Biomechanical analysis of pedicle screw density in posterior spine instrumentation

Abstract INTRODUCTION Posterior spinal instrumentation for fusion using intraoperative computed tomography (CT) navigation is gaining traction as an alternative to the conventional two-dimensional fluoroscopic-guided approach to percutaneous pedicle screw placement. However, few studies to date have directly compared outcomes of these 2 minimally invasive instrumentation methods. METHODS A consecutive cohort of patients undergoing primary percutaneous posterior lumbar spine instrumentation for spine fusion was retrospectively reviewed. Revision surgeries or cases converted to open were excluded. Accuracy of screw placement was assessed using a postoperative CT scan with blinding to the surgical methods used. The Gertzbein-Robbins classification was used to grade cortical breach: Grade 0 (<0 mm cortical breach), Grade I (<2 mm), Grade II (2-4 mm), Grade III (4-6 mm), and Grade IV (>6 mm). RESULTS CT navigation was found to significantly improve accuracy of screw placement (P < .022). There was significantly more facet violation of the unfused level in the fluoroscopy group vs the CT group (9% vs 0.5%; P < .0001). There was also a higher proportion of poor screw placement in the fluoroscopy group (10.1% vs 3.6%). No statistical difference was found in the rate of tip breach, inferomedial breach, or lateral breach. Regression analysis showed that fluoroscopy had twice the odds of incurring poor screw placement as compared to CT navigation. CONCLUSION This radiographic study comparing screw placement in minimally invasive fluoroscopy- vs CT navigation-guided lumbar spine instrumentation provides evidence that CT navigation significantly improves accuracy of screw placement, especially in optimizing the screw trajectory so as to avoid facet violation. Long-term follow-up studies should be performed to ascertain whether this difference can contribute to an improvement in clinical outcomes.

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Implant Distribution Versus Implant Density in Lenke Type 1 Adolescent Idiopathic Scoliosis: Does the Position of the Screw Matter?

Global Spine Journal ◽

10.1177/2192568220941456 ◽

2020 ◽

pp. 219256822094145

Author(s):

Brian L. Dial ◽

Valentine R. Esposito ◽

Anthony A. Catanzano ◽

Robert D. Fitch ◽

Robert K. Lark

Keyword(s):

Pedicle Screw ◽

Multivariable Analysis ◽

Deformity Correction ◽

Concave Side ◽

Convex Side ◽

Coronal Balance ◽

Screw Density ◽

Coronal Correction ◽

Implant Density

Study Design: Retrospective study. Objective: Previous studies have demonstrated that increased implant density (ID) results in improved coronal deformity correction. However, low-density constructs with strategically placed fixation points may achieve similar coronal correction. The purpose of this study was to identify key zones along the spinal fusion where high ID statistically correlated to improved coronal deformity correction. Our hypothesis was that high ID within the periapical zone would not be associated with increased percent Cobb correction. Methods: We identified patients with Lenke type 1 curves with a minimum 2-year follow up. The instrumented vertebral levels were divided into 4 zones: (1) cephalad zone, (2) caudal zone, (3) apical zone, and (4) periapical zone. High and low percent Cobb correction groups were compared, high percent Cobb group was defined as percent correction >67%. Total ID, total concave ID, total convex ID, and ID within each zone of the curve were compared between the groups. A multivariable analysis was performed to identify independent predictors for coronal correction. Subsequently increased and decreased thoracic kyphosis (TK) groups were compared, increased TK was defined as post-operative TK being larger than preoperative TK and decreased TK was defined as post-operative TK being less than preoperative TK. Results: The cohort included 68 patients. The high percent Cobb group compared with the low percent Cobb group had significantly greater ID for the entire construct, the total concave side, the total convex side, the apical convex zone, the periapical zone, and the cephalad concave zone. The high percent Cobb group had greater pedicle screw density for the total construct, total convex side, and total concave side. In the multivariate model ID and pedicle screw density remained significant for percent Cobb correction. Ability to achieve coronal balance was not statistically correlated to ID ( P = .78). Conclusions: Increased ID for the entire construct, the entire convex side, the entire concave side, and within each spinal zone was associated with improved percent Cobb correction. The ability to achieve coronal balance was not statistically influence by ID. The results of this study support that increasing ID along the entire length of the construct improves percent Cobb correction.

