scholarly journals Comparative analysis of clinical factors associated with pedicle screw pull-out during or immediately after surgery between intraoperative cone-beam computed tomography and postoperative computed tomography 

2021 ◽  
Author(s):  
Satoshi Sumiya ◽  
Kazuyuki Fukushima ◽  
Yoshiro Kurosa ◽  
Takashi Hirai ◽  
Hiroyuki Inose ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Pedicle Screw ◽  
Odds Ratio ◽  
Pedicle Screws ◽  
Cone Beam ◽  
Clinical Factors ◽  
Factors Associated ◽  
Pull Out ◽  
History Of

Abstract Background No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors. Methods This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis. Results Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval 1.12–10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out. Conclusions Our findings suggest that age, number of fused segments, presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.

scholarly journals Comparative analysis of clinical factors associated with pedicle screw pull-out during or immediately after surgery between intraoperative cone-beam computed tomography and postoperative computed tomography

2020 ◽  
Author(s):  
Satoshi Sumiya ◽  
Kazuyuki Fukushima ◽  
Yoshiro Kurosa ◽  
Takashi Hirai ◽  
Hiroyuki Inose ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Pedicle Screw ◽  
Odds Ratio ◽  
Pedicle Screws ◽  
Cone Beam ◽  
Clinical Factors ◽  
Factors Associated ◽  
Pull Out ◽  
History Of

Abstract Background No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors.Methods This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis.Results Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval, 1.12–10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out.Conclusions Our findings suggest that age, number of fused segments, the presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.

scholarly journals Comparative analysis of clinical factors associated with pedicle screw pull-out during or immediately after surgery between intraoperative cone-beam computed tomography and postoperative computed tomography

2020 ◽  
Author(s):  
Satoshi Sumiya ◽  
Kazuyuki Fukushima ◽  
Yoshiro Kurosa ◽  
Takashi Hirai ◽  
Hiroyuki Inose ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Pedicle Screw ◽  
Odds Ratio ◽  
Pedicle Screws ◽  
Cone Beam ◽  
Clinical Factors ◽  
Factors Associated ◽  
Pull Out ◽  
History Of

Abstract Background No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors.Methods This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis.Results Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval 1.12–10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out.Conclusions Our findings suggest that age, number of fused segments, presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.

scholarly journals Comparative analysis of clinical factors associated with pedicle screw pull‐out during or immediately after surgery between intraoperative cone‐beam computed tomography and postoperative computed tomography

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Satoshi Sumiya ◽  
Kazuyuki Fukushima ◽  
Yoshiro Kurosa ◽  
Takashi Hirai ◽  
Hiroyuki Inose ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Pedicle Screw ◽  
Odds Ratio ◽  
Pedicle Screws ◽  
Cone Beam ◽  
Clinical Factors ◽  
Factors Associated ◽  
Pull Out ◽  
History Of

Abstract Background No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors. Methods This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis. Results Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval 1.12–10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out. Conclusions Our findings suggest that age, number of fused segments, presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.

scholarly journals Comparative analysis of clinical factors associated with pedicle screw pull-out between intraoperative cone-beam computed tomography and postoperative computed tomography

2020 ◽  
Author(s):  
Satoshi Sumiya ◽  
Kazuyuki Fukushima ◽  
Yoshiro Kurosa ◽  
Takashi Hirai ◽  
Hiroyuki Inose ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Confidence Interval ◽  
Pedicle Screw ◽  
Odds Ratio ◽  
Pedicle Screws ◽  
Cone Beam ◽  
Clinical Factors ◽  
Factors Associated ◽  
Pull Out

Abstract Background No studies to date have elucidated the clinical factors associated with pedicle screw pull-out. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with scans acquired postoperatively using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors. Methods This was a retrospective analysis of prospectively collected data for 636 pedicle screws placed in 66 consecutive patients who underwent at least triple-level posterior fixation of the thoracic or lumbar spine between April 2014 and March 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. The risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis. Results Pedicle screw pull-out was seen with 17 pedicle screws (2.7%) in 13 (19.7%) patients. There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), presence of osteoporosis, and advanced elderly medical service system insurance for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.15, 95% confidence interval 1.04–1.272) and a diagnosis of DISH (odds ratio 6.10, 95% confidence interval, 1.23–30.20). Conclusions Several cases of intraoperative pedicle screw pull-out may be caused by use of connecting rods. Older age and DISH are risk factors for pedicle screw pull-out.

scholarly journals Comparative analysis of clinical factors associated with pedicle screw pull-out between intraoperative cone-beam computed tomography and postoperative computed tomography

2020 ◽  
Author(s):  
Satoshi Sumiya ◽  
Kazuyuki Fukushima ◽  
Yoshiro Kurosa ◽  
Takashi Hirai ◽  
Hiroyuki Inose ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Confidence Interval ◽  
Pedicle Screw ◽  
Odds Ratio ◽  
Pedicle Screws ◽  
Cone Beam ◽  
Clinical Factors ◽  
Factors Associated ◽  
Pull Out

