A Prospective Analysis of Intraoperative Electromyographic Monitoring of Pedicle Screw Placement With Computed Tomographic Scan Confirmation

Abstract BACKGROUND: The learning and development of technical skills are paramount for neurosurgical trainees. External influences and a need for maximizing efficiency and proficiency have encouraged advancements in simulator-based learning models. OBJECTIVE: To confirm the importance of establishing an educational curriculum for teaching minimally invasive techniques of pedicle screw placement using a computer-enhanced physical model of percutaneous pedicle screw placement with simultaneous didactic and technical components. METHODS: A 2-hour educational curriculum was created to educate neurosurgical residents on anatomy, pathophysiology, and technical aspects associated with image-guided pedicle screw placement. Predidactic and postdidactic practical and written scores were analyzed and compared. Scores were calculated for each participant on the basis of the optimal pedicle screw starting point and trajectory for both fluoroscopy and computed tomographic navigation. RESULTS: Eight trainees participated in this module. Average mean scores on the written didactic test improved from 78% to 100%. The technical component scores for fluoroscopic guidance improved from 58.8 to 52.9. Technical score for computed tomography—navigated guidance also improved from 28.3 to 26.6. CONCLUSION: Didactic and technical quantitative scores with a simulator-based educational curriculum improved objectively measured resident performance. A minimally invasive spine simulation model and curriculum may serve a valuable function in the education of neurosurgical residents and outcomes for patients.

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Computed tomographic evaluation of thoracic pedicle screw placement in idiopathic scoliosis

Journal of Pediatric Orthopaedics B ◽

10.1097/bpb.0b013e328344105c ◽

2011 ◽

Vol 20 (4) ◽

pp. 195-198 ◽

Cited By ~ 8

Author(s):

Luciano M.R. Rodrigues ◽

Rodrigo J. Nicolau ◽

Carlo Milani

Keyword(s):

Idiopathic Scoliosis ◽

Pedicle Screw ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Computed Tomographic ◽

Thoracic Pedicle Screw

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Facet Violation With Percutaneous Pedicle Screw Placement: Impact of 3D Navigation and Facet Orientation

HSS Journal ® ◽

10.1177/15563316211026324 ◽

2021 ◽

pp. 155633162110263

Author(s):

Ting Cong ◽

Ahilan Sivaganesan ◽

Christopher M. Mikhail ◽

Avani S. Vaishnav ◽

James Dowdell ◽

...

Keyword(s):

Pedicle Screw ◽

Screw Placement ◽

Radiographic Measurement ◽

Pedicle Screw Placement ◽

3D Navigation ◽

3 Dimensional ◽

Computed Tomographic ◽

Percutaneous Pedicle Screw ◽

Facet Orientation ◽

Placement Accuracy

Background: The gold standard for percutaneous pedicle screw placement is 2-dimensional (2D) fluoroscopy. Data are sparse on the accuracy of 3-dimensional (3D) navigation percutaneous screw placement in minimally invasive spine procedures. Objective: We sought to compare a single surgeon’s percutaneous pedicle screw placement accuracy using 2D fluoroscopy versus 3D navigation, as well as to investigate the effect of facet orientation on facet violation when using 2D fluoroscopy. Methods: We conducted a retrospective radiographic study of consecutive cohort of patients who underwent percutaneous lumbar instrumentation using either 2D fluoroscopy or 3D navigation. All procedures were performed by a single surgeon at 2 academic institutions between 2011 and 2018. Radiographic measurement of screw accuracy was assessed using a postoperative computed tomographic scan. The primary outcome was facet violation, and secondary outcomes were endplate/tip breaches, the Gertzbein-Robbins classification for cortical breaches, and the Simplified Screw Accuracy grade. Statistical comparisons were made between screws placed using 2D fluoroscopy versus 3D navigation. Axial facet angles were also measured to correlate with facet violation rates. Results: In the 138 patients included, 376 screws were placed with fluoroscopy and 193 with navigation. Superior (unfused) level facet violation was higher with 2D fluoroscopy than with 3D navigation (9% vs 0.5%), which comprises the main cause for poor screw placement. Axial facet angles exceeding 45° at L4 and 60° at L5 were correlated with facet violations. Conclusion: This retrospective study found that 3D navigation is associated with lower facet violation rates in percutaneous lumbar pedicle screw placement when compared with 2D fluoroscopy. These findings suggest that 3D navigation may be of particular value when facet joints are coronally oriented.

