Comparison of Superior‐Level Facet Joint Violations Between Robot‐Assisted Percutaneous Pedicle Screw Placement and Conventional Open Fluoroscopic‐Guided Pedicle Screw Placement

Object This study was conducted to assess the in vivo safety and accuracy of percutaneous lumbar pedicle screw placement using the owl's-eye view of the pedicle axis and a new guidance technology system that facilitates orientation of the C-arm into the appropriate fluoroscopic view and the pedicle cannulation tool in the corresponding trajectory. Methods A total of 326 percutaneous pedicle screws were placed from L-3 to S-1 in 85 consecutive adult patients. Placement was performed using simple coaxial imaging of the pedicle with the owl's-eye fluoroscopic view. NeuroVision, a new guidance system using accelerometer technology, helped align the C-arm trajectory into the owl's-eye view and the cannulation tool in the same trajectory. Postoperative fine-cut CT scans were acquired to assess screw position. Medical records were reviewed for complications. Results Five of 326 screws breached a pedicle cortex—all breaches were less than 2 mm—for an accuracy rate of 98.47%. Five screws violated an adjacent facet joint. All were at the S-1 superior facet and included in a fusion. No screw violated an adjacent mobile facet or disc space. There were no cases of new or worsening neurological symptoms or deficits for an overall clinical accuracy of 100%. Conclusions The owl's-eye technique of coaxial pedicle imaging with the C-arm fluoroscopy, facilitated by NeuroVision, is a safe and accurate means by which to place percutaneous pedicle screws for degenerative conditions of the lumbar spine. This is the largest series reported to use the oblique or owl's-eye projection for percutaneous pedicle screw insertion. The accuracy of percutaneous screw insertion with this technique meets or exceeds that of other reported clinical series or techniques.

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Surgical Precision and Efficiency of a Novel Electromagnetic System Compared to a Robot-Assisted System in Percutaneous Pedicle Screw Placement of Endo-LIF

Global Spine Journal ◽

10.1177/21925682211025501 ◽

2021 ◽

pp. 219256822110255

Author(s):

Derong Xu ◽

Xuexiao Ma ◽

Lei Xie ◽

Chuanli Zhou ◽

Biao Kong

Keyword(s):

Pedicle Screw ◽

Navigation System ◽

Guide Wire ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Robot Assisted ◽

Electromagnetic Navigation ◽

X Ray ◽

Percutaneous Pedicle Screw ◽

Electromagnetic Navigation System

Study Design: Retrospective database study. Objectives: To compare the accuracy and safety of 2 types of a computer-assisted navigation system for percutaneous pedicle screw placement during endoscopic lumbar interbody fusion. Methods: From May 2019 to January 2020, data of 56 patients who underwent Endo-LIF with a robot-assisted system and with an electromagnetic navigation system were compared. The pedicles in all patients were subjected to postoperative CT scan to assess screw correction by measuring the perpendicular distance between the pedicle cortical wall and the screw surface. The registration and matching time, guide-wire insertion time, the entire surgery time, and X-ray exposure time were recorded. Results: In the robot-assisted group, 25 cases with 100 percutaneous pedicle screws were included, and the excellent and good rate was 95%. In the electromagnetic navigation group, 31 cases with 124 screws were included, and the excellent rate was 97.6%. There was no statistical difference between the two groups ( P > 0.05). The registration time and the total time for the surgery also showed no statistical differences ( P > 0.05). The main difference between the two groups was the guide-wire insertion time and the X-ray exposure time ( P < 0.05). Conclusions: Both electromagnetic navigation and robot-assisted are safe and efficient for percutaneous pedicle screw placement. Electromagnetic navigation system has obvious advantages over robot-assisted in terms of faster guide-wire placement and less X-ray exposure. Robot-assisted for percutaneous pedicle screw placement offers a preoperative planning system and a stable registration system, with obvious drawbacks of a strict training curve.

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Appropriate insertion point for percutaneous pedicle screw placement in the lumbar spine using c-arm fluoroscopy: a cadaveric study

10.21203/rs.3.rs-38830/v2 ◽

2020 ◽

Author(s):

Wei-Xing Xu ◽

wei-guo Ding ◽

Bin Xu ◽

Tian-Hong Hu ◽

Hong-Feng Sheng ◽

...

