Economic study: a cost-effectiveness analysis of an intraoperative compared with a preoperative image-guided system in lumbar pedicle screw fixation in patients with degenerative spondylolisthesis

Object Symptomatic adjacent-segment lumbar disease (ASLD) after lumbar fusion often requires subsequent surgical intervention. The authors report utilizing cortical bone trajectory (CBT) pedicle screw fixation with intraoperative CT (O-arm) image-guided navigation to stabilize spinal levels in patients with symptomatic ASLD. This unique technique results in the placement of 2 screws in the same pedicle (1 traditional pedicle trajectory and 1 CBT) and obviates the need to remove preexisting instrumentation. Methods The records of 5 consecutive patients who underwent lumbar spinal fusion with CBT and posterior interbody grafting for ASLD were retrospectively reviewed. All patients underwent screw trajectory planning with the O-arm in conjunction with the StealthStation navigation system. Basic demographics, operative details, and radiographic and clinical outcomes were obtained. Results The average patient age was 69.4 years (range 58–82 years). Four of the 5 surgeries were performed with the Minimal Access Spinal Technologies (MAST) Midline Lumbar Fusion (MIDLF) system. The average operative duration was 218 minutes (range 175–315 minutes). In the entire cohort, 5.5-mm cortical screws were placed in previously instrumented pedicles. The average hospital stay was 2.8 days (range 2–3 days) and there were no surgical complications. All patients had more than 6 months of radiographic and clinical follow-up (range 10–15 months). At last follow-up, all patients reported improved symptoms from their preoperative state. Radiographic follow-up showed Lenke fusion grades of A or B. Conclusions The authors present a novel fusion technique that uses CBT pedicle screw fixation in a previously instrumented pedicle with intraoperative O-arm guided navigation. This method obviates the need for hardware removal. This cohort of patients experienced good clinical results. Computed tomography navigation was critical for accurate CBT screw placement at levels where previous traditional pedicle screws were already placed for symptomatic ASLD.

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Clinical and radiological effect of medialized cortical bone trajectory for lumbar pedicle screw fixation in patients with degenerative lumbar spondylolisthesis: study protocol for a randomized controlled trial (mPACT)

Trials ◽

10.1186/s13063-018-2504-z ◽

2018 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Anja Tschugg ◽

Pujan Kavakebi ◽

Sebastian Hartmann ◽

Sara Lener ◽

Christoph Wipplinger ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Cortical Bone ◽

Pedicle Screw ◽

Screw Fixation ◽

Controlled Trial ◽

Pedicle Screw Fixation ◽

Randomized Controlled ◽

Degenerative Lumbar Spondylolisthesis ◽

Lumbar Spondylolisthesis ◽

Lumbar Pedicle

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Supplementary pedicle screw fixation in spinal fusion for degenerative spondylolisthesis in patients aged 65 and over: Outcome after a minimum of 2 years follow-up in 82 patients

Acta Orthopaedica ◽

10.1080/17453670710014789 ◽

2008 ◽

Vol 79 (1) ◽

pp. 67-73 ◽

Cited By ~ 20

Author(s):

Chin-Hsien Wu ◽

Yu-Hsien Kao ◽

Shih-Chieh Yang ◽

Tsai-Sheng Fu ◽

Po-Liang Lai ◽

...

Keyword(s):

Spinal Fusion ◽

Pedicle Screw ◽

Screw Fixation ◽

Degenerative Spondylolisthesis ◽

Pedicle Screw Fixation

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Image-Guided Cervical Pedicle Screw Fixation: Implant Precision and Complications in 67 Consecutive Patients

Global Spine Journal ◽

10.1055/s-0035-1554333 ◽

2015 ◽

Vol 5 (1_suppl) ◽

pp. s-0035-1554333-s-0035-1554333

Author(s):

John Michael Duff ◽

Yves Henchoz ◽

Marc Levivier ◽

Lukas Bobinski

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Cervical Pedicle Screw ◽

Image Guided ◽

Cervical Pedicle

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Effects of different pedicle screw insertion depths on sagittal balance of lumbar degenerative spondylolisthesis, a retrospective comparative study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04736-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Quan Zhou ◽

Jun-xin Zhang ◽

Yi-fei Zheng ◽

Yun Teng ◽

Hui-lin Yang ◽

...

Keyword(s):

Pedicle Screw ◽

Sagittal Balance ◽

Screw Fixation ◽

Degenerative Spondylolisthesis ◽

Leading Edge ◽

Pedicle Screw Fixation ◽

Screw Insertion ◽

Lumbar Degenerative Spondylolisthesis ◽

Screw Group

Abstract Background Few reports to date have evaluated the effects of different pedicle screw insertion depths on sagittal balance and prognosis after posterior lumbar interbody and fusion (PLIF) in patients with lumbar degenerative spondylolisthesis (LDS). Methods A total of 88 patients with single-level PLIF for LDS from January 2018 to December 2019 were enrolled. Long screw group (Group L): 52 patients underwent long pedicle screw fixation (the leading edge of the screw exceeded 80% of the anteroposterior diameter of vertebral body). Short screw group (Group S): 36 patients underwent short pedicle screw fixation (the leading edge of the screw was less than 60% of the anteroposterior diameter of vertebral body). Local deformity parameters of spondylolisthesis including slip degree (SD) and segment lordosis (SL), spino-pelvic sagittal plane parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and lumbar lordosis (LL), Oswestry Disability Index (ODI), and Visual Analog Scale (VAS) for back pain of both groups were compared. Postoperative complications, including vertebral fusion rate and screw loosening rate, were recorded. Results Except that PI in Group S at the final follow-up was not statistically different from the preoperative value (P > 0.05), other parameters were significantly improved compared with preoperative values one month after surgery and at the final follow-up (P < 0.05). There was no significant difference in parameters between Group L and Group S before and one month after surgery (P > 0.05). At the final follow-up, SD, SL, LL, PT and PI-LL differed significantly between the two groups (P < 0.05). Compared with the preoperative results, ODI and VAS in both groups decreased significantly one month after surgery and at the final follow-up (P < 0.05). Significant differences of ODI and VAS were found between the two groups at the final follow-up (P < 0.05). Postoperative complications were not statistically significant between the two groups (P > 0.05). Conclusions PLIF can significantly improve the prognosis of patients with LDS. In terms of outcomes with an average follow-up time of 2 years, the deeper the screw depth is within the safe range, the better the spino-pelvic sagittal balance may be restored and the better the quality of life may be.

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