Does intraoperative CT navigation increase the accuracy of pedicle screw placement in pediatric spinal deformity surgery? A systematic review and meta-analysis

2021 ◽  
Author(s):  
Keith D. Baldwin ◽  
Manasa Kadiyala ◽  
Divya Talwar ◽  
Wudbhav N. Sankar ◽  
John M. Flynn ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pedicle Screw ◽  
Spinal Deformity ◽  
Meta Analysis ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Intraoperative Ct ◽  
Spinal Deformity Surgery

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.

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.

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