Effects of pilot hole preparation technique on pedicle screw fixation in different regions of the osteoporotic thoracic and lumbar spine

2005 ◽  
Vol 3 (5) ◽  
pp. 364-370 ◽  
Author(s):  
Jonathan J. Carmouche ◽  
Robert W. Molinari ◽  
Tad Gerlinger ◽  
John Devine ◽  
Troy Patience
Keyword(s):  
Lumbar Spine ◽  
Thoracic Spine ◽  
Pedicle Screws ◽  
Preparation Technique ◽  
Content Type ◽  
Pilot Hole ◽  
Pullout Resistance ◽  
Insertional Torque ◽  
Upper Thoracic ◽  
Fine Print

Object. The authors evaluated the effects of pilot hole preparation technique on insertional torque and axial pullout resistance in osteoporotic thoracic and lumbar vertebrae. Methods. Using a probe technique and fluoroscopy, 102 pedicle screws were placed in 51 dual-energy x-ray absorptiometry—proven osteoporotic thoracic and lumbar levels. Screws were inserted using the same-size tapping, one-size-under tapping, or no-tapping technique. Insertional torque and axial pullout resistance were measured. Analysis of variance, Fisher exact test, and regression analysis were performed. Same-size tapping decreased pullout resistance in the lumbar spine. There was no effect on pullout resistance in the thoracic spine. Pullout resistance values were lower for all insertion techniques in the upper thoracic spine. Insertional torque and bone mineral density correlated with pullout resistance in the thoracic and lumbar spine. Conclusions. Tapping decreased pedicle screw pullout resistance in the osteoporotic human lumbar spine, although it did not affect pullout strength in the thoracic spine. Tapping decreased insertional torque in upper thoracic levels. Surgeons should optimize overall construct rigidity when placing thoracic pedicle screws in patients with spinal segment osteoporosis.

Effects of hole preparation on screw pullout resistance and insertional torque: a biomechanical study

2001 ◽  
Vol 94 (1) ◽  
pp. 91-96 ◽  
Author(s):  
B. Tunç Öktenoǧlu ◽  
Lisa A. Ferrara ◽  
Niteen Andalkar ◽  
A. Fahir Özer ◽  
Ali Çetin Sarioǧlu ◽  
...  
Keyword(s):  
Pedicle Screws ◽  
Test Material ◽  
Lateral Mass ◽  
Core Diameter ◽  
Content Type ◽  
Pilot Hole ◽  
Pullout Resistance ◽  
Insertional Torque ◽  
Lateral Mass Screws ◽  
Fine Print

Object. The authors conducted a study to assess the effect of a pilot hole preparation on screw pullout resistance and screw insertional torque. Methods. Three different screws were tested: cancellous lateral mass screws, cortical lateral mass screws, and pedicle screws. Synthetic bone blocks were used as the host material. Each screw group was separated into two subgroups. The first subgroup of screws was inserted into the test material following pilot hole preparation. Pilot holes were prepared; a drill bit diameter size smaller than the core diameter of the screws was used. The second group of screws was inserted into the test material without pilot hole preparation (a 3- or 4-mm hole drilled for entrance site preparation only). The insertional torque was measured as the screw was advanced into the material. The screws were axially extracted from the host material at a constant speed of 2.5 mm/minute. The pullout resistances and insertional torques for the pilot hole and the nonpilot hole groups were then statistically compared. The authors found that preparation of a pilot hole caused a significant decrease in the insertional torque. The screws inserted without a pilot hole showed greater pullout resistances compared with those inserted following a pilot hole preparation; however, there was no statistically significant difference. Conclusions. The optimum screw insertion technique may involve drilling a short pilot hole and using a drill bit with a smaller diameter than the screw core diameter to increase bone—screw purchase. This applies to cancellous and cortical lateral mass screws as well as pedicle screws.

Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results

2002 ◽  
Vol 97 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Kevin T. Foley ◽  
Sanjay K. Gupta
Keyword(s):  
Lumbar Spine ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Pedicle Screws ◽  
Pedicle Screw Fixation ◽  
Posterior Fixation ◽  
Content Type ◽  
Insertion Device ◽  
Lumbar Pedicle ◽  
Fine Print

