An Evaluation of the Stryker 90D Pedicle Screw for Use as a Revision Screw

2007 ◽  
Author(s):  
Ferris M. Pfeiffer ◽  
Dennis L. Abernathie
Keyword(s):  
Spinal Fusion ◽  
Pedicle Screw ◽  
Relative Motion ◽  
Bone Growth ◽  
Posterior Instrumentation ◽  
Pedicle Screws

The success of a spinal fusion is often judged by the amount of relative motion between vertebrae following surgery. Proper fusion is aided by fixation instrumentation as well as bone growth subsequent to surgery. In order to allow for proper fusion it is necessary for instrumentation to properly fix the vertebrae until sufficient bone growth has occurred. In many cases pedicle screws are used to provide posterior support. It is the purpose of posterior instrumentation to increase the rate of fusion [1]. However, due to deterioration in the holding capacity of the posterior instrumentation; the quality of the fixed joint can begin to degrade. If this deterioration is significant enough it requires removal or revision of the fixation instrumentation.

Biomechanics of posterior instrumentation in L1–L3 lateral interbody fusion: Pedicle screw rod construct vs. transfacet pedicle screws

2016 ◽  
Vol 31 ◽  
pp. 59-64 ◽  
Author(s):  
Kingsley R. Chin ◽  
Anna G.U. Newcomb ◽  
Marco T. Reis ◽  
Phillip M. Reyes ◽  
Grace A. Hickam ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Pedicle Screws ◽  
Lateral Interbody Fusion ◽  
Lateral Interbody

scholarly journals Utilizing a Cortical Bone Trajectory Pedicle Screw for Lumbar Flexion-Distraction Injury

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Naohisa Miyakoshi ◽  
Shigeto Maekawa ◽  
Masakazu Urayama ◽  
Yoichi Shimada
Keyword(s):  
Cortical Bone ◽  
Pedicle Screw ◽  
Posterior Instrumentation ◽  
Pedicle Screws ◽  
Spinal Mobility ◽  
Cortical Bone Trajectory ◽  
The Right ◽  
L1 And L2 ◽  
Spinal Flexion

Spinal flexion-distraction injuries (FDIs) are unstable fractures, commonly located at the thoracolumbar junction. Management of FDIs often necessitates the use of posterior instrumentation and fusion, but long-segment instrumentation surgery decreases postoperative spinal mobility and increases the risk of junctional kyphosis and fracture. We report the case of a patient with FDI showing an L2 vertebral fracture, unilateral L2 pedicle fracture, and disruptions of the posterior ligamentous complex between L1 and L2. After open reduction using L1 and L2 pedicle screws with a conventional trajectory on the right side, a cortical bone trajectory (CBT) pedicle screw was used as an osteosynthesis screw for the fractured left pedicle. This procedure enabled successful single-level fusion. Follow-up radiological examination revealed good reduction and complete bone union. To the best of our knowledge, utilizing a CBT technique as an osteosynthesis screw in FDIs has not previously been described.

scholarly journals Alternative Pedicle Screw Design via Biomechanical Evaluation

2020 ◽  
Vol 10 (14) ◽  
pp. 4746 ◽  
Author(s):  
Jiwoon Kwon ◽  
Myung Heon Ha ◽  
Moon Gu Lee
Keyword(s):  
Spinal Fusion ◽  
Pedicle Screw ◽  
Bending Strength ◽  
Pedicle Screws ◽  
The Elderly ◽  
Spinal Diseases ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Screw Design ◽  
Experimental Apparatus

With the recent increase in the elderly population, many people suffer from spinal diseases, and, accordingly, spinal fusion surgery using pedicle screws has been widely applied to treat them. However, most research on pedicle screw design has been focused on the test results rather than the behavior of the screws and vertebrae. In this study, a design platform with a series of biomechanical tests and analyses were presented for pedicle screw improvement and evaluation. The platform was then applied to an alternative hybrid screw design with quadruple and double threads. An experimental apparatus was developed to investigate the bending strength of the screw, and several tests were performed based on the ASTM F1717 standard. In the experiments, it was confirmed that the alternative pedicle screw has the highest bending strength. To examine the stress distribution of pedicle screws, finite element models were established, through which it was found that the proposed pedicle screw has sufficient mechanical safety to make it acceptable for spinal fusion treatment. Finally, we conclude that the platform has good potential for the design and evaluation of pedicle screws, and the alternative dual screw design is one of the best options for spinal fusion surgery.

