scholarly journals DOES THE USE OF DYNAMIC SURGICAL GUIDANCE ASSIST ACCURATE PEDICLE SCREW PLACEMENT IN PATIENTS WITH OSTEOPOROSIS OR OSTEOPENIA?

2020 ◽  
Vol 19 (3) ◽  
pp. 189-193
Author(s):  
HELTON L A DEFINO ◽  
JOHN WILLIAMS ◽  
GEORGIA-LEA WILLIAMS ◽  
KERI GEORGE ◽  
RANDAL BETZ ◽  
...  
Keyword(s):  
Pedicle Screws ◽  
Pedicle Screw Placement ◽  
Level Of Evidence ◽  
Radiation Level ◽  
Intraoperative Radiation ◽  
Surgical Guidance ◽  
Pilot Hole ◽  
Surgical Guide ◽  
Pedicular Screw ◽  
Pedicle Wall

ABSTRACT Objective To compare the use of a dynamic surgical guide (PediGuard®) and pilot hole preparation, with the use of a probe and the aid of fluoroscopy in osteoporotic or osteopenic patients undergoing pedicular fixation of the thoracic or lumbar spine. Methods One hundred and eight patients were randomized. A pilot hole was prepared with the dynamic surgical guide (PediGuard®), or with a probe with the aid of fluoroscopy. A total of 657 vertebral pedicles (120 thoracic and 180 lumbar) were included in the study. The parameters used for the comparison were: accuracy of the pedicular screw, number of fluoroscopic shots, and change in intraoperative trajectory of the perforation after detecting pedicle wall rupture. Results In the group with use of the dynamic surgical guide, malpositioning of the pedicle screws was observed in 8 (2.6%) patients and intraoperative change of perforation trajectory in 12 (4%) patients, and there were 52 fluoroscopic shots. In the group without use of the dynamic surgical guide (PediGuard®), misplacement of the pedicle screws was observed in 33 (11%) patients and intraoperative change of perforation trajectory in 47 (13.2%) patients, and there were 136 fluoroscopic shots. Conclusion The use of the dynamic surgical guide (PediGuard®) in patients with osteoporosis or osteopenia enabled more accurate placement of pedicular screws, with less change in the intraoperative course of the perforation and less intraoperative radiation. Level of Evidence II; Randomized clinical trial of lesser quality.

scholarly journals Application of a novel customized guide template in percutaneous pedicle screw placement: an in vitro study

10.29007/qzxg ◽  
2018 ◽  
Author(s):  
Su-Hua Wu ◽  
Guo Zheng ◽  
Jian-Hua Chen ◽  
Sheng-Hai Wang
Keyword(s):  
Pedicle Screw ◽  
Average Distance ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Patient Specific ◽  
Pedicle Screw Placement ◽  
Intraoperative Radiation ◽  
Spine Stabilization ◽  
Percutaneous Pedicle Screw

In open surgery for spine stabilization, the pedicle screws are often placed using patient-specific guide templates since they can improve the screw placement accuracy and simplify surgery. However, the conventional fit-and-lock template requires full exposure of the bony structures and is therefore not suitable for minimally invasive procedures. In this study, we constructed a novel guide template for percutaneous pedicle screw placement. Its feasibility and the accuracy of template-assisted pedicle screw placement were assessed using an excised calf spine model. As a result, all inserted guide wires and 27 of 30 simulated screws (90%) were completely in the pedicle. The remaining screws (10%) penetrated by less than 2 mm. The average distance and angular deviations of the guide wires were 1.46±0.60 mm and 1.10±0.84°. Our study demonstrate that this novel guide template is technically feasible and enhances the accuracy of percutaneous pedicle screw placement. Moreover, it may simplify the surgery and minimize intraoperative radiation. Further research on its clinical applications is warranted.

scholarly journals DIRECT PEDICLE SCREW INSERTION PULLOUT STRENGTH

2021 ◽  
Vol 29 (4) ◽  
pp. 203-206
Author(s):  
RÔMULO PEDROZA PINHEIRO ◽  
ARIANE ZAMARIOLI ◽  
THIBAULT CHANDANSON ◽  
KERI GEORGE ◽  
ANTONIO CARLOS SHIMANO ◽  
...  
Keyword(s):  
Test Machine ◽  
Pullout Strength ◽  
Insertion Technique ◽  
Level Of Evidence ◽  
Surgical Guidance ◽  
Pilot Hole ◽  
Screw Insertion ◽  
Pullout Tests ◽  
Experimental Group

