scholarly journals Cranial facet joint injuries in percutaneous lumbar pedicle screw placement: a matched-pair analysis comparing intraoperative 3D navigation and conventional fluoroscopy

2020 ◽  
Author(s):  
Marc Hohenhaus ◽  
Ralf Watzlawick ◽  
Waseem Masalha ◽  
Florian Volz ◽  
Christoph Scholz ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Facet Joint ◽  
Screw Placement ◽  
Matched Pair ◽  
Pedicle Screw Placement ◽  
3D Navigation ◽  
Matched Pair Analysis ◽  
Joint Injuries ◽  
Pair Analysis ◽  
Lumbar Pedicle

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 Maintenance of Integrity of Upper Facet Joints during Simulated Percutaneous Pedicle Screw Insertion Using 2D versus 3D Planning

2019 ◽  
Vol 80 (04) ◽  
pp. 269-276
Author(s):  
Eleftherios Archavlis ◽  
Florian Ringel ◽  
Sven Kantelhardt
Keyword(s):  
Pedicle Screw ◽  
Facet Joint ◽  
Pedicle Screws ◽  
Entry Point ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Data Set ◽  
Screw Insertion ◽  
Percutaneous Pedicle Screw ◽  
Lumbar Pedicle

Background No studies have directly and quantitatively compared two-dimensional (2D) and three-dimensional (3D) planning as applied during conventional percutaneous or navigated percutaneous pedicle screw placement. Study Aims This lumbar pedicle-based stabilization simulation study aimed to investigate the risk of upper facet joint violation (FJV) during posterior percutaneous pedicle screw placement with conventional 2D planning of screw implantation (as a model for fluoroscopically guided screws) compared with 3D planning (as used with navigation techniques). Methods The placement of monosegmental lumbar pedicle screws using the data sets of 250 consecutive patients was simulated. Conventional surgery (using 2D fluoroscopic images anteroposterior and lateral view) was compared with screw placement using the 3D reconstruction of the planning mode of the same software. Results The 2D planning resulted in 140 upper FJVs (28% of cases), whereas 3D planning resulted in only 24 upper FJVs (4.8% of cases) (p < 0.05). Among those spinal segments with severe facet joint arthropathy, Pathria grades 3 and 4, FJV was significantly higher (p < 0.05) in the 2D-planned screws (64.7%) than in the 3D-planned screws (11.2%). A more lateral (mean distance: 3.5 mm) and inferior (mean distance: 2.5 mm) offset of the pedicle entry point and a larger medial angulation of the trajectory (mean angle: 9 degrees) were observed for the 3D-planned screws at all levels. Conclusion This study demonstrates that the use of 2D planning is associated with a higher risk of upper FJV than when a 3D imaging data set is used. Using a more lateral and inferior entry point for fluoroscopically guided pedicle screws could reduce the rate of FJV in percutaneous pedicle screw placement.

scholarly journals Confirmation of accuracy/inaccuracy of lumbar pedicle screw placement using postoperative computed tomography

2021 ◽  
Vol 12 ◽  
pp. 518
Author(s):  
Mohamed M. Arnaout ◽  
Magdy O. ElSheikh ◽  
Mansour A. Makia
Keyword(s):  
Computed Tomography ◽  
Lumbar Spine ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Operative Intervention ◽  
Screw Placement ◽  
Lumbar Spine Surgery ◽  
Pedicle Screw Placement ◽  
Lumbar Pedicle ◽  
Ct Studies

Background: Transpedicular screws are extensively utilized in lumbar spine surgery. The placement of these screws is typically guided by anatomical landmarks and intraoperative fluoroscopy. Here, we utilized 2-week postoperative computed tomography (CT) studies to confirm the accuracy/inaccuracy of lumbar pedicle screw placement in 145 patients and correlated these findings with clinical outcomes. Methods: Over 6 months, we prospectively evaluated the location of 612 pedicle screws placed in 145 patients undergoing instrumented lumbar fusions addressing diverse pathology with instability. Routine anteroposterior and lateral plain radiographs were obtained 48 h after the surgery, while CT scans were obtained at 2 postoperative weeks (i.e., ideally these should have been performed intraoperatively or within 24–48 h of surgery). Results: Of the 612 screws, minor misplacement of screws (≤2 mm) was seen in 104 patients, moderate misplacement in 34 patients (2–4 mm), and severe misplacement in 7 patients (>4 mm). Notably, all the latter 7 (4.8% of the 145) patients required repeated operative intervention. Conclusion: Transpedicular screw insertion in the lumbar spine carries the risks of pedicle medial/lateral violation that is best confirmed on CT rather than X-rays/fluoroscopy alone. Here, we additional found 7 patients (4.8%) who with severe medial/lateral pedicle breach who warranting repeated operative intervention. In the future, CT studies should be performed intraoperatively or within 24–48 h of surgery to confirm the location of pedicle screws and rule in our out medial or lateral pedicle breaches.

