scholarly journals A Retrospective Review of Spinal Radiofrequency Neurotomy Procedures in Patients with Metallic Posterior Spinal Instrumentation – Is it Safe?

2018 ◽  
Vol 1 (21;1) ◽  
pp. E477-E482 ◽  
Author(s):  
Stephen Ellwood
Keyword(s):  
Adverse Events ◽  
Pedicle Screw ◽  
Research Team ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Medial Branch ◽  
Radiofrequency Neurotomy ◽  
Spine Intervention ◽  
Chart Abstraction ◽  
Metallic Hardware

Background: Recent studies have shown that medial branch radiofrequency neurotomy (RFN) procedures done at the level of a pedicle screw can increase pedicle screw temperature, and it has been speculated that pedicle screw heating may cause thermal injury. There has been a limited amount of investigation into the real-world safety profile of RFN procedures in patients with pedicle screws. Objectives: We aim to demonstrate that the occurrence of serious adverse events is rare for a medial branch RFN procedure completed at a level with metallic spinal hardware when performed according to the Spine Intervention Society practice standards. Study Design: This study involved retrospective chart reviews of every patient who received an RFN procedure for spinal facet joint pain during the 5-year time period from 2012-2016. Setting: The research took place within a single university-based interventional pain management center. Methods: The study sample included 507 patient charts. Data collection included patient demographics, RF denervation sites at a level with metallic hardware, and all serious RF-related complications that could be attributable to heated metallic hardware. The research team developed medical-chart abstraction criteria for each of the following categorized complications: a) superficial burns, b) deep burns, c) denervation of dorsal ramus, d) denervation of ventral ramus, and e) coagulation of a spinal vascular structure. Results: Of the 36 patients who met the inclusion criteria for this study, 43.6% were men and 56.4% were women. The mean age was 59.5 years old, with an age range of 25 to 87 years. There were a total of 56 ablations performed at a level with metallic spinal hardware, of which 11 were cervical, 44 were lumbar, and 1 was thoracic . There were zero documented complications found among our patient population in any of the 5 categories of serious complications. Limitations: As a retrospective chart review, this study was dependent on the availability and accuracy of medical records. Chart abstraction criteria for each outcome measure were developed by the research team without scientific testing. Conclusions: There have been no reported complications attributable to hardware temperature increases when performing medial branch RFNs at the level of a pedicle screw. For safety, it is important to use multiplanar fluoroscopic imaging techniques to ensure that the RFN cannula is not in contact with the pedicle screw. Key Words: Radiofrequency neurotomy, medial branch nerve ablation, safety, thermal injuries, metallic spinal hardware, pedicle screws, lateral mass screws, cervical facet joints, severe complications, adverse events

Image-Guided Spinal Surgery and Robotics in MIS: Where Are We Now?

2018 ◽  
Vol 1 (2) ◽  
pp. 2
Author(s):  
Chiung Chyi Shen
Keyword(s):  
Pedicle Screw ◽  
Spinal Surgery ◽  
Surgical Navigation ◽  
Improve Patient Safety ◽  
Intraoperative Imaging ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Computer Assisted ◽  
Navigation Systems ◽  
Image Guided

Use of pedicle screws is widespread in spinal surgery for degenerative, traumatic, and oncological diseases. The conventional technique is based on the recognition of anatomic landmarks, preparation and palpation of cortices of the pedicle under control of an intraoperative C-arm (iC-arm) fluoroscopy. With these conventional methods, the median pedicle screw accuracy ranges from 86.7% to 93.8%, even if perforation rates range from 21.1% to 39.8%.The development of novel intraoperative navigational techniques, commonly referred to as image-guided surgery (IGS), provide simultaneous and multiplanar views of spinal anatomy. IGS technology can increase the accuracy of spinal instrumentation procedures and improve patient safety. These systems, such as fluoroscopy-based image guidance ("virtual fluoroscopy") and computed tomography (CT)-based computer-guidance systems, have sensibly minimized risk of pedicle screw misplacement, with overall perforation rates ranging from between 14.3% and 9.3%, respectively."Virtual fluoroscopy" allows simultaneous two-dimensional (2D) guidance in multiple planes, but does not provide any axial images; quality of images is directly dependent on the resolution of the acquired fluoroscopic projections. Furthermore, computer-assisted surgical navigation systems decrease the reliance on intraoperative imaging, thus reducing the use of intraprocedure ionizing radiation. The major limitation of this technique is related to the variation of the position of the patient from the preoperative CT scan, usually obtained before surgery in a supine position, and the operative position (prone). The next technological evolution is the use of an intraoperative CT (iCT) scan, which would allow us to solve the position-dependent changes, granting a higher accuracy in the navigation system. 