scholarly journals Single Position Lateral Lumbar Fusion Utilizing Robot Guided Screw Placement

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
George V Huffmon
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Structural Integrity ◽  
Lumbar Fusion ◽  
Posterior Instrumentation ◽  
Pedicle Screws ◽  
Lateral Position ◽  
Screw Placement ◽  
Lumbar Interbody Fusion ◽  
Pedicle Screw Placement

Abstract INTRODUCTION Lateral position interbody lumbar fusion surgery has become popular as an excellent modality for obtaining lumbar fusion and achieving sagital balance. Posterior instrumentation with pedicle screw fixation adds structural integrity to the construct. Maintaining the patient in the lateral position for pedicle screw placement decreases the time that the patient is under general anesthesia. Since August 2017 we have successfully performed 32 single position pedicle screw fixations utilizing robotic guidance. METHODS The lateral position was utilized for interbody fusion using a variety of techniques; oblique lumbar interbody fusion, extreme lateral lumbar interbody fusion, and lateral anterior lumbar interbody fusion. The Mazor X robot (Medtronic) was utilized for guidewire placement maintaining the patient in the lateral position. Pedicle screws of various manufacturers were placed over the guide wires and connecting rods were placed in the lateral position. RESULTS Since August 2017 we have successfully placed pedicle screws in 1 and 2 level single position lateral lumbar fusions in 32 of 39 cases attempted. There were no nerve root injuries nor any complications related to pedicle screw placement. CONCLUSION Single position lateral lumbar fusion cases utilizing robotic guidance for pedicle screw placement is a viable surgical procedure. Placement of the pedicle screws in the lateral position can reduce intraoperative anesthetic time by eliminating the placement of the patient into the prone position. Utilization of robotic guidance can decrease intraoperative fluoroscopy exposure.

scholarly journals Incidence of Proximal Junctional Kyphosis With Pedicle Screws at Upper Instrumented Vertebrae in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

2020 ◽  
pp. 219256822093510
Author(s):  
Yoji Ogura ◽  
Steven D. Glassman ◽  
Daniel Sucato ◽  
M. Timothy Hresko ◽  
Leah Y. Carreon
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Spinal Fusion ◽  
Pedicle Screw ◽  
Standard Procedure ◽  
Pedicle Screws ◽  
Posterior Spinal Fusion ◽  
Proximal Junctional Kyphosis ◽  
The Impact ◽  
Junctional Kyphosis

Study Design: Longitudinal cohort. Objectives: Posterior spinal fusion (PSF) using all-pedicle screw constructs has become the standard procedure in the treatment of adolescent idiopathic scoliosis (AIS). However, there have been several reports that all-pedicle screw constructs or the use of pedicle screws at the upper instrumented vertebrae (UIV) increases the incidence of proximal junctional kyphosis (PJK). We aimed to evaluate the impact of instrumentation type on the incidence of PJK following PSF for AIS. Methods: We performed a stratified random sampling from 3654 patients enrolled in a multicenter database of surgically treated AIS to obtain a representative sample from all Lenke types. Patients were then allocated into 3 groups based on the instrumentation type: all-pedicle screw (PS), hook at UIV with pedicle screws distally (HT), and hybrid constructs (HB). We measured proximal junctional angle (PJA) and defined PJK as PJA ≥ 10° and PJA progression of >10° at the final follow-up. Results: Fifteen (4.3%) of 345 cases had PJK. PJK was significantly more common in PS (11%) compared with HB (1%) and HT (0%) ( P < .001). PJK patients were similar to non-PJK patients regarding age, sex, curve type, UIV, and preoperative coronal Cobb angle. Thoracic kyphosis was significantly higher in the PJK group before surgery. Patients who developed PJK had a statistically significantly larger negative sagittal balance compared with the non-PJK group. Conclusion: The incidence of PJK was 4.3% and was more common in all-pedicle screw constructs. Using hooks at UIV might be a treatment strategy to limit PJK.

scholarly journals Workflow and performance of intraoperative CT, cone-beam CT, and robotic cone-beam CT for spinal navigation in 503 consecutive patients

2022 ◽  
Vol 52 (1) ◽  
pp. E7
Keyword(s):  
Image Quality ◽  
Pedicle Screw ◽  
Posterior Instrumentation ◽  
Cone Beam Ct ◽  
Demographic Data ◽  
Pedicle Screws ◽  
Cone Beam ◽  
Intraoperative Ct ◽  
Spinal Navigation ◽  
And Performance

