scholarly journals Accuracy assessment of pedicle screw insertion with patient specific 3D‑printed guides through superimpose CT-analysis in thoracolumbar spinal deformity surgery

2021 ◽  
Author(s):  
J. Cool ◽  
J. van Schuppen ◽  
M. A. de Boer ◽  
B. J. van Royen
Keyword(s):  
Pedicle Screw ◽  
Spinal Deformity ◽  
Screw Placement ◽  
Patient Specific ◽  
Pedicle Screw Placement ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Spinal Deformity Surgery ◽  
Ct Analysis ◽  
3D Printed

Abstract Purpose In order to avoid pedicle screw misplacement in posterior spinal deformity surgery, patient specific 3D‑printed guides can be used. An accuracy assessment of pedicle screw insertion can be obtained by superimposing CT-scan images from a preoperative plan over those of the postoperative result. The aim of this study is to report on the accuracy of drill guide assisted pedicle screw placement in thoracolumbar spinal deformity surgery by means of a superimpose CT-analysis. Methods Concomitant with the clinical introduction of a new technique for drill guide assisted pedicle screw placement, the accuracy of pedicle screw insertion was analyzed in the first patients treated with this technique by using superimpose CT-analysis. Deviation from the planned ideal intrapedicular screw trajectory was classified according to the Gertzbein scale. Results Superimpose CT-analysis of 99 pedicle screws in 5 patients was performed. The mean linear deviation was 0.92 mm, the mean angular deviation was 2.92° with respect to the preoperatively planned pedicle screw trajectories. According to the Gertzbein scale, 100% of screws were found to be positioned within the “safe zone”. Conclusion The evaluated patient specific 3D-printed guide technology was demonstrated to constitute a safe and accurate tool for precise pedicle screw insertion in spinal deformity surgeries. Superimpose CT-analysis showed a 100% accuracy of pedicle screw placement without any violation of the pedicle wall or other relevant structures. We recommend a superimpose CT-analysis for the first consecutive patients when introducing new technologies into daily clinical practice, such as intraoperative imaging, navigation or robotics.

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 Patient-specific template-guided versus standard freehand lumbar pedicle screw implantation: a randomized controlled trial

2021 ◽  
pp. 1-7
Author(s):  
José Miguel Spirig ◽  
Shayan Golshani ◽  
Nadja A. Farshad-Amacker ◽  
Mazda Farshad
Keyword(s):  
Randomized Controlled Trial ◽  
Radiation Exposure ◽  
Pedicle Screw ◽  
Controlled Trial ◽  
Patient Specific ◽  
Pedicle Screw Placement ◽  
Surgical Time ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Randomized Controlled

OBJECTIVE Patient-specific template-guided (TG) pedicle screw placement currently achieves the highest reported accuracy in cadaveric and early clinical studies, with reports of reduced use of radiation and less surgical time. However, a clinical randomized controlled trial (RCT) eliminating potential biases is lacking. This study compares TG and standard freehand (FH) pedicle screw insertion techniques in an RCT. METHODS Twenty-four patients (mean age 64 years, 9 men and 15 women) scheduled consecutively and independently from this study for 1-, 2-, or 3-level lumbar fusion were randomized to either the FH (n = 12) or TG (n = 12) group. Accuracy of pedicle screw placement, intraoperative parameters, and short-term complications were compared. RESULTS A total of 112 screws (58 FH and 54 TG screws) were implanted in the lumbar spine. Radiation exposure was significantly less in the TG group (78.0 ± 46.3 cGycm2) compared with the FH group (234.1 ± 138.1 cGycm2, p = 0.001). There were 4 pedicle screw perforations (6.9%) in the FH group and 2 (3.7%) in the TG group (p > 0.99), with no clinical consequences. Clinically relevant complications were 1 postoperative pedicle fracture in the FH group (p > 0.99), 1 infection in the FH group, and 2 infections in the TG group (p > 0.99). There were no significant differences in surgical exposure time, screw insertion time, overall surgical time, or blood loss between the FH and TG groups. CONCLUSIONS In this RCT, patient-specific TG pedicle screw insertion in the lumbar region achieved a high accuracy, but not better than a standardized FH technique. Even if intraoperative radiation exposure is less with the TG technique, the need for a preoperative CT scan counterbalances this advantage. However, more difficult trajectories might reveal potential benefits of the TG technique and need further research.

scholarly journals Utilization of the 3D-printed spine model for freehand pedicle screw placement in complex spinal deformity correction

