (3) ◽  
pp. 261-265
Author(s):  
Yuki Taniguchi ◽  
Yoshitaka Matsubayashi ◽  
So Kato ◽  
Takashi Ono ◽  
Yasushi Oshima ◽  
...  
Keyword(s):  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Preoperative Assessment ◽  
Japanese Patients ◽  
Minimal Distance ◽  
Screw Insertion ◽  
The Right

Study Design: Retrospective cohort study. Objectives: To investigate the feasibility of inserting pedicle screws in the proximal thoracic (PT) curve in Lenke type 2 idiopathic scoliosis, using post-myelography computed tomography (CT). Methods: Post-myelography CT images of 46 Japanese patients, 10 to 30 years old, who underwent surgery for Lenke type 2 idiopathic scoliosis were analyzed. A new parameter “SAPS” (space available for pedicle screw) was introduced, which defines the minimal distance between the lateral cortex of the pedicle and the spinal cord, with a SAPS <4.5 mm being “unacceptable.” All 460 pedicles (T2 through T6) were analyzed. Pedicle diameter was classified according to the Akazawa grading system. Results: Most pedicles on the right side at T3 (84.8%) and T4 (97.8%) were unacceptable. The unacceptable rate was 58.7% and 15.2% on the right side at T5 and T6, respectively. A larger Cobb angle of the PT curve was associated with a greater incidence of unacceptable SAPS at these levels. For a Cobb angle of the PT curve >40°, most right T5 pedicles were unacceptable. On the left side, most pedicles from T2 to T5 were acceptable. When T5 was the caudal end vertebra of the PT curve, the left T6 pedicles had an unacceptable SAPS in some cases. When the width of the pedicle channel was ≥2 mm (Akazawa grade 1 or 2), all pedicles from T2 to T6, on both sides, were acceptable. Conclusions: Post-myelography CT enabled us to clearly demonstrate the feasibility of inserting pedicle screws in the PT region.

scholarly journals Management of spinal cord injury–related scoliosis using pedicle screw–only constructs

2015 ◽  
Vol 22 (2) ◽  
pp. 185-191 ◽  
Author(s):  
Steven W. Hwang ◽  
Mina G. Safain ◽  
Joseph J. King ◽  
Jeff S. Kimball ◽  
Robert Ames ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Shoulder Balance ◽  
Radiographic Outcomes ◽  
Cord Injury ◽  
Scoliosis Correction ◽  
Almost All

OBJECT Almost all pediatric patients who incur a spinal cord injury (SCI) will develop scoliosis, and younger patients are at highest risk for curve progression requiring surgical intervention. Although the use of pedicle screws is increasing in popularity, their impact on SCI-related scoliosis has not been described. The authors retrospectively reviewed the radiographic outcomes of pedicle screw–only constructs in all patients who had undergone SCI-related scoliosis correction at a single institution. Methods Medical records and radiographs from Shriner's Hospital for Children–Philadelphia for the period between November 2004 and February 2011 were retrospectively reviewed. Results Thirty-seven patients, whose mean age at the index surgery was 14.91 ± 3.29 years, were identified. The cohort had a mean follow-up of 33.2 ± 22.8 months. The mean preoperative coronal Cobb angle was 65.5° ± 25.7°, which corrected to 20.3° ± 14.4°, translating into a 69% correction (p < 0.05). The preoperative coronal balance was 24.4 ± 22.6 mm, with a postoperative measurement of 21.6 ± 20.7 mm (p = 1.00). Preoperative pelvic obliquity was 12.7° ± 8.7°, which corrected to 4.1° ± 3.8°, translating into a 68% correction (p < 0.05). Preoperative shoulder balance, as measured by the clavicle angle, was 8.2° ± 8.4°, which corrected to 2.7° ± 3.1° (67% correction, p < 0.05). Preoperatively, thoracic kyphosis measured 44.2° ± 23.7° and was 33.8° ± 11.5° postoperatively. Thoracolumbar kyphosis was 18.7° ± 12.1° preoperatively, reduced to 8.1° ± 7.7° postoperatively, and measured 26.8° ± 20.2° at the last follow-up (p < 0.05). Preoperatively, lumbar lordosis was 35.3° ± 22.0°, which remained stable at 35.6° ± 15.0° postoperatively. Conclusions Pedicle screw constructs appear to provide better correction of coronal parameters than historically reported and provide significant improvement of sagittal kyphosis as well. Although pedicle screws appear to provide good radiographic results, correlation with clinical outcomes is necessary to determine the true impact of pedicle screw constructs on SCI-related scoliosis correction.

