Multistep pedicle screw insertion procedure with patient-specific lamina fit-and-lock templates for the thoracic spine

2013 ◽  
Vol 19 (2) ◽  
pp. 185-190 ◽  
Author(s):  
Taku Sugawara ◽  
Naoki Higashiyama ◽  
Shuichi Kaneyama ◽  
Masato Takabatake ◽  
Naoko Watanabe ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Operating Time ◽  
Spinal Instrumentation ◽  
Ct Scans ◽  
Patient Specific ◽  
Mean Deviation ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Adjacent Structures

Object Pedicle screw fixation is a standard procedure of spinal instrumentation, but accurate screw placement is essential to avoid injury to the adjacent structures, such as the vessels, nerves, and viscera. The authors recently developed an intraoperative screw guiding method in which patient-specific laminar templates were used, and verified the accuracy of the multistep procedure in the thoracic spine. Methods Preoperative bone images of the CT scans were analyzed using 3D/multiplanar imaging software and the trajectories of the screws were planned. Plastic templates with screw guiding structures were created for each lamina by using 3D design and printing technology. Three types of templates were made for precise multistep guidance, and all templates were specially designed to fit and lock on the lamina during the procedure. Plastic vertebra models were also generated and preoperative screw insertion simulation was performed. Surgery was performed using this patient-specific screw guide template system, and the placement of screws was postoperatively evaluated using CT scanning. Results Ten patients with thoracic or cervicothoracic pathological entities were selected to verify this novel procedure. Fifty-eight pedicle screws were placed using the screw guide template system. Preoperatively, each template was found to fit exactly and to lock on the lamina of the vertebra models, and screw insertion simulation was successfully performed. Intraoperatively the templates also fit and locked on the patient lamina, and screw insertion was completed successfully. Postoperative CT scans confirmed that no screws violated the cortex of the pedicles, and the mean deviation of the screws from the planned trajectories was 0.87 ± 0.34 mm at the coronal midpoint section of the pedicles. Conclusions The multistep, patient-specific screw guide template system is useful for intraoperative pedicle screw navigation in the thoracic spine. This simple and economical method can improve the accuracy of pedicle screw insertion and reduce the operating time and radiation exposure of spinal fixation surgery.

scholarly journals Patient-Specific Templates for Pedicle Screw Insertion in Spinal Fixation Surgery

10.29007/kbf7 ◽  
2018 ◽  
Author(s):  
Mahmoud Hafez ◽  
Mohamed Fouda
Keyword(s):  
Pedicle Screw ◽  
3D Model ◽  
Pedicle Screws ◽  
Ct Scans ◽  
Patient Specific ◽  
Scoliosis Surgery ◽  
Spinal Fixation ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Surgery Patient

The increased use of pedicle screws in scoliosis creates a challenge for accurate and safe placement ofscrew within the pedicle during the scoliosis surgery. Patient-specific templates (PST) is a novelmethod to guide the surgeons for allocating and detecting the positions and trajectories of pediclescrews in scoliosis surgery. Based on CT-scans and according to certain protocol, this technique willallow the surgeon to construct a 3D model of spine and present the stage and vertebrae which containthe most deformed bone. With preplanned surgery on specific software, we can develop an accurateand safe position of pedicle screws and its trajectories. This method has the ability to customize theplacement and the size of each pedicle screw based on the unique morphology and landmarks of thevertebrae.

