scholarly journals Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery

2017 ◽  
Vol 42 (5) ◽  
pp. E14 ◽  
Author(s):  
Granit Molliqaj ◽  
Bawarjan Schatlo ◽  
Awad Alaid ◽  
Volodymyr Solomiichuk ◽  
Veit Rohde ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Robotic Assistance ◽  
Anatomical Landmarks ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Screw Insertion ◽  
Freehand Technique

OBJECTIVEThe quest to improve the safety and accuracy and decrease the invasiveness of pedicle screw placement in spine surgery has led to a markedly increased interest in robotic technology. The SpineAssist from Mazor is one of the most widely distributed robotic systems. The aim of this study was to compare the accuracy of robot-guided and conventional freehand fluoroscopy-guided pedicle screw placement in thoracolumbar surgery.METHODSThis study is a retrospective series of 169 patients (83 women [49%]) who underwent placement of pedicle screw instrumentation from 2007 to 2015 in 2 reference centers. Pathological entities included degenerative disorders, tumors, and traumatic cases. In the robot-assisted cohort (98 patients, 439 screws), pedicle screws were inserted with robotic assistance. In the freehand fluoroscopy-guided cohort (71 patients, 441 screws), screws were inserted using anatomical landmarks and lateral fluoroscopic guidance. Patients treated before 2009 were included in the fluoroscopy cohort, whereas those treated since mid-2009 (when the robot was acquired) were included in the robot cohort. Since then, the decision to operate using robotic assistance or conventional freehand technique has been based on surgeon preference and logistics. The accuracy of screw placement was assessed based on the Gertzbein-Robbins scale by a neuroradiologist blinded to treatment group. The radiological slice with the largest visible deviation from the pedicle was chosen for grading. A pedicle breach of 2 mm or less was deemed acceptable (Grades A and B) while deviations greater than 2 mm (Grades C, D, and E) were classified as misplacements.RESULTSIn the robot-assisted cohort, a perfect trajectory (Grade A) was observed for 366 screws (83.4%). The remaining screws were Grades B (n = 44 [10%]), C (n = 15 [3.4%]), D (n = 8 [1.8%]), and E (n = 6 [1.4%]). In the fluoroscopy-guided group, a completely intrapedicular course graded as A was found in 76% (n = 335). The remaining screws were Grades B (n = 57 [12.9%]), C (n = 29 [6.6%]), D (n = 12 [2.7%]), and E (n = 8 [1.8%]). The proportion of non-misplaced screws (corresponding to Gertzbein-Robbins Grades A and B) was higher in the robot-assisted group (93.4%) than the freehand fluoroscopy group (88.9%) (p = 0.005).CONCLUSIONSThe authors’ retrospective case review found that robot-guided pedicle screw placement is a safe, useful, and potentially more accurate alternative to the conventional freehand technique for the placement of thoracolumbar spinal instrumentation.

scholarly journals Does the accuracy of pedicle screw placement differ between the attending surgeon and resident in navigated robotic-assisted minimally invasive spine surgery?

2019 ◽  
Vol 14 (4) ◽  
pp. 567-572 ◽  
Author(s):  
Arnold B. Vardiman ◽  
David J. Wallace ◽  
Grant A. Booher ◽  
Neil R. Crawford ◽  
Jessica R. Riggleman ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Spine Surgery ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Robotic Assistance ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Left And Right ◽  
Spine Surgeon

Abstract Robotic assistance with integrated navigation is an area of high interest for improving the accuracy of minimally invasive pedicle screw placement. This study analyzes the accuracy of pedicle screw placement between an attending spine surgeon and a resident by comparing the left and right sides of the first 101 consecutive cases using navigated robotic assistance in a private practice clinical setting. A retrospective, Institutional Review Board-exempt review of the first 106 navigated robot-assisted spine surgery cases was performed. One attending spine surgeon and one resident performed pedicle screw placement consistently on either the left or right side (researchers were blinded). A CT-based Gertzbein and Robbins system (GRS) was used to classify pedicle screw accuracy, with grade A or B considered accurate. There were 630 consecutive lumbosacral pedicle screws placed. Thirty screws (5 patients) were placed without the robot due to surgeon discretion. Of the 600 pedicle screws inserted by navigated robotic guidance (101 patients), only 1.5% (9/600) were repositioned intraoperatively. Based on the GRS CT-based grading of pedicle breach, 98.67% (296/300) of left-side screws were graded A or B, 1.3% (4/300) were graded C, and 0% (0/300) were graded D. For the right-side screws, 97.67% (293/300) were graded A or B, 1.67% (5/300) were graded C, and 0.66% (2/300) were graded D. This study demonstrated a high level of accuracy (based on GRS) with no significant differences between the left- and right-side pedicle screw placements (98.67% vs. 97.67%, respectively) in the clinical use of navigated, robot-assisted surgery.

