scholarly journals How to improve the safety of bicortical pedicle screw insertion in the thoracolumbar veterbrae with osteoporotic: Analysis base on three-dimensional CT reconstruction of patients in prone position

2019 ◽  
Author(s):  
Chao Xu ◽  
Qingxian Hou ◽  
Yanchen Chu ◽  
Xiuling Huang ◽  
Wenjiu Yang ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Prone Position ◽  
Vertebral Body ◽  
Supine Position ◽  
Relative Position ◽  
Three Dimensional ◽  
Ct Reconstruction ◽  
Screw Insertion ◽  
Dimensional Reconstruction ◽  
Great Vessels

Abstract Background: Three-dimensional CT reconstruction of prone position could measure the relative position between the Great vessels and the thoracolumbar vertebrae. The Great vessels positions of the thoracic and lumbar segments were studied to improve the accuracy of pedicle screw insertion, reduce the risk of vascular injury. Methods: Twenty-four adults participated in the present study. Three-dimensional reconstruction of thoracolumbar (T9–L3) CT was performed in the prone and supine positions. The relative distance between the arteriovenous vessels and vertebrae distance (AVD/VVD) was obtained, respectively. The relative position angle of the arteriovenous vessel and the vertebral body was calculated as ∠AOY/∠VOY. Self-controlled experiments were carried out in the prone and supine positions. The data obtained were analyzed using SPSS 22.0 statistical software. Results: With regard to AVD, The AVD of the T12 was the smallest,> 3.2 mm. The difference among the T9, T10, L2 level was statistically significant (P < 0.05). And AVD was greater in the prone position than in the supine position; while the value of ∠AOY is the descending from T9-L3 gradually, there were statistically significant differences in ∠AOY between T9-T12, L2 and L3 in prone and supine position (P < 0.05). The aorta in the prone position was closer to the midline than that of the supine position, varying from 0°to 30°near the Y axis. With regard to VVD, there was no significant difference in contrast between the prone and supine positions (P≥0.05), and the VVD was the smallest in the L3 level> 5.4 mm. Conclusion: The pre-vertebral position of the aorta may change from T9 to L3 due to changes in body position. When the T9-L3 thoracolumbar spine disease was treated with pedicle screw double cortical fixation, the screw was safe and reliable within a range of≤ 3 mm when broken the pre-cortex .The three-dimensional reconstruction of prone position CT could be used to more accurately assess the relative position of the vertebral body and the blood vessel.

scholarly journals How to improve the safety of bicortical pedicle screw insertion in the thoracolumbar vertebrae: Analysis base on three-dimensional CT reconstruction of patients in the prone position

2020 ◽  
Author(s):  
Chao Xu ◽  
Qingxian Hou ◽  
Yanchen Chu ◽  
Xiuling Huang ◽  
Wenjiu Yang ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Prone Position ◽  
Vertebral Body ◽  
Supine Position ◽  
Three Dimensional ◽  
Vena Cava ◽  
Ct Reconstruction ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Significant Difference

Abstract Background: Through the comparison of three-dimensional CT reconstruction between the supine position and the prone position, the relative position of thoracolumbar great vessels and vertebral body was studied, and the shortest safe distance between them was measured to improve the safety of bicortical pedicle screw insertion and reduce the risk of vascular injury. Methods: Forty adults were selected to participate the research. Three-dimensional reconstruction of thoracolumbar (T9-L3) CT was performed in the prone position and the supine position. The relative distance between the Aorta/Inferior Vena Cava (IVC) and vertebral body was obtained as AVD/VVD respectively. The relative angle of the Aorta/ IVC and the vertebral body was calculated as ∠AOY/∠VOY. Self-controlled experiments were carried out in the prone and the supine positions, and the data obtained were analyzed using SPSS 22.0 statistical software. Results: The AVD of the prone position and the supine position was the shortest at T12 (3.18 ±0.68mm), but the difference was not statistically significant. The aorta of the T9-L3 segment was shifted from the anterolateral to the anteromedial. The ∠AOY of the other groups differed significantly between the prone and supine positions in all vertebrae except L1 (P < 0.05), and the aorta in the prone position was more anteromedial than that of supine position. With regard to VVD/∠VOY, there was no significant difference between the prone and supine positions (P≥0.05), and the minimum VVD of L3 segment is greater than 5.4mm. The IVC has no obvious mobility and is fixed in the range of 20 °~ 30 ° near the midline. Conclusion: When using bicortical anchoring of pedicle screws, it is safe to ensure that the protruding tips of the screw is less than 3mm. Due to the mobility of the aorta in different postures and individual differences in anatomy, the prone position CT can help doctors to make better preoperative plans and decisions.

