scholarly journals Accuracy of pedicle screw insertion in posterior scoliosis surgery: a comparison between intraoperative navigation and preoperative navigation techniques

2016 ◽  
Vol 26 (6) ◽  
pp. 1756-1764 ◽  
Author(s):  
Wei Zhang ◽  
Tomoyuki Takigawa ◽  
YongGang Wu ◽  
Yoshihisa Sugimoto ◽  
Masato Tanaka ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Intraoperative Navigation ◽  
Scoliosis Surgery ◽  
Screw Insertion ◽  
Pedicle Screw Insertion

Neurological events due to pedicle screw malpositioning with lateral fluoroscopy–guided pedicle screw insertion

2020 ◽  
Vol 33 (6) ◽  
pp. 806-811
Author(s):  
Inge J. M. H. Caelers ◽  
Kim Rijkers ◽  
Sander M. J. van Kuijk ◽  
Henk van Santbrink ◽  
Rob A. de Bie ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Lumbar Fusion ◽  
Intraoperative Navigation ◽  
Ct Scans ◽  
Screw Placement ◽  
Total Study Population ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Screw Malpositioning ◽  
Screw Malposition

OBJECTIVEThe risk of novel postoperative neurological events due to pedicle screw malpositioning in lumbar fusion surgery is minimized by using one of the several image-guided techniques for pedicle screw insertion. These techniques for guided screw insertion range from intraoperative fluoroscopy to intraoperative navigation. A practical technique consists of anatomical identification of the screw entry point followed by lateral fluoroscopy used for guidance during insertion of the screw. This technique is available in most clinics and is less expensive than intraoperative navigation. However, the safety of lateral fluoroscopy–guided pedicle screw placement with regard to novel postoperative neurological events due to screw malposition has been addressed only rarely in the literature. In this study the authors aimed to determine the rate of novel postoperative neurological events due to intraoperative and postoperatively established screw malpositioning during lateral fluoroscopy–assisted screw insertion.METHODSIncluded patients underwent lateral fluoroscopy–assisted lumbosacral screw insertion between January 2012 and August 2017. The occurrence of novel postoperative neurological events was analyzed from patient files. In case of an event, surgical reports were screened for the occurrence of intraoperative screw malposition. Furthermore, postoperative CT scans were analyzed to identify and describe possible screw malposition.RESULTSIn total, 246 patients with 1079 screws were included. Novel postoperative neurological events were present in 36 patients (14.6%). In 8 of these 36 patients (3.25% of the total study population), the neurological events could be directly attributed to screw malposition. Screw malpositioning was caused either by problematic screw insertion with immediate screw correction (4 patients) or by malpositioned screws for which the malposition was established postoperatively using CT scans (4 patients). Three patients with screw malposition underwent revision surgery without subsequent symptom relief.CONCLUSIONSLateral fluoroscopy–assisted lumbosacral screw placement results in low rates of novel postoperative neurological events caused by screw malposition. In the majority of patients suffering from novel postoperative neurological events, these events could not be attributed to screw malpositioning, but rather were due to postoperative neurapraxia of peripheral nerves, neuropathy, or intraoperative traction of nerve roots.

scholarly journals Patient-Specific Templates for Pedicle Screw Insertion in Spinal Fixation Surgery

10.29007/kbf7 ◽  
2018 ◽  
Author(s):  
Mahmoud Hafez ◽  
Mohamed Fouda
Keyword(s):  
Pedicle Screw ◽  
3D Model ◽  
Pedicle Screws ◽  
Ct Scans ◽  
Patient Specific ◽  
Scoliosis Surgery ◽  
Spinal Fixation ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Surgery Patient

The increased use of pedicle screws in scoliosis creates a challenge for accurate and safe placement ofscrew within the pedicle during the scoliosis surgery. Patient-specific templates (PST) is a novelmethod to guide the surgeons for allocating and detecting the positions and trajectories of pediclescrews in scoliosis surgery. Based on CT-scans and according to certain protocol, this technique willallow the surgeon to construct a 3D model of spine and present the stage and vertebrae which containthe most deformed bone. With preplanned surgery on specific software, we can develop an accurateand safe position of pedicle screws and its trajectories. This method has the ability to customize theplacement and the size of each pedicle screw based on the unique morphology and landmarks of thevertebrae.

