scholarly journals Freehand Pedicle Screw Placement Using a Universal Entry Point and Sagittal and Axial Trajectory for All Subaxial Cervical, Thoracic and Lumbosacral Spines

2019 ◽  
Vol 12 (1) ◽  
pp. 141-152
Author(s):  
Zheng‐feng Zhang
Keyword(s):  
Pedicle Screw ◽  
Entry Point ◽  
Screw Placement ◽  
Pedicle Screw Placement

scholarly journals Which of MIS-TLIF and TLIF Can Leads to Better Pedicle Screws Placement Accuracy and Clinical Outcomes with Navigation Guidance?

2021 ◽  
Author(s):  
JiaBin Liu ◽  
JunLong Wu ◽  
Rui Zuo ◽  
ChangQing Li ◽  
Chao Zhang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Entry Point ◽  
Screw Placement ◽  
Transfusion Rate ◽  
Pedicle Screw Placement ◽  
Multifidus Muscle ◽  
Lower Accuracy ◽  
Significant Difference

Abstract Background Although previous studies have suggested that navigation can improve the accuracy of pedicle screw placement, there are still few studies comparing navigation-assisted transforaminal lumbar interbody fusion (TLIF) and navigation-assisted minimally-invasive TLIF (MIS-TLIF). The pedicle screw insertion entry point of navigation-assisted MIS-TLIF may be deflected from the planned entry point due to uneven bone-surface, which may result in misplacement. The purpose of this study was to explore the pedicle screws accuracy and clinical consequences of MIS-TLIF and TLIF both under O-arm navigation to determine which surgical method is better.MethodsA retrospective study of 54 patients who underwent single-segment navigation-assisted MIS-TLIF (NM-TLIF) or navigation-assisted TLIF (N-TLIF) was conducted. In addition to the patient's demographic characteristics, intraoperative indicators and complications, the ODI and VAS scores were recorded and analyzed preoperatively, at 1, 6, 12 months and at the final follow-up postoperatively. The clinical accuracy and absolute accuracy of pedicle screw placement was assessed by postoperative CT. Multifidus muscle injury were evaluated by T2-weighted MRI.ResultsCompared with N-TLIF, NM-TLIF was more advantageous in the incision length, intraoperative blood loss, drainage volume, time before ambulation, length of hospital stays, blood transfusion rate and analgesia rate (p<0.05). The ODI and VAS for low back pain scores were better than those of N-TLIF at 1 month and 6 months after surgery (p<0.05). There was no significant difference in the screw clinical qualitative accuracy (97.3% vs. 96.2%, p>0.05). The absolute quantitative accuracy results show that the axial translational error, sagittal translational error and sagittal angle error of NM-TLIF group are significantly greater than that in N-TLIF group (P<0.05). The mean T2-weighted signal intensity of multifidus muscle in the NM-TLIF group was significantly lower than that in the N-TLIF group (P<0.05)ConclusionsCompared with N-TLIF, NM-TLIF has more minimally invasive advantages, it does not yield a lower accuracy of screw placement and can achieve better symptom relief in the middle stage of postoperative recovery. However，more attention on real-time adjustment should be paid to pedicle insertion in NM-TLIF, rather than just following the entry point and trajectory of the intraoperative plan.

scholarly journals Freehand thoracic pedicle screw technique using a uniform entry point and sagittal trajectory for all levels: preliminary clinical experience

2014 ◽  
Vol 21 (5) ◽  
pp. 778-784 ◽  
Author(s):  
Vernard S. Fennell ◽  
Sheri Palejwala ◽  
Jesse Skoch ◽  
David A. Stidd ◽  
Ali A. Baaj
Keyword(s):  
Pedicle Screw ◽  
Pedicle Screws ◽  
Transverse Process ◽  
Pedicle Screw Fixation ◽  
Entry Point ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Thoracic Pedicle Screw ◽  
Thoracic Pedicle Screws ◽  
Screw Diameter

Object Experience with freehand thoracic pedicle screw placement is well described in the literature. Published techniques rely on various starting points and trajectories for each level or segment of the thoracic spine. Furthermore, few studies provide specific guidance on sagittal and axial trajectories. The goal of this study was to propose a uniform entry point and sagittal trajectory for all thoracic levels during freehand pedicle screw placement and determine the accuracy of this technique. Methods The authors retrospectively reviewed postoperative CT scans of 33 consecutive patients who underwent open, freehand thoracic pedicle-screw fixation using a uniform entry point and sagittal trajectory for all levels. The same entry point for each level was defined as a point 3 mm caudal to the junction of the transverse process and the lateral margin of the superior articulating process, and the sagittal trajectory was always orthogonal to the dorsal curvature of the spine at that level. The medial angulation (axial trajectory) was approximately 30° at T-1 and T-2, and 20° from T-3 to T-12. Breach was defined as greater than 25% of the screw diameter residing outside of the pedicle or vertebral body. Results A total of 219 thoracic pedicle screws were placed with a 96% accuracy rate. There were no medial breaches and 9 minor lateral breaches (4.1%). None of the screws had to be repositioned postoperatively, and there were no neurovascular complications associated with the breaches. Conclusions It is feasible to place freehand thoracic pedicle screws using a uniform entry point and sagittal trajectory for all levels. The entry point does not have to be adjusted for each level as reported in existing studies, although this technique was not tested in severe scoliotic spines. While other techniques are effective and widely used, this particular method provides more specific parameters and may be easier to learn, teach, and adopt.

