scholarly journals Percutaneous Pedicle Screws Positioning by means of the “Scotty Dog” Imaging Monitoring Technique in Spine Surgery: A Case Series

2016 ◽  
Vol 35 (01) ◽  
pp. 031-038
Author(s):  
José Galvão ◽  
Piero Scarparo ◽  
Humberto Bortolo Neto ◽  
Pil Choi ◽  
Adriano Garcia
Keyword(s):  
Spine Surgery ◽  
Case Series ◽  
Pedicle Screws ◽  
Monitoring Technique

Ninety-day complication, revision, and readmission rates for current-generation robot-assisted thoracolumbar spinal fusion surgery: results of a multicenter case series

2021 ◽  
pp. 1-8
Author(s):  
Jason I. Liounakos ◽  
Asham Khan ◽  
Karen Eliahu ◽  
Jennifer Z. Mao ◽  
Christopher R. Good ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Revision Surgery ◽  
Readmission Rate ◽  
Revision Rate ◽  
Case Series ◽  
Pedicle Screws ◽  
Robot Assisted ◽  
Readmission Rates ◽  
Current Generation ◽  
Guidance Systems

OBJECTIVE Robotics is a major area for research and development in spine surgery. The high accuracy of robot-assisted placement of thoracolumbar pedicle screws is documented in the literature. The authors present the largest case series to date evaluating 90-day complication, revision, and readmission rates for robot-assisted spine surgery using the current generation of robotic guidance systems. METHODS An analysis of a retrospective, multicenter database of open and minimally invasive thoracolumbar instrumented fusion surgeries using the Mazor X or Mazor X Stealth Edition robotic guidance systems was performed. Patients 18 years of age or older and undergoing primary or revision surgery for degenerative spinal conditions were included. Descriptive statistics were used to calculate rates of malpositioned screws requiring revision, as well as overall complication, revision, and readmission rates within 90 days. RESULTS In total, 799 surgical cases (Mazor X: 48.81%; Mazor X Stealth Edition: 51.19%) were evaluated, involving robot-assisted placement of 4838 pedicle screws. The overall intraoperative complication rate was 3.13%. No intraoperative implant-related complications were encountered. Postoperatively, 129 patients suffered a total of 146 complications by 90 days, representing an incidence of 16.1%. The rate of an unrecognized malpositioned screw resulting in a new postoperative radiculopathy requiring revision surgery was 0.63% (5 cases). Medical and pain-related complications unrelated to hardware placement accounted for the bulk of postoperative complications within 90 days. The overall surgical revision rate at 90 days was 6.63% with 7 implant-related revisions, representing an implant-related revision rate of 0.88%. The 90-day readmission rate was 7.13% with 2 implant-related readmissions, representing an implant-related readmission rate of 0.25% of cases. CONCLUSIONS The results of this multicenter case series and literature review suggest current-generation robotic guidance systems are associated with low rates of intraoperative and postoperative implant-related complications, revisions, and readmissions at 90 days. Future outcomes-based studies are necessary to evaluate complication, revision, and readmission rates compared to conventional surgery.

scholarly journals Complications and Revisions After Spine Surgery in Patients With Skeletal Dysplasia: Have We Improved?

2021 ◽  
pp. 219256822199478
Author(s):  
Karim Shafi ◽  
Francis Lovecchio ◽  
Maria Sava ◽  
Michael Steinhaus ◽  
Andre Samuel ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Skeletal Dysplasia ◽  
Spinal Surgery ◽  
Cardiovascular Health ◽  
Surgical Complication ◽  
Case Series ◽  
Neurologic Complication ◽  
Complication Rates ◽  
Retrospective Case ◽  
Average Patient

