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.

Thoracic Pedicle Screw Placement Guided by Computed Tomographic Measurements

1999 ◽  
Vol 10 (3) ◽  
pp. 222???226
Author(s):  
Rongming Xu ◽  
Nabil A. Ebraheim ◽  
Matthew E. Shepherd ◽  
Richard A. Yeasting
Keyword(s):  
Pedicle Screw ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Computed Tomographic ◽  
Thoracic Pedicle Screw

A Prospective Analysis of Intraoperative Electromyographic Monitoring of Pedicle Screw Placement With Computed Tomographic Scan Confirmation

Spine ◽  
1995 ◽  
Vol 20 (12) ◽  
pp. 1375-1379 ◽  
Author(s):  
Steven D. Glassman ◽  
John R. Dimar ◽  
Rolando M. Puno ◽  
John R. Johnson ◽  
Christopher B. Shields ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Placement ◽  
Prospective Analysis ◽  
Pedicle Screw Placement ◽  
Computed Tomographic ◽  
Computed Tomographic Scan

Clinical Assessment of Percutaneous Lumbar Pedicle Screw Placement Using the O-Arm Multidimensional Surgical Imaging System

Neurosurgery ◽  
2011 ◽  
Vol 70 (4) ◽  
pp. 990-995 ◽  
Author(s):  
John K. Houten ◽  
Rani Nasser ◽  
Nrupen Baxi
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Imaging System ◽  
Intraoperative Imaging ◽  
Lumbar Fusion ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Percutaneous Pedicle Screw ◽  
Clinical Series

Abstract BACKGROUND: Increasing popularity of minimally invasive surgery for lumbar fusion has led to dependence upon intraoperative fluoroscopy for pedicle screw placement, because limited muscle dissection does not expose the bony anatomy necessary for traditional, freehand techniques nor for registration steps in image-guidance techniques. This has raised concerns about cumulative radiation exposure for both surgeon and operating room staff. The recent introduction of the O-arm Multidimensional Surgical Imaging System allows for percutaneous placement of pedicle screws, but there is limited clinical experience with the technique and data examining its accuracy. OBJECTIVE: We present the first large clinical series of percutaneous screw placement using navigation of O-arm imaging and compare the results with the fluoroscopy-guided method. METHODS: A retrospective review of a 24-month period identified patients undergoing minimally invasive lumbar interbody fusion. The O-arm was introduced in the middle of this period and was used for all subsequent patients. Accuracy of screw placement was assessed by examination of axial computed tomography or O-arm scans. RESULTS: The fluoroscopy group included 141 screws in 42 patients, and the O-arm group included 205 screws in 52 patients. The perforation rate was 12.8% in the fluoroscopy group and 3% in the O-arm group (P < .001). Single-level O-arm procedures took a mean 200 (153–241) minutes, whereas fluoroscopy took 221 (178–302) minutes (P < .03). CONCLUSION: Percutaneous pedicle screw placement with the O-arm Multidimensional Intraoperative Imaging System is a safe and effective technique and provided improved overall accuracy and reduced operative time compared with conventional fluoroscopic techniques.

A Prospective Analysis of Intraoperative Electromyographic Monitoring of Pedicle Screw Placement With Computed Tomographic Scan Confirmation

Spine ◽  
1995 ◽  
Vol 20 (12) ◽  
pp. 1375-1379 ◽  
Author(s):  
Steven D. Glassman ◽  
John R. Dimar ◽  
Rolando M. Puno ◽  
John R. Johnson ◽  
Christopher B. Shields ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Placement ◽  
Prospective Analysis ◽  
Pedicle Screw Placement ◽  
Computed Tomographic ◽  
Computed Tomographic Scan

Simulated Lumbar Minimally Invasive Surgery Educational Model With Didactic and Technical Components