806 Virtual Fluoroscopy Improves Lumbar Pedicle Screw Placement Accuracy

Neurosurgery ◽  
2000 ◽  
Vol 47 (2) ◽  
pp. 530-530 ◽  
Author(s):  
Kevin T. Foley ◽  
Ramesh L. Sahjpaul ◽  
Gerald R. Rodts
Keyword(s):  
Pedicle Screw ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Placement Accuracy ◽  
Lumbar Pedicle

Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial

2019 ◽  
Vol 30 (5) ◽  
pp. 615-622 ◽  
Author(s):  
Xiaoguang Han ◽  
Wei Tian ◽  
Yajun Liu ◽  
Bo Liu ◽  
Da He ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Radiation Exposure ◽  
Pedicle Screw ◽  
Spinal Surgery ◽  
Facet Joint ◽  
Postoperative Hospital Stay ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
The Mean

OBJECTIVEThe object of this study was to compare the safety and accuracy of pedicle screw placement using the TiRobot system versus conventional fluoroscopy in thoracolumbar spinal surgery.METHODSPatients with degenerative or traumatic thoracolumbar spinal disorders requiring spinal instrumentation were randomly assigned to either the TiRobot-assisted group (RG) or the freehand fluoroscopy-assisted group (FG) at a 1:1 ratio. The primary outcome measure was the accuracy of screw placement according to the Gertzbein-Robbins scale; grades A and B (pedicle breach < 2 mm) were considered clinically acceptable. In the RG, discrepancies between the planned and actual screw placements were measured by merging postoperative CT images with the trajectory planning images. Secondary outcome parameters included proximal facet joint violation, duration of surgery, intraoperative blood loss, conversion to freehand approach in the RG, postoperative hospital stay, and radiation exposure.RESULTSA total of 1116 pedicle screws were implanted in 234 patients (119 in the FG, and 115 in the RG). In the RG, 95.3% of the screws were perfectly positioned (grade A); the remaining screws were graded B (3.4%), C (0.9%), and D (0.4%). In the FG, 86.1% screws were perfectly positioned (grade A); the remaining screws were graded B (7.4%), C (4.6%), D (1.4%), and E (0.5%). The proportion of clinically acceptable screws was significantly greater in the RG than in the FG (p < 0.01). In the RG, the mean deviation was 1.5 ± 0.8 mm for each screw. The most common direction of screw deviation was lateral in the RG and medial in the FG. Two misplaced screws in the FG required revision surgery, whereas no revision was required in the RG. None of the screws in the RG violated the proximal facet joint, whereas 12 screws (2.1%) in the FG violated the proximal facet joint (p < 0.01). The RG had significantly less blood loss (186.0 ± 255.3 ml) than the FG (217.0 ± 174.3 ml; p < 0.05). There were no significant differences between the two groups in terms of surgical time and postoperative hospital stay. The mean cumulative radiation time was 81.5 ± 38.6 seconds in the RG and 71.5 ± 44.2 seconds in the FG (p = 0.07). Surgeon radiation exposure was significantly less in the RG (21.7 ± 11.5 μSv) than in the FG (70.5 ± 42.0 μSv; p < 0.01).CONCLUSIONSTiRobot-guided pedicle screw placement is safe and useful in thoracolumbar spinal surgery.Clinical trial registration no.: NCT02890043 (clinicaltrials.gov)

Joint kinematics of surgeons during lumbar pedicle screw placement

2015 ◽  
Vol 12 (4) ◽  
pp. 701-709
Author(s):  
Jeong-Yoon Park ◽  
Kyung-Hyun Kim ◽  
Sung-Uk Kuh ◽  
Dong-Kyu Chin ◽  
Keun-Su Kim ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Joint Kinematics ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Lumbar Pedicle

A comparison of two techniques in image-guided thoracic pedicle screw placement: a retrospective study of 37 patients and 277 pedicle screws

2007 ◽  
Vol 7 (4) ◽  
pp. 393-398 ◽  
Author(s):  
Gregory P. Lekovic ◽  
Eric A. Potts ◽  
Dean G. Karahalios ◽  
Graham Hall
Keyword(s):  
Pedicle Screw ◽  
Image Guidance ◽  
Vascular Complications ◽  
Pedicle Screws ◽  
Guidance System ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
3D Navigation ◽  
Thoracic Pedicle Screw ◽  
Computed Tomography Scanning

Object The goal of this study was to compare the accuracy of thoracic pedicle screw placement aided by two different image-guidance modalities. Methods The charts of 40 consecutive patients who had undergone stabilization of the thoracic spine between January 2003 and January 2005 were retrospectively reviewed. Three patients were excluded from the study because, on the basis of preoperative findings, small pedicle diameter precluded the use of pedicle screws. Thus, a total of 37 patients had 277 screws placed with the aid of either virtual fluoroscopy or isocentric C-arm 3D navigation. The indications for surgery included trauma, degenerative disease, and tumor, and were similar in both groups. All 37 patients underwent postoperative computed tomography scanning, and an independent reviewer graded all screws based on axial, sagittal, and coronal projections for a full determination of the placement of the screw in the pedicle. Results The rate of unintended perforations was found to depend on pedicle diameter (p < 0.0001). There were no statistical differences between groups with regard to rate or grade of cortical perforations. Overall, the rate and grade of perforations was low, and there were no neurological or vascular complications. Conclusions The authors have shown that either image-guidance system may be used with a high degree of accuracy and safety. Because both systems were found to be comparably safe and accurate, the choice of image-guidance modality may be determined by the level of surgeon comfort and/or availability of the system.

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