Study Design: Retrospective case series. Objective: To report contemporary rates of complications and subsequent surgery after spinal surgery in patients with skeletal dysplasia. Methods: A case series of 25 consecutive patients who underwent spinal surgery between 2007 and 2017 were identified from a single institution’s skeletal dysplasia registry. Patient demographics, medical history, surgical indication, complications, and subsequent surgeries (revisions, extension to adjacent levels, or for pathology at a non-contiguous level) were collected. Charlson comorbidity indices were calculated as a composite measure of overall health. Results: Achondroplasia was the most common skeletal dysplasia (76%) followed by spondyloepiphyseal dysplasia (20%); 1 patient had diastrophic dysplasia (4%). Average patient age was 53.2 ± 14.7 years and most patients were in excellent cardiovascular health (88% Charlson Comorbidity Index 0-4). Mean follow up after the index procedure was 57.4 ± 39.2 months (range). Indications for surgery were mostly for neurologic symptoms. The most commonly performed surgery was a multilevel thoracolumbar decompression without fusion (57%). Complications included durotomy (36%), neurologic complication (12%), and infection requiring irrigation and debridement (8%). Nine patients (36%) underwent a subsequent surgery. Three patients (12%) underwent a procedure at a non-contiguous anatomic zone, 3 (12%) underwent a revision of the previous surgery, and another 3 (12%) required extension of their previous decompression or fusion. Conclusions: Surgical complication rates remain high after spine surgery in patients with skeletal dysplasia, likely attributable to inherent characteristics of the disease. Patients should be counseled on their risk for complication and subsequent surgery.

scholarly journals Hi-PoAD technique for Adolescent Idiopathic Scoliosis in Adult: Personal case series

2021 ◽  
Author(s):  
Cesare Faldini ◽  
Francesca Barile ◽  
Fabrizio Perna ◽  
Stefano Pasini ◽  
Michele Fiore ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Idiopathic Scoliosis ◽  
Case Series ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Mechanical Complication ◽  
Non Union ◽  
Implant Retention ◽  
Surgical Data

Abstract Purpose The aim of this article is to present an original surgical technique for the treatment of rigid Adult Idiopathic Scoliosis (AdIS) and the results at minimum 2 years follow-up in a cohort of 40 patients. Methods We retrospectively reviewed 40 patients affected by rigid AdIS, older than 40 years and operated with a posterior one stage surgical technique summarized with the acronym Hi-PoAD, (high-density pedicle screws, Ponte osteotomies, asymmetric rods contouring, direct vertebral rotation). The demographic and surgical data were collected, and the improvement of clinical scores and radiologic parameters was obtained after surgery, at 1 and 2 years and at final follow-up, to assess deformity correction, coronal and sagittal balance and clinical outcome. Results The average follow-up was 2.9 years (range 2–3.5). Average coronal Cobb angle decreased from 65.0° ± 8.4 to 18.9° ± 3.9 (p < 0.01). Rotation sagittal angle decreased from 26.2° ± 4.4° to 12.4° ± 2.8° (p < 0.01). Mean thoracic kyphosis improved from 23.1° ± 3.6° to 36.0° ± 3.9°. SRS-22 improved form 2.9 ± 0.4 to 3.7 ± 0.6 (p < 0.01). Four early post-operative deep wound infections were observed, all healed after debridement and implant retention. No mechanical complication, junctional kyphosis, deformity progression or non-union were recorded at the last follow-up. Conclusions Hi-PoAD technique proved to be safe and effective in the treatment of rigid Adult Idiopathic Scoliosis. The reason for the success is related to the combined strategies adopted, that dissipates corrective forces over several levels, reducing mechanical stress at the screw–bone interface and optimizing corrective potential.

Contribution of Dynamic Surgical Guidance to the Accurate Placement of Pedicle Screws in Deformity Surgery: A Retrospective Case Series

2018 ◽  
Vol 120 ◽  
pp. e466-e471 ◽  
Author(s):  
Mohamed Allaoui ◽  
Fahed Zairi ◽  
Marie-Charlotte Tétard ◽  
John Gaughan ◽  
Daniel Chopin ◽  
...  
Keyword(s):  
Case Series ◽  
Pedicle Screws ◽  
Retrospective Case ◽  
Surgical Guidance ◽  
Retrospective Case Series

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.