The Evaluation of a Novel Three-Dimensional Printed Expandable Pedicle Screw Sleeve Insert

2019 ◽  
Vol 13 (3) ◽  
Author(s):  
Timothy A. Burkhart ◽  
Manjunath Sadashivaiah ◽  
Jacob Reeves ◽  
Paraham Rasounlinejad
Keyword(s):  
Pedicle Screw ◽  
Vertebral Body ◽  
Degenerative Spondylolisthesis ◽  
Three Dimensional ◽  
Area Under The Curve ◽  
Tensile Load ◽  
The Novel ◽  
Conflicting Information ◽  
Screw Augmentation ◽  
3D Printed

When used in combination with decompression, spinal fusion is a successful procedure for treating patients with spinal stenosis and degenerative spondylolisthesis. While a number of auxiliary devices have been proposed to enhance the fixation of the screw within the pedicle and vertebral body, there is conflicting information regarding the efficacy of their use. Therefore, the aim of this study was to determine the ability of a novel expandable pedicle screw to improve the fixation of the pedicle screw within the pedicle and vertebral body. A three-dimensional (3D) printed, screw sleeve was designed that expanded within the pedicle and vertebral body when a standard pedicle screw was inserted into it. The left and right pedicle of ten (N = 10) cadaveric lumbar spine specimens (L3–L5) were randomly assigned to be instrumented with either a pedicle screw and the sleeve or a pedicle screw only. Following instrumentation, the screws were exposed to tensile load at 5 mm/min until failure. The failure force, failure deformation, and area under the force–deformation curve were determined and compared between screw conditions. There were no significant differences between the screws and sleeve, and the screw only conditions for the failure force (p = 0.24), failure displacement (p = 0.10), and area under the curve (p = 0.38). While the novel screw sleeve presented here performed as well as a screw without a sleeve, it was better than other screw augmentation devices reported previously. In addition, it is likely that this device would prove useful as an enhancement to revision.

scholarly journals Bone registration method for robot assisted surgery: Pedicle screw insertion

1997 ◽  
Vol 211 (3) ◽  
pp. 221-233 ◽  
Author(s):  
K Abdel-Malek ◽  
D P McGowan ◽  
V K Goel ◽  
D Kowalski ◽  
S B Smith
Keyword(s):  
Pedicle Screw ◽  
Three Dimensional ◽  
Pedicle Screws ◽  
Bone Geometry ◽  
Registration Method ◽  
Screw Insertion ◽  
Manipulator Arm ◽  
Vertebral Bodies ◽  
Five Axis

A registration method that identifies bone geometry with respect to a robotic manipulator arm is presented. Although the method is generally applicable to many orthopaedic internal fixation procedures, it was only demonstrated for the insertion of pedicle screws in vertebral bodies for spine fixation. The method relies upon obtaining an impression of the vertebral bodies. Computerized tomography (CT) scans of both vertebrae and mould are reconstructed using a computer aided engineering (CAE) system. From the reconstructions, the surgeon is able to do preoperative planning including selection of pedicle screw diameter, direction of screw through pedicle, point of entry and length of engagement. The three-dimensional models are then meshed to determine positions of the surgeon's preoperative plan relative to the mould. Intra-operative positions are defined in space by a mechanical fixture rigidly attached to the mould and designed to allow a manipulator end-effector to recognize the global coordinates of the in vivo spine. The theory and methodology were validated using a five-axis manipulator arm. This initial presentation assumes and allows no relative motion between vertebrae in vivo.

scholarly journals The accuracy of multi-slice three-dimensional computerized tomography on the verification of the pedicle screw trajectory

2009 ◽  
Vol 1 (1) ◽  
pp. 22
Author(s):  
Suat Erol Çelik ◽  
Bilal Kelten ◽  
Recai Gökcan ◽  
Ahmet Cevri Yıldız
Keyword(s):  
Pedicle Screw ◽  
Computerized Tomography ◽  
Spinal Surgery ◽  
Three Dimensional ◽  
Pedicle Screws ◽  
Ct Reconstruction ◽  
Axial Ct ◽  
Diagnostic Power ◽  
Ct Slices

The purpose of our study was to determine the diagnostic power of three-dimensional reformatted multi-slice computerized tomography (CT) images on misplaced pedicle screws in spinal surgery. Eighty-four consecutive patients with 458 screws in situ were investigated prospectively using both axial CT slices and reformatted images after operation by two blinded investigators. All the screw misplacements were documented and the differences between the two imaging modalities were recorded. Axial CT slices were able to show only 23 of 60 misplaced pedicle screws; multi-slice CT was three times more powerful in the diagnosis of pedicle screw complications in spinal surgery (p<0.05). We concluded that multi-slice CT reconstruction should be the primary diagnostic tool after screw implantation in the human spine.

Sign in / Sign up

Export Citation Format

Share Document