scholarly journals Surgical correction of spinal deformity with the use of transpedicular screw spinal systems in children with idiopathic thoracic scoliosis

2016 ◽  
Vol 4 (2) ◽  
pp. 37-44
Author(s):  
Nurbek N Nadirov ◽  
Sergei M Belyanchikov ◽  
Dmitriy N Kokushin ◽  
Vladislav V Murashko ◽  
Kirill A Kartavenko
Keyword(s):  
Idiopathic Scoliosis ◽  
Pedicle Screw ◽  
Spinal Deformity ◽  
Pedicle Screws ◽  
Surgical Correction ◽  
Spinal Curvature ◽  
Thoracic Scoliosis ◽  
Use Of Data ◽  
Transpedicular Screw ◽  
Metal Construction

Aim.To compare the results of surgical correction of spinal deformity in children with idiopathic thoracic scoliosis with the use of transpedicular screw spinal systems with different pedicle screw placement.Material and methods.Thirty-one patients (14–17 years) with spinal curvature with a Cobb angle from 40° to 79° were operated on. Surgical correction of the deformity was performed using two methods, depending on the possible placement of a pedicle screw. The first group included 16 patients for whom the transpedicular support elements were placed on both sides, throughout the completely deformed spine. The second group included 15 patients for whom the pedicle screws were not placed for two or more vertebrae on the concave side of the curve, at the top of the main curve.Results.The mean percent correction of the spinal deformity for the first and second groups was 92.5% and 82.6%, respectively. The mean percentage of derotation of the apical vertebra for the first and second groups was 73.9% and 23%, respectively.Conclusion.The use of data based on the anatomical and anthropometric features of the vertebral body with scoliosis facilitates selection of the best option for correction of thoracic curve in children with idiopathic scoliosis using pedicle multi-support metal construction. The use of the spinal pedicle system for correction of spinal deformity in children with idiopathic scoliosis enabled a uniform load distribution along the support elements of the metal construction and maintained the correction in the late postoperative follow-up period.

scholarly journals Breach Rate Analysis of Pedicle Screw Instrumentation using Free-Hand Technique in the Surgical Correction of Adolescent Idiopathic Scoliosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Didik Librianto ◽  
Ifran Saleh ◽  
Fachrisal Saleh ◽  
Widyastuti Srie Utami ◽  
Witantra Dhamar Hutami
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screw ◽  
Lumbar Vertebrae ◽  
Pedicle Screws ◽  
Surgical Correction ◽  
Low Grade ◽  
Pedicle Screw Instrumentation ◽  
Rate Analysis ◽  
Free Hand Technique

Introduction: Free-hand technique is one of the techniques used by spine surgeon during pedicle screw instrumentation of surgical correction of spinal deformities, including scoliosis. The previous studies showed that this technique is safe. However, some inherent factors may influence its outcomes, including screw breaching which is potentially violates spinal cord and other intimate structures. To con?rm the safety and accuracy of this technique, additional study measuring the breach rate of pedicle screw placement in scoliosis is mandatory. Materials and Methods: We performed a retrospective study of patients with adolescent idiopathic scoliosis (AIS) from Fatmawati General Hospital, Jakarta, treated for surgical correction during a period of 2017–2018 using free-hand technique for pedicle screw instrumentation. Post-operative computed tomography scan (CT scan) was analyzed to measure the medial and lateral breaches. P < 0.05 was deemed to be statistically significant. Results: A total of 94 pedicle screws from six female patients with AIS were included in our study. Overall breach occurred in 33% instrumented screws, the majority of it was a low-grade breach. Of the breached screws, medial and lateral breach occurred in 20% and 12% of screws, respectively. There were no differences in the overall, medial, and lateral breaches between thoracic and lumbar vertebrae (P > 0.05). Medial breach was significantly higher in middle thoracic segment compared to other thoracic segments (P = 0.048). Risk of medial breach was 3 times higher in the convex side of deformity (P = 0.012), whereas risk of lateral breach was 4.6 times higher in the concave side of the deformity (P = 0.021). Conclusion: The majority of breached screws were low-grade violation within the safe zone, with no neurological sequelae. Our study found that free-hand technique is safe and effective method of pedicle screw instrumentation for correction of AIS. Some inherent factors may influence the risk of

scholarly journals Preoperative Assessment of the Feasibility of Pedicle Screw Insertion at the Proximal Thoracic Curve in Lenke Type 2 Idiopathic Scoliosis

2019 ◽  
Vol 10 (3) ◽  
pp. 261-265
Author(s):  
Yuki Taniguchi ◽  
Yoshitaka Matsubayashi ◽  
So Kato ◽  
Takashi Ono ◽  
Yasushi Oshima ◽  
...  
Keyword(s):  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Preoperative Assessment ◽  
Japanese Patients ◽  
Minimal Distance ◽  
Screw Insertion ◽  
The Right