Perioperative outcomes for patients on chronic buprenorphine undergoing spine surgery: A case series

2021 ◽  
Vol 17 (7) ◽  
pp. 171-177
Author(s):  
Ashley L. Sharp, MD ◽  
Stephanie Gilbert, MD ◽  
Danielle N. Perez, MD ◽  
Kerstin Kolodzie, MD, PhD, MAS ◽  
Matthias Behrends, MD
Keyword(s):  
Pain Management ◽  
Outcome Measures ◽  
Spine Surgery ◽  
Elective Surgery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Perioperative Outcomes ◽  
Perioperative Pain ◽  
Perioperative Pain Management

Objective: Pain management following spine surgery can be challenging as patients routinely suffer from chronic pain and opioid tolerance. The increasing popularity of buprenorphine use for pain management in this population may further complicate perioperative pain management due to the limited efficacy of other opioids in the presence of buprenorphine. This study describes perioperative management and outcomes in patients on chronic buprenorphine who underwent elective inpatient spine surgery.Design: The authors performed a retrospective chart review of all patients 18 years of age taking chronic buprenorphine for any indication who had elective inpatient spine surgery at a single institution. Perioperative pain management data were analyzed for all patients who underwent spine surgery and were maintained on buprenorphine during their hospital stay.Setting: The study was performed at a single tertiary academic medical center. Main outcome measures: The primary outcome measures were post-operative pain scores and analgesic medication requirements.Results: Twelve patients on buprenorphine underwent inpatient spine surgery. Acceptable pain control was achieved in all cases. Management included preoperative dose limitation of buprenorphine when indicated and the extensive use of multimodal analgesia.Conclusion: The question whether patients presenting for painful, elective surgery should continue using buprenorphine perioperatively is an area of controversy, and the present manuscript provides more evidence for the concept of therapy continuation with buprenorphine.

scholarly journals Microendoscopic Posterior Decompression for Treating Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum: Case Series

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 684
Author(s):  
Satoshi Baba ◽  
Ryutaro Shiboi ◽  
Jyunichi Yokosuka ◽  
Yasushi Oshima ◽  
Yuichi Takano ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Thoracic Spine ◽  
Rating Scale ◽  
Ligamentum Flavum ◽  
Case Series ◽  
Lumbar Spine Surgery ◽  
Thoracic Myelopathy ◽  
Posterior Decompression ◽  
Postoperative Hematoma ◽  
The Mean

Background and Objectives: Ossification of the ligamentum flavum (OLF) is a relatively common cause of thoracic myelopathy. Surgical treatment is recommended for patients with myelopathy. Generally, open posterior decompression, with or without fusion, is selected to treat OLF. We performed minimally invasive posterior decompression using a microendoscope and investigated the efficacy of this approach in treating limited type of thoracic OLF. Materials and Methods: Microendoscopic posterior decompression was performed for 19 patients (15 men and four women) with thoracic OLF with myelopathy aged between 35 to 81 years (mean age, 61.9 years). Neurological examination and preoperative magnetic resonance imaging (MRI) and computed tomography (CT) were used to identify the location and morphology of OLF. The surgery was performed using a midline approach or a unilateral paramedian approach depending on whether the surgeon used a combination of a tubular retractor and endoscope. The numerical rating scale (NRS) and modified Japanese Orthopedic Association (mJOA) scores were compared pre- and postoperatively. Perioperative complications and the presence of other spine surgeries before and after thoracic OLF surgery were also investigated. Results: Four midline and 15 unilateral paramedian approaches were performed. The average operative time per level was 99 min, with minor blood loss. Nine patients had a history of cervical or lumbar spine surgery before or after thoracic spine surgery. The mean pre- and postoperative NRS scores were 6.6 and 5.3, respectively. The mean recovery rate as per the mJOA score was 33.1% (mean follow-up period, 17.8 months), the recovery rates were significantly different between patients who underwent thoracic spine surgery alone (50.5%) and patients who underwent additional spine surgeries (13.7%). Regarding adverse events, one patient experienced dural tear, another experienced postoperative hematoma, and one other underwent reoperation for adjacent thoracic stenosis. Conclusion: Microendoscopic posterior decompression was applicable in limited type of thoracic OLF surgery including beak-shaped type and multi vertebral levels. However, whole spine evaluation is important to avoid missing other combined stenoses that may affect outcomes.

scholarly journals Ambulatory Surgical Centers: Improving Quality of Operative Spine Care?