scholarly journals Surgical treatment of degenerative and traumatic spinal diseases with expandable screws in patients with osteoporosis: 2-year follow-up clinical study

2016 ◽  
Vol 25 (5) ◽  
pp. 610-619 ◽  
Author(s):  
Roberto Gazzeri ◽  
Raffaelino Roperto ◽  
Claudio Fiore
Keyword(s):  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Posterior Fixation ◽  
Spinal Diseases ◽  
Fixation Failure ◽  
Increased Risk ◽  
Screw Breakage ◽  
The Mean

OBJECTIVE Pedicle screw instrumentation of the osteoporotic spine carries an increased risk of screw loosening, pullout, and fixation failure. A variety of techniques have been used clinically to improve pedicle screw fixation in the presence of compromised bone. Pedicle screws may be augmented with cement, but this may lead to cement leakage and result in disastrous consequences. To avoid these complications, a multiaxial expandable pedicle screw has been developed. This was a prospective, single-center study designed to evaluate the clinical results of patients with osteoporosis with traumatic and degenerative spinal diseases treated with expandable pedicle screws. METHODS Thirty-three patients (mean age 61.4 years) with osteoporosis and traumatic or degenerative spinal diseases underwent spinal posterior fixation with expandable screws. Preoperative and postoperative visual analog scale (VAS) for pain and Oswestry Disability Index (ODI) questionnaire scores were obtained. The immediate postoperative screw position was measured and compared with the final position on lateral plain radiographs and axial CT scans at the 1- and 2-year follow-up examinations. RESULTS A total of 182 pedicle screws were used, including 174 expandable and 8 regular screws. The mean preoperative patient VAS score improved from 8.2 to 3.6 after surgery. The mean ODI score improved from 83.7% before surgery to 29.7% after the operation and to 36.1% at the final follow-up. No screw migration had occurred at the 1-year follow-up, but 1 screw breakage/migration was visualized on spinal radiography at the 2-year follow-up. CONCLUSIONS The results of this study show that the multiaxial expandable pedicle screw is a safe and practical technique for patients with osteoporosis and various spinal diseases and adds a valuable tool to the armamentarium of spinal instrumentation.

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 Assessment of the outcome of percutaneous pedicle screws in management of degenerative and traumatic dorsal and lumbar pathologies

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Ayman Hussein ◽  
Hamdy Ibrahim ◽  
Hazem Mashaly ◽  
Sameh Hefny ◽  
Abdelrahman El Gayar
Keyword(s):  
Minimally Invasive ◽  
Functional Outcome ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Morbidity Rate ◽  
Percutaneous Technique ◽  
Percutaneous Pedicle Screw