Neurosurgery ◽  
2013 ◽  
Vol 73 (suppl_1) ◽  
pp. S107-S110
Author(s):  
Rohan Chitale ◽  
George M. Ghobrial ◽  
Darlene Lobel ◽  
James Harrop
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Educational Curriculum ◽  
Computed Tomographic ◽  
Percutaneous Pedicle Screw ◽  
Starting Point ◽  
Objectively Measured ◽  
Invasive Techniques

Abstract BACKGROUND: The learning and development of technical skills are paramount for neurosurgical trainees. External influences and a need for maximizing efficiency and proficiency have encouraged advancements in simulator-based learning models. OBJECTIVE: To confirm the importance of establishing an educational curriculum for teaching minimally invasive techniques of pedicle screw placement using a computer-enhanced physical model of percutaneous pedicle screw placement with simultaneous didactic and technical components. METHODS: A 2-hour educational curriculum was created to educate neurosurgical residents on anatomy, pathophysiology, and technical aspects associated with image-guided pedicle screw placement. Predidactic and postdidactic practical and written scores were analyzed and compared. Scores were calculated for each participant on the basis of the optimal pedicle screw starting point and trajectory for both fluoroscopy and computed tomographic navigation. RESULTS: Eight trainees participated in this module. Average mean scores on the written didactic test improved from 78% to 100%. The technical component scores for fluoroscopic guidance improved from 58.8 to 52.9. Technical score for computed tomography—navigated guidance also improved from 28.3 to 26.6. CONCLUSION: Didactic and technical quantitative scores with a simulator-based educational curriculum improved objectively measured resident performance. A minimally invasive spine simulation model and curriculum may serve a valuable function in the education of neurosurgical residents and outcomes for patients.

Facet Violation With Percutaneous Pedicle Screw Placement: Impact of 3D Navigation and Facet Orientation

2021 ◽  
pp. 155633162110263
Author(s):  
Ting Cong ◽  
Ahilan Sivaganesan ◽  
Christopher M. Mikhail ◽  
Avani S. Vaishnav ◽  
James Dowdell ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Placement ◽  
Radiographic Measurement ◽  
Pedicle Screw Placement ◽  
3D Navigation ◽  
3 Dimensional ◽  
Computed Tomographic ◽  
Percutaneous Pedicle Screw ◽  
Facet Orientation ◽  
Placement Accuracy

Background: The gold standard for percutaneous pedicle screw placement is 2-dimensional (2D) fluoroscopy. Data are sparse on the accuracy of 3-dimensional (3D) navigation percutaneous screw placement in minimally invasive spine procedures. Objective: We sought to compare a single surgeon’s percutaneous pedicle screw placement accuracy using 2D fluoroscopy versus 3D navigation, as well as to investigate the effect of facet orientation on facet violation when using 2D fluoroscopy. Methods: We conducted a retrospective radiographic study of consecutive cohort of patients who underwent percutaneous lumbar instrumentation using either 2D fluoroscopy or 3D navigation. All procedures were performed by a single surgeon at 2 academic institutions between 2011 and 2018. Radiographic measurement of screw accuracy was assessed using a postoperative computed tomographic scan. The primary outcome was facet violation, and secondary outcomes were endplate/tip breaches, the Gertzbein-Robbins classification for cortical breaches, and the Simplified Screw Accuracy grade. Statistical comparisons were made between screws placed using 2D fluoroscopy versus 3D navigation. Axial facet angles were also measured to correlate with facet violation rates. Results: In the 138 patients included, 376 screws were placed with fluoroscopy and 193 with navigation. Superior (unfused) level facet violation was higher with 2D fluoroscopy than with 3D navigation (9% vs 0.5%), which comprises the main cause for poor screw placement. Axial facet angles exceeding 45° at L4 and 60° at L5 were correlated with facet violations. Conclusion: This retrospective study found that 3D navigation is associated with lower facet violation rates in percutaneous lumbar pedicle screw placement when compared with 2D fluoroscopy. These findings suggest that 3D navigation may be of particular value when facet joints are coronally oriented.

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.

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