ABSTRACT Objective: Study the in vitro pullout strength of SpineGuard/Zavation Dynamic Surgical Guidance Z-Direct Screw (DSG Screw), a screw pedicle designed to be inserted using a direct insertion technique. Methods: DSG Screws of 5.5 mm and 6.5 mm were introduced into polyurethane blocks with a density of 10 PCF (0,16 g/cm3). According to the experimental group, screws were inserted without pilot hole, with pilot without tapping, undertapping and line-to-line tapping. Screw pullout tests were performed using a universal test machine after screw insertion into polyurethane blocks. Results: Screws inserted directly into the polyurethane blocks without pilot hole and tapping showed a statistically higher pullout strength. Insertion of the screw without tapping or with undertapping increases the pullout screw strength compared to line-to-line tapping. Conclusion: DSG Screw showed the highest pullout strength after its insertion without pilot hole and tapping. Level of Evidence V, Expert Opinion.

scholarly journals INFLUENCE OF THE CONGRUENCE OF PILOT HOLE TAPPING ON THE ANCHORAGE OF THE PEDICLE SCREW

2020 ◽  
Vol 19 (3) ◽  
pp. 197-200
Author(s):  
RODRIGO BARRA CAIADO FLEURY ◽  
ANTÔNIO CARLOS SHIMANO ◽  
THIAGO DANTAS MATOS ◽  
KELSEN DE OLIVEIRA TEIXEIRA ◽  
VALÉRIA ROMERO ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Smooth Surface ◽  
Pedicle Screws ◽  
Strength Test ◽  
Drill Bit ◽  
Level Of Evidence ◽  
Pilot Hole ◽  
Pullout Resistance ◽  
Tensile Strength Test ◽  
Therapeutic Study

ABSTRACT Objectives To observe the influence of the congruence of the tapping of the pilot hole on the anchorage of the pedicle screws. Methods 5.5 and 6.5 mm screws from two vertebral fixation systems (Pedicol and Safe) were inserted into polyurethane blocks. Experimental groups were formed according to the pilot hole preparation: A- drilling with a 2.7 mm drill bit, B- Tapping of the pilot hole with a tap of lesser diameter than the diameter of the screw with a congruent thread design, C- Tapping of the pilot hole with a tap of lesser diameter than the diameter of the screw and an incongruous thread design. The polyurethane blocks with the screws were subjected to a tensile strength test to evaluate the pullout resistance of the screws. Results Using congruent pilot hole tapping of a lesser diameter and congruent thread design increased the pullout resistance of the rough-surface screws (Safe). The screws with a smooth surface (Pedicol) presented greater pullout resistance with tapping of a lesser diameter and incongruous thread design. Conclusions The congruence of the tap used to prepare the pilot hole increased the pullout resistance of the rough-surfaced screws. Level of Evidence III; Therapeutic Study.

scholarly journals Accuracy and Safety of Percutaneous Lumbosacral Pedicle Screw Placement Using Dual-Planar Intraoperative Fluoroscopy

2018 ◽  
Vol 12 (2) ◽  
pp. 238-245 ◽  
Author(s):  
Conor Dunn ◽  
Michael Faloon ◽  
Edward Milman ◽  
Sina Pourtaheri ◽  
Kumar Sinah ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Case Series ◽  
Pedicle Screws ◽  
Guidance System ◽  
Screw Placement ◽  
Lumbosacral Spine ◽  
Pedicle Screw Placement ◽  
Ct Guided ◽  
Clinical Symptomatology ◽  
Pedicle Wall