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Corrigendum to “Biomechanical analysis of different types of pedicle screw augmentation: a cadaveric and synthetic bone sample study of instrumented vertebral specimens” [Med. Eng. Phys. 35/10 (2013) 1506–1522]

Medical Engineering & Physics ◽

10.1016/j.medengphy.2015.04.002 ◽

2015 ◽

Vol 37 (7) ◽

pp. 717

Author(s):

Kuo-Hua Chao ◽

Yu-Shu Lai ◽

Wen-Chuan Chen ◽

Chia-Ming Chang ◽

Colin J. McClean ◽

...

Keyword(s):

Pedicle Screw ◽

Bone Sample ◽

Biomechanical Analysis ◽

Synthetic Bone ◽

Screw Augmentation ◽

Different Types

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Initial academic experience and learning curve with robotic spine instrumentation

Neurosurgical FOCUS ◽

10.3171/2017.2.focus175 ◽

2017 ◽

Vol 42 (5) ◽

pp. E4 ◽

Cited By ~ 22

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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Use of the Anatomic Trajectory for Thoracic Pedicle Screw Salvage After Failure/Violation Using the Straight-Forward Technique: A Biomechanical Analysis

Spine ◽

10.1097/01.brs.0000084628.37133.ba ◽

2003 ◽

Vol 28 (18) ◽

pp. 2072-2077 ◽

Cited By ~ 47

Author(s):

Ronald A. Lehman ◽

Timothy R. Kuklo

Keyword(s):

Pedicle Screw ◽

Biomechanical Analysis ◽

Thoracic Pedicle Screw

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Biomechanical Analysis of Pedicle Screw Fixation for Thoracolumbar Burst Fractures

Orthopedics ◽

10.3928/01477447-20160427-09 ◽

2016 ◽

Vol 39 (3) ◽

pp. e514-e518 ◽

Cited By ~ 8

Author(s):

Matthew McDonnell ◽

Kalpit N. Shah ◽

David J. Paller ◽

Nikhil A. Thakur ◽

Sarath Koruprolu ◽

...

Keyword(s):

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Biomechanical Analysis ◽

Thoracolumbar Burst Fractures ◽

Burst Fractures

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Assessment of conformity of actual thoraco-lumbar pedicle screw dimensions to manufacturers’ specifications

Science Progress ◽

10.1177/00368504211035035 ◽

2021 ◽

Vol 104 (3) ◽

pp. 003685042110350

Author(s):

Marian Banas ◽

Nirjhar Hore ◽

Michael Buchfelder ◽

Sebastian Brandner

Keyword(s):

Pedicle Screw ◽

Pedicle Screws ◽

Correct Selection ◽

Experimental Setup ◽

Actual Length ◽

Spine Instrumentation ◽

The Difference ◽

Measured Length ◽

Different Diameters ◽

Selection Of

Although correct selection of pedicle screw dimensions is indispensable to achieving optimum results, manufacturer-specified or intended dimensions may differ from actual dimensions. Here we analyzed the reliability of specifications made by various manufacturers by comparing them to the actual lengths and diameters of pedicle screws in a standardized experimental setup. We analyzed the actual length and diameter of pedicle screws of five different manufacturers. Four different screw lengths and for each length two different diameters were measured. Measurements were performed with the pedicle screws attached to a rod, with the length determined from the bottom of the tulip to the tip of the screw and the diameters determined at the proximal and distal threads. Differences in length of > 1 mm were found between the manufacturers’ specifications and our actual measurements in 24 different pedicle screws. The highest deviation of the measured length from the manufacturers’ specification was 3.2 mm. The difference in length between the shortest and longest screw with identical specifications was 3.4 mm. The highest deviation of the measured proximal thread diameters and the manufacturer’s specifications was 0.5 mm. The diameter of the distal thread depends on the shape of the pedicle screw and hence varies between manufacturers in conical screws. We found clear differences in the length of pedicle screws with identical manufacturer specifications. Since differences between the actual dimensions and the dimensions indicated by the manufacturer may vary, this needs to be taken into account during the planning of spine instrumentation.

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