scholarly journals Accuracy of thoracic pedicle screw placement using freehand technique and triggered EMG in adolescent idiopathic scoliosis: Is it different between concave and convex side?

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901878497 ◽  
Author(s):  
Woo-Kie Min ◽  
Sang-bong Na ◽  
Jin-An Jang
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screws ◽  
Convex Side ◽  
Pedicle Screw Placement ◽  
Freehand Technique ◽  
Thoracic Pedicle Screw ◽  
Thoracic Pedicle Screws ◽  
Group A ◽  
Group B

Purpose: To evaluate and compare the accuracy of the placement of thoracic pedicle screws between concave and convex side curve using freehand technique and triggered electromyogram (EMG). Methods: Three-hundred sixty eight thoracic pedicle screws were included for the evaluation of accuracy from postoperative computed tomography (CT) scans in 24 patients with adolescent idiopathic scoliosis with a mean follow-up of 27 months (range 24–58 months). All screws had stimulation thresholds greater than 6 mA. We divided the screws into two groups: (1) group A: concave side curve—254 screws (2) group B: convex side curve—114 screws. Results: The mean age at surgery was 12.8 years (range 11–17 years). The preoperative Cobb angle was 57.5° (range 50–75°). There were 41 total breaches (medial = 21, lateral = 20, p = 0.66) with an overall incidence of 11.1%. The overall breach rate did not attain statistically significant difference (group A = 11.8%, group B = 9.6%, p = 0.59). The rate of medial breaches was also similar for both concave and convex side (group A = 6.1%, group B = 5.9%, p > 0.05). No postoperative neurological or vascular complications were noted in both groups. Conclusion: Thoracic pedicle screw placement using both freehand technique and triggered EMG for adolescent idiopathic scoliosis surgery is safe and reliable. The overall accuracy rate is 88.9% with similar breaches on the concave and convex side on postoperative CT scans.

scholarly journals Uniplanar cannulated pedicle screws in the correction of Lenke type 1 adolescent idiopathic scoliosis (AIS)

2020 ◽  
Author(s):  
Yiwei Zhao ◽  
Wubo Liu ◽  
Suomao Yuan ◽  
Yonghao Tian ◽  
Xinyu Liu
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screws ◽  
Vertebral Rotation ◽  
Concave Side ◽  
Convex Side ◽  
X Rays ◽  
Group A ◽  
Group B

Abstract Background In the present study, we reported the clinical use of uniplanar cannulated pedicle screws for the correction of Lenke type 1 adolescent Idiopathic scoliosis (AIS), and its safety and clinical outcomes were also evaluated. Methods 68 patients with Lenke type 1 AIS were included, among which 38 patients were treated with uniplanar cannulated screws at the concave side of periapical levels and multiaxial screws at the other levels (group A). Moreover, the remaining 30 patients were treated with all multiaxial screws (group B). The preoperative and postoperative radiographic parameters of the Lenke type 1 AIS, axial vertebral rotation, and the safety of the pedicle screws were evaluated by X-rays and computed tomography (CT). Results Preoperative data was comparable between two groups. The postoperative proximal thoracic (PT) curve, main thoracic (MT) curve, thoracolumbar/lumbar (TL/L) curve, and apical vertebral rotation were significantly improved compared with the preoperative data. The coronal correction rates in group A and B were 83% and 81.9%, respectively (P > 0.05). The derotation rates in group A and B were 60.8% and 43.2%, respectively (P < 0.05). The rotation classification in the group A was also better compared with the group B. The misplacement rate in group A and B was 7.9% and 11.8%, respectively (P < 0.05), and the total misplacement rate on the concave side (11.4%) was higher than that of convex side (8.4%). The lateral perforation was found at the concave side, while the medial perforation was found at the convex side. On the concave side, the misplacement rate in group A and B was 9.7% and 12.3%, respectively (P < 0.05). The grades 2 and 3 perforations were three (3.5%) in the group A and eight (8.2%) in the group B (P < 0.05). On the convex side, the misplacement rate in group A and B was 5.9% and 11.1%, respectively (P < 0.05). The grades 2 and 3 perforations were one (0.9%) in the group A and four (4.4%) in the group B (P < 0.05). Conclusion Collectively, uniplanar cannulated pedicle screws could effectively increase the accuracy of pedicle screws and facilitate the derotation of the apical vertebra compared with the multiaxial pedicle screws. Trial registration retrospectively registered

