Personalised image-based templates for intra-operative guidance

2005 ◽  
Vol 219 (2) ◽  
pp. 111-118 ◽  
Author(s):  
E Berry ◽  
M Cuppone ◽  
S Porada ◽  
P A Millner ◽  
A Rao ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Dimensional Stability ◽  
Ct Images ◽  
High Rate ◽  
Screw Placement ◽  
Navigation Systems ◽  
Application Area ◽  
Screw Insertion ◽  
Image Guided ◽  
Improve Accuracy

The high rate of unplanned perforation, poor fixation, and nerve injury with freehand pedicle screw insertion has led to the use of image-guided navigation systems. Although these improve accuracy, they have several drawbacks that could be overcome by using image-based drilling guide templates. The accuracy of such templates was tested in a cadaveric study of screw placement in the lumbar, thoracic, and cervical regions of the spine. The dimensional stability with autoclaving of duraform polyamide, to be used for manufacturing the guides, was first determined using test specimens. Computed tomography (CT) images were acquired of 4 cadaveric spines, and placement of 4 cervical, 32 thoracic, and 14 lumbar screws was planned. Eighteen personalized drilling guide templates, in four different designs, were built. Orthopaedic surgeons experienced in the freehand techniques used the templates. CT images were acquired to assess placement position with respect to the pedicle. Duraform polyamide was found to be unaffected by sterilization. Two of the template designs facilitated the placement of 20/20 screws without error. Templates can lead to successful screw placement, even in small pedicles, providing their design is optimized for the application area, e.g. with enhanced rotational stabilization.

scholarly journals Placement of Guide-Wireless Sharp Percutaneous Pedicle Screws Utilizing Computed Tomography-Navigation and Sentinel Fluoroscopy: 2-Dimensional Operative Video

2019 ◽  
Vol 19 (2) ◽  
pp. E149-E150 ◽  
Author(s):  
Nikolay L Martirosyan ◽  
Joshua T Wewel ◽  
Juan S Uribe
Keyword(s):  
Computed Tomography ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Transverse Process ◽  
Screw Placement ◽  
Osteoporotic Bone ◽  
Screw Insertion ◽  
Institutional Review ◽  
Stab Incision ◽  
Anterior Posterior

Abstract Many established techniques exist for minimally invasive pedicle screw placement. Nearly all techniques incorporate the use of a Kershner wire (K-wire) at various points in the work-flow. The use of a K-wire adds an additional step. If its position is lost, it requires repeating all previous steps, and placement is not without complication. The use of a guide-wireless sharp screws allows the surgeon to place a pedicle screw in 1 step with several fluid maneuvers.1 The patient underwent Institutional Review Board-approved consent for this study. Following traditional computed tomography-based navigation, a stab incision is made, followed by fascial dissection with monopolar cautery. The sharp screw is placed percutaneously at the facet-transverse process junction. The precise entry point is confirmed with navigation, followed by a sentinel anterior-posterior fluoroscopic image, verifying the accuracy of the navigation. The cortical bone is traversed by malleting the sharp tip through the cortex. When the cancellous bone is engaged, the screw is then advanced through the pedicle. This set of steps allows for safe, efficient placement of percutaneous pedicle screws without the need for a guidewire. Mal-placement regarding sharp pedicle screw insertion is similar to K-wire-dependent screw placement. Surgeons must be cognoscente of exceptionally sclerotic bone, which can prove difficult to cannulate. Conversely, osteoporotic bone that is liable to a cortical pedicle breach, transverse process fracture, and/or maltrajectory are all considerations when placing a K-wireless, sharp pedicle screw. Anterior-posterior fluoroscopy is utilized to confirm accuracy of image-guided navigation and mitigate malplacement of pedicle screws.

Pediatric Pedicle Screw Placement Using Intraoperative Computed Tomography and 3-Dimensional Image-Guided Navigation

Spine ◽  
2012 ◽  
Vol 37 (3) ◽  
pp. E188-E194 ◽  
Author(s):  
A. Noelle Larson ◽  
Edward R. G. Santos ◽  
David W. Polly ◽  
Charles G. T. Ledonio ◽  
Jonathan N. Sembrano ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pedicle Screw ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Intraoperative Computed Tomography ◽  
3 Dimensional ◽  
Dimensional Image ◽  
Image Guided

THE PATH OF SCREW INSERTION FOR STABILIZATION OF THE SCAPHOLUNATE JOINT: A CADAVERIC STUDY

Hand Surgery ◽  
2014 ◽  
Vol 19 (01) ◽  
pp. 145-149
Author(s):  
O. M. Flannery ◽  
L. C. Murphy ◽  
P. Dockery ◽  
M. E. O'Sullivan
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Articular Surface ◽  
Cadaveric Study ◽  
Screw Placement ◽  
Ulnar Styloid ◽  
Screw Insertion ◽  
Articular Surfaces ◽  
Radial Styloid ◽  
The Right

