Short Segment Spinal Instrumentation With Index Vertebra Pedicle Screw Placement for Pathologies Involving the Anterior and Middle Vertebral Column Is as Effective as Long Segment Stabilization With Cage Reconstruction

Spine ◽  
2015 ◽  
Vol 40 (22) ◽  
pp. 1729-1736 ◽  
Author(s):  
Viktor Bartanusz ◽  
Jonathan Harris ◽  
Mark Moldavsky ◽  
Yiwei Cai ◽  
Brandon Bucklen
Keyword(s):  
Pedicle Screw ◽  
Vertebral Column ◽  
Spinal Instrumentation ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Short Segment

scholarly journals Radiographic Accuracy of Percutaneous Pedicle Screw Placement in Fluoroscopic- Versus CT Navigation-Guided Lumbar Spine Instrumentation

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Guang-Ting Cong ◽  
Avani Vaishnav ◽  
Joseph Barbera ◽  
Hiroshi Kumagai ◽  
James Dowdell ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Minimally Invasive ◽  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Intraoperative Computed Tomography ◽  
Percutaneous Pedicle Screw ◽  
Spine Instrumentation ◽  
Surgical Methods

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.

scholarly journals Accuracy of robot-guided versus freehand fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery

2017 ◽  
Vol 42 (5) ◽  
pp. E14 ◽  
Author(s):  
Granit Molliqaj ◽  
Bawarjan Schatlo ◽  
Awad Alaid ◽  
Volodymyr Solomiichuk ◽  
Veit Rohde ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Robotic Assistance ◽  
Anatomical Landmarks ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Screw Insertion ◽  
Freehand Technique

OBJECTIVEThe quest to improve the safety and accuracy and decrease the invasiveness of pedicle screw placement in spine surgery has led to a markedly increased interest in robotic technology. The SpineAssist from Mazor is one of the most widely distributed robotic systems. The aim of this study was to compare the accuracy of robot-guided and conventional freehand fluoroscopy-guided pedicle screw placement in thoracolumbar surgery.METHODSThis study is a retrospective series of 169 patients (83 women [49%]) who underwent placement of pedicle screw instrumentation from 2007 to 2015 in 2 reference centers. Pathological entities included degenerative disorders, tumors, and traumatic cases. In the robot-assisted cohort (98 patients, 439 screws), pedicle screws were inserted with robotic assistance. In the freehand fluoroscopy-guided cohort (71 patients, 441 screws), screws were inserted using anatomical landmarks and lateral fluoroscopic guidance. Patients treated before 2009 were included in the fluoroscopy cohort, whereas those treated since mid-2009 (when the robot was acquired) were included in the robot cohort. Since then, the decision to operate using robotic assistance or conventional freehand technique has been based on surgeon preference and logistics. The accuracy of screw placement was assessed based on the Gertzbein-Robbins scale by a neuroradiologist blinded to treatment group. The radiological slice with the largest visible deviation from the pedicle was chosen for grading. A pedicle breach of 2 mm or less was deemed acceptable (Grades A and B) while deviations greater than 2 mm (Grades C, D, and E) were classified as misplacements.RESULTSIn the robot-assisted cohort, a perfect trajectory (Grade A) was observed for 366 screws (83.4%). The remaining screws were Grades B (n = 44 [10%]), C (n = 15 [3.4%]), D (n = 8 [1.8%]), and E (n = 6 [1.4%]). In the fluoroscopy-guided group, a completely intrapedicular course graded as A was found in 76% (n = 335). The remaining screws were Grades B (n = 57 [12.9%]), C (n = 29 [6.6%]), D (n = 12 [2.7%]), and E (n = 8 [1.8%]). The proportion of non-misplaced screws (corresponding to Gertzbein-Robbins Grades A and B) was higher in the robot-assisted group (93.4%) than the freehand fluoroscopy group (88.9%) (p = 0.005).CONCLUSIONSThe authors’ retrospective case review found that robot-guided pedicle screw placement is a safe, useful, and potentially more accurate alternative to the conventional freehand technique for the placement of thoracolumbar spinal instrumentation.

Percutaneous Pedicle Screw Placement for Spinal Instrumentation

2009 ◽  
pp. 149-158
Author(s):  
Hormoz Sheikh ◽  
Ramiro A. Perez de la Torre ◽  
Oksana Didyuk ◽  
Vickram Tejwani ◽  
Mick J. Perez-Cruet
Keyword(s):  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Percutaneous Pedicle Screw

The effect of simulation training on resident proficiency in thoracolumbar pedicle screw placement using computer-assisted navigation

2021 ◽  
Vol 34 (1) ◽  
pp. 127-134
Author(s):  
Andrew M. Gardeck ◽  
Xuan Pu ◽  
Qiuyu Yang ◽  
David W. Polly ◽  
Kristen E. Jones
Keyword(s):  
Pedicle Screw ◽  
Orthopedic Surgery ◽  
Simulation Training ◽  
Spinal Instrumentation ◽  
Screw Placement ◽  
Computer Assisted ◽  
Pedicle Screw Placement ◽  
Assisted Navigation ◽  
Significant Difference ◽  
Standardized Curriculum