2018 ◽  
Vol 4 (2) ◽  
pp. 319-327 ◽  
Author(s):  
Lee A. Tan ◽  
Ketan Yerneni ◽  
Alexander Tuchman ◽  
Xudong J. Li ◽  
Meghan Cerpa ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Spinal Deformity ◽  
Deformity Correction ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Spine Model ◽  
3D Printed

Less Invasive Pediatric Spinal Deformity Surgery: The Case for Robotic-Assisted Placement of Pedicle Screws

2021 ◽  
pp. 155633162110278
Author(s):  
Kyle W. Morse ◽  
Hila Otremski ◽  
Kira Page ◽  
Roger F. Widmann
Keyword(s):  
Pedicle Screw ◽  
Current Literature ◽  
Spinal Deformity ◽  
Spinal Surgery ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Robotic Assisted ◽  
Less Invasive ◽  
Spinal Deformity Surgery

Introduction: Pediatric spinal deformity involves a complex 3-dimensional (3D) deformity that increases the risk of pedicle screw placement due to the close proximity of neurovascular structures. To increase screw accuracy, improve patient safety, and minimize surgical complications, the placement of pedicle screws is evolving from freehand techniques to computer-assisted navigation and to the introduction of robotic-assisted placement. Purpose: The aim of this review was to review the current literature on the use of robotic navigation in pediatric spinal deformity surgery to provide both an error analysis of these techniques and to provide recommendations to ensure its safe application. Methods: A narrative review was conducted in April 2021 using the MEDLINE (PubMed) database. Studies were included if they were peer-reviewed retrospective or prospective studies, included pediatric patients, included a primary diagnosis of pediatric spine deformity, utilized robotic-assisted spinal surgery techniques, and reported thoracic or lumbar pedicle screw breach rates or pedicle screw malpositioning. Results: In the few studies published on the use of robotic techniques in pediatric spinal deformity surgery, several found associations between the technology and increased rates of screw placement accuracy, reduced rates of breach, and minimal complications. All were retrospective studies. Conclusions: Current literature is of a low level of evidence; nonetheless, the findings suggest the accuracy and safety of robotic-assisted spinal surgery in pediatric pedicle screw placement. The introduction of robotics may drive further advances in less invasive pediatric spinal deformity surgery. Further study is warranted.

Accuracy of pedicle screw placement using patient-specific template guide system

2021 ◽  
Author(s):  
Ryo Fujita ◽  
Itaru Oda ◽  
Hirohito Takeuchi ◽  
Shigeki Oshima ◽  
Masanori Fujiya ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Placement ◽  
Patient Specific ◽  
Pedicle Screw Placement ◽  
Guide System

scholarly journals Does the application of Robotics improve outcomes of pedicle screw insertion in spine surgery compared to conventional fluoroscopy guidance? A protocol for Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Vishal Kumar ◽  
Vishnu Baburaj ◽  
Prasoon Kumar ◽  
Sarvdeep Singh Dhatt
Keyword(s):  
Systematic Review ◽  
Pedicle Screw ◽  
Clinical Outcomes ◽  
Spine Surgery ◽  
Meta Analysis ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Fluoroscopy Guidance

AbstractBackgroundPedicle screw insertion is routinely carried out in spine surgery that has traditionally been performed under fluoroscopy guidance. Robotic guidance has recently gained popularity in order to improve the accuracy of screw placement. However, it is unclear whether the use of robotics alters the accuracy of screw placement or clinical outcomes.ObjectivesThis systematic review aims to compare the results of pedicle screws inserted under fluoroscopy guidance, with those inserted under robotic guidance, in terms of both short-term radiographic outcomes, as well as long-term clinical outcomes.MethodsThis systematic review will be conducted according to the PRISMA guidelines. A literature search will be conducted on the electronic databases of PubMed, Embase, Scopus, and Ovid with a pre-determined search strategy. A manual bibliography search of included studies will also be done. Original articles in English that directly compare pedicle screw insertion under robotic guidance to those inserted under fluoroscopy guidance will be included. Data on outcomes will be extracted from included studies and analysis carried out with the help of appropriate software.

Accuracy of Patient-Specific Template-Guided Versus Freehand Cervical Pedicle Screw Placement from C2 to C7: A Randomized Cadaveric Study

2019 ◽  
Vol 126 ◽  
pp. e803-e813 ◽  
Author(s):  
Manuel Moser ◽  
Mazda Farshad ◽  
Nadja A. Farshad-Amacker ◽  
Michael Betz ◽  
José Miguel Spirig
Keyword(s):  
Pedicle Screw ◽  
Cadaveric Study ◽  
Screw Placement ◽  
Patient Specific ◽  
Pedicle Screw Placement ◽  
Cervical Pedicle Screw ◽  
Cervical Pedicle
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