The aim of this study was to determine the path of screw placement to avoid breaching the articular surface of both lunate and scaphoid bones at the radiocarpal and midcarpal joints. An Acutrak screw was inserted into the right scapholunate joint of ten cadavers starting immediately distal to the tip of the radial styloid and aiming for the tip of the ulnar styloid. The articular surfaces of the scaphoid and lunate bones in all ten cadavers were exposed and examined. A computed tomography (CT) scan of four wrists was performed. Eight of the ten cadavers had no perforation or destruction of the articular surfaces. Screw stabilization of the scapholunate joint can be performed without perforation or destruction of the lunate or scaphoid surfaces. We recommend that if this form of fixation is being used then the screw should be inserted commencing at the radial styloid tip and aiming for ulnar styloid tip, under radiological guidance.

scholarly journals Postoperative 320 multi-slice computed tomography in assessment of pedicle screw insertion in thoraco-lumbar fixation

2019 ◽  
Vol 50 (1) ◽  
Author(s):  
Alsiagy A. Salama ◽  
Mohamed A. Amin ◽  
Ahmed Y. Soliman ◽  
Ahmed El-Tantaway
Keyword(s):  
Computed Tomography ◽  
Pedicle Screw ◽  
Assessment Tool ◽  
Three Dimensional ◽  
Screw Placement ◽  
Spinal Fixation ◽  
Pedicle Screw Placement ◽  
Screw Insertion ◽  
Postoperative Assessment ◽  
Reformatted Ct

Abstract Background Pedicle screw instrumentation is used widely in lumbar spine for stabilization to enhance arthrodesis and has been accepted in the thoracic spine in recent years. The purpose of this study was to assess the value of postoperative 320 multi-slice computed tomography (MSCT) in assessment of pedicle screw placement in patients with spinal fixation with clinical and surgical correlation. Results A total of 340 pedicular screws were inserted to 70 cases. 286 (84.12%) were in, 54 screws (15.88%) were violated, and revision surgeries were required for 5 displaced screws. On axial, coronal reconstruction and three-dimensional (3D) reformatted CT images 36, 47, and 54 displaced screws were detected, respectively. Both sensitivity and specificity for 3D reformatted images were 100%. For axial image, they were 97.6% and 89.4%, respectively, compared with surgical findings in 5 revised screws. Conclusion Multi-slice CT scan is a valuable and valid postoperative assessment tool of accuracy of spinal pedicle screw placement.

Letter to the Editor Regarding “Accuracy of Pedicle Screw Insertion Among 3 Image-Guided Navigation Systems: A Systematic Review and Meta-Analysis”

2020 ◽  
Vol 138 ◽  
pp. 595-597 ◽  
Author(s):  
Giuseppe Emmanuele Umana ◽  
Maurizio Passanisi ◽  
Marco Fricia ◽  
Stefano Chiriatti ◽  
Saverio Fagone ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pedicle Screw ◽  
Meta Analysis ◽  
Navigation Systems ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Image Guided ◽  
Letter To The Editor

Computed Tomography-Based Image-Guided System in Spinal Surgery

2015 ◽  
Vol 11 (1) ◽  
pp. 59-68 ◽  
Author(s):  
Francesco Costa ◽  
Gianluigi Dorelli ◽  
Alessandro Ortolina ◽  
Andrea Cardia ◽  
Luca Attuati ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Spinal Instrumentation ◽  
P Value ◽  
Fisher Exact Test ◽  
Navigation Systems ◽  
Intraoperative Ct ◽  
Image Guided ◽  
Group I ◽  
Group Ii

Abstract BACKGROUND Image-guided navigation systems (IGS) grant excellent clinical and radiological results, minimizing risks correlated with spinal instrumentation. However, there is some concern regarding the real need for IGS and its indications. OBJECTIVE To analyze the accuracy, technical aspect, and radiation exposure data of the principal IGS based on computed tomography (CT) imaging. METHODS The data of all patients treated for spinal instrumentation with the aid of an IGS system from January 2003 to March 2013 were retrospectively analyzed. We defined 2 groups: group I with an IGS system based on a preoperative CT scan; group II relied on an intraoperative CT scan. Screw accuracy was assessed with a postoperative CT scan control. Radiation dosage for patients was defined by using the technical parameters and dose report data. Statistical analysis was performed using the Fisher exact test with a significance of 5% (P value < .05). RESULTS Two thousand twenty patients and 11 144 screws were analyzed. Group I had 794 patients (4246 screws); the accuracy was 96.1%. Group II had 1226 patients (6898 screws) treated, with 98.5% accuracy (P = .001). The radiation dose analysis showed better results in group II, with significant reduction of the effective dose to the patient. CONCLUSION The IGS based on an intraoperative CT scan grants excellent results, eliminating the rate of reoperation for misplaced instrumentations (screws, plate, and cage) or for inadequate bone decompression. However, this technology cannot replace the surgical skills, experience, and knowledge necessary for spine surgery.

Accuracy of Pedicle Screw Insertion Among 3 Image-Guided Navigation Systems: Systematic Review and Meta-Analysis

2018 ◽  
Vol 109 ◽  
pp. 24-30 ◽  
Author(s):  
Jin Peng Du ◽  
Yong Fan ◽  
Qi Ning Wu ◽  
Dai Hua Wang ◽  
Jing Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pedicle Screw ◽  
Meta Analysis ◽  
Navigation Systems ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Image Guided
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