Biomechanical Comparison of Costotransverse Process Screw Fixation and Pedicle Screw Fixation of the Upper Thoracic Spine

2010 ◽  
Vol 66 (suppl_1) ◽  
pp. ons-178-ons-182
Author(s):  
Andrew S. Little ◽  
Leonardo B.C. Brasiliense ◽  
Bruno C.R. Lazaro ◽  
Phillip M. Reyes ◽  
Curtis A. Dickman ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Pedicle Screw ◽  
Thoracic Spine ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Lateral Bending ◽  
Upper Thoracic Spine ◽  
Pull Out ◽  
Upper Thoracic

Abstract Objective: To compare the biomechanics of costotransverse process screw fixation with those of pedicle screw fixation in a cadaveric model of the upper thoracic spine. Methods: Ten human thoracic spines were instrumented across the T3–T4 segment with costotransverse and pedicle screws. Nonconstraining pure moments (maximum, 6.0 Nm) were applied to induce flexion, extension, lateral bending, and axial rotation. The range of motion, lax zone, and stiff zone were determined in each specimen in the normal state, after 3-column destabilization, and after instrumentation. After flexibility testing was completed, axial screw pull-out strength was assessed. Results: In all directions of loading, both fixation techniques significantly decreased lax zone and range of motion at T3–T4 compared with the destabilized state (P < .001). During all loading modes except lateral bending, pedicle screw fixation allowed significantly less range of motion than costotransverse screw fixation. Pedicle screws provided 62% greater resistance to axial pull-out than costotransverse screws. Conclusion: The costotransverse screw technique seems to provide only moderately stiff fixation of the destabilized thoracic spine. Pedicle screw fixation seems to have more favorable biomechanical properties. These data suggest that the costotransverse process construct is better used as a salvage procedure rather than as a primary fixation strategy.

scholarly journals Novel free-hand T1 pedicle screw method: Review of 44 consecutive cases

2014 ◽  
Vol 05 (04) ◽  
pp. 349-354 ◽  
Author(s):  
Mark A. Rivkin ◽  
Jessica F. Okun ◽  
Steven S. Yocom
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Pedicle Screws ◽  
High Rate ◽  
Imaging Modalities ◽  
Neurological Deficits ◽  
Upper Thoracic Spine ◽  
Starting Point ◽  
Grade 3 ◽  
Upper Thoracic

ABSTRACT Summary of Background Data: Multilevel posterior cervical instrumented fusions are becoming more prevalent in current practice. Biomechanical characteristics of the cervicothoracic junction may necessitate extending the construct to upper thoracic segments. However, fixation in upper thoracic spine can be technically demanding owing to transitional anatomy while suboptimal placement facilitates vascular and neurologic complications. Thoracic instrumentation methods include free-hand, fluoroscopic guidance, and CT-based image guidance. However, fluoroscopy of upper thoracic spine is challenging secondary to vertebral geometry and patient positioning, while image-guided systems present substantial financial commitment and are not readily available at most centers. Additionally, imaging modalities increase radiation exposure to the patient and surgeon while potentially lengthening surgical time. Materials and Methods: Retrospective review of 44 consecutive patients undergoing a cervicothoracic fusion by a single surgeon using the novel free-hand T1 pedicle screw technique between June 2009 and November 2012. A starting point medial and cephalad to classic entry as well as new trajectory were utilized. No imaging modalities were employed during screw insertion. Postoperative CT scans were obtained on day 1. Screw accuracy was independently evaluated according to the Heary classification. Results: In total, 87 pedicle screws placed were at T1. Grade 1 placement occurred in 72 (82.8%) screws, Grade 2 in 4 (4.6%) screws and Grade 3 in 9 (10.3%) screws. All Grade 2 and 3 breaches were <2 mm except one Grade 3 screw breaching 2-4 mm laterally. Only two screws (2.3%) were noted to be Grade 4, both breaching medially by less than 2 mm. No new neurological deficits or returns to operating room took place postoperatively. Conclusions: This modification of the traditional starting point and trajectory at T1 is safe and effective. It attenuates additional bone removal or imaging modalities while maintaining a high rate of successful screw placement compared to historical controls.