Insertion Torque Profile During Pedicle Screw Insertion of the Thoracic Spine With and Without Violation of the Pedicle Wall

Spine ◽  
2006 ◽  
Vol 31 (22) ◽  
pp. E840-E846 ◽  
Author(s):  
Hwan T. Hee ◽  
Mohammad Shazad Khan ◽  
James C. Goh ◽  
Hee K. Wong
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Insertion Torque ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Pedicle Wall

CT-based Patient-specific Simulation Software for Pedicle Screw Insertion

2009 ◽  
Vol 22 (7) ◽  
pp. 502-506 ◽  
Author(s):  
Shawn Klein ◽  
Cari M. Whyne ◽  
Raphael Rush ◽  
Howard J. Ginsberg
Keyword(s):  
Pedicle Screw ◽  
Simulation Software ◽  
Patient Specific ◽  
Screw Insertion ◽  
Pedicle Screw Insertion

Neurological events due to pedicle screw malpositioning with lateral fluoroscopy–guided pedicle screw insertion

2020 ◽  
Vol 33 (6) ◽  
pp. 806-811
Author(s):  
Inge J. M. H. Caelers ◽  
Kim Rijkers ◽  
Sander M. J. van Kuijk ◽  
Henk van Santbrink ◽  
Rob A. de Bie ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Lumbar Fusion ◽  
Intraoperative Navigation ◽  
Ct Scans ◽  
Screw Placement ◽  
Total Study Population ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Screw Malpositioning ◽  
Screw Malposition

OBJECTIVEThe risk of novel postoperative neurological events due to pedicle screw malpositioning in lumbar fusion surgery is minimized by using one of the several image-guided techniques for pedicle screw insertion. These techniques for guided screw insertion range from intraoperative fluoroscopy to intraoperative navigation. A practical technique consists of anatomical identification of the screw entry point followed by lateral fluoroscopy used for guidance during insertion of the screw. This technique is available in most clinics and is less expensive than intraoperative navigation. However, the safety of lateral fluoroscopy–guided pedicle screw placement with regard to novel postoperative neurological events due to screw malposition has been addressed only rarely in the literature. In this study the authors aimed to determine the rate of novel postoperative neurological events due to intraoperative and postoperatively established screw malpositioning during lateral fluoroscopy–assisted screw insertion.METHODSIncluded patients underwent lateral fluoroscopy–assisted lumbosacral screw insertion between January 2012 and August 2017. The occurrence of novel postoperative neurological events was analyzed from patient files. In case of an event, surgical reports were screened for the occurrence of intraoperative screw malposition. Furthermore, postoperative CT scans were analyzed to identify and describe possible screw malposition.RESULTSIn total, 246 patients with 1079 screws were included. Novel postoperative neurological events were present in 36 patients (14.6%). In 8 of these 36 patients (3.25% of the total study population), the neurological events could be directly attributed to screw malposition. Screw malpositioning was caused either by problematic screw insertion with immediate screw correction (4 patients) or by malpositioned screws for which the malposition was established postoperatively using CT scans (4 patients). Three patients with screw malposition underwent revision surgery without subsequent symptom relief.CONCLUSIONSLateral fluoroscopy–assisted lumbosacral screw placement results in low rates of novel postoperative neurological events caused by screw malposition. In the majority of patients suffering from novel postoperative neurological events, these events could not be attributed to screw malpositioning, but rather were due to postoperative neurapraxia of peripheral nerves, neuropathy, or intraoperative traction of nerve roots.

Accuracy of freehand versus modified funnel technique for pedicle screw insertion in the thoracic spine

2021 ◽  
Author(s):  
Omer Faruk Kilicaslan ◽  
Mehmet Ali Tokgoz ◽  
Sevket Butun ◽  
Vugar Nabi ◽  
Serdar Akalin
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Funnel Technique

scholarly journals Patient-specific template-guided versus standard freehand lumbar pedicle screw implantation: a randomized controlled trial

2021 ◽  
pp. 1-7
Author(s):  
José Miguel Spirig ◽  
Shayan Golshani ◽  
Nadja A. Farshad-Amacker ◽  
Mazda Farshad
Keyword(s):  
Randomized Controlled Trial ◽  
Radiation Exposure ◽  
Pedicle Screw ◽  
Controlled Trial ◽  
Patient Specific ◽  
Pedicle Screw Placement ◽  
Surgical Time ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Randomized Controlled