Ball tip technique for thoracic pedicle screw placement in patients with adolescent idiopathic scoliosis

2010 ◽  
Vol 13 (2) ◽  
pp. 246-252 ◽  
Author(s):  
Kota Watanabe ◽  
Morio Matsumoto ◽  
Takashi Tsuji ◽  
Ken Ishii ◽  
Hironari Takaishi ◽  
...  
Keyword(s):  
Clinical Study ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screws ◽  
Conventional Technique ◽  
Cadaveric Study ◽  
Conventional Group ◽  
Starting Point ◽  
Freehand Technique ◽  
Thoracic Pedicle Screws

Object The aim in this study was to evaluate the efficacy of the ball tip technique in placing thoracic pedicle screws (TPSs), as compared with the conventional freehand technique, in both a cadaveric study and a clinical study of patients with adolescent idiopathic scoliosis. Although posterior spinal surgery using TPSs has been widely applied, these screws are associated with the potential risk of vascular, pulmonary, or neurological complications. To further enhance the accuracy and safety of TPS placement, the authors developed the ball tip technique. Methods After creating an appropriate starting point for probe insertion, a specially designed ball tip probe consisting of a ball-shaped tip with a flexible metal shaft is used to make a guide hole into the pedicle. Holding the probe with the fingertips while using an appropriate amount of pressure or by tapping it gently and continuously with a hammer, one can safely insert the ball tip probe into the cancellous channel in the pedicle. In a cadaveric study, 5 spine fellows with similar levels of experience in placing TPSs applied the ball tip or the conventional technique to place screws in 5 cadavers with no spinal deformities. The incidence of misplaced screws was evaluated by dissecting the spines. In a clinical study, 40 patients with adolescent idiopathic scoliosis underwent posterior surgery with TPS placement via the ball tip or conventional technique (20 patients in each treatment group). The accuracy of the TPS placements was evaluated on postoperative axial CT scanning. Results In the cadaveric study, 100 TPSs were evaluated, and the incidence of misplaced screws was 14% in the ball tip group and 34% in the conventional group (p = 0.0192). In the clinical study, 574 TPSs were evaluated. One hundred seventy-one intrapedicular screws (67%) were recognized in the conventional group and 288 (90%) in the ball tip group (p < 0.01). In the conventional and ball tip groups, the respective numbers of TPSs with a pedicle breach of ≤ 2 mm were 20 (8%) and 15 (5%), those with a pedicle breach of > 2 mm were 32 (13%) and 9 (3%; p < 0.01), and those located in the costovertebral joints were 32 (13%) and 7 (2%). Conclusions In both cadaveric and clinical studies the ball tip technique enhanced the accuracy of TPS placement as compared with the conventional freehand technique. Thus, the ball tip technique is useful for the accurate and safe placement of TPSs in deformed spines.