scholarly journals Accuracy of 2D Fluoroscopy with Preoperative CT Fused Neuronavigation in Thoracic and Lumbar Pedicle Screw Insertion

2020 ◽  
pp. 20-25
Author(s):  
Adrian Bălașa ◽  
Corina-Ionela Hurghiș ◽  
Flaviu Tămaș ◽  
Ioan-Alexandru Florian ◽  
Levente Peter ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Pedicle Screw Fixation ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Screw Insertion ◽  
Freehand Technique ◽  
Preoperative Ct ◽  
Placement Accuracy ◽  
The Difference

Aim: Pedicle screw fixation is an established technique in the lumbar and thoracic area. Fluoroscopy-guided screw placement and subsequently navigation have decreased the rate of misplaced screws, but no technique has wholly eliminated this risk. This paper aims to study the difference between the accuracy of the fluoroscopic guided screw placement to that of the 2D fluoroscopy- preop CT fused neuronavigation guided technique, a lesser-used navigation technique.  Material and Methods: This retrospective study reflects our results using both techniques between March 2018 and March 2019 in both degenerative or traumatic spinal pathology for thoracic and lumbar regions. The accuracy of the screw placement was measured using Mirza grading system on postoperative CT images. Results: A total number of 56 patients underwent spinal instrumentation surgery. A total of 274 screws were placed with a mean number of 4.89 screws per patient; 199 screws were implanted using neuronavigation and 75 using the freehand-2D fluoroscopy-guided technique.  The accuracy rate of pedicle screw placement in the freehand technique guided by 2D fluoroscopy was 88,00%. With the use of neuronavigation, the accuracy increased to 89,96%. Conclusion:  Pedicle screw placement accuracy is higher when guided by CT-fluoro matching neuronavigation compared to freehand fluoroscopy-guided technique and can be used in departments where there is no intraoperative O-arm or 3D fluoroscopy available.

scholarly journals Evaluation of C2 pedicle screw placement via the freehand technique by neurosurgical trainees

2018 ◽  
Vol 29 (3) ◽  
pp. 235-240 ◽  
Author(s):  
Martin H. Pham ◽  
Joshua Bakhsheshian ◽  
Patrick C. Reid ◽  
Ian A. Buchanan ◽  
Vance L. Fredrickson ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Medical Center ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
C2 Pedicle Screw ◽  
Canal Diameter ◽  
Screw Length ◽  
Freehand Technique ◽  
Screw Diameter

OBJECTIVEFreehand placement of C2 instrumentation is technically challenging and has a learning curve due the unique anatomy of the region. This study evaluated the accuracy of C2 pedicle screws placed via the freehand technique by neurosurgical resident trainees.METHODSThe authors retrospectively reviewed all patients treated at the LAC+USC Medical Center undergoing C2 pedicle screw placement in which the freehand technique was used over a 1-year period, from June 2016 to June 2017; all procedures were performed by neurosurgical residents. Measurements of C2 were obtained from preoperative CT scans, and breach rates were determined from coronal reconstructions on postoperative scans. Severity of breaches reflected the percentage of screw diameter beyond the cortical edge (I = < 25%; II = 26%–50%; III = 51%–75%; IV = 76%–100%).RESULTSNeurosurgical residents placed 40 C2 pedicle screws in 24 consecutively treated patients. All screws were placed by or under the guidance of Pham, who is a postgraduate year 7 (PGY-7) neurosurgical resident with attending staff privileges, with a PGY-2 to PGY-4 resident assistant. The authors found an average axial pedicle diameter of 5.8 mm, axial angle of 43.1°, sagittal angle of 23.0°, spinal canal diameter of 25.1 mm, and axial transverse foramen diameter of 5.9 mm. There were 17 screws placed by PGY-2 residents, 7 screws placed by PGY-4 residents, and 16 screws placed by the PGY-7 resident. The average screw length was 26.0 mm, with a screw diameter of 3.5 mm or 4.0 mm. There were 7 total breaches (17.5%), of which 4 were superior (10.0%) and 3 were lateral (7.5%). There were no medial breaches. The breaches were classified as grade I in 3 cases (42.9%), II in 3 cases (42.9%), III in 1 case (14.3%), and IV in no cases. There were 3 breaches that occurred via placement by a PGY-2 resident, 3 breaches by a PGY-4 resident, and 1 breach by the PGY-7 resident. There were no clinical sequelae due to these breaches.CONCLUSIONSFreehand placement of C2 pedicle screws can be done safely by neurosurgical residents in early training. When breaches occurred, they tended to be superior in location and related to screw length choice, and no breaches were found to be clinically significant. Controlled exposure to this unique anatomy is especially pertinent in the era of work-hour restrictions.