<sec><title>Study Design</title><p>Retrospective case series with prospective arm.</p></sec><sec><title>Purpose</title><p>To assess the safety and accuracy of percutaneous lumbosacral pedicle screw placement (PLPSP) in the lumbosacral spine using intraoperative dual-planar fluoroscopy (DPF).</p></sec><sec><title>Overview of Literature</title><p>There are several techniques available for achieving consistent, safe, and accurate results with PLPSP. There is a paucity of literature describing the beneficial operative, economic, and clinical outcomes of DPF, the most readily accessible image guidance system.</p></sec><sec><title>Methods</title><p>From 2004 to 2014, 451 consecutive patients underwent PLPSP using DPF, for a total of 2,345 screw placement. The results of prospectively obtained postoperative computed tomography (CT) examinations of an additional 41 consecutive patients were compared with the results of 104 CT examinations obtained postoperatively due to clinical symptomatology; these results were interpreted by three reviewers. The rates of revision indicated by misplaced screws with consistent clinical symptomatology were compared between groups. Pedicle screw placement was graded according to 2-mm increments in medial pedicle wall breach and measurement of screw axis placement.</p></sec><sec><title>Results</title><p>Seven of the 2,345 pedicle screws placed percutaneously with the use of the dual-planar fluoroscopic technique required revision because of a symptomatic misplaced screw, for a screw revision rate of 0.3%. There were no statistically significant demographic differences between patients who had screws revised and those who did not. All screws registered greater than 10 mA on electromyographic stimulation. In the 41 prospectively obtained CT examinations, one out of 141 screws (0.7%) was revised due to pedicle wall breach; whereas among the 104 patients with 352 screws, three screws were revised (0.9%).</p></sec><sec><title>Conclusions</title><p>DPF is an extremely accurate, safe, and reproducible technique for placement of percutaneous pedicle screws and is a readily available and cost-effective alternative to CT-guided pedicle screw placement techniques. Postoperative CT evaluation is not necessary with PLPSP unless the patient is symptomatic. Acceptable electromyographic thresholds may need to be reevaluated.</p></sec>

scholarly journals Diagnosis and management of the infected total knee replacement: a practical surgical guide

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Akos Zahar ◽  
Martin Sarungi
Keyword(s):  
Surgical Management ◽  
Joint Infection ◽  
Level Of Evidence ◽  
Surgical Guide ◽  
Diagnosis And Management ◽  
Early Revision ◽  
Prosthetic Joint ◽  
Implant Retention ◽  
Total Knee ◽  
Key Steps

Abstract Purpose Prosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a significant burden in health care. Diagnosis and proper management are challenging. A standardised procedure for the diagnostic workup and surgical management provides clear benefits in outcome. Methods Several diagnostic protocols and definitions for PJI were established in recent years. Proper PJI diagnosis remains critical for success and for choosing the optimal treatment option. A distinct workup of diagnostic steps, the evaluation of the results in a multidisciplinary setup and the meticulous surgical management of the infection are the key factors of successful treatment. Results The management of PJI after TKA consists of early revision with debridement and implant retention (DAIR) in early cases or staged revision in late infections beyond 30 days postoperative or after onset of acute symptoms. The revision is performed as a two-stage procedure with the use of a fixed or mobile antibiotic spacer, or in selected cases as a single-stage operation with the use of local and systemic antibiotic treatment. Conclusions This paper reflects the opinion of two revision surgeons who follow the same protocol for diagnosis and treatment of PJI after TKA, highlighting the key steps in diagnosis and management. Level of evidence Expert’s opinion

scholarly journals Validation of Freehand Cervical Pedicle Screw Placement in Subaxial Spine Using the “Burcev Technique”: A Cadaveric Study

2021 ◽  
Author(s):  
Mantu Jain ◽  
Rabi N. Sahu ◽  
Manisha R. Gaikwad ◽  
Sashikanta Panda ◽  
Amit Tirpude ◽  
...  
Keyword(s):  
Horizontal Plane ◽  
Sagittal Plane ◽  
Pedicle Screws ◽  
Continuous Variables ◽  
Pedicle Screw Placement ◽  
Cervical Pedicle Screw ◽  
Freehand Technique ◽  
Computed Tomography Scans ◽  
Cervical Pedicle ◽  
Cervical Pedicle Screws

AbstractThe present study attempted to validate the “Burcev freehand method” based on anatomical observations in Indian cadavers. The study was conducted on 32 cervical pedicle screws (CPSs) that were placed in four cadavers by the authors according to the “freehand technique,” described by Burcev et al, without the aid of fluoroscopy and the trajectory verified by computed tomography scans. The screws were designated as satisfactory, permissible, or unacceptable. Descriptive variables were represented in number and percentages, continuous variables were represented as mean ± standard deviation (SD). Of the 32 CPSs placed, 24 (75%) exhibited a satisfactory position, 1 (3%) exhibited a permissible position, and 7 (22%) exhibited an unacceptable position. Of the seven CPSs in the unacceptable group, four exhibited a lateral breach and three exhibited a medial breach, whereas the CPS in the permissible group exhibited a medial breach. The overall angle with contralateral lamina in the horizontal plane in terms of mean ± SD was 175.43 ± 2.82, 169.49, and 169.65 ± 6.46 degrees in the satisfactory, permissible, and unacceptable groups, respectively. In the sagittal plane, the screws exhibited an angle of 88.15 ± 3.56 degrees. No breach was observed superiorly or inferiorly. The “Burcev technique” is replicable with similar results in cadavers. Further studies must be conducted in a clinical setting to ensure its safety.