Translaminar screw fixation in the upper thoracic spine

2006 ◽  
Vol 5 (6) ◽  
pp. 527-533 ◽  
Author(s):  
Ryan M. Kretzer ◽  
Daniel M. Sciubba ◽  
Carlos A. Bagley ◽  
Jean-Paul Wolinsky ◽  
Ziya L. Gokaslan ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Pedicle Screws ◽  
Attractive Alternative ◽  
Rigid Fixation ◽  
Upper Thoracic Spine ◽  
Pull Out ◽  
Translaminar Screw ◽  
Upper Thoracic ◽  
Translaminar Screws

Object The use of pedicle screws (PSs) for instrument-assisted fusion in the cervical and thoracic spine has increased in recent years, allowing smaller constructs with improved biomechanical stability and repositioning possibilities. In the smaller pedicles of the upper thoracic spine, the placement of PSs can be challenging and may increase the risk of damage to neural structures. As an alternative to PSs, translaminar screws can provide spinal stability, and they may be used when pedicular anatomy precludes successful placement of PSs. The authors describe the technique of translaminar screw placement in the T-1 and T-2 vertebrae. Methods Seven patients underwent cervicothoracic fusion to treat trauma, neoplasm, or degenerative disease. Nineteen translaminar screws were placed, 13 at T-1 and six at T-2. A single asymptomatic T-2 screw violated the ventral laminar cortex and was removed. The mean clinical and radiographic follow up exceeded 14 months, at which time there were no cases of screw pull-out, screw fracture, or progressive kyphotic deformity. Conclusions Rigid fixation with translaminar screws offers an attractive alternative to PS fixation, allowing the creation of sound spinal constructs and minimizing potential neurological morbidity. Their use requires intact posterior elements, and care should be taken to avoid violation of the ventral laminar wall.

scholarly journals Adjacent-segment disease after thoracic pedicle screw fixation

2018 ◽  
Vol 28 (3) ◽  
pp. 280-286 ◽  
Author(s):  
Nitin Agarwal ◽  
Robert F. Heary ◽  
Prateek Agarwal
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Spine Deformity ◽  
Fracture Stabilization ◽  
Thoracic Pedicle Screw

OBJECTIVEPedicle screw fixation is a technique widely used to treat conditions ranging from spine deformity to fracture stabilization. Pedicle screws have been used traditionally in the lumbar spine; however, they are now being used with increasing frequency in the thoracic spine as a more favorable alternative to hooks, wires, or cables. Although safety concerns, such as the incidence of adjacent-segment disease (ASD) after cervical and lumbar fusions, have been reported, such issues in the thoracic spine have yet to be addressed thoroughly. Here, the authors review the literature on ASD after thoracic pedicle screw fixation and report their own experience specifically involving the use of pedicle screws in the thoracic spine.METHODSSelect references from online databases, such as PubMed (provided by the US National Library of Medicine at the National Institutes of Health), were used to survey the literature concerning ASD after thoracic pedicle screw fixation. To include the authors’ experience at Rutgers New Jersey Medical School, a retrospective review of a prospectively maintained database was performed to determine the incidence of complications over a 13-year period in 123 consecutive adult patients who underwent thoracic pedicle screw fixation. Children, pregnant or lactating women, and prisoners were excluded from the review. By comparing preoperative and postoperative radiographic images, the occurrence of thoracic ASD and disease within the surgical construct was determined.RESULTSDefinitive radiographic fusion was detected in 115 (93.5%) patients. Seven incidences of instrumentation failure and 8 lucencies surrounding the screws were observed. One patient was observed to have ASD of the thoracic spine. The mean follow-up duration was 50 months.CONCLUSIONSThis long-term radiographic evaluation revealed the use of pedicle screws for thoracic fixation to be an effective stabilization modality. In particular, ASD seems to be less of a problem in the relatively immobile thoracic spine than in the more mobile cervical and lumbar spines.

scholarly journals Application of patient-specific 3D navigation templates for pedicle screw fixation of subaxial and upper thoracic vertebrae

2019 ◽  
Vol 16 (2) ◽  
pp. 35-41 ◽  
Author(s):  
R. A. Kovalenko ◽  
V. V. Rudenko ◽  
V. A. Kashin ◽  
V. Yu. Cherebillo ◽  
D. A. Ptashnikov
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Bone Structure ◽  
Pedicle Screws ◽  
Patient Specific ◽  
Thoracic Vertebrae ◽  
3D Navigation ◽  
Average Deviation ◽  
Upper Thoracic Spine ◽  
Upper Thoracic

Objective. To analyze the safety and accuracy of pedicle screw placement in the subaxial cervical and upper thoracic spine using patient-specific 3D navigation templates.Material and Methods. The study included 16 patients who underwent transpedicular implantation of screws in the subaxial cervical and upper thoracic vertebrae using patient-specific 3D navigation templates. A total of 88 screws were installed. All patients underwent preoperative CT angiography to assess visualization of the vertebral artery. Customized vertebral models and navigation templates were created using 3D printing technology. Models and templates were sterilized and used during surgery. The results of screw implantation, as well as the safety and accuracy of the placement, were assessed by postoperative CT.Results. The average deviation from the planned trajectory was 1.8 ± 0.9 mm. Deviation was estimated as class 1 (<2 mm) for 57 (64.77 %) screws, class 2 (2–4 mm) for 29 (32.95 %), and class 3 for two (2.27 %). The safety of screw implantation of grade 0 (the screw is completely inside the bone structure) was in 79 (89.77 %) cases, of grade 1 (<50 % of the screw diameter perforates the bone) – in 5 (5.68 %), and of grade 3 – in 2 (2.27 %).Conclusion. Using 3D navigation templates is an affordable and safe method of installing pedicle screws in the cervical and upper thoracic spine. The method can be used as an alternative to intraoperative CT navigation.