Abstract Background: No studies to date have elucidated the clinical factors associated with pedicle screw pull-out. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with scans acquired postoperatively using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors.Methods: This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis.Results: Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 (34.2%) patients. There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval, 1.12–10.00).Conclusions: Several cases of intraoperative pedicle screw pull-out may be caused by use of connecting rods. Older age and DISH are risk factors for pedicle screw pull-out.

scholarly journals Correlation between the Computed Tomography Values of the Screw Path and Pedicle Screw Pullout Strength: An Experimental Study in Porcine Vertebrae

2020 ◽  
Vol 14 (3) ◽  
pp. 265-272
Author(s):  
Atsushi Ikeura ◽  
Taketoshi Kushida ◽  
Kenichi Oe ◽  
Yoshihisa Kotani ◽  
Muneharu Ando ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Mineral Density ◽  
Pedicle Screw ◽  
Bone Mineral ◽  
Lumbar Vertebrae ◽  
Pedicle Screws ◽  
Mineral Density ◽  
Screw Insertion ◽  
Pull Out ◽  
Pull Out Strength

Study Design: Biomechanical study.Purpose: To assess the correlation between the computed tomography (CT) values of the pedicle screw path and screw pull-out strength.Overview of Literature: The correlation between pedicle screw pull-out strength and bone mineral density has been well established. In addition, several reports have demonstrated a correlation between bone mineral density and CT values. However, no previous biomechanical studies investigated the correlation between CT values and pedicle screw pull-out strength.Methods: Sixty fresh-frozen lumbar vertebrae from 6-month-old pigs were used. Before screw insertion, the CT values of the screw path were obtained for each sample. Specimens were then randomly divided into three equal groups. Each group had one of three pedicle screws inserted: 4.0-mm LEGACY (4.0-LEG), 4.5-mm LEGACY (4.5-LEG), or 4.5-mm SOLERA (4.5-SOL) (all from Medtronic Sofamor Danek Inc., Memphis, TN, USA). Each screw had a consistent 30-mm thread length. Axial pull-out testing was performed at a rate of 1.0 mm/min. Correlations between the CT values and pedicle screw pull-out strength were evaluated using Pearson’s correlation coefficient analysis.Results: The correlation coefficients between the CT values of the screw path and pedicle screw pull-out strength for the 4.0-LEG, 4.5-LEG, and 4.5-SOL groups were 0.836 (<i>p</i> <0.001), 0.780 (<i>p</i> <0.001), and 0.873 (<i>p</i> <0.001), respectively. Greater CT values were associated with greater screw pull-out strength.Conclusions: The CT values of the screw path were strongly positively correlated with pedicle screw pull-out strength, regardless of the screw type and diameter, suggesting that the CT values could be clinically useful for predicting pedicle screw pull-out strength.

scholarly journals Early Onset of Coronary Artery Calcification in Women With Previous Preeclampsia

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Laura Benschop ◽  
Laura Brouwers ◽  
Gerbrand A. Zoet ◽  
Cindy Meun ◽  
Eric Boersma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Cardiovascular Risk Factors ◽  
Odds Ratio ◽  
Coronary Computed Tomography ◽  
History Of ◽  
Normotensive Pregnancy

Background: Preeclampsia, coronary artery calcification (CAC), and atherosclerotic plaque are risk factors for the development of cardiovascular disease. We determined at what age CAC becomes apparent on coronary computed tomography after preeclampsia and to what extent modifiable cardiovascular risk factors were associated. Methods: We measured cardiovascular risk factors, CAC by coronary computed tomography, and coronary plaque by coronary computed tomography angiography in 258 previously preeclamptic women aged 40-63. Results were compared to 644 age- and ethnicity-equivalent women from the Framingham Heart Study with previous normotensive pregnancies. Results: Any CAC was more prevalent after preeclampsia than after a normotensive pregnancy (20% versus 13%). However, this difference was greatest and statistically significant only in women ages 45 to 50 (23% versus 10%). The degree of CAC advanced 4× faster between the ages of 40 to 45 and ages 45 to 50 in women with a history of preeclampsia (odds ratio, 4.3 [95% CI, 1.5–12.2] versus odds ratio, 1.2 [95% CI, 0.6–2.3]). Women with a preeclampsia history maintained greater advancement of CAC with age into their early 60s, although this difference declined after the perimenopausal years. Women with a previous normotensive pregnancy were 4.9 years (95% CI, 1.8–8.0) older when they had similar CAC scores as previously preeclamptic women. These observations were not explained by the greater prevalence of cardiovascular disease risk factors, and the higher Framingham Risk Scores also observed in women with a history of preeclampsia. Conclusions: Previously preeclamptic women have more modifiable cardiovascular risk factors and develop CAC ≈5 years earlier from the age of 45 years onwards compared to women with normotensive pregnancies. Therefore, women who experienced preeclampsia might benefit from regular cardiovascular screening and intervention before this age. Registration: URL: https://www.trialregister.nl/trial/5406 ; Unique identifier: NTR5531.