OBJECTIVE A direct comparison of intraoperative CT (iCT), cone-beam CT (CBCT), and robotic cone-beam CT (rCBCT) has been necessary to identify the ideal imaging solution for each individual user’s need. Herein, the authors sought to analyze workflow, handling, and performance of iCT, CBCT, and rCBCT imaging for navigated pedicle screw instrumentation across the entire spine performed within the same surgical environment by the same group of surgeons. METHODS Between 2014 and 2018, 503 consecutive patients received 2673 navigated pedicle screws using iCT (n = 1219), CBCT (n = 646), or rCBCT (n = 808) imaging during the first 24 months after the acquisition of each modality. Clinical and demographic data, workflow, handling, and screw assessment and accuracy were analyzed. RESULTS Intraoperative CT showed image quality and workflow advantages for cervicothoracic cases, obese patients, and long-segment instrumentation, whereas CBCT and rCBCT offered independent handling, around-the-clock availability, and the option of performing 2D fluoroscopy. All modalities permitted reliable intraoperative screw assessment. Navigated screw revision was possible with each modality and yielded final accuracy rates > 92% in all groups (iCT 96.2% vs CBCT 92.3%, p < 0.001) without a difference in the accuracy of cervical pedicle screw placement or the rate of secondary screw revision surgeries. CONCLUSIONS Continuous training and an individual setup of iCT, CBCT, and rCBCT has been shown to permit safe and precise navigated posterior instrumentation across the entire spine with reliable screw assessment and the option of immediate revision. The perceived higher image quality and larger scan area of iCT should be weighed against the around-the-clock availability of CBCT and rCBCT technology with the option of single-handed robotic image acquisition.

An Ultrasound Technique of Bone Thickness Estimation for Pedicle Screw Insertion

2014 ◽  
Vol 18 (4) ◽  
pp. 529-537
Author(s):  
Muhamad Khairul Ali Hassan ◽  
◽  
Kouki Nagamune ◽  
Kenichiro Kakutani ◽  
Koichiro Maeno ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Cancellous Bone ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Bone Thickness ◽  
Ultrasound Technique ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Real Time Measurement

Information on bone thickness is useful to surgeons in fixing pedicle screws in place. The quality of pedicle screw insertion continues to increase with the introduction of such techniques as navigation based on computed tomography and fluoroscopy. These techniques reduce error in pedicle screw placement and injury. However, the information reported on the real time measurement of depths drilled through cancellous bone, also known as trabecular bone or sponge bone, by the pedicle screw is minimal. It currently depends on palpation by the physician for judging the boundary between cortical and cancellous bone – an inaccurate technique that may produce errors in screw placement and the risk of injury during surgical processes. Ultrasound is used to help overcome such problems. Bone thickness is estimated in this study using an ultrasound transducer attached to 20 mm of polymethyl methacrylate, a clear glass-like acrylic. The bone thickness of five specimens was measured using ultrasound echo signals. Error in estimating bone thickness was small, 8.121%, showing the accuracy in bone thickness to be more than 90.00% which is suitable for use in estimating bone thickness in pedicle screw insertion.

Distraction Osteogenesis in the Treatment of Craniofacial Anomalies: Applications and Outcomes

2020 ◽  
Vol 5 (6) ◽  
pp. 1469-1481 ◽  
Author(s):  
Joseph A. Napoli ◽  
Carrie E. Zimmerman ◽  
Linda D. Vallino
Keyword(s):  
Distraction Osteogenesis ◽  
Bone Growth ◽  
Upper Airway ◽  
Craniofacial Anomalies ◽  
Craniofacial Skeleton ◽  
Facial Skeleton ◽  
Psychosocial Impairment ◽  
And Function ◽  
Correct Structure

Purpose Craniofacial anomalies (CFA) often result in growth abnormalities of the facial skeleton adversely affecting function and appearance. The functional problems caused by the structural anomalies include upper airway obstruction, speech abnormalities, feeding difficulty, hearing deficits, dental/occlusal defects, and cognitive and psychosocial impairment. Managing disorders of the craniofacial skeleton has been improved by the technique known as distraction osteogenesis (DO). In DO, new bone growth is stimulated allowing bones to be lengthened without need for bone graft. The purpose of this clinical focus article is to describe the technique and clinical applications and outcomes of DO in CFA. Conclusion Distraction can be applied to various regions of the craniofacial skeleton to correct structure and function. The benefits of this procedure include improved airway, feeding, occlusion, speech, and appearance, resulting in a better quality of life for patients with CFA.