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.

scholarly journals Minimally invasive versus conventional fixation of tracer in robot-assisted pedicle screw insertion surgery: a randomized control trial

2019 ◽  
Author(s):  
Li Yongqi ◽  
Zhang Dehua ◽  
Wu Hongzi ◽  
Zhang Ke ◽  
Yang Rui ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Screw Insertion ◽  
Minimal Invasiveness ◽  
Fixation Group ◽  
Minimal Trauma ◽  
Significant Difference

Abstract Background This study evaluated the minimal invasiveness, safety, and accuracy of robot-assisted pedicle screw placement procedure using a modified tracer fixation device. Methods Patients were randomly assigned to conventional fixation group (25 patients) and modified fixation group (27 patients). Results No baseline statistical difference was observed between the groups ( P >0.05). The length of unnecessary incision, amount of bleeding, and fixation duration for tracer fixation respectively were 6.08±1.02 mm, 1.46±0.84 ml, and 1.56±0.32 min in the modified fixation group and 40.28±8.52 mm, 12.02±2.24 ml, and 5.08±1.06 min in the conventional group. The difference between both groups was significant ( P <0.05). However, no significant difference between the two groups was observed in terms of the accuracy of pedicle screw placement ( P >0.05). Conclusions The modified minimally invasive procedure for tracer fixation results in minimal trauma and is simple, reliable, and highly safe. Additionally, the procedure does not compromise the accuracy of pedicle screw placement. Thus, it has great clinical applicable value.

scholarly journals Minimally invasive versus conventional fixation of tracer in robot-assisted pedicle screw insertion surgery: a randomized control trial

2020 ◽  
Author(s):  
Li Yongqi ◽  
Zhang Dehua ◽  
Wu Hongzi ◽  
Zhang Ke ◽  
Yang Rui ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Screw Insertion ◽  
Minimal Invasiveness ◽  
Fixation Group ◽  
Minimal Trauma ◽  
Significant Difference

Abstract Background This study evaluated the minimal invasiveness, safety, and accuracy of robot-assisted pedicle screw placement procedure using a modified tracer fixation device. Methods Patients were randomly assigned to conventional fixation group (25 patients) and modified fixation group (27 patients). Results No baseline statistical difference was observed between the groups ( P >0.05). The length of unnecessary incision, amount of bleeding, and fixation duration for tracer fixation respectively were 6.08±1.02 mm, 1.46±0.84 ml, and 1.56±0.32 min in the modified fixation group and 40.28±8.52 mm, 12.02±2.24 ml, and 5.08±1.06 min in the conventional group. The difference between both groups was significant ( P <0.05). However, no significant difference between the two groups was observed in terms of the accuracy of pedicle screw placement ( P >0.05). Conclusions The modified minimally invasive procedure for tracer fixation results in minimal trauma and is simple, reliable, and highly safe. Additionally, the procedure does not compromise the accuracy of pedicle screw placement. Thus, it has great clinical applicable value.

scholarly journals Comparison of intraoperative O-arm- and conventional fluoroscopy (C-arm)-assisted insertion of pedicle screws in the treatment of fracture of thoracic vertebrae