Keyword(s):

Lumbar Spine ◽

Pedicle Screw ◽

Facet Joint ◽

Outer Edge ◽

Screw Placement ◽

Insertion Point ◽

Pedicle Screw Placement ◽

X Ray ◽

Articular Process ◽

Percutaneous Pedicle Screw

Abstract Background: We studied the characteristics and regularity of appropriate insertion points for percutaneous pedicle screw placement in the lumbar spine using C-arm X-ray fluoroscopy. The purpose of this study was to improve the accuracy of percutaneous pedicle screw placement and reduce the incidence of superior-level facet joint violation. Methods: Six normal spinal specimens were included. Three different methods for placing percutaneous pedicle screws in the lumbar spine were applied, including the Roy-Camille method, Magerl method and Weinstein method. The relationships among the insertion point, pedicle projection and proximal facet joint on C-arm X-ray films were studied. The projection morphology of the vertebral pedicle in different segments of the lumbar spine was observed. The relationship between the outer edge of the pedicle projection and the outer edge of the cranial articular process was also studied. The distance between the insertion point and the facet joint (M1), the distance between the insertion point and outer edge of the cranial articular process (M2), and the distance between the insertion point and the projection center of the pedicle (M) were measured. Results: In this study, we found that the projection shape of the vertebral pedicle differed across segments of the lumbar spine: the shape for L1-L3 was oval, and that for L4-L5 was round. The radiographic study showed that the outer edge of the cranial articular process was located on the lateral side of the outer edge of the pedicle projection and did not overlap with the pedicle projection. M for the Weinstein group was larger than that for the Roy-Camille group (P < 0.05). M1 for the Weinstein group was larger than that for the Roy-Camille and Magerl groups (P < 0.05). M2 for the Roy-Camille group was negative, M2 for the Magerl group was 0, and M2 for the Weinstein group was positive. Conclusion: Under C-arm X-ray fluoroscopy, we were able to accurately identify the characteristics and regularity of the appropriate insertion point for percutaneous pedicle screw placement in the lumbar spine, which was important for improving the accuracy of percutaneous pedicle screw placement and reducing the incidence of superior-level facet joint violation.

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Accuracy of Robot-Assisted Percutaneous Pedicle Screw Placement Under Regional Anaesthesia: A Comparative Cohort Study

10.21203/rs.3.rs-487003/v1 ◽

2021 ◽

Author(s):

Shangju Gao ◽

Jingchao Wei ◽

Wenyi Li ◽

Long Zhang ◽

Can Cao ◽

...

Keyword(s):

Minimally Invasive ◽

General Anaesthesia ◽

Pedicle Screw ◽

Regional Anaesthesia ◽

Interbody Fusion ◽

Screw Placement ◽

Lumbar Interbody Fusion ◽

Pedicle Screw Placement ◽

Robot Assisted ◽

Percutaneous Pedicle Screw

Abstract Background: Robot-assisted pedicle screw placement is usually performed under general anaesthesia to keep the body still. The aim of this study was to compare the accuracy of the robot-assisted technique under regional anaesthesia with conventional fluoroscopy-guided percutaneous pedicle screw placement under general anaesthesia in minimally invasive lumbar fusion surgery.Methods: Patients who underwent robot-assisted percutaneous endoscopic lumbar interbody fusion (PELIF) or fluoroscopy-guided minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) from December 2017 to February 2020 in a single centre were included. Based on the method of percutaneous pedicle screw placement used, patients were divided into the robot-assisted under regional anaesthesia (group RE-RO) and fluoroscopy-guided under general anaesthesia (group GE-FLU) groups. The primary outcome measures were screw accuracy and the incidence of facet joint violation (FJV). Secondary outcome measures included X-ray exposure and intraoperative adverse events.Results: Eighteen patients were included in group RE-RO, and 23 patients were included in group GE-FLU. The percentages of clinically acceptable screws (Gertzbein and Robbins grades A and B) were 94.4% and 91.5%, respectively. There was no significant difference in the percentages of clinically acceptable screws (p=0.44) or overall Gertzbein and Robbins screw accuracy grades (p=0.35). Only the top screws were included in the analysis of FJVs. The percentages of FJV (Babu grades 1, 2 and 3) were 5.6% and 28.3%, respectively. This difference was statistically significant (p=0.01). Overall, the FJV grades in group RE-RO were significantly better than those in group GE-FLU (p=0.009). The mean fluoroscopy time for each screw in group RE-RO was significantly shorter than that in group GE-FLU (group RE-RO, 5.4±1.9 seconds, group GE-FLU, 6.8±2.0 seconds; P=0.03). The intraoperative adverse events included 1 case of registration failure and 1 case of guide-wire dislodgment in group RE-RO as well as 2 cases of screw misplacement in group GE-FLU. No complications related to anaesthesia were observed.Conclusion: Robot-assisted pedicle screw placement under regional anaesthesia can be performed effectively and safely. The accuracy is comparable to the conventional technique. Moreover, this technique has the advantage of fewer FJVs and a lower radiation time.