Image-Guided Spinal Surgery and Robotics in MIS: Where Are We Now?

2018 ◽  
Vol 1 (2) ◽  
pp. 2
Author(s):  
Chiung Chyi Shen
Keyword(s):  
Pedicle Screw ◽  
Spinal Surgery ◽  
Surgical Navigation ◽  
Improve Patient Safety ◽  
Intraoperative Imaging ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Computer Assisted ◽  
Navigation Systems ◽  
Image Guided

Use of pedicle screws is widespread in spinal surgery for degenerative, traumatic, and oncological diseases. The conventional technique is based on the recognition of anatomic landmarks, preparation and palpation of cortices of the pedicle under control of an intraoperative C-arm (iC-arm) fluoroscopy. With these conventional methods, the median pedicle screw accuracy ranges from 86.7% to 93.8%, even if perforation rates range from 21.1% to 39.8%.The development of novel intraoperative navigational techniques, commonly referred to as image-guided surgery (IGS), provide simultaneous and multiplanar views of spinal anatomy. IGS technology can increase the accuracy of spinal instrumentation procedures and improve patient safety. These systems, such as fluoroscopy-based image guidance ("virtual fluoroscopy") and computed tomography (CT)-based computer-guidance systems, have sensibly minimized risk of pedicle screw misplacement, with overall perforation rates ranging from between 14.3% and 9.3%, respectively."Virtual fluoroscopy" allows simultaneous two-dimensional (2D) guidance in multiple planes, but does not provide any axial images; quality of images is directly dependent on the resolution of the acquired fluoroscopic projections. Furthermore, computer-assisted surgical navigation systems decrease the reliance on intraoperative imaging, thus reducing the use of intraprocedure ionizing radiation. The major limitation of this technique is related to the variation of the position of the patient from the preoperative CT scan, usually obtained before surgery in a supine position, and the operative position (prone). The next technological evolution is the use of an intraoperative CT (iCT) scan, which would allow us to solve the position-dependent changes, granting a higher accuracy in the navigation system. 

Augmented reality–assisted pedicle screw insertion: a cadaveric proof-of-concept study

2019 ◽  
Vol 31 (1) ◽  
pp. 139-146 ◽  
Author(s):  
Camilo A. Molina ◽  
Nicholas Theodore ◽  
A. Karim Ahmed ◽  
Erick M. Westbroek ◽  
Yigal Mirovsky ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Pedicle Screw ◽  
User Experience ◽  
Pedicle Screws ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Insertion Method ◽  
Comparative Accuracy ◽  
Placement Accuracy ◽  
Surgical Field

OBJECTIVEAugmented reality (AR) is a novel technology that has the potential to increase the technical feasibility, accuracy, and safety of conventional manual and robotic computer-navigated pedicle insertion methods. Visual data are directly projected to the operator’s retina and overlaid onto the surgical field, thereby removing the requirement to shift attention to a remote display. The objective of this study was to assess the comparative accuracy of AR-assisted pedicle screw insertion in comparison to conventional pedicle screw insertion methods.METHODSFive cadaveric male torsos were instrumented bilaterally from T6 to L5 for a total of 120 inserted pedicle screws. Postprocedural CT scans were obtained, and screw insertion accuracy was graded by 2 independent neuroradiologists using both the Gertzbein scale (GS) and a combination of that scale and the Heary classification, referred to in this paper as the Heary-Gertzbein scale (HGS). Non-inferiority analysis was performed, comparing the accuracy to freehand, manual computer-navigated, and robotics-assisted computer-navigated insertion accuracy rates reported in the literature. User experience analysis was conducted via a user experience questionnaire filled out by operators after the procedures.RESULTSThe overall screw placement accuracy achieved with the AR system was 96.7% based on the HGS and 94.6% based on the GS. Insertion accuracy was non-inferior to accuracy reported for manual computer-navigated pedicle insertion based on both the GS and the HGS scores. When compared to accuracy reported for robotics-assisted computer-navigated insertion, accuracy achieved with the AR system was found to be non-inferior when assessed with the GS, but superior when assessed with the HGS. Last, accuracy results achieved with the AR system were found to be superior to results obtained with freehand insertion based on both the HGS and the GS scores. Accuracy results were not found to be inferior in any comparison. User experience analysis yielded “excellent” usability classification.CONCLUSIONSAR-assisted pedicle screw insertion is a technically feasible and accurate insertion method.

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