Optimization of Pedicle Screw Depth in the Lumbar Spine

2013 ◽  
Author(s):  
Laura E. Buckenmeyer ◽  
Kristophe J. Karami ◽  
Ata M. Kiapour ◽  
Vijay K. Goel ◽  
Teck M. Soo ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Fixation Strength ◽  
Osteoporotic Patient ◽  
Insertion Depth ◽  
Anterior Cortex ◽  
Screw Insertion ◽  
Clinical Challenge ◽  
Series Of Experiments

Optimization of pedicle screw insertion depth for ideal fixation and fusion remains a clinical challenge. Improved screw purchase may improve fixation strength 1, which is especially critical in an osteoporotic patient population. Extended screw insertion depths, up to and through the anterior cortex, have yet to be compared to more commonly used shorter pedicle screws in a laboratory controlled series of experiments. The purpose of this study is to evaluate screw purchase in the osteoporotic lumbar spine as a function of insertion depth, which may be used to optimize pedicle screw-rod constructs.

scholarly journals Placement of Guide-Wireless Sharp Percutaneous Pedicle Screws Utilizing Computed Tomography-Navigation and Sentinel Fluoroscopy: 2-Dimensional Operative Video

2019 ◽  
Vol 19 (2) ◽  
pp. E149-E150 ◽  
Author(s):  
Nikolay L Martirosyan ◽  
Joshua T Wewel ◽  
Juan S Uribe
Keyword(s):  
Computed Tomography ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Transverse Process ◽  
Screw Placement ◽  
Osteoporotic Bone ◽  
Screw Insertion ◽  
Institutional Review ◽  
Stab Incision ◽  
Anterior Posterior

Abstract Many established techniques exist for minimally invasive pedicle screw placement. Nearly all techniques incorporate the use of a Kershner wire (K-wire) at various points in the work-flow. The use of a K-wire adds an additional step. If its position is lost, it requires repeating all previous steps, and placement is not without complication. The use of a guide-wireless sharp screws allows the surgeon to place a pedicle screw in 1 step with several fluid maneuvers.1 The patient underwent Institutional Review Board-approved consent for this study. Following traditional computed tomography-based navigation, a stab incision is made, followed by fascial dissection with monopolar cautery. The sharp screw is placed percutaneously at the facet-transverse process junction. The precise entry point is confirmed with navigation, followed by a sentinel anterior-posterior fluoroscopic image, verifying the accuracy of the navigation. The cortical bone is traversed by malleting the sharp tip through the cortex. When the cancellous bone is engaged, the screw is then advanced through the pedicle. This set of steps allows for safe, efficient placement of percutaneous pedicle screws without the need for a guidewire. Mal-placement regarding sharp pedicle screw insertion is similar to K-wire-dependent screw placement. Surgeons must be cognoscente of exceptionally sclerotic bone, which can prove difficult to cannulate. Conversely, osteoporotic bone that is liable to a cortical pedicle breach, transverse process fracture, and/or maltrajectory are all considerations when placing a K-wireless, sharp pedicle screw. Anterior-posterior fluoroscopy is utilized to confirm accuracy of image-guided navigation and mitigate malplacement of pedicle screws.

Accuracy of percutaneous lumbar pedicle screw placement using the oblique or “owl's-eye” view and novel guidance technology

2010 ◽  
Vol 13 (4) ◽  
pp. 509-515 ◽  
Author(s):  
Cary Idler ◽  
Kevin W. Rolfe ◽  
Josef E. Gorek
Keyword(s):  
Pedicle Screw ◽  
Facet Joint ◽  
Pedicle Screws ◽  
Guidance System ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Screw Insertion ◽  
Percutaneous Pedicle Screw ◽  
Clinical Series ◽  
Lumbar Pedicle

Object This study was conducted to assess the in vivo safety and accuracy of percutaneous lumbar pedicle screw placement using the owl's-eye view of the pedicle axis and a new guidance technology system that facilitates orientation of the C-arm into the appropriate fluoroscopic view and the pedicle cannulation tool in the corresponding trajectory. Methods A total of 326 percutaneous pedicle screws were placed from L-3 to S-1 in 85 consecutive adult patients. Placement was performed using simple coaxial imaging of the pedicle with the owl's-eye fluoroscopic view. NeuroVision, a new guidance system using accelerometer technology, helped align the C-arm trajectory into the owl's-eye view and the cannulation tool in the same trajectory. Postoperative fine-cut CT scans were acquired to assess screw position. Medical records were reviewed for complications. Results Five of 326 screws breached a pedicle cortex—all breaches were less than 2 mm—for an accuracy rate of 98.47%. Five screws violated an adjacent facet joint. All were at the S-1 superior facet and included in a fusion. No screw violated an adjacent mobile facet or disc space. There were no cases of new or worsening neurological symptoms or deficits for an overall clinical accuracy of 100%. Conclusions The owl's-eye technique of coaxial pedicle imaging with the C-arm fluoroscopy, facilitated by NeuroVision, is a safe and accurate means by which to place percutaneous pedicle screws for degenerative conditions of the lumbar spine. This is the largest series reported to use the oblique or owl's-eye projection for percutaneous pedicle screw insertion. The accuracy of percutaneous screw insertion with this technique meets or exceeds that of other reported clinical series or techniques.

scholarly journals Minimally invasive guidewireless, navigated pedicle screw placement: a technical report and case series