Cable-Strengthened C2 Pedicle Screw Fixation in the Treatment of Congenital C2-3 Fusion, Atlas Occipitalization, and Atlantoaxial Dislocation

Neurosurgery ◽  
2012 ◽  
Vol 71 (5) ◽  
pp. 976-984 ◽  
Author(s):  
Shenglin Wang ◽  
Chao Wang ◽  
Huijie Leng ◽  
Weidong Zhao ◽  
Ming Yan ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Atlantoaxial Dislocation ◽  
C2 Pedicle Screw ◽  
Significant Difference ◽  
Solid Fusion ◽  
C2 Fixation

Abstract BACKGROUND: Atlas occipitalization and congenital C2-3 fusion often result in atlantoaxial dislocation (AAD) and superior odontoid migration that requires occipitocervical fixation. The widely used technique is posterior occiput-C2 fixation with pedicle screws. However, congenital C2-3 fusion cases tend to have thinner C2 pedicles that are inadequate for normal-sized pedicle screw fixation. With the presence of AAD, the strength of the fixation is further compromised as the C2 pedicle screws (C2PS) sustain considerable cephalic shearing force during the reduction procedure. Therefore, a novel technique has been developed to augment the C2 pedicle screw fixation with a strengthening cable. OBJECTIVE: To introduce and assess this new technique. METHODS: Seventy-six patients who underwent this procedure were reviewed. The position of the instrument and resultant fusion were examined retrospectively. In the biomechanical test, 6 fresh specimens were subjected to 2 types of fixation in the order of Oc-C2 screw-plate fixation followed by additional use of strengthening cable. Under 3 loading modes (extension-flexion, lateral bending, and axial rotation), the relative movement between the occiput and C2 was measured and compared in the form of range of motion. RESULTS: The average follow-up time was 26 months. Solid fusion was achieved in 75 patients (98.7%) as assessed radiologically. The only patient who experienced hardware failure eventually obtained solid fusion between the occiput and C2 after revision. Biomechanically, there was significant difference between the occiput and C2 fixation and cable-strengthened fixation in range of motion for all modes. CONCLUSION: This technique is a promising option for the treatment of AAD with congenital C2-3 fusion and occipitalization. Biomechanically, this technique can reduce the occipital-axial motion significantly compared with occiput-C2 fixation.

scholarly journals Thoracic spondylotic myelopathy presumably caused by diffuse idiopathic skeletal hyperostosis in a patient who underwent decompression and percutaneous pedicle screw fixation

2021 ◽  
Vol 9 ◽  
pp. 2050313X2098779
Author(s):  
Shota Miyoshi ◽  
Tadao Morino ◽  
Haruhiko Takeda ◽  
Hiroshi Nakata ◽  
Masayuki Hino ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Pedicle Screw Fixation ◽  
Vertebral Bone ◽  
Bone Bridge ◽  
Percutaneous Pedicle Screw ◽  
Bilateral Lower Limb ◽  
Upper Thoracic ◽  
Percutaneous Pedicle Screw Fixation

A 74-year-old man developed bilateral lower limb spastic paresis. He was diagnosed with thoracic spondylotic myelopathy presumably caused by mechanical stress that was generated in the intervertebral space (T1-T2) between a vertebral bone bridge (C5-T1) due to diffuse idiopathic skeletal hyperostosis after anterior fixation of the lower cervical spine and a vertebral bone bridge (T2-T7) due to diffuse idiopathic skeletal hyperostosis in the upper thoracic spine. Treatment included posterior decompression (T1-T2 laminectomy) and percutaneous pedicle screw fixation at the C7-T4 level. Six months after surgery, the patient could walk with a cane, and the vertebral bodies T1-T2 were bridged without bone grafting. For thoracic spondylotic myelopathy associated with diffuse idiopathic skeletal hyperostosis, decompression and percutaneous pedicle screw fixation are effective therapies.

Pedicle Screw Fixation of the Thoracic Spine: An In Vitro Biomechanical Study on Different Configurations

Spine ◽  
2005 ◽  
Vol 30 (22) ◽  
pp. 2530-2537 ◽  
Author(s):  
Vedat Deviren ◽  
Emre Acaroglu ◽  
Joe Lee ◽  
Masaru Fujita ◽  
Serena Hu ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Biomechanical Study
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