Abstract Background Percutaneous pedicle screw technique is relatively a recent technique that evolved the concept of posterior spinal instrumentation, utilizing familiar fluoroscopic landmarks to guide the procedure of screws insertion, which despite being technically demanding, it avoids the Musculo-ligamentous damage associated with the conventional posterior technique. Aim of the work This study aims to report our experience in managing traumatic and degenerative spine pathologies by the minimally invasive percutaneous technique and assessing its radiological and functional outcome. Materials and methods A prospective observational study that included the analysis of the functional, operative, biochemical, and radiological outcomes of 20 patients who underwent uniplanar fluoroscopic-guided dorsal and/or lumbar percutaneous pedicle screw fixation procedures with or without fusion using the sextant, longitude, and Spineart system and any reported complications between January 2018 and December 2019. Results The clinical and radiological analysis of 100 percutaneous pedicle screws in degenerative (n:11) and traumatic (n:9) dorsal and/or lumbar cases revealed that the biomechanical stabilizing characteristics are comparable to the conventional posterior approach with the added benefits of the paraspinal muscle-sparing. Satisfactory functional outcome represented in the improvement of the postoperative back pain visual analog score and Oswestry Disability Index Score with acceptable morbidity and complications rate was noticed. Conclusions Percutanous pedicle screw fixation is a landmark in the evolution of the minimally invasive spine surgery which can be a safe alternative to the conventional posterior muscle stripping technique with a comparable functional and radiological outcome and good biomechanical profile and an acceptable morbidity rate.

scholarly journals Development of a Quantitative Method to Evaluate Pedicle Screw Loosening After Spinal Instrumentation Using Digital Tomosynthesis

2021 ◽  
Author(s):  
Kentaro Mataki ◽  
Yuki Hara ◽  
Eriko Okano ◽  
Katsuya Nagashima ◽  
Hiroshi Noguchi ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Posterior Spinal Fusion ◽  
Standing Position ◽  
Digital Tomosynthesis ◽  
Cross Sectional ◽  
Tomographic Images ◽  
Spinal Fusion Surgery ◽  
Displacement Angle

Abstract BackgroundIn general, the diagnosis of pedicle screw (PS) loosening is evaluated qualitatively based on the presence of a radiolucent area around the implant wider than 1 mm on plain radiographs and computed tomography (CT). Digital tomosynthesis is a novel imaging technology that can acquire reconstructed tomographic images of patients in different postures with relatively low radiation. In this study, PS loosening is evaluated quantitatively by measuring the PS displacement angle in the vertebrae using digital tomosynthesis. MethodsWe evaluated 41 patients who underwent posterior spinal fusion surgery using PS. The 72 pedicle screws at the cranial end of the fused segments were evaluated. The patients were divided in two groups, one with PS loosening (7 patients, 12 screws) and the other without PS loosening (34 patients, 60 screws), based on conventional CT findings. All patients underwent tomosynthesis in two different postures during a single CT session. ResultsThe displacement angles of the PS in patients in a lying position and in a standing position were measured using selected slices of the same cross-sectional view from digital tomosynthesis. The displacement angle was significantly greater in the PS loosening group (5.7°) than in the group without PS loosening (0.6°) (p＜0.01). Based on the ROC analysis, the optimal cut-off value of the PS displacement angle for identification of loosened screws was 1.7° with a sensitivity of 100% and specificity of 93% (AUC=0.98). ConclusionsThis new method using digital tomosynthesis has the potential to aid diagnosis of PS loosening quantitatively and more accurately than conventional evaluations.

scholarly journals The use of radiolucent (carbon fibre-reinforced polymer) pedicle screw fixation for serial monitoring of clear cell meningioma: a case report

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Daniel Ho ◽  
Thanh Ha Thy Phan ◽  
Ralph Jasper Mobbs ◽  
Rajesh Reddy
Keyword(s):  
Local Recurrence ◽  
Carbon Fibre ◽  
Pedicle Screw ◽  
Clear Cell ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Radiotherapy Planning ◽  
Clear Cell Meningioma ◽  
Carbon Fibre Reinforced Polymer

Abstract Clear cell meningioma is an uncommon variant of meningioma associated with high rates of local recurrence and metastasis. However, monitoring for local recurrence may be complicated by metal-related artefacts generated by spinal instrumentation. We present a patient with recurrent lumbar atypical clear cell meningioma, which had been resected multiple times throughout her adolescence. Due to extensive bone and ligament resection, posterior stabilization of the lumbar spine with pedicle screws was required. To ensure clear postoperative visualization of the spinal cord for local recurrence, a carbon fibre/polyetheretherketone (CF/PEEK) pedicle screw and rod construct was used. CF/PEEK has non-inferior biomechanical and biocompatible properties to titanium, with a clear advantage of radiolucency to assist in detecting the local recurrence early and facilitating accurate radiotherapy planning.