Study Design: Retrospective cohort study. Objectives: To investigate the feasibility of inserting pedicle screws in the proximal thoracic (PT) curve in Lenke type 2 idiopathic scoliosis, using post-myelography computed tomography (CT). Methods: Post-myelography CT images of 46 Japanese patients, 10 to 30 years old, who underwent surgery for Lenke type 2 idiopathic scoliosis were analyzed. A new parameter “SAPS” (space available for pedicle screw) was introduced, which defines the minimal distance between the lateral cortex of the pedicle and the spinal cord, with a SAPS <4.5 mm being “unacceptable.” All 460 pedicles (T2 through T6) were analyzed. Pedicle diameter was classified according to the Akazawa grading system. Results: Most pedicles on the right side at T3 (84.8%) and T4 (97.8%) were unacceptable. The unacceptable rate was 58.7% and 15.2% on the right side at T5 and T6, respectively. A larger Cobb angle of the PT curve was associated with a greater incidence of unacceptable SAPS at these levels. For a Cobb angle of the PT curve >40°, most right T5 pedicles were unacceptable. On the left side, most pedicles from T2 to T5 were acceptable. When T5 was the caudal end vertebra of the PT curve, the left T6 pedicles had an unacceptable SAPS in some cases. When the width of the pedicle channel was ≥2 mm (Akazawa grade 1 or 2), all pedicles from T2 to T6, on both sides, were acceptable. Conclusions: Post-myelography CT enabled us to clearly demonstrate the feasibility of inserting pedicle screws in the PT region.

scholarly journals Comparative analysis of pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery

2016 ◽  
Vol 7 (04) ◽  
pp. 550-553 ◽  
Author(s):  
Sohail Rafi ◽  
Naseem Munshi ◽  
Asad Abbas ◽  
Rabia Hassan Shaikh ◽  
Imtiaz Hashmi
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Scoliosis Surgery ◽  
Hybrid Instrumentation ◽  
System Versus ◽  
Cobb’S Angle

ABSTRACT Introduction: Adolescent idiopathic scoliosis is the most common type of scoliosis. A Cobb angle of 50° will progress beyond the age of spinal maturity. Surgery over bracing is advised at a Cobb angle above or equal to 50°. The aim of surgery is to bring the Cobb angle down below 50° to prevent reprogression as well as improve the quality of life. The objective of the study is to analyze the efficacy and significance in lifestyle improvement of pedicle screw-only fixation system versus the more common hybrid instrumentation system used for the surgical treatment of adolescent idiopathic scoliosis. Materials and Methods: A prospective cohort study was conducted involving two groups of patients were included in the study. One group was operated with pedicle screw-only method while the other with hybrid instrumentation system. The pre- and post-operative Cobb’s angles were taken across a follow-up of 4 years. An SRS-30 questionnaire was given in a yearly follow-up to assess the lifestyle improvement of the patient. Results: Pedicle screw-only method was significantly more effective in reducing Cobb’s angle (P = 0.0487). It was showed less loss of correction (P = 0.009) pedicle screw-only surgery was also better at reducing thoracic curves (P = 0.001). There seemed a better recovery time with pedicle screw surgery (P = 0.003). Conclusion: Pedicle screws are more effective and durable than hybrid systems at when treating adolescent idiopathic scoliosis.

Apical Sublaminar Wires Versus Pedicle Screws—Which Provides Better Results for Surgical Correction of Adolescent Idiopathic Scoliosis?

Spine ◽  
2005 ◽  
Vol 30 (18) ◽  
pp. 2104-2112 ◽  
Author(s):  
Ivan Cheng ◽  
Yongjung Kim ◽  
Munish C. Gupta ◽  
Keith H. Bridwell ◽  
Robert K. Hurford ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screws ◽  
Surgical Correction

scholarly journals What causes different coronal curve patterns in idiopathic scoliosis?

2020 ◽  
Author(s):  
Saba Pasha
Keyword(s):  
Idiopathic Scoliosis ◽  
Spinal Deformity ◽  
Vertebral Rotation ◽  
Classification Systems ◽  
Axial Plane ◽  
Spinal Curvature ◽  
Group I ◽  
Plane Projection ◽  
Group Ii ◽  
Deformation Patterns

AbstractBackgroundAdolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spinal column in otherwise healthy adolescents. The underlying mechanisms associated with the spinal deformity development have been explored which delineated the role of the sagittal curvature of the spine. The patterns of the spinal deformity vary between the AIS patients as shown in several classification systems. It remains to further investigate how variations in sagittal profiles result in different coronal plane deformities in AIS and how these deformation patterns are intrinsically different.MethodsA total of 71 Lenke 1 and 52 Lenke 5 AIS patients were included retrospectively. The 3D models of the spine were generated from biplanar radiographs to calculate the clinical spinal parameters, vertebral axial rotations, and the 3D centerline of the spinal curvature. A classification based on the centerlines’ axial plane projection was developed. The 3D curvature of the centerline was calculated at each point. A 2D elastic rod finite element model (FEM) of the sagittal spinal curvature for each axial subtype was developed to calculate the 3D deformity of the spine under gravity and axial torsion. Differences in the axial clusters’ clinical parameters, curvature of the spine, and the deformation patterns of the FEM were compared. The characteristics of the sagittal curvature of these axial clusters were determined.ResultsLenke1 was divided into two axial groups (I and II) whereas the Lenke 5 cohort all had the same axial projection pattern (loop shape). T5-T12 kyphosis was significantly different between Lenke1-Group I and the other two groups, p=0.04. The vertebral rotation in both Lenke1-Group I and Lenke 5 had only one maximum value and the FEM deformed in a loop shaped whereas Lenke1-group II showed two maximum values for vertebral rotation and the FEM of the centerline deformed in a lemniscate shape. The ratio of the spinal arc lengths above and below the sagittal inflection points for Lenke1-Groups I and II and Lenke 5 were 0.52, 1.16, and 3.24, respectively.ConclusionVariations in the axial plane projection of the curve were observed within Lenke types. Lenke 1- Group I and Lenke 5 showed similar 3D curve characteristics suggesting one 3D curve whereas Lenke1-Group II, with two 3D curves, behaved differently. The length of the spinal arcs above and below the sagittal inflection point related to the patterns of axial deformity.

scholarly journals Transpedicular Screw Placement Accuracy Using the O-Arm Versus Freehand Technique at a Single Institution

2020 ◽  
pp. 219256822095697
Author(s):  
Benjamin D. Crawford ◽  
Corbyn M. Nchako ◽  
Kelsey A. Rebehn ◽  
Heidi Israel ◽  
Howard M. Place
Keyword(s):  
Pedicle Screw ◽  
Intraoperative Imaging ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Spinal Level ◽  
Imaging Tool ◽  
Freehand Technique ◽  
Transpedicular Screw ◽  
Significant Difference ◽  
Placement Accuracy

Study Design: Retrospective cohort. Objective: The objective of this study was to assess the effectiveness of the O-arm as an intraoperative imaging tool by comparing accuracy of pedicle screw placement to freehand technique. Methods: The study comprised a total of 1161 screws placed within the cervical (n = 187) thoracic (n = 657), or lumbar (n = 317) spinal level. A pedicle breach was determined by any measurable displacement of the screw outside of the pedicle cortex in any plane on postoperative images. Each pedicle screw was subsequently classified by its placement relative to the targeted pedicle. Statistical analysis was then performed to determine the frequency and type of pedicle screw mispositioning that occurred using the O-arm versus freehand technique. Results: A total of 155 cases (O-arm 84, freehand 71) involved the placement of 454 pedicle screws in the O-arm group and 707 pedicle screws in the freehand group. A pedicle breach occurred in 89 (12.6%) screws in the freehand group and 55 (12.1%) in the O-arm group ( P = .811). Spinal level operated upon did not influence pedicle screw accuracy between groups ( P > .05). Three screws required revision surgery between the 2 groups (O-arm 1, freehand 2, P > .05). The most frequent breach type was a lateral pedicle breach (O-arm 22/454, 4.8%; freehand 54/707, 7.6%), without a significant difference between groups ( P > .05). Conclusions: The use of the O-arm coupled with navigation does not assure improved transpedicular screw placement accuracy when compared with the freehand technique.

scholarly journals Thoracic pedicle screw fixation for spinal deformity

2003 ◽  
Vol 14 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Michael K. Rosner ◽  
David W. Polly ◽  
Timothy R. Kuklo ◽  
Stephen L. Ondra
Keyword(s):  
Spinal Deformity ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Thoracic Pedicle Screw ◽  
Transpedicular Screw ◽  
Thoracic Pedicle Screws ◽  
Spinal Deformity Surgery ◽  
Minimum Number ◽  
Transpedicular Screw Fixation

Techniques to improve segmental fixation have advanced the ability to correct complex spinal deformity. The purpose of instrumentation is to correct spinal deformity or to stabilize the spine to enhance the long-term biological fusion. The ultimate goal of spinal deformity surgery is the creation of a stable, balanced, pain-free spine centered over the pelvis in the coronal and sagittal planes. The minimum number of segments should be fused. These concepts remain challenging in the setting of deformity and instability. Successful results can be obtained if the surgeon understands the technology available, its capabilities, biological limitations, and the desired solution. The authors prefer to use thoracic pedicle screws when treating patients with spinal deformity because they provide greater corrective forces for realignment. This allows shorter-segment constructs and the possibility of true derotation in correction. In this article the authors focus on the use of thoracic transpedicular screw fixation in the management of complex spinal disorders and deformity.

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