Design and Application of Individualized, 3-Dimensional-Printed Navigation Template for Placing Cortical Bone Trajectory Screws in Middle-Upper Thoracic Spine: Cadaver Research Study

Study Design: Clinical case series describing a novel surgical technique. Objective: Stabilization across the cervicothoracic junction (CTJ) poses technical difficulties which make this procedure challenging. The transition from cervical lordosis to thoracic kyphosis and the orientation of the lateral masses of the cervical spine compared with the pedicles of the thoracic spine create the need to accommodate for 2 planes of alignment when placing instrumentation. A novel surgical technique for instrumentation across the cervicothoracic junction is described. Methods: The use of cortical bone trajectory (CBT) technique for pedicle fixation in the upper thoracic spine is described in combination with cervical lateral mass or pedicle screws. The application in our first 12 patients for stabilization across the CTJ is described. Two case presentations illustrate the technique. Results: All the patients had rod screw constructs without the need to skip levels, there was no requirement for transverse connectors and only 1 plane of contouring was required. Conclusions: The use of CBT technique has not been described for the upper thoracic spine. This technique avoids many technical problems associated with posterior instrumentation of the CTJ. The facility of their use in this application arises from the similar coronal plane entry points as the cervical lateral mass screws compared with the more lateral starting point of traditional thoracic pedicle screws. The technique has clinical equipoise to traditional thoracic pedicle screw insertion but with the benefits of an easier ability to perform the instrumentation and saving levels of fusion.

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Chance Fracture of the Upper Thoracic Spine

American Journal of Roentgenology ◽

10.2214/ajr.185.2.01850555 ◽

2005 ◽

Vol 185 (2) ◽

pp. 555-555 ◽

Cited By ~ 1

Author(s):

Richard H. Daffner

Keyword(s):

Thoracic Spine ◽

Upper Thoracic Spine ◽

Chance Fracture ◽

Upper Thoracic

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Novel free-hand T1 pedicle screw method: Review of 44 consecutive cases

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.139974 ◽

2014 ◽

Vol 05 (04) ◽

pp. 349-354 ◽

Cited By ~ 2

Author(s):

Mark A. Rivkin ◽

Jessica F. Okun ◽

Steven S. Yocom

Keyword(s):

Pedicle Screw ◽

Thoracic Spine ◽

Pedicle Screws ◽

High Rate ◽

Imaging Modalities ◽

Neurological Deficits ◽

Upper Thoracic Spine ◽

Starting Point ◽

Grade 3 ◽

Upper Thoracic

ABSTRACT Summary of Background Data: Multilevel posterior cervical instrumented fusions are becoming more prevalent in current practice. Biomechanical characteristics of the cervicothoracic junction may necessitate extending the construct to upper thoracic segments. However, fixation in upper thoracic spine can be technically demanding owing to transitional anatomy while suboptimal placement facilitates vascular and neurologic complications. Thoracic instrumentation methods include free-hand, fluoroscopic guidance, and CT-based image guidance. However, fluoroscopy of upper thoracic spine is challenging secondary to vertebral geometry and patient positioning, while image-guided systems present substantial financial commitment and are not readily available at most centers. Additionally, imaging modalities increase radiation exposure to the patient and surgeon while potentially lengthening surgical time. Materials and Methods: Retrospective review of 44 consecutive patients undergoing a cervicothoracic fusion by a single surgeon using the novel free-hand T1 pedicle screw technique between June 2009 and November 2012. A starting point medial and cephalad to classic entry as well as new trajectory were utilized. No imaging modalities were employed during screw insertion. Postoperative CT scans were obtained on day 1. Screw accuracy was independently evaluated according to the Heary classification. Results: In total, 87 pedicle screws placed were at T1. Grade 1 placement occurred in 72 (82.8%) screws, Grade 2 in 4 (4.6%) screws and Grade 3 in 9 (10.3%) screws. All Grade 2 and 3 breaches were <2 mm except one Grade 3 screw breaching 2-4 mm laterally. Only two screws (2.3%) were noted to be Grade 4, both breaching medially by less than 2 mm. No new neurological deficits or returns to operating room took place postoperatively. Conclusions: This modification of the traditional starting point and trajectory at T1 is safe and effective. It attenuates additional bone removal or imaging modalities while maintaining a high rate of successful screw placement compared to historical controls.