OBJECTIVE Patient-specific template-guided (TG) pedicle screw placement currently achieves the highest reported accuracy in cadaveric and early clinical studies, with reports of reduced use of radiation and less surgical time. However, a clinical randomized controlled trial (RCT) eliminating potential biases is lacking. This study compares TG and standard freehand (FH) pedicle screw insertion techniques in an RCT. METHODS Twenty-four patients (mean age 64 years, 9 men and 15 women) scheduled consecutively and independently from this study for 1-, 2-, or 3-level lumbar fusion were randomized to either the FH (n = 12) or TG (n = 12) group. Accuracy of pedicle screw placement, intraoperative parameters, and short-term complications were compared. RESULTS A total of 112 screws (58 FH and 54 TG screws) were implanted in the lumbar spine. Radiation exposure was significantly less in the TG group (78.0 ± 46.3 cGycm2) compared with the FH group (234.1 ± 138.1 cGycm2, p = 0.001). There were 4 pedicle screw perforations (6.9%) in the FH group and 2 (3.7%) in the TG group (p > 0.99), with no clinical consequences. Clinically relevant complications were 1 postoperative pedicle fracture in the FH group (p > 0.99), 1 infection in the FH group, and 2 infections in the TG group (p > 0.99). There were no significant differences in surgical exposure time, screw insertion time, overall surgical time, or blood loss between the FH and TG groups. CONCLUSIONS In this RCT, patient-specific TG pedicle screw insertion in the lumbar region achieved a high accuracy, but not better than a standardized FH technique. Even if intraoperative radiation exposure is less with the TG technique, the need for a preoperative CT scan counterbalances this advantage. However, more difficult trajectories might reveal potential benefits of the TG technique and need further research.

Free-Hand Pedicle Screw Insertion of Thoracic Spine Using Fennell Technique: Initial Results and Review of Literature

2019 ◽  
Vol 16 (01) ◽  
pp. 10-13
Author(s):  
Ayusman Satapathy ◽  
Chinmaya Dash ◽  
Arunav Sharma ◽  
Rabi Narayan Sahu
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Pedicle Screws ◽  
Wound Complications ◽  
Reliable Technique ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Number Of Patients ◽  
Thoracic Pedicle Screw ◽  
Safe Technique

Abstract Aim of the Study This article aims to study the safety and feasibility of Fennell technique of free-hand pedicle screw insertion in thoracic spine. Methods Consecutive 10 patients in whom 40 thoracic pedicle screw were inserted using Fennell’s technique were included in the study. Postoperative computed tomography scan was done in all the patients. Breach in individual pedicle was analyzed using Gertzbein classification. Results A total of 40 screws were placed in the thoracic spine in 10 patients by free-hand technique described by Fennell et al. Out of 40 pedicle screws, 26 were placed at the D10 to D12 level, 8 screws were placed at the D7 to D9 level, and 6 screws were placed at the D1 to D6 level. There was one pedicle with grade 1 lateral breach and one pedicle with grade 1 medial breach as per Gertzbein classification. All other screws were contained within the pedicle (Gertzbein grade 0). None of the patients had any added deficits or wound complications in the postoperative period. Conclusion Thoracic pedicle screw insertion is challenging in nature because of the anatomic variability and proximity of critical structures to the pedicles. Our experience suggests that Fennell technique is a reliable technique, which can be used to place thoracic pedicles consistently, with acceptable rates of pedicle breach. A study involving larger number of patients might prove to establish this technique as an easily reproducible and safe technique for free-hand pedicle screw insertion in thoracic spine.

scholarly journals Accuracy assessment of pedicle screw insertion with patient specific 3D‑printed guides through superimpose CT-analysis in thoracolumbar spinal deformity surgery