2017 ◽  
Vol 43 (2) ◽  
pp. E9 ◽  
Author(s):  
Brandon W. Smith ◽  
Jacob R. Joseph ◽  
Michael Kirsch ◽  
Mary Oakley Strasser ◽  
Jacob Smith ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Kirschner Wire ◽  
Case Series ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Minimally Invasive Spinal Surgery ◽  
Screw Insertion ◽  
Percutaneous Pedicle Screw

OBJECTIVEPercutaneous pedicle screw insertion (PPSI) is a mainstay of minimally invasive spinal surgery. Traditionally, PPSI is a fluoroscopy-guided, multistep process involving traversing the pedicle with a Jamshidi needle, placement of a Kirschner wire (K-wire), placement of a soft-tissue dilator, pedicle tract tapping, and screw insertion over the K-wire. This study evaluates the accuracy and safety of PPSI with a simplified 2-step process using a navigated awl-tap followed by navigated screw insertion without use of a K-wire or fluoroscopy.METHODSPatients undergoing PPSI utilizing the K-wire–less technique were identified. Data were extracted from the electronic medical record. Complications associated with screw placement were recorded. Postoperative radiographs as well as CT were evaluated for accuracy of pedicle screw placement.RESULTSThirty-six patients (18 male and 18 female) were included. The patients’ mean age was 60.4 years (range 23.8–78.4 years), and their mean body mass index was 28.5 kg/m2 (range 20.8–40.1 kg/m2). A total of 238 pedicle screws were placed. A mean of 6.6 pedicle screws (range 4–14) were placed over a mean of 2.61 levels (range 1–7). No pedicle breaches were identified on review of postoperative radiographs. In a subgroup analysis of the 25 cases (69%) in which CT scans were performed, 173 screws were assessed; 170 (98.3%) were found to be completely within the pedicle, and 3 (1.7%) demonstrated medial breaches of less than 2 mm (Grade B). There were no complications related to PPSI in this cohort.CONCLUSIONSThis streamlined 2-step K-wire–less, navigated PPSI appears safe and accurate and avoids the need for radiation exposure to surgeon and staff.

Pedicle screw insertion in the thoracolumbar spine: comparison of 4 guidance techniques in the intact cadaveric spine

2011 ◽  
Vol 14 (5) ◽  
pp. 664-669 ◽  
Author(s):  
Husam Alhabib ◽  
Andrew Nataraj ◽  
Mohammed Khashab ◽  
James Mahood ◽  
Frank Kortbeek ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Thoracolumbar Spine ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Anatomical Landmarks ◽  
Imaging Data ◽  
Anatomical Dissection ◽  
Screw Insertion ◽  
Fluoroscopic Navigation ◽  
Screw Position

Object Pedicle screw fixation is a mainstay of thoracolumbar stabilization. Screw insertion using anatomical landmarks and fluoroscopy is common but can be technically challenging and generally involves substantial exposure to ionizing radiation. Computerized navigation has been reported to improve accuracy but is expensive and complex. The authors undertook this study to evaluate these 3 methods in comparison with a fourth technique using standard cervical distractor screws to mark the entry point and trajectory. Methods Four cadaveric human spines were used for this study. After an initial CT scan, 34 pedicle screws were inserted in each intact spine from T-1 to L-5 using the following 4 screw insertion guidance techniques (1 technique per specimen): use of anatomical landmarks, use of cervical distractor screws and spot fluoroscopy, fluoroscopy-based navigation, and fluoroscopy- and CT-based navigation (using merged imaging data). Postprocedural CT and anatomical dissection were then performed to evaluate screw position for site and degree of breach. Results The cervical distractor screw method had a breach rate of 5.9% versus 29.4%, 32.4%, and 20.6% for use of anatomical landmarks, fluoroscopic navigation, and fluoroscopic-CT navigation, respectively (p < 0.05). There is also a significant association between degree of medial and distal breach and the method of screw insertion (p < 0.05). Conclusions Cervical distractor screws as pedicle markers offer favorable insertion accuracy and reduction of radiation exposure compared with the other 3 methods used in clinical practice.

Biomechanical Effects of Lumbar Pedicle Screw Insertion Depth on Screw Loosening and Fulcrum Location

2013 ◽  
Author(s):  
Laura E. Buckenmeyer ◽  
Kristophe J. Karami ◽  
Ata M. Kiapour ◽  
Vijay K. Goel ◽  
Constantine K. Demetropoulos ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Pedicle Screws ◽  
Screw Loosening ◽  
Pullout Strength ◽  
Insertion Depth ◽  
Bone Implant ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Increased Risk ◽  
Screw Length

Osteoporosis is a critical challenge in orthopedic surgery. Osteoporotic patients have an increased risk of loosening and failure of implant constructs due to a weaker bone-implant interface than with healthy bone. Pullout strength of pedicle screws is enhanced by increased screw insertion depth. However, more knowledge is needed to define optimal pedicle screw insertion depth in relation to screw-bone interface biomechanics and the resulting loosening risk. This study evaluates the effects of screw length on loosening risk in the osteoporotic lumbar spine.

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