Monaxial Versus Multiaxial Thoracic Pedicle Screws in the Correction of Adolescent Idiopathic Scoliosis

Spine ◽  
2005 ◽  
Vol 30 (18) ◽  
pp. 2113-2120 ◽  
Author(s):  
Timothy R. Kuklo ◽  
Benjamin K. Potter ◽  
David W. Polly ◽  
Lawrence G. Lenke
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screws ◽  
Thoracic Pedicle Screws

scholarly journals Evaluation of thoracic pedicle screw placement in adolescent idiopathic scoliosis

2009 ◽  
Vol 18 (12) ◽  
pp. 1892-1897 ◽  
Author(s):  
Ahmet Yılmaz Şarlak ◽  
Bilgehan Tosun ◽  
Halil Atmaca ◽  
Hasan Tahsin Sarisoy ◽  
Levent Buluç
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screw ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Thoracic Pedicle Screw

scholarly journals Comparison of Clinical and Radiologic Outcome of Adolescent Idiopathic Scoliosis Treated with Hybrid Hook-Screw Instrumentation versus Universal Clamp System

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Ebrahim Ghayem Hassankhani ◽  
Farzad Omidi-Kashani ◽  
Shahram Moradkhani ◽  
Golnaz Ghayem Hassankhani ◽  
Mohammad Taghi Shakeri
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Blood Loss ◽  
Idiopathic Scoliosis ◽  
Operative Time ◽  
Intraoperative Blood Loss ◽  
Curve Correction ◽  
Universal Clamp ◽  
Outcome Scores ◽  
Group A ◽  
Group B

Background. In surgical treatment of adolescent idiopathic scoliosis (AIS), hybrid universal clamp system has been used by some authors. We aimed to compare the clinical and radiologic outcome of hybrid universal clamp with hybrid thoracic hook lumbar screw. Methods. A prospective study was performed on 56 consecutive patients with AIS, who had alternatively undergone a posterior spinal fusion and instrumentation with hybrid thoracic hook lumbar screw system (28 patients: group A) and hybrid universal clamp system (28 patients: group B) between June 2006 and January 2014 at Imam Reza University Hospital and had been followed up for more than two years. The comparison was according to radiographic changes, operative time, intraoperative blood loss, complications, and Scoliosis Research Society (SRS-22) outcome scores. Results. The preoperative mean curve Cobb angle was 58°±7° (42°–74°) in group A and 60°±9° (46°–75°) in group B. The mean final coronal curve correction was 60.4% and 75.5% in groups A and B, respectively (P=0.001). Postoperative SRS outcome scores were also comparable. Conclusion. Universal clamp instrumentation had a significantly better curve correction and lower complication rate compared with hybrid thoracic hook lumbar screw. Both instrumentation methods had similar operative time, intraoperative blood loss, and postoperative SRS outcome scores.

scholarly journals Learning Curve for Placement of Thoracic Pedicle Screws in the Deformed Spine

Neurosurgery ◽  
2010 ◽  
Vol 66 (2) ◽  
pp. 290-295 ◽  
Author(s):  
Amer F. Samdani ◽  
Ashish Ranade ◽  
Vilas Saldanha ◽  
Menacham Z. Yondorf
Keyword(s):  
Learning Curve ◽  
Pedicle Screw ◽  
Statistical Significance ◽  
Pedicle Screws ◽  
Neurophysiologic Monitoring ◽  
Surgeon Experience ◽  
Thoracic Pedicle Screws ◽  
Group A ◽  
Group B ◽  
Over Time