scholarly journals Complications of Robotic Spine Surgery

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Daniel Myers ◽  
Gordon Mao ◽  
Alexander Kwong-Tak Yu ◽  
Donald M Whiting
Keyword(s):  
Pedicle Screw ◽  
Spine Surgery ◽  
Complication Rate ◽  
Surgical Complications ◽  
Surgical Complication ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Medical Complication ◽  
Complication Rates ◽  
Robotic Assisted

Abstract INTRODUCTION Robotic assisted spine surgery is becoming increasingly widespread during spinal instrumentation cases. We report our early experience utilizing robotic assisted spinal instrumentation. The aim of the study is to review complications experienced during robotic assisted spinal instrumentation including analysis of pedicle screw accuracy, medical, and surgical complications. METHODS This study was performed as a descriptive, retrospective study. We reviewed cases over the course of 12 mo and examined all operative and postoperative data including pedicle screw accuracy, medical, and surgical complications related to the surgery and hospital stay. Pedicle screw accuracy was assessed utilizing the Gertzbein–Robbins scale. RESULTS The study included 67 consecutive patients undergoing 68 robotic-assisted procedures. Patient ages ranged from 20 to 90 yr. There were 37 males and 30 females. Indications for surgery included degenerative disease 33, trauma 24, tumor 5, and infection 1. There were a total of 592 pedicle screws placed. A total of 26 (4.3%) screws were revised intraoperatively using the robot. An additional 32 (5.4%) screws were aborted from robotic assistance. Pedicle screw accuracy was noted to be excellent with 97% of screws rated as clinically acceptable. There were 4 deaths (5.8%), 18 patients (26%) experienced a medical complication, 26 patients (38%) experienced a surgical complication and 6 patients (9%) experienced both a medical and surgical complication. A total of 38 patients (55%) experienced any morbidity or mortality related to surgery. Mean operative time was 277 min. CONCLUSION We report our initial experience with robotic-assisted spine surgery. Pedicle screw accuracy was noted to be high. We experienced a broad array of medical and surgical complications. The high complication rate may be due to long operative times and presence of a learning curve utilizing the robot. Further study is warranted to note if more experience decreases complication rates. It is unclear if the complication rate is significantly different compared to traditional methods of spinal instrumentation.

Clinical accuracy and initial experience with augmented reality–assisted pedicle screw placement: the first 205 screws

2021 ◽  
pp. 1-7
Author(s):  
Ann Liu ◽  
Yike Jin ◽  
Ethan Cottrill ◽  
Majid Khan ◽  
Erick Westbroek ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Lower Extremity Weakness ◽  
Head Mounted Display ◽  
Clinical Accuracy

OBJECTIVE Augmented reality (AR) is a novel technology which, when applied to spine surgery, offers the potential for efficient, safe, and accurate placement of spinal instrumentation. The authors report the accuracy of the first 205 pedicle screws consecutively placed at their institution by using AR assistance with a unique head-mounted display (HMD) navigation system. METHODS A retrospective review was performed of the first 28 consecutive patients who underwent AR-assisted pedicle screw placement in the thoracic, lumbar, and/or sacral spine at the authors’ institution. Clinical accuracy for each pedicle screw was graded using the Gertzbein-Robbins scale by an independent neuroradiologist working in a blinded fashion. RESULTS Twenty-eight consecutive patients underwent thoracic, lumbar, or sacral pedicle screw placement with AR assistance. The median age at the time of surgery was 62.5 (IQR 13.8) years and the median body mass index was 31 (IQR 8.6) kg/m2. Indications for surgery included degenerative disease (n = 12, 43%); deformity correction (n = 12, 43%); tumor (n = 3, 11%); and trauma (n = 1, 4%). The majority of patients (n = 26, 93%) presented with low-back pain, 19 (68%) patients presented with radicular leg pain, and 10 (36%) patients had documented lower extremity weakness. A total of 205 screws were consecutively placed, with 112 (55%) placed in the lumbar spine, 67 (33%) in the thoracic spine, and 26 (13%) at S1. Screw placement accuracy was 98.5% for thoracic screws, 97.8% for lumbar/S1 screws, and 98.0% overall. CONCLUSIONS AR depicted through a unique HMD is a novel and clinically accurate technology for the navigated insertion of pedicle screws. The authors describe the first 205 AR-assisted thoracic, lumbar, and sacral pedicle screws consecutively placed at their institution with an accuracy of 98.0% as determined by a Gertzbein-Robbins grade of A or B.

