scholarly journals Rate and Risk Factors of Superior Facet Joint Violation during Cortical Bone Trajectory Screw Placement: A Comparison of Robot‐Assisted Approach with a Conventional Technique

2019 ◽  
Vol 12 (1) ◽  
pp. 133-140 ◽  
Author(s):  
Xiao‐feng Le ◽  
Zhan Shi ◽  
Qi‐long Wang ◽  
Yun‐feng Xu ◽  
Jing‐wei Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cortical Bone ◽  
Facet Joint ◽  
Conventional Technique ◽  
Screw Placement ◽  
Robot Assisted ◽  
Cortical Bone Trajectory ◽  
Facet Joint Violation

Incidence and Risk Factors of Adjacent Cranial Facet Joint Violation Following Pedicle Screw Insertion Using Cortical Bone Trajectory Technique

Spine ◽  
2016 ◽  
Vol 41 (14) ◽  
pp. E851-E856 ◽  
Author(s):  
Keitaro Matsukawa ◽  
Takashi Kato ◽  
Yoshiyuki Yato ◽  
Hiroshi Sasao ◽  
Hideaki Imabayashi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cortical Bone ◽  
Pedicle Screw ◽  
Facet Joint ◽  
Cortical Bone Trajectory ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Facet Joint Violation

scholarly journals 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

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.

Incidence and Risk Factors of Superior Facet Joint Violation in Percutaneous and Open Instrumentation Using Cortical Bone Trajectory Technique

2020 ◽  
Vol 33 (3) ◽  
pp. E127-E134
Author(s):  
Xiaofeng Le ◽  
Zhan Shi ◽  
Yunfeng Xu ◽  
Qilong Wang ◽  
Jingwei Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cortical Bone ◽  
Facet Joint ◽  
Cortical Bone Trajectory ◽  
Facet Joint Violation

scholarly journals Comparison of facet joint violation in lumbar posterior spinal instrumentation using different techniques including cortical bone trajectory

2020 ◽  
Vol 27 (1) ◽  
pp. 57-62
Author(s):  
CY To ◽  
P Cheung ◽  
W Ng ◽  
WY Mok
Keyword(s):  
Cortical Bone ◽  
Pedicle Screw ◽  
Facet Joint ◽  
Spinal Instrumentation ◽  
Entry Site ◽  
Cortical Bone Trajectory ◽  
Percutaneous Pedicle Screw ◽  
Iatrogenic Damage ◽  
Percutaneous Screws ◽  
Facet Joint Violation

Study background: A retrospective study to compare the rate of facet joint violation (FJV) in lumbar posterior spinal instrumentation using open pedicle screw, percutaneous pedicle screw, and cortical bone trajectory (CBT) technique. CBT is a new posterior spinal instrumentation technique in which a more caudal entry point can minimize iatrogenic damage to the cranial facet joint. Only one recent study reports incidence of FJV of 11%; however, no previous reports comment on radiological outcomes comparing to traditional open and percutaneous screws. Methods: We reviewed 90 patients who underwent lumbar posterior spinal instrumentation from January 2016 to June 2017. Postoperative computer tomography scans were performed to evaluate FJV. Incidence of FJV was graded by three reviewers according to Seo classification. Results: Totally, 446 screws (open 43.4%, percutaneous 37.8%, CBT 18.9%) were inserted. Among these, 6.3% (28/446) had screw head or rod in contact with facet joint and 0.9% (4/446) had screws directly invaded the facet joint. Overall, FJV was 7.2% (CTB = 3.4%, open = 10.4%, and percutaneous = 4.5%, p = 0.075). Conclusion: CBT technique has potential advantage in reducing FJV. It has a unique entry site at lateral aspect of pars interarticular with a caudomedial to craniolateral pathway. It is a reasonable alternative to open or percutaneous techniques in lumbar posterior spinal instrumentation.

scholarly journals Anatomical and technical factors associated with superior facet joint violation in lumbar fusion

2018 ◽  
Vol 28 (2) ◽  
pp. 173-180 ◽  
Author(s):  
Alisson R. Teles ◽  
Michael Paci ◽  
Gabriel Gutman ◽  
Fahad H. Abduljabbar ◽  
Jean A. Ouellet ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Surgical Technique ◽  
Facet Joint ◽  
Lumbar Fusion ◽  
Screw Placement ◽  
Multivariate Logistic Regression ◽  
Factors Associated ◽  
Facet Joint Violation ◽  
Superior Level