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P39. Radiographic Outcome of Pedicle Screw Fixation for Upper Thoracic Spine (T1-T5) Fractures

The Spine Journal ◽

10.1016/j.spinee.2006.06.298 ◽

2006 ◽

Vol 6 (5) ◽

pp. 102S-103S

Author(s):

Ralph Mobbs ◽

Charles Fisher ◽

Sandeep Singh

Keyword(s):

Pedicle Screw ◽

Thoracic Spine ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Radiographic Outcome ◽

Upper Thoracic Spine ◽

Upper Thoracic

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FLEXION-DISTRACTION INJURY OF THE UPPER THORACIC SPINE ASSOCIATED WITH TRACHEOESOPHAGEAL PERFORATION

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200206000-00021 ◽

2002 ◽

Vol 84 (6) ◽

pp. 1028-1031 ◽

Cited By ~ 6

Author(s):

SHIH-HAO CHEN ◽

TSUNG-JEN HUANG ◽

YEUNG-JEN CHEN ◽

HUI-PING LIU ◽

ROBERT WEN-WEI HSU

Keyword(s):

Thoracic Spine ◽

Upper Thoracic Spine ◽

Upper Thoracic

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Cortical Bone Trajectory Screw Placement Accuracy with a Patient-Matched 3-Dimensional Printed Guide in Lumbar Spinal Surgery: A Clinical Study

World Neurosurgery ◽

10.1016/j.wneu.2019.05.241 ◽

2019 ◽

Vol 130 ◽

pp. e98-e104 ◽

Cited By ~ 8

Author(s):

Nicola Marengo ◽

Keitaro Matsukawa ◽

Matteo Monticelli ◽

Marco Ajello ◽

Paolo Pacca ◽

...

Keyword(s):

Clinical Study ◽

Cortical Bone ◽

Spinal Surgery ◽

Screw Placement ◽

Cortical Bone Trajectory ◽

3 Dimensional ◽

Placement Accuracy ◽

Lumbar Spinal Surgery ◽

Lumbar Spinal

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Widespread Pressure Pain Sensitivity and Referred Pain from Trigger Points in Patients with Upper Thoracic Spine Pain

Pain Medicine ◽

10.1093/pm/pnz020 ◽

2019 ◽

Vol 20 (7) ◽

pp. 1379-1386 ◽

Cited By ~ 1

Author(s):

Ricardo Ortega-Santiago ◽

Maite Maestre-Lerga ◽

César Fernández-de-las-Peñas ◽

Joshua A Cleland ◽

Gustavo Plaza-Manzano

Keyword(s):

Thoracic Spine ◽

Pain Sensitivity ◽

Trigger Points ◽

Pressure Pain ◽

Upper Thoracic Spine ◽

Upper Trapezius ◽

Spine Pain ◽

Pressure Pain Thresholds ◽

Upper Thoracic ◽

Thoracic Spine Pain

Abstract Objectives The presence of trigger points (MTrPs) and pressure pain sensitivity has been well documented in subjects with neck and back pain; however, it has yet to be examined in people with upper thoracic spine pain. The purpose of this study was to investigate the presence of MTrPs and mechanical pain sensitivity in individuals with upper thoracic spine pain. Methods Seventeen subjects with upper thoracic spine pain and 17 pain-free controls without spine pain participated. MTrPs were examined bilaterally in the upper trapezius, rhomboid, iliocostalis thoracic, levator scapulae, infraspinatus, and anterior and middle scalene muscles. Pressure pain thresholds (PPTs) were assessed over T2, the C5-C6 zygapophyseal joint, the second metacarpal, and the tibialis anterior. Results The numbers of MTrPs between both groups were significantly different (P < 0.001) between patients and controls. The number of MTrPs for each patient with upper thoracic spine pain was 12.4 ± 2.8 (5.7 ± 4.0 active TrPs, 6.7 ± 3.4 latent TrPs). The distribution of MTrPs was significantly different between groups, and active MTrPs within the rhomboid (75%), anterior scalene (65%), and middle scalene (47%) were the most prevalent in patients with upper thoracic spine pain. A higher number of active MTrPs was associated with greater pain intensity and longer duration of pain history. Conclusions This study identified active MTrPs and widespread pain hypersensitivity in subjects with upper thoracic spine pain compared with asymptomatic people. Identifying proper treatment strategies might be able to reduce pain and improve function in individuals with upper thoracic spine pain. However, future studies are needed to examine this.

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