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Accuracy of Robot-Assisted Percutaneous Pedicle Screw Placement under Regional Anesthesia: A Retrospective Cohort Study

Pain Research and Management ◽

10.1155/2021/6894001 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Shangju Gao ◽

Jingchao Wei ◽

Wenyi Li ◽

Long Zhang ◽

Can Cao ◽

...

Keyword(s):

General Anesthesia ◽

Pedicle Screw ◽

Regional Anesthesia ◽

Interbody Fusion ◽

Screw Placement ◽

Lumbar Interbody Fusion ◽

Pedicle Screw Placement ◽

Robot Assisted ◽

Percutaneous Pedicle Screw ◽

Anesthesia Group

Background. Robot-assisted pedicle screw placement is usually performed under general anesthesia to keep the body still. The aim of this study was to compare the accuracy of the robot-assisted technique under regional anesthesia with that of conventional fluoroscopy-guided percutaneous pedicle screw placement under general anesthesia in minimally invasive lumbar fusion surgery. Methods. This study recruited patients who underwent robot-assisted percutaneous endoscopic lumbar interbody fusion (PELIF) or fluoroscopy-guided minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) between December 2017 and February 2020 at a single center. Based on the method of percutaneous pedicle screw placement used, patients were divided into the robot-assisted under regional anesthesia (group RE-RO) and fluoroscopy-guided under general anesthesia (group GE-FLU) groups. The primary outcome measures were screw accuracy and the incidence of facet joint violation (FJV). Secondary outcome measures included X-ray and visual analogue scale (VAS) scores which were used to evaluate the degree of the postoperative pain at 4 hours and on postoperative days 1, 2, and 3. Intraoperative adverse events were also recorded. Results. Eighteen patients were included in group RE-RO, and 23 patients were included in group GE-FLU. The percentages of clinically acceptable screws (Gertzbein and Robbins grades A and B) were 94.4% and 91.5%, respectively. There was no significant difference in the percentages of clinically acceptable screws ( p = 0.44 ) or overall Gertzbein and Robbins screw accuracy grades ( p = 0.35 ). Only the top screws were included in the analysis of FJVs. The percentages of FJV (Babu grades 1, 2, and 3) were 5.6% and 28.3%, respectively. This difference was statistically significant ( p = 0.01 ). Overall, the FJV grades in group RE-RO were significantly better than those in group GE-FLU ( p = 0.009 ). The mean fluoroscopy time for each screw in group RE-RO was significantly shorter than that in group GE-FLU (group RE-RO: 5.4 ± 1.9 seconds and group GE-FLU: 6.8 ± 2.0 seconds; p = 0.03 ). The postoperative pain between the RE-RO and GE-FLU groups was not statistically significant. The intraoperative adverse events included 1 case of registration failure and 1 case of guide-wire dislodgment in group RE-RO, as well as 2 cases of screw misplacement in group GE-FLU. No complications related to anesthesia were observed. Conclusion. Robot-assisted pedicle screw placement under regional anesthesia can be performed effectively and safely. The accuracy is comparable to the conventional technique. Moreover, this technique has the advantage of fewer FJVs and a lower radiation time.

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Accuracy of Robot-Assisted Percutaneous Pedicle Screw Placement for Treatment of Lumbar Spondylolisthesis: A Comparative Cohort Study

Medical Science Monitor ◽

10.12659/msm.913124 ◽

2019 ◽

Vol 25 ◽

pp. 2479-2487 ◽

Cited By ~ 4

Author(s):

Jun-Song Yang ◽

Baorong He ◽

Fang Tian ◽

Tuan-Jiang Liu ◽

Peng Liu ◽

...

