scholarly journals Patient-Matched 3-D-Printed Guides for the Insertion of Cervical Pedicle Screws in Tumor Surgery

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
C.-E. Heyde ◽  
G. Osterhoff ◽  
Spiegl UJA ◽  
A. Völker ◽  
N. H. von der Höh ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Ct Scan ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Patient Specific ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Intraoperative Fluoroscopy ◽  
Cervical Pedicle ◽  
Cervical Pedicle Screws

Background. Pedicle screw fixation in the cervical spine provides biomechanical advantages compared to other stabilization techniques. However, pedicle screw insertion in this area is challenging due to the anatomical conditions with a high risk of breaching the small pedicles and violating the vertebral artery or neural structures. Today, several techniques to facilitate screw insertion and to make the procedure safer are used. 3-D-printed patient-matched guides based on a CT reconstruction are a helpful technique which allows to reduce operation time and to improve the safety of pedicle screw insertion at the cervical spine. Cases. 3-D-printed patient-matched drill guides based on a CT scan with a 3-D reconstruction of the spine were used in two challenging cervical spine surgical tumor cases to facilitate the implantation of the pedicle screws. The screw position was controlled postoperatively by means of the routinely performed CT scan. Results. Postoperative imaging (conventional radiographs and CT scan) revealed the correct position of the pedicle screws. The time needed for screw insertion was short, and the need for intraoperative fluoroscopy could be reduced. There was no intra- or postoperative complication related to the pedicle screw implantation. Both tumors could be removed completely. Conclusion. These preliminary results show that 3-D-printed patient-specific guides are a promising tool to support and facilitate the implantation of cervical pedicle screws. The time needed for insertion is short, and intraoperative fluoroscopy time can be reduced. This technique allows for both a meticulous preoperative planning and a correct and therefore safe intraoperative positioning of cervical spine pedicle screws.

scholarly journals Novel Landmark for Cervical Pedicle Screw Insertion Point from Computed Tomography-Based Study

2017 ◽  
Vol 11 (1) ◽  
pp. 82-87 ◽  
Author(s):  
Kazuya Nishizawa ◽  
Kanji Mori ◽  
Akira Nakamura ◽  
Shinji Imai
Keyword(s):  
Cervical Spine ◽  
Pedicle Screw ◽  
Sagittal Plane ◽  
Pedicle Screws ◽  
Degenerative Changes ◽  
Insertion Point ◽  
Cervical Pedicle Screw ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Cervical Pedicle

<sec><title>Study Design</title><p>Cross-sectional study.</p></sec><sec><title>Purpose</title><p>The purpose of this study was to evaluate a novel landmark for the cervical pedicle screw insertion point.</p></sec><sec><title>Overview of Literature</title><p>To improve the accuracy of pedicle screw placement, several studies have employed the lateral mass, lateral vertical notch, and/or inferior articular process as landmarks; however, we often encounter patients in whom we cannot identify accurate insertion points for pedicle screws using these landmarks because of degenerative changes in the facet joints. The superomedial edge of the lamina is less affected by degenerative changes, and we hypothesized that it could be a new landmark for identifying an accurate cervical pedicle screw insertion point.</p></sec><sec><title>Methods</title><p>A total of 327 consecutive patients, who had undergone neck computed tomographic scanning for determination of neck disease in our institute, were included in the study. At first, the line was drawn parallel to the superior border of the pedicle in the sagittal plane and parallel to the vertical body in the coronal plane. The line was moved downward in 1-mm increments to the inferior border of the pedicle. We determined whether the line passing through the superomedial edge of the lamina (termed the “N-line”) was located between the superior and inferior borders of the pedicle in the sagittal plane.</p></sec><sec><title>Results</title><p>The percentages of N-lines located between the superior and inferior borders of the pedicle were 100% at C3, 100% at C4, 99% at C5, 96% at C6, and 97% at C7. The lower cervical spine has the higher N-line location.</p></sec><sec><title>Conclusions</title><p>The N-line was frequently located at the level of the pedicle of each cervical spine in the sagittal plane. The superomedial edge of the lamina could be a new landmark for the insertion point of the cervical pedicle screw.</p></sec>

scholarly journals Patient-Specific Templates for Pedicle Screw Insertion in Spinal Fixation Surgery

