Threshold-based Monitoring of Compound Muscle Action Potentials for Percutaneous Pedicle Screw Placement in the Lumbosacral Spine

Spine ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Yoichi Tani ◽  
Takanori Saito ◽  
Shinichiro Taniguchi ◽  
Masayuki Ishihara ◽  
Masaaki Paku ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Action Potentials ◽  
Screw Placement ◽  
Lumbosacral Spine ◽  
Muscle Action ◽  
Pedicle Screw Placement ◽  
Percutaneous Pedicle Screw ◽  
Compound Muscle Action Potentials

scholarly journals Increased Axial Facet Angle Correlates With Poor Percutaneous Pedicle Screw Placement

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Guang-Ting Cong ◽  
James Dowdell ◽  
Avani Vaishnav ◽  
Steven Mcanany ◽  
Sravisht Iyer ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Preoperative Planning ◽  
Safe Zone ◽  
Screw Placement ◽  
Lumbosacral Spine ◽  
Pedicle Screw Placement ◽  
Instrumented Fusion ◽  
Percutaneous Pedicle Screw ◽  
The Mean ◽  
Global Mean

Abstract INTRODUCTION To test the hypothesis that axial facet angle correlates with poor pedicle screw placement (and especially facet violation) in percutaneous fluoroscopy-guided pedicle screw placement. METHODS A total of 95 consecutive patients who underwent minimally invasive fluoroscopic instrumented fusion of the lumbar or lumbosacral spine were included. Postoperative computed tomography (CT) was used to categorize pedicle screw placement as follows: good (no breach), acceptable (breach within safe zone and/or any amount of tip breach), poor (outside safe zone, and/or violation of unfused facet, and/or unfused endplate violation). Safe zone was defined as 4 mm lateral or 2 mm inferomedial breach of pedicle cortex. Axial facet angle was measured against a midsagittal line. Global mean axial facet angles at L4, L5, and S1 were calculated. RESULTS Of the total 349 screws, 38 (10.7%) were categorized as poor placement, and of these 31 (82%) were due to unfused facet violation. Global axial facet angle means were 36.8 degrees for L4, 45.8 for L5, and 50.5 for S1. Mean axial facet angles associated with poorly placed screws were 42.7 degrees for L4 and 51.4 degrees for L5 these angles are higher than the global means at L4 (P = .063) and L5 (P = .028). Subgroup analysis demonstrated that the mean axial facet angles associated with unfused facet violation was 44.0 degrees for L4 and 53.2 degrees for L5. These means were significantly higher than the global means at L4 (P = .027) and L5 (P = .009). No poor screw placement was found at the S1 level. CONCLUSION Increased axial facet angle significantly correlates with poor screw placement and especially with facet violation in percutaneous fluoroscopy-guided pedicle screw placement at L4 and L5. Care should be taken to evaluate for high axial facet angles in preoperative planning.

Accuracy and technical limits of percutaneous pedicle screw placement in the thoracolumbar spine

2021 ◽  
Author(s):  
Yann Philippe Charles ◽  
Yves Ntilikina ◽  
Arnaud Collinet ◽  
Sébastien Schuller ◽  
Julien Garnon ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Thoracolumbar Spine ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Percutaneous Pedicle Screw

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 The complications associated with guidewire use in spine surgeries involving pedicle screw placement: A comprehensive literature review

2018 ◽  
Vol 5 (1) ◽  
pp. 14
Author(s):  
John B. Pracyk ◽  
Nicole Ferko ◽  
Adrian P. Turner ◽  
Sara N. Root ◽  
Heather Cannon ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Operating Time ◽  
Healthcare Resource Utilization ◽  
Screw Placement ◽  
Cerebrospinal Fluid Leakage ◽  
Metal Fatigue ◽  
Pedicle Screw Placement ◽  
Hardware Failure ◽  
Pull Out ◽  
Percutaneous Pedicle Screw

Guidewires (Kirschner or “K” wires) are often required during minimally invasive spine surgery to facilitate percutaneous pedicle screw placement. The use of guidewires involves a multi-step process that carries the risk of complications and their associated consequences. To date, the reporting of such information has been limited, and the literature has not been thoroughly evaluated. The objective of this study was to conduct a narrative review and assess the burden associated with guidewire use in spine surgeries. Databases searched included PubMed and Embase between the years of 1988 and 2017. In addition to databases, recent data from relevant trade journals were hand-searched. Inclusion criteria were broad to avoid potential exclusion of relevant publications. In total, 31 articles were included. This review found that the risk of complications associated with guidewire use in spine procedures ranged from 0.4% to 14.8%. Complication types included guidewire fracture, cerebrospinal fluid leakage, post-operative ileus, infection, and other spinal hardware failure (e.g., pedicle screw pull-out). Causes of complications typically included breakage and migration of the guidewire (metal fatigue), inexperience with guidewire use, or lack of tactile or visual feedback. Specific surgery types or patient populations may be more susceptible to guidewire-related complications (e.g., L5-S1 level operations). Complications associated with guidewire use may also lead to healthcare resource utilization, including additional operating time, radiation exposure, and re-operations. Solutions to help minimize the risk of such complications and associated consequences are required.

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