Radiation Exposure to the Surgeon and the Patient During Low Thoracic and Lumbar Spine Instrumentation, A Prospective Comparison of Navigation Versus Free-Hand Technique

✓ The short-rod/two-claw (SRTC) technique of spine instrumentation was recently introduced for the treatment of thoracic and lumbar spine fractures. The use of this technique in 10 patients harboring wedge compression or burst fractures of the thoracic or lumbar spine is described. Of three patients treated with the construct placed in a distraction mode, the average follow-up loss of angle (the difference between the immediate postoperative and follow-up midsagittal angle as measured on x-ray films) was 18.3°. Of the seven patients in whom the instrumentation was placed in a compression mode, the average observed loss of angle at follow-up examination was 1.6°. Two patients had a preoperative scoliotic deformity at the fracture site. and both deformities were exaggerated by the placement of the SRTC technique in compression. Although no patient experienced an adverse outcome and all achieved a solid fusion, the application of the SRTC technique of universal spine instrumentation in distraction was associated with an exaggerated loss of angle. Loss of angle and deformity exaggeration are not desirable and are preventable by strict patient selection and by applying the construct in a compression mode. It is emphasized that few patients are candidates for this form of instrumentation. When applicable. however, the advantages of decreased pain and stiffness and the elimination of the need for instrumentation removal make the SRTC and related short-segment techniques desirable alternatives to traditional methods of spinal fixation.

Download Full-text

Accuracy of Free-Hand Pedicle Screws in the Thoracic and Lumbar Spine: Analysis of 6816 Consecutive Screws

Neurosurgery ◽

10.1227/neu.0b013e3181fdfaf4 ◽

2011 ◽

Vol 68 (1) ◽

pp. 170-178 ◽

Cited By ~ 132

Author(s):

Scott L. Parker ◽

Matthew J. McGirt ◽

S Harrison. Farber ◽

Anubhav G. Amin ◽

Anne-Marie. Rick ◽

...

Keyword(s):

Lumbar Spine ◽

Radiation Exposure ◽

Pedicle Screw ◽

Pedicle Screws ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Intraoperative Fluoroscopy ◽

Thoracic And Lumbar Spine ◽

Institutional Experience ◽

Screw Diameter

Abstract BACKGROUND: Pedicle screws are used to stabilize all 3 columns of the spine, but can be technically demanding to place. Although intraoperative fluoroscopy and stereotactic-guided techniques slightly increase placement accuracy, they are also associated with increased radiation exposure to patient and surgeon as well as increased operative time. OBJECTIVE: To describe and critically evaluate our 7-year institutional experience with placement of pedicle screws in the thoracic and lumbar spine using a free-hand technique. METHODS: We retrospectively reviewed records of all patients undergoing free-hand pedicle screw placement without fluoroscopy in the thoracic or lumbar spine between June 2002 and June 2009. Incidence and extent of cortical breach by misplaced pedicle screw was determined by review of postoperative computed tomography scans. We defined breach as more than 25% of the screw diameter residing outside of the pedicle or vertebral body cortex. RESULTS: A total of 964 patients received 6816 free-hand placed pedicle screws in the thoracic or lumbar spine. Indications for hardware placement were degenerative/deformity disease (51.2%), spondylolisthesis (23.7%), tumor (22.7%), trauma (11.3%), infection (7.6%), and congenital (0.9%). A total of 115 screws (1.7%) were identified as breaching the pedicle in 87 patients (9.0%). Breach occurred more frequently in the thoracic than the lumbar spine (2.5% and 0.9%, respectively; P < .0001) and was more often lateral (61.3%) than medial (32.8%) or superior (2.5%). T4 (4.1%) and T6 (4.0%) experienced the highest breach rate, whereas L5 and S1 had the lowest breach rate. Eight patients (0.8%) underwent revision surgery to correct malpositioned screws. CONCLUSION: Free-hand pedicle screw placement based on external anatomy alone can be performed with acceptable safety and accuracy and allows avoidance of radiation exposure encountered in fluoroscopic techniques. Image-guided assistance may be most valuable when placing screws between T4 and T6, where breach rates are highest.

Download Full-text

Radiation exposure to the patients in thoracic and lumbar spine fusion using a new intraoperative cone-beam computed tomography imaging technique: a preliminary study

European Spine Journal ◽

10.1007/s00586-017-4968-z ◽

2017 ◽

Vol 26 (11) ◽

pp. 2811-2817 ◽

Cited By ~ 12

Author(s):

Ludovic Kaminski ◽

V. Cordemans ◽

O. Cartiaux ◽

M. Van Cauter

Keyword(s):

Computed Tomography ◽

Lumbar Spine ◽

Radiation Exposure ◽

Cone Beam Computed Tomography ◽

Imaging Technique ◽

Cone Beam ◽

Computed Tomography Imaging ◽

Tomography Imaging ◽

Thoracic And Lumbar Spine ◽

Preliminary Study

Download Full-text

Thoracic and lumbar spine instrumentation

Spine Secrets Plus ◽

10.1016/b978-0-323-06952-6.00038-5 ◽

2012 ◽

pp. 206-213

Author(s):

Edward A. Smirnov ◽

D. Greg Anderson ◽

Vincent J. Devlin

Keyword(s):

Lumbar Spine ◽

Spine Instrumentation ◽

Thoracic And Lumbar Spine

Download Full-text

The sequential hook insertion technique for universal spine instrumentation application

Journal of Neurosurgery ◽

10.3171/jns.1993.79.4.0608 ◽

1993 ◽

Vol 79 (4) ◽

pp. 608-611 ◽

Cited By ~ 3

Author(s):