Keyword(s):

Cohort Study ◽

Pedicle Screw ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Robot Assisted ◽

Percutaneous Pedicle Screw ◽

Comparative Cohort Study ◽

Lumbar Spondylolisthesis

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Incidence of and risk factors for superior facet violation in minimally invasive versus open pedicle screw placement during transforaminal lumbar interbody fusion: a comparative analysis

Journal of Neurosurgery Spine ◽

10.3171/2013.1.spine12882 ◽

2013 ◽

Vol 18 (4) ◽

pp. 356-361 ◽

Cited By ~ 47

Author(s):

Darryl Lau ◽

Samuel W. Terman ◽

Rakesh Patel ◽

Frank La Marca ◽

Paul Park

Keyword(s):

Risk Factors ◽

Minimally Invasive ◽

Pedicle Screw ◽

Interbody Fusion ◽

Facet Joint ◽

Transforaminal Lumbar Interbody Fusion ◽

Screw Placement ◽

Lumbar Interbody Fusion ◽

Pedicle Screw Placement ◽

Percutaneous Pedicle Screw

Object A reported risk factor for adjacent-segment disease is injury to the superior facet joint from pedicle screw placement. Given that the facet joint is not typically visualized during percutaneous pedicle screw insertion, there is a concern for increased facet violation (FV) in minimally invasive fusion procedures. The purpose of this study was to analyze and compare the incidence of FV among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MITLIF) and open transforaminal lumbar interbody fusion (TLIF). The impact of O-arm navigation compared with traditional fluoroscopy on FV in MITLIF is also assessed, as are risk factors for FV. Methods The authors identified a consecutive population of patients who underwent MITLIF with percutaneous pedicle screw placement, as well as a matched cohort of patients who underwent open TLIF. Postoperative CT imaging was assessed to determine intraarticular FV due to pedicle screw placement. Patients were stratified into minimally invasive and open TLIF groups. Within the MITLIF group, the authors performed a subanalysis of image guidance methods used in cases of FV. Two-tailed Student t-test, ANOVA, chi-square testing, and logistic regression were used for statistical analysis. Results A total of 282 patients were identified, with a total of 564 superior pedicle screw placements. The MITLIF group consisted of 142 patients with 284 screw insertions. The open TLIF group consisted of 140 patients with 280 screw insertions. Overall, 21 (7.4%) of 282 patients experienced FV. A total of 21 screws violated a facet joint for a screw-based FV rate of 3.7% (21 of 564 screws). There were no significant differences between the MITLIF and open TLIF groups in the percentage of patients with FV (6.3% vs 8.6%) and or the percentage of screws with FV (3.2% vs 4.3%) (p = 0.475 and p = 0.484, respectively). Further stratifying the MI group into O-arm navigation and fluoroscopic guidance subgroups, the patient-based rates of FV were 10.8% (4 of 37 patients) and 4.8% (5 of 105 patients), respectively, and the screw-based rates of FV were 5.4% (4 of 74 screws) and 2.4% (5 of 210 screws), respectively. There was no significant difference between the subgroups with respect to patient-based or screw-based FV rates (p = 0.375 and p = 0.442, respectively). The O-arm group had a significantly higher body mass index (BMI) (p = 0.021). BMI greater than 29.9 was independently associated with higher FV (OR 2.36, 95% CI 1.65–8.53, p = 0.039). Conclusions The findings suggest that minimally invasive pedicle screw placement is not associated with higher rates of FV. Overall violation rates were similar in MITLIF and open TLIF. Higher BMI, however, was a risk factor for increased FV. The use of O-arm fluoroscopy with computer-assisted guidance did not significantly decrease the rate of FV.

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Rates and Risk Factors of Intrapedicular Accuracy and Cranial Facet Joint Violation Among Robot- Assisted, Fluoroscopy-Guided Percutaneous, and Freehand Techniques in Pedicle Screw Fixation of Thoracolumbar Fractures: A Comparative Cohort Study

10.21203/rs.3.rs-961441/v1 ◽

2021 ◽

Author(s):

Ren-Jie Zhang ◽

Lu-Ping Zhou ◽

Hua-Qing Zhang ◽

Peng Ge ◽

Chong-Yu Jia ◽

...