Accuracy of Pedicle Screw Placement for Lumbar Fusion using Anatomic Landmarks versus Open Laminectomy: A Comparison of Two Surgical Techniques in Cadaveric Specimens

2006 ◽  
Vol 59 (suppl_1) ◽  
pp. ONS-13-ONS-19 ◽  
Author(s):  
Aftab Karim ◽  
Debi Mukherjee ◽  
Jorge Gonzalez-Cruz ◽  
Alan Ogden ◽  
Donald Smith ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Lumbar Fusion ◽  
Entry Point ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Anatomic Landmarks ◽  
Computed Tomographic ◽  
Entry Points ◽  
Tomographic Analysis ◽  
The Ideal

Abstract OBJECTIVE: We determined whether the accuracy of lumbar pedicle screw placement is optimized by performing a laminectomy before screw placement with screw entry point and trajectory being guided by pedicle visualization and palpation (Technique 1). This technique was compared with a technique using anatomic landmarks for pedicle screw placement (Technique 2). The biomechanical stability of the instrumented constructs, in the absence and presence of a laminectomy, was also compared. METHODS: Twelve L1–L3 specimens were harvested from fresh cadavers. The intact laminectomy and instrumented spines were biomechanically tested in flexion and extension, lateral bending, and axial rotation. Laminectomies were performed in six of the 12 specimens before pedicle screw placement using Technique 1. The remaining six specimens underwent pedicle screw and rod fixation using Technique 2. Computed tomographic images were obtained for all instrumented specimens. Deviation of the screws from the ideal entry point or trajectory was analyzed to quantitatively compare the two techniques. RESULTS: Computed tomographic analysis of the specimens showed that all screw placements were within the pedicles. Scatter plot analysis demonstrated that screws placed using Technique 2 were more likely to have the combination of entry points and trajectories medial to the ideal entry point and trajectory. Laminectomy did not weaken the final pedicle screw and rod-fixated constructs. CONCLUSION: All screw placements were grossly within the confines of the pedicles, regardless of technique, as evidenced by computed tomographic analysis. Furthermore, the anatomic landmark technique and the open laminectomy technique yielded biomechanically equivalent pedicle screw and rod-fixated constructs.

scholarly journals Maintenance of Integrity of Upper Facet Joints during Simulated Percutaneous Pedicle Screw Insertion Using 2D versus 3D Planning

2019 ◽  
Vol 80 (04) ◽  
pp. 269-276
Author(s):  
Eleftherios Archavlis ◽  
Florian Ringel ◽  
Sven Kantelhardt
Keyword(s):  
Pedicle Screw ◽  
Facet Joint ◽  
Pedicle Screws ◽  
Entry Point ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Data Set ◽  
Screw Insertion ◽  
Percutaneous Pedicle Screw ◽  
Lumbar Pedicle

Background No studies have directly and quantitatively compared two-dimensional (2D) and three-dimensional (3D) planning as applied during conventional percutaneous or navigated percutaneous pedicle screw placement. Study Aims This lumbar pedicle-based stabilization simulation study aimed to investigate the risk of upper facet joint violation (FJV) during posterior percutaneous pedicle screw placement with conventional 2D planning of screw implantation (as a model for fluoroscopically guided screws) compared with 3D planning (as used with navigation techniques). Methods The placement of monosegmental lumbar pedicle screws using the data sets of 250 consecutive patients was simulated. Conventional surgery (using 2D fluoroscopic images anteroposterior and lateral view) was compared with screw placement using the 3D reconstruction of the planning mode of the same software. Results The 2D planning resulted in 140 upper FJVs (28% of cases), whereas 3D planning resulted in only 24 upper FJVs (4.8% of cases) (p < 0.05). Among those spinal segments with severe facet joint arthropathy, Pathria grades 3 and 4, FJV was significantly higher (p < 0.05) in the 2D-planned screws (64.7%) than in the 3D-planned screws (11.2%). A more lateral (mean distance: 3.5 mm) and inferior (mean distance: 2.5 mm) offset of the pedicle entry point and a larger medial angulation of the trajectory (mean angle: 9 degrees) were observed for the 3D-planned screws at all levels. Conclusion This study demonstrates that the use of 2D planning is associated with a higher risk of upper FJV than when a 3D imaging data set is used. Using a more lateral and inferior entry point for fluoroscopically guided pedicle screws could reduce the rate of FJV in percutaneous pedicle screw placement.

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 Overview of Robotic Technology in Spine Surgery

2021 ◽  
pp. 155633162110266
Author(s):  
Ram K. Alluri ◽  
Fedan Avrumova ◽  
Ahilan Sivaganesan ◽  
Avani S. Vaishnav ◽  
Darren R. Lebl ◽  
...  
Keyword(s):  
Economic Impact ◽  
Pedicle Screw ◽  
Clinical Outcomes ◽  
Spine Surgery ◽  
Screw Placement ◽  
Complication Rates ◽  
Robotic Technology ◽  
Pedicle Screw Placement ◽  
The Past ◽  
Compare And Contrast

As robotics in spine surgery has progressed over the past 2 decades, studies have shown mixed results on its clinical outcomes and economic impact. In this review, we highlight the evolution of robotic technology over the past 30 years, discussing early limitations and failures. We provide an overview of the history and evolution of currently available spinal robotic platforms and compare and contrast the available features of each. We conclude by summarizing the literature on robotic instrumentation accuracy in pedicle screw placement and clinical outcomes such as complication rates and briefly discuss the future of robotic spine surgery.

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