OBJECTIVEResidency work-hour restrictions necessitate efficient, reproducible training. Simulation training for spinal instrumentation placement shows significant benefit to learners’ subjective and objective proficiency. Cadaveric laboratories are most effective but have high cost and low availability. The authors’ goal was to create a low-cost, efficient, reproducible spinal instrumentation placement simulation curriculum for neurosurgery and orthopedic surgery residents using synthetic models and 3D computer-assisted navigation, assessing subjective and objective proficiency with placement of thoracolumbar pedicle screws.METHODSFifteen neurosurgery and orthopedic surgery residents participated in a standardized curriculum with lecture followed by two separate sessions of thoracolumbar pedicle screw placement in a synthetic spine model utilizing 3D computer-assisted navigation. Data were collected on premodule experience, time and accuracy of screw placement, and both subjective and objective ratings of proficiency.RESULTSFifteen of 15 residents demonstrated improvement in subjective (Physician Performance Diagnostic Inventory Scale [PPDIS]) and 14 in objective (Objective Structured Assessment of Technical Skills [OSATS]) measures of proficiency in navigated screw placement with utilization of this curriculum (p < 0.001 for both), regardless of the number of cases of previous experience using thoracolumbar spinal instrumentation. Fourteen of 15 residents demonstrated decreased time per screw placement from session 1 to session 2 (p = 0.006). There was no significant difference in pedicle screw accuracy between session 1 and session 2.CONCLUSIONSA standardized curriculum using synthetic simulation training for navigated thoracolumbar pedicle screw placement results in significantly improved resident subjective and objective proficiency. Development of a nationwide competency curriculum using simulation training for spinal instrumentation placement should be considered for safe, efficient resident training.

scholarly journals Clinical efficiency of operating room-based sliding gantry CT as compared to mobile cone-beam CT-based navigated pedicle screw placement in 853 patients and 6733 screws

2021 ◽  
Author(s):  
Sebastian Ille ◽  
Lea Baumgart ◽  
Thomas Obermueller ◽  
Bernhard Meyer ◽  
Sandro M. Krieg
Keyword(s):  
Pedicle Screw ◽  
Operating Room ◽  
Cone Beam Ct ◽  
Spinal Instrumentation ◽  
High Volume ◽  
Cone Beam ◽  
Screw Placement ◽  
Daily Routine ◽  
Pedicle Screw Placement ◽  
Mean Time

Abstract Purpose Multiple solutions for navigation-guided pedicle screw placement are available. However, the efficiency with regard to clinical and resource implications has not yet been analyzed. The present study’s aim was to analyze whether an operating room sliding gantry CT (ORCT)-based approach for spinal instrumentation is more efficient than a mobile cone-beam CT (CBCT)-based approach. Methods This cohort study included a random sample of 853 patients who underwent spinal instrumentation using ORCT-based or CBCT-based pedicle screw placement due to tumor, degenerative, trauma, infection, or deformity disorders between November 2015 and January 2020. Results More screws had to be revised intraoperatively in the CBCT group due to insufficient placement (ORCT: 98, 2.8% vs. CBCT: 128, 4.0%; p = 0.0081). The mean time of patients inside the OR (Interval 5 Entry–Exit) was significantly shorter for the ORCT group (ORCT: mean, [95% CI] 256.0, [247.8, 264.3] min, CBCT: 283.0, [274.4, 291.5] min; p < 0.0001) based on shorter times for Interval 2 Positioning—Incision (ORCT: 18.8, [18.1, 19.9] min, CBCT: 33.6, [32.2, 35.5] min; p < 0.0001) and Interval 4 Suture—Exit (ORCT: 24.3, [23.6, 26.1] min, CBCT: 29.3, [27.5, 30.7] min; p < 0.0001). Conclusions The choice of imaging technology for navigated pedicle screw placement has significant impact on standard spine procedures even in a high-volume spine center with daily routine in such devices. Particularly with regard to the duration of surgeries, the shorter time needed for preparation and de-positioning in the ORCT group made the main difference, while the accuracy was even higher for the ORCT.

Clinical accuracy and initial experience with augmented reality–assisted pedicle screw placement: the first 205 screws

2021 ◽  
pp. 1-7
Author(s):  
Ann Liu ◽  
Yike Jin ◽  
Ethan Cottrill ◽  
Majid Khan ◽  
Erick Westbroek ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Lower Extremity Weakness ◽  
Head Mounted Display ◽  
Clinical Accuracy