scholarly journals P.174 Accuracy of pedicle screw placement with X-ray versus O-arm image-guided navigation

2021 ◽  
Vol 48 (s3) ◽  
pp. S69-S70
Author(s):  
L Neuburger ◽  
Y Cheng ◽  
DR Fourney
Keyword(s):  
Pedicle Screw ◽  
Odds Ratio ◽  
Three Dimensional ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Two Dimensional ◽  
Pedicle Screw Placement ◽  
X Ray ◽  
Image Guided

Background: Image-guided navigation is routinely used in spine surgery to improve placement of pedicle screws. However, most reports have relied on two-dimensional X-ray evaluation to determine accuracy of screw positioning. In this study, computed tomography (CT) and O-arm imaging enabled a detailed three-dimensional comparison of screw placement. The objective was to compare the accuracy of pedicle screw placement with intraoperative X-ray versus O-arm image-guided navigation. Methods: This was a retrospective analysis of image-guided pedicle screw placement in patients who underwent spinal instrumentation. Post-operative CT and O-arm imaging allowed grading of screw accuracy based on pedicle breaches. Clinical outcomes included patient and operative factors. Results: Pedicle screws were placed in 208 patients (1116 screws). Three-dimensional O-arm guidance was utilized for 126 patients, while the remainder underwent two-dimensional X-ray imaging and post-operative CT assessment. O-arm navigation was associated with improved pedicle screw accuracy: pedicle breaches were more likely to be low grade (odds ratio 2.84, p=0.001) and less likely to be medium grade (odds ratio 0.35, p=0.007) or high grade (odds ratio 0.31, p=0.025). Conclusions: This study provided a detailed comparison of surgical accuracy with X-ray versus O-arm guidance. Navigation with O-arm imaging is associated with benefits in spinal instrumentation, without impacting operative risks for patients.

scholarly journals Intraoperative image-guided spinal navigation: technical pitfalls and their avoidance

2014 ◽  
Vol 36 (3) ◽  
pp. E3 ◽  
Author(s):  
Gazanfar Rahmathulla ◽  
Eric W. Nottmeier ◽  
Stephen M. Pirris ◽  
H. Gordon Deen ◽  
Mark A. Pichelmann
Keyword(s):  
Pedicle Screw ◽  
3D Imaging ◽  
Image Guidance ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Navigation Systems ◽  
Spinal Fixation ◽  
Pedicle Screw Placement ◽  
Screw Insertion ◽  
Spinal Navigation

Spinal instrumentation has made significant advances in the last two decades, with transpedicular constructs now widely used in spinal fixation. Pedicle screw constructs are routinely used in thoracolumbar-instrumented fusions, and in recent years, the cervical spine as well. Three-column fixations with pedicle screws provide the most rigid form of posterior stabilization. Surgical landmarks and fluoroscopy have been used routinely for pedicle screw insertion, but a number of studies reveal inaccuracies in placement using these conventional techniques (ranging from 10% to 50%). The ability to combine 3D imaging with intraoperative navigation systems has improved the accuracy and safety of pedicle screw placement, especially in more complex spinal deformities. However, in the authors' experience with image guidance in more than 1500 cases, several potential pitfalls have been identified while using intraoperative spinal navigation that could lead to suboptimal results. This article summarizes the authors' experience with these various pitfalls using spinal navigation, and gives practical tips on their avoidance and management.

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