scholarly journals Intraoperative cone beam computed tomography is as reliable as conventional computed tomography for identification of pedicle screw breach in thoracolumbar spine surgery

2020 ◽  
Author(s):  
Gustav Burström ◽  
Paulina Cewe ◽  
Anastasios Charalampidis ◽  
Rami Nachabe ◽  
Michael Söderman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pedicle Screw ◽  
Negative Predictive Value ◽  
Spine Surgery ◽  
Cone Beam Computed Tomography ◽  
Predictive Value ◽  
Pedicle Screws ◽  
Ct Scans ◽  
Cone Beam ◽  
Spinal Fixation

Abstract Objectives To test the hypothesis that intraoperative cone beam computed tomography (CBCT) using the Allura augmented reality surgical navigation (ARSN) system in a dedicated hybrid operating room (OR) matches computed tomography (CT) for identification of pedicle screw breach during spine surgery. Methods Twenty patients treated with spinal fixation surgery (260 screws) underwent intraoperative CBCT as well as conventional postoperative CT scans (median 12 months after surgery) to identify and grade the degree of pedicle screw breach on both scan types, according to the Gertzbein grading scale. Blinded assessments were performed by three independent spine surgeons and the CT served as the standard of reference. Screws graded as Gertzbein 0 or 1 were considered clinically accurate while grades 2 or 3 were considered inaccurate. Sensitivity, specificity, and negative predictive value were the primary metrics of diagnostic performance. Results For this patient group, the negative predictive value of an intraoperative CBCT to rule out pedicle screw breach was 99.6% (CI 97.75–99.99%). Among 10 screws graded as inaccurate on CT, 9 were graded as such on the CBCT, giving a sensitivity of 90.0% (CI 55.5–99.75%). Among the 250 screws graded as accurate on CT, 244 were graded as such on the CBCT, giving a specificity of 97.6% (CI 94.85–99.11%). Conclusions CBCT, performed intraoperatively with the Allura ARSN system, is comparable and non-inferior to a conventional postoperative CT scan for ruling out misplaced pedicle screws in spinal deformity cases, eliminating the need for a postoperative CT. Key Points • Intraoperative cone beam computed tomography (CT) using the Allura ARSN is comparable with conventional CT for ruling out pedicle screw breaches after spinal fixation surgery. • Intraoperative cone beam computed tomography can be used to assess need for revisions of pedicle screws making routine postoperative CT scans unnecessary. • Using cone beam computed tomography, the specificity was 97.6% and the sensitivity was 90% for detecting pedicle screw breaches and the negative predictive value for ruling out a pedicle screw breach was 99.6%.

scholarly journals Prolonged Carriage of Carbapenemase-Producing Enterobacteriaceae: Clinical Risk Factors and the Influence of Carbapenemase and Organism Types

2021 ◽  
Vol 10 (2) ◽  
pp. 310
Author(s):  
Yong Kyun Kim ◽  
In Bok Chang ◽  
Han Sung Kim ◽  
Wonkeun Song ◽  
Seung Soon Lee
Keyword(s):  
Risk Factors ◽  
Odds Ratio ◽  
Clinical Specimen ◽  
Clinical Factors ◽  
Factors Associated ◽  
Logistic Analysis ◽  
Clostridioides Difficile ◽  
Kaplan Meier ◽  
Clostridioides Difficile Infection

Prolonged carriage of carbapenemase-producing Enterobacteriaceae (CPE) constitutes a substantial epidemiologic threat. This study aimed to evaluate whether the types of carbapenemase and organism can affect the duration of carriage and to evaluate the clinical factors associated with prolonged carriage. We retrospectively reviewed data for patients admitted between May 2013 and August 2018 who were identified as CPE carriers. A total of 702 patients were identified; the major types of carbapenemase and organism were Oxacillinase (OXA)-48-like (n = 480, 68.4%) and Klebsiella pneumoniae (K. pneumoniae) (n = 584, 83.2%). The analyses of time to spontaneous decolonization using the Kaplan–Meier method showed that OXA-48-like and K. pneumoniae were significantly associated with prolonged carriage (log rank, p = 0.001 and p < 0.001). In multivariable logistic analysis to assess the risk factors for CPE prolonged carriage in the 188 patients with available follow-up culture data for 3 months, K. pneumoniae (adjusted odds ratio [aOR] 6.58; 95% confidence interval [CI], 1.05–41.27; p = 0.044), CPE positive clinical specimen (aOR 11.14; 95% CI, 4.73–26.25; p < 0.001), and concurrent Clostridioides difficile infection (CDI) (aOR 3.98, 95% CI 1.29–12.26; p = 0.016) were predictive of prolonged carriage. Our results suggest that CP-K. pneumoniae may have higher probability of prolonged carriage, while the effect of OXA-48-like CPE is inconclusive. Furthermore, patients with CP-K. pneumoniae who had positive clinical specimen or concurrent CDI can cause a vicious circle in prolonged carriage.

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