Edward C. Benzel ◽

Perry A. Ball ◽

Nevan G. Baldwin ◽

Erich P. Marchand

Keyword(s):

Lumbar Spine ◽

Operative Time ◽

Deformity Correction ◽

Insertion Technique ◽

Content Type ◽

Spine Instrumentation ◽

Thoracic And Lumbar Spine ◽

A New Technique ◽

Texas Scottish Rite Hospital ◽

Fine Print

✓ A new technique of universal spine instrumentation insertion for the management of thoracic and lumbar spine instability is presented and the results in 10 patients are described. The technique involves the sequential insertion of Texas Scottish Rite Hospital (TSRH) central-post hooks, followed by hook fixation to the rod; force is then applied with correction of deformity, if needed. This allows for methodical, safe, and rapid instrumentation insertion. The new TSRH central-post hook configuration permits manipulation of the hook/rod relationships to the advantage of the surgeon (and patient) by providing more room for both hook insertion and hook/rod fixation. This technique has reduced operative time, facilitated case of deformity correction, and provided uniformly acceptable early postsurgical results.

Download Full-text

Radiation dose reduction in thoracic and lumbar spine instrumentation using navigation based on an intraoperative cone beam CT imaging system: a prospective randomized clinical trial

European Spine Journal ◽

10.1007/s00586-017-5229-x ◽

2017 ◽

Vol 26 (11) ◽

pp. 2818-2827 ◽

Cited By ~ 9

Author(s):

Nathalie Pireau ◽

Virginie Cordemans ◽

Xavier Banse ◽

Nadia Irda ◽

Sébastien Lichtherte ◽

...

Keyword(s):

Clinical Trial ◽

Lumbar Spine ◽

Radiation Dose ◽

Imaging System ◽

Cone Beam Ct ◽

Cone Beam ◽

Prospective Randomized Clinical Trial ◽

System A ◽

Spine Instrumentation ◽

Thoracic And Lumbar Spine

Download Full-text

Use of the Airo mobile intraoperative CT system versus the O-arm for transpedicular screw fixation in the thoracic and lumbar spine: a retrospective cohort study of 263 patients

Journal of Neurosurgery Spine ◽

10.3171/2018.1.spine17927 ◽

2018 ◽

Vol 29 (4) ◽

pp. 397-406 ◽

Cited By ~ 15

Author(s):

Pietro Scarone ◽

Gabriele Vincenzo ◽

Daniela Distefano ◽

Filippo Del Grande ◽

Alessandro Cianfoni ◽

...

Keyword(s):

Lumbar Spine ◽

Radiation Exposure ◽

Screw Fixation ◽

Transpedicular Screw ◽

Significant Difference ◽

Thoracic And Lumbar Spine ◽

Surgical Data ◽

The Mean ◽

Transpedicular Screw Fixation ◽

Mobile Ct

OBJECTIVENavigation-enabling technology such as 3D-platform (O-arm) or intraoperative mobile CT (iCT-Airo) systems for use in spinal surgery has considerably improved accuracy over that of traditional fluoroscopy-guided techniques during pedicular screw positioning. In this study, the authors compared 2 intraoperative imaging systems with navigation, available in their neurosurgical unit, in terms of the accuracy they provided for transpedicular screw fixation in the thoracic and lumbar spine.METHODSThe authors performed a retrospective analysis of clinical and surgical data of 263 consecutive patients who underwent thoracic and lumbar spine screw placement in the same center. Data on 97 patients who underwent surgery with iCT-Airo navigation (iCT-Airo group) and 166 with O-arm navigation (O-arm group) were analyzed. Most patients underwent surgery for a degenerative or traumatic condition that involved thoracic and lumbar pedicle screw fixation using an open or percutaneous technique. The primary endpoint was the proportion of patients with at least 1 screw not correctly positioned according to the last intraoperative image. Secondary endpoints were the proportion of screws that were repositioned during surgery, the proportion of patients with a postoperative complication related to screw malposition, surgical time, and radiation exposure. A blinded radiologist graded screw positions in the last intraoperative image according to the Heary classification (grade 1–3 screws were considered correctly placed).RESULTSA total of 1361 screws placed in 97 patients in the iCT-Airo group (503 screws) and in 166 in the O-arm group (858 screws) were graded. Of those screws, 3 (0.6%) in the iCT-Airo group and 4 (0.5%) in the O-arm group were misplaced. No statistically significant difference in final accuracy between these 2 groups or in the subpopulation of patients who underwent percutaneous surgery was found. Three patients in the iCT-Airo group (3.1%, 95% CI 0%–6.9%) and 3 in the O-arm group (1.8%, 95% CI 0%–4.0%) had a misplaced screw (Heary grade 4 or 5). Seven (1.4%) screws in the iCT-Airo group and 37 (4.3%) in the O-arm group were repositioned intraoperatively (p = 0.003). One patient in the iCT-Airo group and 2 in the O-arm group experienced postoperative neurological deficits related to hardware malposition. The mean surgical times in both groups were similar (276 [iCT-Airo] and 279 [O-arm] minutes). The mean exposure to radiation in the iCT-Airo group was significantly lower than that in the O-arm group (15.82 vs 19.12 mSv, respectively; p = 0.02).CONCLUSIONSIntroduction of a mobile CT scanner reduced the rate of screw repositioning, which enhanced patient safety and diminished radiation exposure for patients, but it did not improve overall accuracy compared to that of a mobile 3D platform.

Download Full-text