The Contribution of an Electronic Conductivity Device to the Safety of Pedicle Screw Insertion in Scoliosis Surgery

Spine ◽  
2011 ◽  
Vol 36 (20) ◽  
pp. E1314-E1321 ◽  
Author(s):  
Dror Ovadia ◽  
Akiva Korn ◽  
Michael Fishkin ◽  
David M. Steinberg ◽  
Shlomo Wientroub ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Electronic Conductivity ◽  
Scoliosis Surgery ◽  
Screw Insertion ◽  
Pedicle Screw Insertion

scholarly journals Safety of Pedicle Screws in Adolescent Idiopathic Scoliosis Surgery

2017 ◽  
Vol 11 (6) ◽  
pp. 998-1007 ◽  
Author(s):  
Chris Yin Wei Chan ◽  
Mun Keong Kwan
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screw ◽  
Computer Navigation ◽  
Pedicle Screws ◽  
Aortic Injury ◽  
Scoliosis Surgery ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Pedicle Perforation

<p>To review existing publications on the safety of pedicle screw insertions in adolescent idiopathic scoliosis (AIS). Despite having increased risk for neurological and visceral injuries, the use of pedicle screws have led to increased correction rates in scoliosis surgery. A review was performed on topics pertinent to pedicle screw insertion in AIS, which included pedicle morphometry in AIS, structures at risk during pedicle screw insertion, and accuracy and safety of various pedicle screw insertion techniques. The importance of computer navigation and future research regarding pedicle screw placement in AIS were also briefly reviewed. Many authors have reported abnormal pedicle anatomy in AIS. Injury to the neural structures was highest over the apical region, whereas aortic injury was the highest at T5 and T10. In the proximal thoracic spine, the esophagus could be injured even with screws as short as 25 mm. Overall pedicle perforation rates for perforations &gt;0 and &gt;2 mm (assessed by computed tomography) ranged from 6.4% to 65.0% and 3.7% to 29.9%, respectively. The critical pedicle perforation (&gt;2 mm excluding lateral thoracic) and anterior perforation (&gt;0 mm) rates was reported to range from 1.5% to 14.5% and 0.0% to 16.1%, respectively. Pedicle perforation rates were lower with the use of computer navigation. The incidence of neurological adverse events after scoliosis surgery was 0.06%–1.9%. Aortic injury has only been observed in case reports. According to the available literature, pedicle screw insertion in AIS is considered safe with low rates of clinical adverse events. Moreover, the use of navigation technology has been shown to reduce pedicle perforation rates.</p>

Accuracy of powered surgical instruments compared with manual instruments for pedicle screw insertion: Evaluation using o-arm-based navigation in scoliosis surgery

2018 ◽  
Vol 23 (5) ◽  
pp. 765-769 ◽  
Author(s):  
Toshiaki Kotani ◽  
Tsutomu Akazawa ◽  
Tsuyoshi Sakuma ◽  
Keita Nakayama ◽  
Shunji Kishida ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Surgical Instruments ◽  
Scoliosis Surgery ◽  
Screw Insertion ◽  
Pedicle Screw Insertion

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.

Thoracic Pedicle Screw Insertion in Scoliosis Using Posteroanterior C-arm rotation Method

2005 ◽  
Vol 12 (2) ◽  
pp. 123
Author(s):  
Young Joon Ahn ◽  
Choon Sung Lee ◽  
Ji Hyo Kim ◽  
Kyeong Il Jeong ◽  
Yung Tae Kim
Keyword(s):  
Pedicle Screw ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Rotation Method ◽  
Thoracic Pedicle Screw
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