2020 ◽  
Vol 10 (1_suppl) ◽  
pp. 29S-35S ◽  
Author(s):  
Christopher D. Witiw ◽  
Jefferson R. Wilson ◽  
Michael G. Fehlings ◽  
Vincent C. Traynelis
Keyword(s):  
Health Care Providers ◽  
Spine Surgery ◽  
Cost Optimization ◽  
Safety Data ◽  
Case Series ◽  
Surgical Care ◽  
Narrative Review ◽  
Care Providers ◽  
Ambulatory Surgical Centers

Study Design: Narrative review with commentary. Objective: Present healthcare reform focuses on cost-optimization and quality improvement. Spine surgery has garnered particular attention; owing to its costly nature. Ambulatory Surgical Centers (ASC) present a potential avenue for expenditure reduction. While the economic advantage of ASCs is being defined, cost saving should not come at the expense of quality or safety. Methods: This narrative review focuses on current definitions, regulations, and recent medical literature pertinent to spinal surgery in the ASC setting. Results: The past decade witnessed a substantial rise in the proportion of certain spinal surgeries performed at ASCs. This setting is attractive from the payer perspective as remuneration rates are generally less than for equivalent hospital-based procedures. Opportunity for physician ownership and increased surgeon productivity afforded by more specialized centers make ASCs attractive from the provider perspective as well. These factors serve as extrinsic motivators which may optimize and improve quality of surgical care. Much data supports the safety of spine surgery in the ASC setting. However, health care providers and policy makers must recognize that current regulations regarding safety and quality are less than comprehensive and the data is predominately from selected case-series or comparative cohorts with inherent biases, along with ambiguities in the definition of “outpatient.” Conclusions: ASCs hold promise for providing safe and efficient surgical management of spinal conditions; however, as more procedures shift from the hospital to the ASC rigorous quality and safety data collection is needed to define patient appropriateness and track variability in quality-related outcomes.

scholarly journals Initial academic experience and learning curve with robotic spine instrumentation

2017 ◽  
Vol 42 (5) ◽  
pp. E4 ◽  
Author(s):  
Timur M. Urakov ◽  
Ken Hsuan-kan Chang ◽  
S. Shelby Burks ◽  
Michael Y. Wang
Keyword(s):  
Pedicle Screw ◽  
Spine Surgery ◽  
Pedicle Screws ◽  
Guidance System ◽  
Screw Placement ◽  
Fluoroscopy Time ◽  
Academic Experience ◽  
Robot Assisted ◽  
Spine Instrumentation ◽  
Significant Difference

OBJECTIVESpine surgery is complex and involves various steps. Current robotic technology is mostly aimed at assisting with pedicle screw insertion. This report evaluates the feasibility of robot-assisted pedicle instrumentation in an academic environment with the involvement of residents and fellows.METHODSThe Renaissance Guidance System was used to plan and execute pedicle screw placement in open and percutaneous consecutive cases performed in the period of December 2015 to December 2016. The database was reviewed to assess the usability of the robot by neurosurgical trainees. Outcome measures included time per screw, fluoroscopy time, breached screws, and other complications. Screw placement was assessed in patients with postoperative CT studies. The speed of screw placement and fluoroscopy time were collected at the time of surgery by personnel affiliated with the robot’s manufacturer. Complication and imaging data were reviewed retrospectively.RESULTSA total of 306 pedicle screws were inserted in 30 patients with robot guidance. The average time for junior residents was 4.4 min/screw and for senior residents and fellows, 4.02 min/screw (p = 0.61). Among the residents dedicated to spine surgery, the average speed was 3.84 min/screw, while nondedicated residents took 4.5 min/screw (p = 0.41). Evaluation of breached screws revealed some of the pitfalls in using the robot.CONCLUSIONSNo significant difference regarding the speed of pedicle instrumentation was detected between the operators’ years of experience or dedication to spine surgery, although more participants are required to investigate this completely. On the other hand, there was a trend toward improved efficiency with more cases performed. To the authors’ knowledge, this is the first reported academic experience with robot-assisted spine instrumentation.

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