10.29007/kbf7 ◽  
2018 ◽  
Author(s):  
Mahmoud Hafez ◽  
Mohamed Fouda
Keyword(s):  
Pedicle Screw ◽  
3D Model ◽  
Pedicle Screws ◽  
Ct Scans ◽  
Patient Specific ◽  
Scoliosis Surgery ◽  
Spinal Fixation ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Surgery Patient

The increased use of pedicle screws in scoliosis creates a challenge for accurate and safe placement ofscrew within the pedicle during the scoliosis surgery. Patient-specific templates (PST) is a novelmethod to guide the surgeons for allocating and detecting the positions and trajectories of pediclescrews in scoliosis surgery. Based on CT-scans and according to certain protocol, this technique willallow the surgeon to construct a 3D model of spine and present the stage and vertebrae which containthe most deformed bone. With preplanned surgery on specific software, we can develop an accurateand safe position of pedicle screws and its trajectories. This method has the ability to customize theplacement and the size of each pedicle screw based on the unique morphology and landmarks of thevertebrae.

scholarly journals Perforation Rates of Cervical Pedicle Screw Insertion by Disease and Vertebral Level

2010 ◽  
Vol 4 (1) ◽  
pp. 142-146 ◽  
Author(s):  
Masashi Uehara ◽  
Jun Takahashi ◽  
Hiroki Hirabayashi ◽  
Hiroyuki Hashidate ◽  
Nobuhide Ogihara ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Pedicle Screws ◽  
Vertebral Level ◽  
Perforation Rate ◽  
Spine Tumor ◽  
Cervical Pedicle Screw ◽  
Screw Insertion ◽  
Screw Perforation ◽  
Cervical Pedicle ◽  
Cervical Pedicle Screws

Background: Different perforation rates for cervical pedicle screws by disease are expected in relation to bone quality and pedicle morphology; however, no report comparing pedicle screw perforation rate by disease had previously been published. This study investigated the perforation rates of pedicle screws inserted to cervical pedicle by disease and vertebral level using a CT-based navigation system. Materials/Methods: Fifty-three patients who underwent cervical pedicle screw insertion using CT based navigation system were studied. Diseases included rheumatoid arthritis (RA) (24 cases), destructive spondyloarthropathy (DSA) (10), cervical spondylotic myelopathy (CSM) (9), spine tumor (6), and cervical spondylotic myelopathy associated with athetoid cerebral palsy (CP) (4). Screw perforation rates for cervical pedicle screws were studied. Major perforation was defined as perforation 50% of screw diameter or more. Results: Major perforation rate by disease from C3 to C7 was as follows: spine tumor (0/24, 0%), RA (2/59, 3.4%), DSA (3/65, 4.6%), CP (2/20, 10.0%), and CSM (6/40, 15.0%). There were no clinically important complications such as vertebra arterial injury, spinal cord injury, or nerve root injury caused by any screw perforation. Major perforation rate by vertebral level was: C2(2/30, 6.7%), C3(4/49, 8.2%), C4(6/43, 14.0%), C5(1/32, 3.1%), C6(1/41, 2.4%), and C7(1/45, 2.2%), showing highest rate for C4, followed by C3. Conclusions: Cervical pedicle screw perforation rate by disease was higher in CSM compared to RA and DSA. The perforation rate by vertebral level was higher for C4 and C3, in this order.

scholarly journals Computer-assisted surgery navigation of pedicle screw insertion by standardized trainees