Abstract OBJECTIVE The placement of thoracic pedicle screws, particularly in the deformed spine, poses unique challenges, and a learning curve. We measured the in vivo accuracy of placement of thoracic pedicle screws by computed tomography in the deformed spine by a single surgeon over time. METHODS After obtaining institutional review board approval, we retrospectively selected the first 30 consecutive patients who had undergone a posterior spinal fusion using a pedicle screw construct for adolescent idiopathic scoliosis by a single surgeon. The average patient age was 14 years, and their preoperative thoracic Cobb angle was, on average, 62.6 degrees. Patients were divided into 3 groups: group A, patients 1 to 10; group B, patients 11 to 20; and group C, patients 21 to 30. Intraoperative evaluation of all pedicle screws included probing of the pedicle screw tract, neurophysiologic monitoring, and fluoroscopic confirmation. Postoperative computed tomographic scans were evaluated by 2 spine surgeons, and a consensus read was established, as previously described (Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD. Free hand pedicle screw placement in the thoracic spine: is it safe? Spine. 2004;29(3):333–342), as (1) “in,” axis of pedicle screw within the confines of the pedicle; or (2) “out,” axis of pedicle screw outside the confines of the pedicle. RESULTS A total of 553 thoracic pedicle screws were studied (group A, n = 181; group B, n = 189; group C, n = 183) with 64 graded as out (medial, 35; lateral, 29), for an overall breach rate of 11.6%. When the breach rates were stratified by the surgeon's evolving experience, there was a temporal decrease in the breach rate (group A, 15.5%; group B, 10.6%; group C, 8.7%; P &lt; .05). This decreased breach rate was reflected in fewer medial breaches over time (group A, 9.4%; group B, 5.8%; group C, 3.8%; P &lt; .05). Similar trends were observed for the concave periapical screws, although statistical significance was not attained (group A, 21.2%; group B, 16.2%; group C, 10.5%). CONCLUSION The overall accuracy of placement of thoracic pedicle screws in the deformed spine was 88.4%, with no neurologic or visceral complications. One patient from group A returned to the operating room on postoperative day 2 for removal of an asymptomatic left T7 thoracic pedicle screw abutting the aorta. As surgeon experience increased, there was an overall decreased breach rate, which was mainly reflected in fewer medial breaches.

scholarly journals Plasma Technology Reduces Blood Loss in Adolescent Idiopathic Scoliosis Surgery: A Prospective Randomized Clinical Trial

2020 ◽  
pp. 219256822092834
Author(s):  
Andrea Piazzolla ◽  
Davide Bizzoca ◽  
Giuseppe Solarino ◽  
Claudia Parato ◽  
Biagio Moretti
Keyword(s):  
Clinical Trial ◽  
Adolescent Idiopathic Scoliosis ◽  
Blood Loss ◽  
Idiopathic Scoliosis ◽  
Randomized Clinical Trial ◽  
Intraoperative Blood Loss ◽  
Prospective Randomized Clinical Trial ◽  
Group A ◽  
Bipolar Sealer ◽  
Group B

Study Design: Prospective randomized clinical trial. Objectives: To assess the effectiveness of PEAK Plasmablade (PPB), compared with bipolar sealer and standard electrocautery, in the posterior spinal instrumentation and fusion (PSF) surgery performed for adolescent idiopathic scoliosis (AIS). Methods: Ninety-three patients undergoing PSF surgery for AIS were randomized in 2 groups: group-A patients (n = 45) underwent PSF surgery using PPB; group-B patients (n = 48) were treated with bipolar sealer and standard electrocautery. Demographic and surgical data was recorded. All the patients underwent serial blood tests on the day before surgery (T0) and at 24 (T1), 48 (T2), 72 (T3), and 96 (T4) hours postoperatively. Visual analogue scale for pain (VAS) score, the percentage of paracetamol assumption, and the blood transfusion rate were recorded in the time-lapse T1 to T4. Intergroup variability was assessed. Pearson correlation test was performed. A P value <.05 was considered significant. Results: In group A, a significantly shorter total operative time ( P = .0087), a significantly lower total intraoperative blood loss (TBL) ( P = .001), and a higher postoperative hemoglobin (Hb) ( P = .01) were recorded. A significant higher mean Hb concentration and mean albumin value was recorded in group A at 24 and 48 hours postoperatively. A significant correlation between TBL and hospital stay was recorded in both groups (group A, P = .00 001; group B, P = .00 006); moreover, in both groups, a significant correlation was observed between TBL and mean VAS at 72 hours postoperatively (group A, P = .0009; group B, P = .0001) and at 96 hours postoperatively (group A, P = .000 044; group B, P = .00 001). Conclusions: PPB reduces the intraoperative blood loss in PSF performed for AIS, thus allowing a patient’s faster recovery.

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