Three-dimensional Printed Drill Guides Versus Fluoroscopic-guided Freehand Technique for Pedicle Screw Placement

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Nicholas Wallace ◽  
Bilal B. Butt ◽  
Ilyas Aleem ◽  
Rakesh Patel
Keyword(s):  
Pedicle Screw ◽  
Three Dimensional ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Freehand Technique

scholarly journals Evaluation of C2 pedicle screw placement via the freehand technique by neurosurgical trainees

2018 ◽  
Vol 29 (3) ◽  
pp. 235-240 ◽  
Author(s):  
Martin H. Pham ◽  
Joshua Bakhsheshian ◽  
Patrick C. Reid ◽  
Ian A. Buchanan ◽  
Vance L. Fredrickson ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Medical Center ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
C2 Pedicle Screw ◽  
Canal Diameter ◽  
Screw Length ◽  
Freehand Technique ◽  
Screw Diameter

OBJECTIVEFreehand placement of C2 instrumentation is technically challenging and has a learning curve due the unique anatomy of the region. This study evaluated the accuracy of C2 pedicle screws placed via the freehand technique by neurosurgical resident trainees.METHODSThe authors retrospectively reviewed all patients treated at the LAC+USC Medical Center undergoing C2 pedicle screw placement in which the freehand technique was used over a 1-year period, from June 2016 to June 2017; all procedures were performed by neurosurgical residents. Measurements of C2 were obtained from preoperative CT scans, and breach rates were determined from coronal reconstructions on postoperative scans. Severity of breaches reflected the percentage of screw diameter beyond the cortical edge (I = < 25%; II = 26%–50%; III = 51%–75%; IV = 76%–100%).RESULTSNeurosurgical residents placed 40 C2 pedicle screws in 24 consecutively treated patients. All screws were placed by or under the guidance of Pham, who is a postgraduate year 7 (PGY-7) neurosurgical resident with attending staff privileges, with a PGY-2 to PGY-4 resident assistant. The authors found an average axial pedicle diameter of 5.8 mm, axial angle of 43.1°, sagittal angle of 23.0°, spinal canal diameter of 25.1 mm, and axial transverse foramen diameter of 5.9 mm. There were 17 screws placed by PGY-2 residents, 7 screws placed by PGY-4 residents, and 16 screws placed by the PGY-7 resident. The average screw length was 26.0 mm, with a screw diameter of 3.5 mm or 4.0 mm. There were 7 total breaches (17.5%), of which 4 were superior (10.0%) and 3 were lateral (7.5%). There were no medial breaches. The breaches were classified as grade I in 3 cases (42.9%), II in 3 cases (42.9%), III in 1 case (14.3%), and IV in no cases. There were 3 breaches that occurred via placement by a PGY-2 resident, 3 breaches by a PGY-4 resident, and 1 breach by the PGY-7 resident. There were no clinical sequelae due to these breaches.CONCLUSIONSFreehand placement of C2 pedicle screws can be done safely by neurosurgical residents in early training. When breaches occurred, they tended to be superior in location and related to screw length choice, and no breaches were found to be clinically significant. Controlled exposure to this unique anatomy is especially pertinent in the era of work-hour restrictions.

Accuracy of upper thoracic pedicle screw placement using three-dimensional image guidance

2009 ◽  
Vol 9 (10) ◽  
pp. 817-821 ◽  
Author(s):  
Jonathan M. Bledsoe ◽  
Doug Fenton ◽  
Jeremy L. Fogelson ◽  
Eric W. Nottmeier
Keyword(s):  
Pedicle Screw ◽  
Image Guidance ◽  
Three Dimensional ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Dimensional Image ◽  
Thoracic Pedicle Screw ◽  
Upper Thoracic

Accuracy of C2 pedicle screw placement using the anatomic freehand technique

2014 ◽  
Vol 125 ◽  
pp. 24-27 ◽  
Author(s):  
Mohamad Bydon ◽  
Dimitrios Mathios ◽  
Mohamed Macki ◽  
Rafael De la Garza-Ramos ◽  
Nafi Aygun ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
C2 Pedicle Screw ◽  
Freehand Technique

Clinical accuracy of three-dimensional fluoroscopy-based computer-assisted cervical pedicle screw placement: a retrospective comparative study of conventional versus computer-assisted cervical pedicle screw placement

2010 ◽  
Vol 13 (5) ◽  
pp. 606-611 ◽  
Author(s):  
Yoshimoto Ishikawa ◽  
Tokumi Kanemura ◽  
Go Yoshida ◽  
Zenya Ito ◽  
Akio Muramoto ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Three Dimensional ◽  
Screw Placement ◽  
Computer Assisted ◽  
Pedicle Screw Placement ◽  
Cervical Pedicle Screw ◽  
Retrospective Clinical Study ◽  
Significant Difference ◽  
Cervical Pedicle ◽  
Grade 3

Object The authors performed a retrospective clinical study to evaluate the feasibility and accuracy of cervical pedicle screw (CPS) placement using 3D fluoroscopy-based navigation (3D FN). Methods The study involved 62 consecutive patients undergoing posterior stabilization of the cervical spine between 2003 and 2008. Thirty patients (126 screws) were treated using conventional techniques (CVTs) with a lateral fluoroscopic view, whereas 32 patients (150 screws) were treated using 3D FN. Screw positions were classified into 4 grades based on the pedicle wall perforations observed on postoperative CT. Results The prevalence of perforations in the CVT group was 27% (34 screws): 92 (73.0%), 12 (9.5%), 6 (4.8%), and 16 (12.7%) for Grade 0 (no perforation), Grade 1 (perforation < 1 mm), Grade 2 (perforation ≥ 1 and < 2 mm), and Grade 3 (perforation ≥ 2 mm), respectively. In the 3D FN group, the prevalence of perforations was 18.7% (28 screws): 122 (81.3%), 17 (11.3%), 6 (4%), and 5 (3.3%) for Grades 0, 1, 2, and 3, respectively. Statistical analysis showed no significant difference in the prevalence of Grade 1 or higher perforations between the CVT and 3D FN groups. A higher prevalence of malpositioned CPSs was seen in Grade 2 or higher (17.5% vs 7.3%, p < 0.05) in the 3D FN group and Grade 3 (12.7% vs 7.3%, p < 0.05) perforations in the CVT group. The ORs for CPS malpositioning in the CVT group were 2.72 (95% CI 1.16–6.39) in Grade 2 or higher perforations and 3.89 (95% CI 1.26–12.02) in Grade 3 perforations. Conclusions Three-dimensional fluoroscopy-based navigation can improve the accuracy of CPS insertion; however, severe CPS malpositioning that causes injury to the vertebral artery or neurological complications can occur even with 3D FN. Advanced techniques for the insertion of CPSs and the use of modified insertion devices can reduce the risk of a malpositioned CPS and provide increased safety.

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.

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