2021 ◽  
Author(s):  
J. Cool ◽  
J. van Schuppen ◽  
M. A. de Boer ◽  
B. J. van Royen
Keyword(s):  
Pedicle Screw ◽  
Spinal Deformity ◽  
Screw Placement ◽  
Patient Specific ◽  
Pedicle Screw Placement ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Spinal Deformity Surgery ◽  
Ct Analysis ◽  
3D Printed

Abstract Purpose In order to avoid pedicle screw misplacement in posterior spinal deformity surgery, patient specific 3D‑printed guides can be used. An accuracy assessment of pedicle screw insertion can be obtained by superimposing CT-scan images from a preoperative plan over those of the postoperative result. The aim of this study is to report on the accuracy of drill guide assisted pedicle screw placement in thoracolumbar spinal deformity surgery by means of a superimpose CT-analysis. Methods Concomitant with the clinical introduction of a new technique for drill guide assisted pedicle screw placement, the accuracy of pedicle screw insertion was analyzed in the first patients treated with this technique by using superimpose CT-analysis. Deviation from the planned ideal intrapedicular screw trajectory was classified according to the Gertzbein scale. Results Superimpose CT-analysis of 99 pedicle screws in 5 patients was performed. The mean linear deviation was 0.92 mm, the mean angular deviation was 2.92° with respect to the preoperatively planned pedicle screw trajectories. According to the Gertzbein scale, 100% of screws were found to be positioned within the “safe zone”. Conclusion The evaluated patient specific 3D-printed guide technology was demonstrated to constitute a safe and accurate tool for precise pedicle screw insertion in spinal deformity surgeries. Superimpose CT-analysis showed a 100% accuracy of pedicle screw placement without any violation of the pedicle wall or other relevant structures. We recommend a superimpose CT-analysis for the first consecutive patients when introducing new technologies into daily clinical practice, such as intraoperative imaging, navigation or robotics.

scholarly journals The safety and accuracy of robot-assisted pedicle screw internal fixation for spine disease

2020 ◽  
Vol 9 (10) ◽  
pp. 653-666
Author(s):  
Weishang Li ◽  
Gaoyu Li ◽  
Wenting Chen ◽  
Lin Cong
Keyword(s):  
Pedicle Screw ◽  
Subgroup Analysis ◽  
Statistical Significance ◽  
Operating Time ◽  
Mean Difference ◽  
Cochrane Library ◽  
Robot Assisted ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Spine Disease

Aims The aim of this study was to systematically compare the safety and accuracy of robot-assisted (RA) technique with conventional freehand with/without fluoroscopy-assisted (CT) pedicle screw insertion for spine disease. Methods A systematic search was performed on PubMed, EMBASE, the Cochrane Library, MEDLINE, China National Knowledge Infrastructure (CNKI), and WANFANG for randomized controlled trials (RCTs) that investigated the safety and accuracy of RA compared with conventional freehand with/without fluoroscopy-assisted pedicle screw insertion for spine disease from 2012 to 2019. This meta-analysis used Mantel-Haenszel or inverse variance method with mixed-effects model for heterogeneity, calculating the odds ratio (OR), mean difference (MD), standardized mean difference (SMD), and 95% confidence intervals (CIs). The results of heterogeneity, subgroup analysis, and risk of bias were analyzed. Results Ten RCTs with 713 patients and 3,331 pedicle screws were included. Compared with CT, the accuracy rate of RA was superior in Grade A with statistical significance and Grade A + B without statistical significance. Compared with CT, the operating time of RA was longer. The difference between RA and CT was statistically significant in radiation dose. Proximal facet joint violation occurred less in RA than in CT. The postoperative Oswestry Disability Index (ODI) of RA was smaller than that of CT, and there were some interesting outcomes in our subgroup analysis. Conclusion RA technique could be viewed as an accurate and safe pedicle screw implantation method compared to CT. A robotic system equipped with optical intraoperative navigation is superior to CT in accuracy. RA pedicle screw insertion can improve accuracy and maintain stability for some challenging areas. Cite this article: Bone Joint Res 2020;9(10):653–666.

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