The accuracy of pedicle screw placement using intraoperative image guidance systems

2014 ◽  
Vol 20 (2) ◽  
pp. 196-203 ◽  
Author(s):  
Alexander Mason ◽  
Renee Paulsen ◽  
Jason M. Babuska ◽  
Sharad Rajpal ◽  
Sigita Burneikiene ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Image Guidance ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Data Sets ◽  
Pedicle Screw Placement ◽  
Fluoroscopic Image ◽  
Fluoroscopic Navigation ◽  
Guidance Systems ◽  
Accuracy Rates

Object Several retrospective studies have demonstrated higher accuracy rates and increased safety for navigated pedicle screw placement than for free-hand techniques; however, the accuracy differences between navigation systems has not been extensively studied. In some instances, 3D fluoroscopic navigation methods have been reported to not be more accurate than 2D navigation methods for pedicle screw placement. The authors of this study endeavored to identify if 3D fluoroscopic navigation methods resulted in a higher placement accuracy of pedicle screws. Methods A systematic analysis was conducted to examine pedicle screw insertion accuracy based on the use of 2D, 3D, and conventional fluoroscopic image guidance systems. A PubMed and MEDLINE database search was conducted to review the published literature that focused on the accuracy of pedicle screw placement using intraoperative, real-time fluoroscopic image guidance in spine fusion surgeries. The pedicle screw accuracy rates were segregated according to spinal level because each spinal region has individual anatomical and morphological variations. Descriptive statistics were used to compare the pedicle screw insertion accuracy rate differences among the navigation methods. Results A total of 30 studies were included in the analysis. The data were abstracted and analyzed for the following groups: 12 data sets that used conventional fluoroscopy, 8 data sets that used 2D fluoroscopic navigation, and 20 data sets that used 3D fluoroscopic navigation. These studies included 1973 patients in whom 9310 pedicle screws were inserted. With conventional fluoroscopy, 2532 of 3719 screws were inserted accurately (68.1% accuracy); with 2D fluoroscopic navigation, 1031 of 1223 screws were inserted accurately (84.3% accuracy); and with 3D fluoroscopic navigation, 4170 of 4368 screws were inserted accurately (95.5% accuracy). The accuracy rates when 3D was compared with 2D fluoroscopic navigation were also consistently higher throughout all individual spinal levels. Conclusions Three-dimensional fluoroscopic image guidance systems demonstrated a significantly higher pedicle screw placement accuracy than conventional fluoroscopy or 2D fluoroscopic image guidance methods.

Contribution of Dynamic Surgical Guidance to the Accurate Placement of Pedicle Screws in Deformity Surgery: A Retrospective Case Series

2018 ◽  
Vol 120 ◽  
pp. e466-e471 ◽  
Author(s):  
Mohamed Allaoui ◽  
Fahed Zairi ◽  
Marie-Charlotte Tétard ◽  
John Gaughan ◽  
Daniel Chopin ◽  
...  
Keyword(s):  
Case Series ◽  
Pedicle Screws ◽  
Retrospective Case ◽  
Surgical Guidance ◽  
Retrospective Case Series

scholarly journals Utility of intraoperative electromyography in placing C7 pedicle screws

2020 ◽  
Vol 32 (6) ◽  
pp. 891-899 ◽  
Author(s):  
Jonathan J. Rasouli ◽  
Brooke T. Kennamer ◽  
Frank M. Moore ◽  
Alfred Steinberger ◽  
Kevin C. Yao ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Pedicle Screw ◽  
Thoracolumbar Spine ◽  
Pedicle Screws ◽  
Neurological Injury ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Data Set ◽  
Subaxial Cervical Spine ◽  
Increased Risk