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Computer-assisted Fluoroscopic Targeting System for Pedicle Screw Insertion

Neurosurgery ◽

10.1097/00006123-200010000-00017 ◽

2000 ◽

Vol 47 (4) ◽

pp. 872-878 ◽

Cited By ~ 93

Author(s):

William W. Choi ◽

Barth A. Green ◽

Allan D. O. Levi

Keyword(s):

Pedicle Screw ◽

Preclinical Study ◽

Guidance System ◽

Screw Placement ◽

Computer Assisted ◽

Pedicle Screw Placement ◽

End Effector ◽

Screw Insertion ◽

Computed Tomographic ◽

Fluoroscopic Imaging

Abstract OBJECTIVE Biplanar fluoroscopic imaging linked to a computer-driven mechanical end-effector is under development as a targeting system for spinal surgery. This technology has the potential to enhance standard intraoperative fluoroscopic information for localization of the pedicle entry point and trajectory, and it may be an effective alternative to the computed tomography-based image-guided system (IGS) in pedicle screw placement. A preclinical study to assess the accuracy and time efficiency of this system versus a conventional IGS was conducted. METHODS Pedicle screw placement was performed in six cadavers from T1 to S1 levels using the ViewPoint IGS (Picker International, Inc., Cleveland, OH) on one side versus the Fluorotactic guidance system (Z-Kat, Inc., Miami, FL) on the other side. Of 216 possible pedicles, 208 were instrumented; 8 pedicle diameters were too small or were not adequately imaged. Postinsertion, each pedicle was assessed for the presence and location of cortical perforation using computed tomographic scanning and direct visualization. RESULTS The number of successful screw placements was 89 (87.3%) of 102 for IGS and 87 (82.1%) of 106 for the Fluorotactic guidance system, respectively. The mean time to register and operate on one level using the Fluorotactic guidance system was 14:34 minutes (minutes:seconds), compared with 6:50 minutes using the IGS. The average fluoroscope time was 4.6 seconds per pedicle. CONCLUSION Our data indicate that this first-generation fluoroscopy-based targeting system can significantly assist the surgeon in pedicle screw placement. The overall accuracy is comparable to an IGS, especially in the region of T9–L5. A second-generation system with a faster end-effector and user-friendly interface should significantly reduce the operating and fluoroscope time.

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Thoracic Pedicle Screw Placement Guided by Computed Tomographic Measurements

Journal of Spinal Disorders ◽

10.1097/00002517-199906000-00010 ◽

1999 ◽

Vol 10 (3) ◽

pp. 222???226

Author(s):

Rongming Xu ◽

Nabil A. Ebraheim ◽

Matthew E. Shepherd ◽

Richard A. Yeasting

Keyword(s):

Pedicle Screw ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Computed Tomographic ◽

Thoracic Pedicle Screw

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Accuracy of Pedicle Screw Placement for Lumbar Fusion using Anatomic Landmarks versus Open Laminectomy: A Comparison of Two Surgical Techniques in Cadaveric Specimens

Operative Neurosurgery ◽

10.1227/01.neu.0000219942.12160.5c ◽

2006 ◽

Vol 59 (suppl_1) ◽

pp. ONS-13-ONS-19 ◽

Cited By ~ 1

Author(s):

Aftab Karim ◽

Debi Mukherjee ◽

Jorge Gonzalez-Cruz ◽

Alan Ogden ◽

Donald Smith ◽

...

Keyword(s):

Pedicle Screw ◽

Lumbar Fusion ◽

Entry Point ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Anatomic Landmarks ◽

Computed Tomographic ◽

Entry Points ◽

Tomographic Analysis ◽

The Ideal

Abstract OBJECTIVE: We determined whether the accuracy of lumbar pedicle screw placement is optimized by performing a laminectomy before screw placement with screw entry point and trajectory being guided by pedicle visualization and palpation (Technique 1). This technique was compared with a technique using anatomic landmarks for pedicle screw placement (Technique 2). The biomechanical stability of the instrumented constructs, in the absence and presence of a laminectomy, was also compared. METHODS: Twelve L1–L3 specimens were harvested from fresh cadavers. The intact laminectomy and instrumented spines were biomechanically tested in flexion and extension, lateral bending, and axial rotation. Laminectomies were performed in six of the 12 specimens before pedicle screw placement using Technique 1. The remaining six specimens underwent pedicle screw and rod fixation using Technique 2. Computed tomographic images were obtained for all instrumented specimens. Deviation of the screws from the ideal entry point or trajectory was analyzed to quantitatively compare the two techniques. RESULTS: Computed tomographic analysis of the specimens showed that all screw placements were within the pedicles. Scatter plot analysis demonstrated that screws placed using Technique 2 were more likely to have the combination of entry points and trajectories medial to the ideal entry point and trajectory. Laminectomy did not weaken the final pedicle screw and rod-fixated constructs. CONCLUSION: All screw placements were grossly within the confines of the pedicles, regardless of technique, as evidenced by computed tomographic analysis. Furthermore, the anatomic landmark technique and the open laminectomy technique yielded biomechanically equivalent pedicle screw and rod-fixated constructs.

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