OBJECTIVEThe aim of this study was to evaluate the anatomical and surgical risk factors for screw-related facet joint violation at the superior level in lumbar fusion.METHODSThe authors conducted a retrospective review of a consecutive series of posterior lumbar instrumented fusions performed by a single surgeon. Inclusion criteria were primary lumbar fusion of 1 or 2 levels for degenerative disorders. The following variables were analyzed as possible risk factors: surgical technique (percutaneous vs open screw placement), depth of surgical field, degree of anterior slippage of the superior level, pedicle and facet angle, and facet degeneration of the superior level. Postoperative CT scans were evaluated by 2 independent reviewers. Axial, sagittal, and coronal views were reviewed. Pedicle screws were graded as intra-articular if they clearly interposed between the superior and inferior facet joints of the superior level. Multivariate logistic regression analyses were conducted to assess the factors associated with this complication.RESULTSOne hundred thirty-one patients were included. Interobserver reliability for facet joint violation assessment was high (κ = 0.789). The incidence of superior facet joint violation was 12.59% per top-level screw (33 of 262 proximal screws). The rate of facet violation was 28.0% in the percutaneous technique group (14 of 50 patients) and 12.3% in the open surgery group (10 of 81 patients) (OR 2.26, 95% CI 1.09–4.21; p = 0.024). In multivariate logistic regression analysis, independent predictors of facet violation were percutaneous screw placement (adjusted OR 3.31, 95% CI 1.42–7.73; p = 0.006), right-side pedicle screw (adjusted OR 3.14, 95% CI 1.29–7.63; p = 0.011), and facet angle > 45° (adjusted OR 10.95, 95% CI 4.64–25.84; p < 0.0001).CONCLUSIONSThe incidence of facet joint violation was higher in percutaneous minimally invasive than in open technique for posterior lumbar spine surgery. Also, coronal orientation of the facet joint is a significant risk factor independent of the surgical technique.

Simulation with 3D Neuronavigation for Learning Cortical Bone Trajectory Screw Placement

2020 ◽  
Author(s):  
Juan Delgado-Fernández ◽  
Natalia Frade-Porto ◽  
Guillermo Blasco ◽  
Patricia Gonzalez-Tarno ◽  
Ricardo Gil-Simoes ◽  
...  
Keyword(s):  
Cortical Bone ◽  
Facet Joint ◽  
Surgical Anatomy ◽  
Intraoperative Complication ◽  
Cortical Bone Trajectory ◽  
Hardware Failure ◽  
Physician Performance ◽  
Before And After ◽  
A New Technique ◽  
Facet Joint Violation

Abstract Background and Objective Learning a new technique in neurosurgery is a big challenge especially for trainees. In recent years, simulations and simulators got into the focus as a teaching tool. Our objective is to propose a simulator for placement of cortical bone trajectory (CBT) screws to improve results and reduce complications. Methods We have created a platform consisting of a sawbone navigated with a 3D fluoroscope to familiarize our trainees and consultants with CBT technique and later implement it in our department. Objective Structured Assessment of Technical Skills (OSATS) and Physician Performance Diagnostic Inventory Scale (PPDI) were obtained before and after the use of the simulator by the five participants in the study. Patients who were operated on after the implementation of the technique were retrospectively reviewed. Results During the simulation, there were 4 cases of pedicle breach out of 24 screws inserted (16.6%). After having completed simulation, participants demonstrated an improvement in OSATS and PPDI (p = 0.039 and 0.042, respectively). Analyzing the answers to the different items of the tests, participants mainly improved in the knowledge (p = 0.038), the performance (p = 0.041), and understanding of the procedure (p = 0.034). In our retrospective series, eight patients with L4–L5 instability were operated on using CBT, improving their Oswestry Disability Index (ODI) score (preoperative ODI 58.5 [SD 16.7] vs. postoperative ODI 31 [SD 13.4]; p = 0.028). One intraoperative complication due to a dural tear was observed. In the follow-up, we found a case of pseudoarthrosis and a facet joint violation, but no other complications related to misplacement, pedicle fracture, or hardware failure. Conclusion The simulation we have created is useful for the implementation of CBT. In our study, consultants and trainees have valued very positively the learning obtained using the system. Moreover, simulation facilitated the learning of the technique and the understanding of surgical anatomy. We hope that simulation helps reducing complications in the future.

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