OBJECTIVEThe C7 vertebral body is morphometrically unique; it represents the transition from the subaxial cervical spine to the upper thoracic spine. It has larger pedicles but relatively small lateral masses compared to other levels of the subaxial cervical spine. Although the biomechanical properties of C7 pedicle screws are superior to those of lateral mass screws, they are rarely placed due to increased risk of neurological injury. Although pedicle screw stimulation has been shown to be safe and effective in determining satisfactory screw placement in the thoracolumbar spine, there are few studies determining its utility in the cervical spine. Thus, the purpose of this study was to determine the feasibility, clinical reliability, and threshold characteristics of intraoperative evoked electromyographic (EMG) stimulation in determining satisfactory pedicle screw placement at C7.METHODSThe authors retrospectively reviewed a prospectively collected data set. All adult patients who underwent posterior cervical decompression and fusion with placement of C7 pedicle screws at the authors’ institution between January 2015 and March 2019 were identified. Demographic, clinical, neurophysiological, operative, and radiographic data were gathered. All patients underwent postoperative CT scanning, and the position of C7 pedicle screws was compared to intraoperative neurophysiological data.RESULTSFifty-one consecutive C7 pedicle screws were stimulated and recorded intraoperatively in 25 consecutive patients. Based on EMG findings, 1 patient underwent intraoperative repositioning of a C7 pedicle screw, and 1 underwent removal of a C7 pedicle screw. CT scans demonstrated ideal placement of the C7 pedicle screw in 40 of 43 instances in which EMG stimulation thresholds were > 15 mA. In the remaining 3 cases the trajectories were suboptimal but safe. When the screw stimulation thresholds were between 11 and 15 mA, 5 of 6 screws were suboptimal but safe, and in 1 instance was potentially dangerous. In instances in which the screw stimulated at thresholds ≤ 10 mA, all trajectories were potentially dangerous with neural compression.CONCLUSIONSIdeal C7 pedicle screw position strongly correlated with EMG stimulation thresholds > 15 mA. In instances, in which the screw stimulates at values between 11 and 15 mA, screw trajectory exploration is recommended. Screws with thresholds ≤ 10 mA should always be explored, and possibly repositioned or removed. In conjunction with other techniques, EMG threshold testing is a useful and safe modality in determining appropriate C7 pedicle screw placement.

scholarly journals Confirmation of accuracy/inaccuracy of lumbar pedicle screw placement using postoperative computed tomography

2021 ◽  
Vol 12 ◽  
pp. 518
Author(s):  
Mohamed M. Arnaout ◽  
Magdy O. ElSheikh ◽  
Mansour A. Makia
Keyword(s):  
Computed Tomography ◽  
Lumbar Spine ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Operative Intervention ◽  
Screw Placement ◽  
Lumbar Spine Surgery ◽  
Pedicle Screw Placement ◽  
Lumbar Pedicle ◽  
Ct Studies

Background: Transpedicular screws are extensively utilized in lumbar spine surgery. The placement of these screws is typically guided by anatomical landmarks and intraoperative fluoroscopy. Here, we utilized 2-week postoperative computed tomography (CT) studies to confirm the accuracy/inaccuracy of lumbar pedicle screw placement in 145 patients and correlated these findings with clinical outcomes. Methods: Over 6 months, we prospectively evaluated the location of 612 pedicle screws placed in 145 patients undergoing instrumented lumbar fusions addressing diverse pathology with instability. Routine anteroposterior and lateral plain radiographs were obtained 48 h after the surgery, while CT scans were obtained at 2 postoperative weeks (i.e., ideally these should have been performed intraoperatively or within 24–48 h of surgery). Results: Of the 612 screws, minor misplacement of screws (≤2 mm) was seen in 104 patients, moderate misplacement in 34 patients (2–4 mm), and severe misplacement in 7 patients (>4 mm). Notably, all the latter 7 (4.8% of the 145) patients required repeated operative intervention. Conclusion: Transpedicular screw insertion in the lumbar spine carries the risks of pedicle medial/lateral violation that is best confirmed on CT rather than X-rays/fluoroscopy alone. Here, we additional found 7 patients (4.8%) who with severe medial/lateral pedicle breach who warranting repeated operative intervention. In the future, CT studies should be performed intraoperatively or within 24–48 h of surgery to confirm the location of pedicle screws and rule in our out medial or lateral pedicle breaches.

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