2019 ◽  
Author(s):  
Ming Yong Liu
Keyword(s):  
Ct Scan ◽  
Pedicle Screw ◽  
Navigation System ◽  
Pedicle Screws ◽  
Computer Assisted Surgery ◽  
Control Group ◽  
Computer Assisted ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Thoracic Pedicle Screws

Objective: To assess the precision and efficiency computer-assisted surgery navigation of pedicle screw insertion by standardized trainees. Methods: From September 2013 to June 2016, 360 thoracic pedicle screws were inserted into 100 patients by standardized trainees (n = 30). Screws on the left side were inserted by hands (control group), while the other side were inserted under the guidance of computer-assistant navigation system (guided group). The insertion time and volume of blood lost by each screw were retrospectively analyzed. The precision ratio was assessed by computerized tomography (CT) scan after operation. Results: The time consumed in screw insertion was significantly shorter in the guided group than that in the control group. The blood lost volume was lesser in the guided group. Post-operation CT scan revealed higher precision in the guided group than that in the control group. Conclusion: Computer-assistant navigation system facilitates the learning of standardized trainees, and reduces the time-consuming and bleeding in thoracic pedicle screw insertion.

Cervical pedicle screw insertion using a computed tomography cutout technique

2009 ◽  
Vol 11 (6) ◽  
pp. 681-687 ◽  
Author(s):  
Hiroshi Miyamoto ◽  
Koki Uno
Keyword(s):  
Cervical Spine ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Ct Images ◽  
Entry Point ◽  
New Technique ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Insertion Line ◽  
Screw Diameter

Object The pedicle screw has been reported to provide the strongest fixation for the cervical spine, but there is a possibility of malpositioning the screws, which may cause fatal complications such as vertebral artery and neural injuries. Using the conventional freehand technique, between 6.7 and 29% of the screws have been found to be malpositioned. If an accurate entry point and insertion trajectory through the isthmus of the pedicle can be maintained during surgery, safer insertion of the pedicle screw should be achieved. The authors have developed a new pedicle screw insertion method, called the “CT cutout” technique, and report on the technical and clinical aspects of this new technique in terms of accuracy. Methods A total of 130 pedicle screws were inserted from C-2 to T-1 in 29 consecutive patients using the new technique. In the CT cutout technique, a CT slice of every vertebra in which the authors intended to insert pedicle screws was captured from 3D CT images of the cervical spine with the gantry parallel to the pedicle. A life-sized CT image was developed for each level, and the desired insertion line, passing through the middle of the isthmus, was drawn on the image. The images were then cut along the insertion line and the posterior margin of the lamina, and sterilized. During surgery, the proper cephalocaudal entry point was determined using a lateral fluoroscopic image, the CT cutout was placed on the posterior surface of the lamina, and the appropriate entry point and trajectory of pedicle screw insertion were chosen with reference to the CT cutout. The percentage of malpositioned pedicle screws and the deviation between the intended entry point and angle of the pedicle screw, and those that were achieved in practice, was investigated using postoperative CT images. Results Three perforations (2.3%) in which more than half a screw diameter was exposed outside the pedicle, and 2 penetrations (1.5%) in which a screw diameter was completely exposed, were identified on the postoperative CT images. All breaches were directed laterally. No neural or vascular injuries were observed. The deviation between the intended entry point and angle of the pedicle screw and the actual values was 0.20 ± 0.75 mm and 1.46 ± 4.21°, respectively. Conclusions Several techniques for pedicle screw insertion such as computer-assisted navigation, CT-based navigation, and acquisition of fluoroscopic intraoperative pedicle axis views have been used for improving accuracy. However, there remains a possibility of misplacement, and these costly procedures often require delivery of a high x-ray dose to both patients and surgeons, and/or time-consuming configuration of reference points during surgery. The CT cutout technique is an easy, low-cost procedure that can be performed with the aid of single-plane fluoroscopy and without the need of configuration. This new technique shows great promise for safe pedicle screw insertion for the cervical spine.

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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