OBJECTIVE Augmented reality (AR) is a novel technology which, when applied to spine surgery, offers the potential for efficient, safe, and accurate placement of spinal instrumentation. The authors report the accuracy of the first 205 pedicle screws consecutively placed at their institution by using AR assistance with a unique head-mounted display (HMD) navigation system. METHODS A retrospective review was performed of the first 28 consecutive patients who underwent AR-assisted pedicle screw placement in the thoracic, lumbar, and/or sacral spine at the authors’ institution. Clinical accuracy for each pedicle screw was graded using the Gertzbein-Robbins scale by an independent neuroradiologist working in a blinded fashion. RESULTS Twenty-eight consecutive patients underwent thoracic, lumbar, or sacral pedicle screw placement with AR assistance. The median age at the time of surgery was 62.5 (IQR 13.8) years and the median body mass index was 31 (IQR 8.6) kg/m2. Indications for surgery included degenerative disease (n = 12, 43%); deformity correction (n = 12, 43%); tumor (n = 3, 11%); and trauma (n = 1, 4%). The majority of patients (n = 26, 93%) presented with low-back pain, 19 (68%) patients presented with radicular leg pain, and 10 (36%) patients had documented lower extremity weakness. A total of 205 screws were consecutively placed, with 112 (55%) placed in the lumbar spine, 67 (33%) in the thoracic spine, and 26 (13%) at S1. Screw placement accuracy was 98.5% for thoracic screws, 97.8% for lumbar/S1 screws, and 98.0% overall. CONCLUSIONS AR depicted through a unique HMD is a novel and clinically accurate technology for the navigated insertion of pedicle screws. The authors describe the first 205 AR-assisted thoracic, lumbar, and sacral pedicle screws consecutively placed at their institution with an accuracy of 98.0% as determined by a Gertzbein-Robbins grade of A or B.

scholarly journals Accuracy of 2D Fluoroscopy with Preoperative CT Fused Neuronavigation in Thoracic and Lumbar Pedicle Screw Insertion

2020 ◽  
pp. 20-25
Author(s):  
Adrian Bălașa ◽  
Corina-Ionela Hurghiș ◽  
Flaviu Tămaș ◽  
Ioan-Alexandru Florian ◽  
Levente Peter ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Spinal Instrumentation ◽  
Pedicle Screw Fixation ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Screw Insertion ◽  
Freehand Technique ◽  
Preoperative Ct ◽  
Placement Accuracy ◽  
The Difference

Aim: Pedicle screw fixation is an established technique in the lumbar and thoracic area. Fluoroscopy-guided screw placement and subsequently navigation have decreased the rate of misplaced screws, but no technique has wholly eliminated this risk. This paper aims to study the difference between the accuracy of the fluoroscopic guided screw placement to that of the 2D fluoroscopy- preop CT fused neuronavigation guided technique, a lesser-used navigation technique.  Material and Methods: This retrospective study reflects our results using both techniques between March 2018 and March 2019 in both degenerative or traumatic spinal pathology for thoracic and lumbar regions. The accuracy of the screw placement was measured using Mirza grading system on postoperative CT images. Results: A total number of 56 patients underwent spinal instrumentation surgery. A total of 274 screws were placed with a mean number of 4.89 screws per patient; 199 screws were implanted using neuronavigation and 75 using the freehand-2D fluoroscopy-guided technique.  The accuracy rate of pedicle screw placement in the freehand technique guided by 2D fluoroscopy was 88,00%. With the use of neuronavigation, the accuracy increased to 89,96%. Conclusion:  Pedicle screw placement accuracy is higher when guided by CT-fluoro matching neuronavigation compared to freehand fluoroscopy-guided technique and can be used in departments where there is no intraoperative O-arm or 3D fluoroscopy available.

scholarly journals P.174 Accuracy of pedicle screw placement with X-ray versus O-arm image-guided navigation

2021 ◽  
Vol 48 (s3) ◽  
pp. S69-S70
Author(s):  
L Neuburger ◽  
Y Cheng ◽  
DR Fourney
Keyword(s):  
Pedicle Screw ◽  
Odds Ratio ◽  
Three Dimensional ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Two Dimensional ◽  
Pedicle Screw Placement ◽  
X Ray ◽  
Image Guided

Background: Image-guided navigation is routinely used in spine surgery to improve placement of pedicle screws. However, most reports have relied on two-dimensional X-ray evaluation to determine accuracy of screw positioning. In this study, computed tomography (CT) and O-arm imaging enabled a detailed three-dimensional comparison of screw placement. The objective was to compare the accuracy of pedicle screw placement with intraoperative X-ray versus O-arm image-guided navigation. Methods: This was a retrospective analysis of image-guided pedicle screw placement in patients who underwent spinal instrumentation. Post-operative CT and O-arm imaging allowed grading of screw accuracy based on pedicle breaches. Clinical outcomes included patient and operative factors. Results: Pedicle screws were placed in 208 patients (1116 screws). Three-dimensional O-arm guidance was utilized for 126 patients, while the remainder underwent two-dimensional X-ray imaging and post-operative CT assessment. O-arm navigation was associated with improved pedicle screw accuracy: pedicle breaches were more likely to be low grade (odds ratio 2.84, p=0.001) and less likely to be medium grade (odds ratio 0.35, p=0.007) or high grade (odds ratio 0.31, p=0.025). Conclusions: This study provided a detailed comparison of surgical accuracy with X-ray versus O-arm guidance. Navigation with O-arm imaging is associated with benefits in spinal instrumentation, without impacting operative risks for patients.

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