Robot-Assisted C2 Pedicle Screw Placement for the Treatment of Hangman’s Fracture

2020 ◽  
pp. 55-64
Author(s):  
Bo Liu ◽  
Jingye Wu ◽  
Huadong Wang ◽  
Wei Tian
Keyword(s):  
Pedicle Screw ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Hangman’S Fracture ◽  
C2 Pedicle Screw ◽  
Hangman's Fracture

scholarly journals Anatomic considerations for C2 pedicle screw placement: the use of computerized tomography measurements

2009 ◽  
Vol 8 (1) ◽  
pp. 80-83
Author(s):  
Adebukoa Onibokun ◽  
Simona Bistazzoni ◽  
Marco Sassi ◽  
Larry T. Khoo
Keyword(s):  
Pedicle Screw ◽  
Computerized Tomography ◽  
Preoperative Planning ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
C2 Pedicle Screw ◽  
Anatomical Knowledge ◽  
Axial Ct ◽  
The Mean ◽  
Pedicle Width

OBJECTIVE: more detailed anatomical knowledge of the C2 pedicle is required to optimize and minimize the risk of screw placement. The aim of this study was to evaluate the linear and angular dimensions of the true C2 pedicle using axial CT. METHODS: ninety three patients (47 males, 46 females mean age 48 years) who had cervical spinal CT imaging performed were evaluated for this study. Axial images of the C2 pedicle were selected and the following pedicle parameters were determined: pedicle width (PW, the mediolateral diameter of the pedicle isthmus, perpendicular to the pedicle axis) and pedicle transverse angle (PTA, that is, the angle between the pedicle axis and the midline of the vertebral body). RESULTS: the overall mean pedicle width was 5.8 1.2mm. The mean pedicle width in males (6.01.3mm) was greater than that in the female subjects (5.6 1.1mm). This difference was not found to be statistically significant (p=.6790). The overall mean pedicle transverse angle was 43.93.9 degrees. The mean PTA in males was 43.23.8 degrees, while that in females was 44.73.7 degrees. CONCLUSION: preoperative planning is absolutely mandatory, particularly in determining not only screw trajectory, but in analyzing individual patient anatomy and reception to a C2 pedicle screw.

scholarly journals Four Year Experience of Robot-Assisted Pedicle Screw Placement: An Australian Prospective Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Jordan Cory ◽  
Mohammed A Awad ◽  
Richard G Bittar
Keyword(s):  
Pedicle Screw ◽  
Spinal Surgery ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Intraoperative Radiation ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery

Abstract INTRODUCTION Robot-assisted surgery has emerged as an innovative and minimally-invasive technique, touted as superior to the traditional free-hand technique of pedicle screw fixation in spinal fusion surgery. Complications of misplaced pedicle screws include inadequate fixation and surgical failure requiring revision, neural injury, cerebrospinal fluid (CSF) leak, vascular injury, and facet joint trauma with sequela of adjacent segment disease. Literature reports an incidence of pedicle screw misplacement in up to 10% with free-hand technique. Robot-assisted surgery has reported superiority with increased accuracy of pedicle screw placement and reduced complication rates. This prospective multi-institutional single cohort analysis reports the outcomes in robot-assisted spinal fusion surgery in Melbourne, Australia over 4 yr. METHODS Data was prospectively collected from 2015 to 2019 from robot-assisted spinal surgeries performed by 2 surgeons across 2 institutions. Postoperative spinal computed tomography (CT) scan was compared to preoperative CT based planning to determine the accuracy of pedicle screw placement to 0.1 mm. Accurate pedicle screw placement was defined as within 2.0 mm from the target. Intraoperative radiation exposure time, operative time and length of hospital stay were also collected. RESULTS The total number of cases was 164 and the total number of screws placed was 744. Accurate pedicle screw placement was 98.65%. Average intraoperative radiation exposure time was 9.9 s. Average operative time for single-level surgery was 74 min. The average length of hospital stay was 2.4 d. CONCLUSION The authors conclude that robot-assisted pedicle screw placement is a safe and highly accurate adjunct to spinal surgery. While robot-assisted spinal surgery significantly improves patient outcomes with reduced patient morbidity and revision rates, it has limitations in primary capital expenditure, consumable costs and, in training and accreditation. It is the authors’ opinion that the robot-assisted spinal surgery technique requires nuanced patient selection and expertise in the traditional free-hand method is still essential in the event of technological failure.

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.

The Vertebral Artery Cave at C2: Anatomic Study with Application to C2 Pedicle Screw Placement

2016 ◽  
Vol 94 ◽  
pp. 368-374 ◽  
Author(s):  
R. Shane Tubbs ◽  
Andre Granger ◽  
Christian Fisahn ◽  
Marios Loukas ◽  
Marc Moisi ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Pedicle Screw ◽  
Screw Placement ◽  
Anatomic Study ◽  
Pedicle Screw Placement ◽  
C2 Pedicle Screw
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