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668409 ◽  
Author(s):  
Hao Liu ◽  
Yimeng Wang ◽  
Bin Pi ◽  
Zhonglai Qian ◽  
Xiaoyu Zhu ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Thoracic Vertebrae ◽  
Pedicle Screw Placement ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Computed Tomography Images ◽  
Hospitalization Time ◽  
Time Required

Purpose: To introduce the intraoperative O-arm-assisted pedicle screw insertion without any navigation system in the treatment of thoracic vertebrae fracture and compare it to conventional fluoroscopy (C-arm)-assisted pedicle screw insertion technique. Methods: About 156 pedicle screws were inserted in 23 patients (C-arm group), and 208 pedicle screws were inserted in 30 patients (O-arm group). The postoperative computed tomography images were analyzed for pedicle violation based on Gertzbein classification. The total surgery time, the average time required for inserting a screw, the mean action times of adjusting guide probe and pedicle screw, and the hospitalization time were compared in both groups, respectively. The American Spinal Injury Association (ASIA) was used for evaluating the health outcomes pre- and postoperatively. Results: There are the higher accuracy rate of satisfactory pedicle screw placement (grades 0 and 1) and the less incidence of medial perforation in the O-arm group compared to the C-arm group ( p < 0.05). The average time required for inserting a screw, the action times of adjusting the guide probe and pedicle screw, and the hospitalization time in the O-arm group are less than the respective ones in the C-arm group ( p < 0.05). There was no significant difference for the total surgery time between both groups. No further damage of the nerve function postoperatively is found according to the ASIA grade. Conclusion: The O-arm-assisted pedicle screw insertion without navigation we described provides higher accuracy of pedicle screw placement and better clinical efficacy compared to conventional fluoroscopy (C-arm) technique.

scholarly journals The "slide technique" - a novel free-hand method of subaxial cervical pedicle screw placement

2019 ◽  
Author(s):  
Bin Liu ◽  
Xiangyang Liu ◽  
Xiongjie Shen ◽  
Guoping Wang ◽  
Yixin Chen
Keyword(s):  
Pedicle Screw ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Target Area ◽  
Lateral Mass ◽  
Pedicle Screw Placement ◽  
Cervical Pedicle Screw ◽  
Screw Insertion ◽  
Cervical Pedicle ◽  
Slide Technique

Abstract Background : Cervical Pedicle Screw(CPS) placement is a challenging work due to high risk of neurovascular complications. Although there have been a number of different free-hand or navigation assisted techniques for CPS placement, perforations always occur during screw insertion, especially lateral perforation. The objective of this research is to describe a novel free-hand technique for subaxial CPS placement (C3–C7) for improving security and decreasing the chances of perforation. Methods : Thirty-two patients undergoing surgery with CPS instrumentation (C3–C7) at our institute between June 2017 and December 2018 were included in the study. All the patients had cervical trauma, and pedicle screw insertion was made according to the free-hand “slide technique”. Lamina, lateral mass and facet joint of the target area were clearly exposed and the optimal entry point was found on the lateral mass posterior surface. A pedicular probe was then inserted and gently advanced. During the pedicle probe insertion, the cortex of the medial margin of the pedicle acted as a “slide” to permit safe insertion of the screw. If the pedicle screw pathway was intact, screw of appropriate size was carefully placed. Three-dimensional (3D) CT imaging reconstruction was performed in all the patients after surgery, and screw perforations were graded with the Gertzbein-Robbins classification. Results : A total of 257 CPSs (C3-7) were inserted, of which 41 CPSs in C3, 61 CPSs in C4, 55 CPSs in C5, 53 CPSs in C6, and 47 CPSs in C7. The diameter and length of CPSs were 3.5 mm and 22-26 mm respectively. According to the Gertzbein-Robbins classification, grade 0, 231 screws; grade 1, 19 screws; and grade 2, 7 screws. No neurovascular complications occurred stemming from malpositioning of pedicle screws. In perforated screws (26 screws), lateral perforations were 16, medical perforations were 5, and inferior perforations were 4. Conclusions : The initial usage result show the “slide technique” is a safe, effective and cost-effective technique for pedicle screw placement in the cervical spine. This is the first report of such technique, we recommend it to wide practical application though further studies are needed.

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