Keyword(s):

Risk Factors ◽

Pedicle Screw ◽

Facet Joint ◽

Pedicle Screw Fixation ◽

Screw Placement ◽

Thoracolumbar Fractures ◽

Pedicle Screw Placement ◽

Robot Assisted ◽

Facet Joint Osteoarthritis ◽

Facet Joint Violation

Abstract Background Robot-assisted (RA) technique has been increasingly applied in clinical practice, providing promising outcomes of inserting accuracy and cranial facet joint protection. However, studies comparing this novel method with other assisted methods are rare, and the controversy of the superiority between the insertion techniques remains. Thus, we compare the rates and risk factors of intrapedicular accuracy and cranial facet joint violation (FJV) of RA, fluoroscopy-guided percutaneous (FP), and freehand (FH) techniques in the treatment of thoracolumbar fractures. Methods A total of 90 patients with thoracolumbar fractures requiring pedicle screw instruments were retrospectively included and divided into RA, FP, and FH groups at 1:1:1 ratio from June 2016 to May 2020. The primary outcomes were the intrapedicular accuracy and cranial FJV. The factors that affected the intrapedicular accuracy and cranial FJV were assessed using multivariate analyses.Results The optimal intrapedicular accuracy of pedicle screw placement (Grade A) in the RA, FP, and FH groups was 94.3%, 79.3%, and 88.7%, respectively. This finding indicates no significant differences between RA and FH techniques (P =0.062), but significantly higher accuracies of RA over FP (P＜0.001), and FH over FP (P= 0.013). In addition, the rates of proximal FJV in RA, FP, and FH groups were 13.9%, 29.3%, and 22.7%, respectively. The RA had a significantly greater proportion of intact facet joints than the FP (P= 0.001) and FH (P= 0.035). However, FP and FH showed significantly similar outcomes with respect to the proximal FJV (P= 0.149). The logistic regression analysis showed that FP technique (OR= 2.791), pedicle angle (OR= 0.916), and L3 insertion (OR= 0.081) were independently associated with insertion accuracy. Meanwhile, the age (OR= 0.966), pedicle angle (OR= 0.940), mild facet joint osteoarthritis (OR= 5.906), moderate facet joint osteoarthritis (OR= 5.906), severe facet joint osteoarthritis (OR= 9.991), and distance from skin to insertion point (OR= 0.575) were independently associated with cranial FJV.Conclusion RA technique showed higher rate of intrapedicular accuracy and lower rate of cranial FJV than FH and FP techniques, and it might be a safe method for pedicle screw placement in thoracolumbar surgery.

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Appropriate insertion point for percutaneous pedicle screw placement in the lumbar spine using c-arm fluoroscopy: a cadaveric study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03751-y ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Wei-Xing Xu ◽

Wei-Guo Ding ◽

Bin Xu ◽

Tian-Hong Hu ◽

Hong-Feng Sheng ◽

...

Keyword(s):

Lumbar Spine ◽

Pedicle Screw ◽

Facet Joint ◽

Outer Edge ◽

Screw Placement ◽

Insertion Point ◽

Pedicle Screw Placement ◽

X Ray ◽

Articular Process ◽

Percutaneous Pedicle Screw

Abstract Background We studied the characteristics and regularity of appropriate insertion points for percutaneous pedicle screw placement in the lumbar spine using C-arm X-ray fluoroscopy. The purpose of this study was to improve the accuracy of percutaneous pedicle screw placement and reduce the incidence of superior-level facet joint violation. Methods Six normal spinal specimens were included. Three different methods for placing percutaneous pedicle screws in the lumbar spine were applied, including the Roy-Camille method, Magerl method and Weinstein method. The relationships among the insertion point, pedicle projection and proximal facet joint on C-arm X-ray films were studied. The projection morphology of the vertebral pedicle in different segments of the lumbar spine was observed. The relationship between the outer edge of the pedicle projection and the outer edge of the cranial articular process was also studied. The distance between the insertion point and the facet joint (M1), the distance between the insertion point and outer edge of the cranial articular process (M2), and the distance between the insertion point and the projection center of the pedicle (M) were measured. Results In this study, we found that the projection shape of the vertebral pedicle differed across segments of the lumbar spine: the shape for L1-L3 was oval, and that for L4-L5 was round. The radiographic study showed that the outer edge of the cranial articular process was located on the lateral side of the outer edge of the pedicle projection and did not overlap with the pedicle projection. M for the Weinstein group was larger than that for the Roy-Camille group (P < 0.05). M1 for the Weinstein group was larger than that for the Roy-Camille and Magerl groups (P < 0.05). M2 for the Roy-Camille group was negative, M2 for the Magerl group was 0, and M2 for the Weinstein group was positive. Conclusion Under C-arm X-ray fluoroscopy, we were able to accurately identify the characteristics and regularity of the appropriate insertion point for percutaneous pedicle screw placement in the lumbar spine, which was important for improving the accuracy of percutaneous pedicle screw placement and reducing the incidence of superior-level facet joint violation.

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