Object. Standard techniques for pedicle screw fixation of the lumbar spine involve open exposures and extensive muscle dissection. The purpose of this study was to report the initial clinical experience with a novel device for percutaneous posterior fixation of the lumbar spine. Methods. An existing multiaxial lumbar pedicle screw system was modified to allow screws to be placed percutaneously by using an extension sleeve that permits remote manipulation of the polyaxial screw heads and remote engagement of the screw-locking mechanism. A unique rod-insertion device was developed that linked to the screw extension sleeves, allowing for a precut and -contoured rod to be placed through a small stab wound. Because the insertion device relies on the geometrical constraint of the rod pathway through the screw heads, minimal manipulation is required to place the rods in a standard submuscular position, there is essentially no muscle dissection, and the need for direct visual feedback is avoided. Twelve patients (six men and six women) who ranged in age from 23 to 68 years underwent pedicle screw fixation in which the rod-insertion device was used. Spondylolisthesis was present in 10 patients and osseous nonunion of a prior interbody fusion was present in two. All patients underwent successful percutaneous fixation. Ten patients underwent single-level fusions (six at L5—S1, three at L4–5, and one at L2–3), and two underwent two-level fusions (one from L3–5 and the other from L4—S1). The follow-up period ranged from 10 to 19 months (mean 13.8 months). Conclusions. Although percutaneous lumbar pedicle screw placement has been described previously, longitudinal connector (rod or plate) insertion has been more problematic. The device used in this study allows for straightforward placement of lumbar pedicle screws and rods through percutaneous stab wounds. Paraspinous tissue trauma is minimized without compromising the quality of spinal fixation. Preliminary experience involving the use of this device has been promising.

A transsternoclavicular approach for the anterior decompression and fusion of the upper thoracic spine

2005 ◽  
Vol 2 (2) ◽  
pp. 226-229 ◽  
Author(s):  
Mutsuhiro Tamura ◽  
Masashi Saito ◽  
Masafumi Machida ◽  
Keiichi Shibasaki
Keyword(s):  
Thoracic Spine ◽  
Anterior Approach ◽  
Anterior Decompression ◽  
Thoracic Region ◽  
Anatomical Structures ◽  
Content Type ◽  
Upper Thoracic Spine ◽  
Upper Thoracic ◽  
Anterior Decompression And Fusion ◽  
Fine Print

✓ The anterior approach is commonly used to reach the upper thoracic region to achieve decompression and stabilization; however, upper thoracic lesions are difficult to treat because of the regional anatomical structures, and this approach is associated with risks of complication. The authors evaluated the advantages of using a transsternoclavicular approach to aid in treating upper thoracic lesions. The procedure and surgery-related outcomes are discussed.

Use of a guide device to place pedicle screws in the thoracic spine: a cadaveric study

2001 ◽  
Vol 94 (2) ◽  
pp. 328-333 ◽  
Author(s):  
Jee Soo Jang ◽  
Won Bok Lee ◽  
Hansen A. Yuan
Keyword(s):  
Thoracic Spine ◽  
Pedicle Screws ◽  
Lateral Wall ◽  
Cadaveric Study ◽  
Medial Wall ◽  
Screw Placement ◽  
Content Type ◽  
Thoracic Pedicle Screws ◽  
Guide Device ◽  
Fine Print

✓ In this cadaveric study, the safety and accuracy of a specially designed guide device for the placement of thoracic pedicle screws was investigated in a normal anatomical situation. Five embalmed human cadaveric thoracic spines (T1–12) were used for the study of transpedicular screw placement in the thoracic spine. Overall 120 screws were placed at all thoracic levels. The screws were inserted bilaterally in the thoracic pedicles by using a specially designed guide device. No radiographs or other imaging studies were obtained. Following screw placement, computerized tomography scans were performed to evaluate the accuracy of the pedicle screw positioning. Seven (5.8%) of the screws penetrated the pedicle wall or the vertebral body (VB) cortex. Two screws (1.7%) penetrated the medial wall of the pedicle. Two screws (1.7%) penetrated the lateral wall of the pedicle, and one screw (0.8%) penetrated the lateral wall of the pedicle and the anterior VB cortex simultaneously. Two screws (1.7%) penetrated the anterior VB cortex. Compared with the results of other studies, the findings here indicate that using this device to guide the placement of thoracic pedicle screws can significantly reduce the incidence of pedicle penetration, particularly in the medial wall.

Transpedicular screw-rod fixation of the lumbar spine: operative technique and outcome in 104 cases

1992 ◽  
Vol 77 (6) ◽  
pp. 860-870 ◽  
Author(s):  
Curtis A. Dickman ◽  
Richard G. Fessler ◽  
Michael MacMillan ◽  
Regis W. Haid
Keyword(s):  
Lumbar Spine ◽  
Internal Fixation ◽  
Vertebral Osteomyelitis ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Spinal Epidural Hematoma ◽  
Content Type ◽  
Operative Revision ◽  
Rod System ◽  
Fine Print

✓ A total of 104 patients underwent transpedicular spinal instrumentation using the Cotrel-Dubousset (71 cases) or the Texas Scottish Rite Hospital (33) screw-rod system. Surgery was performed for lumbar vertebral column instability secondary to fractures (28 cases), spondylolisthesis (29), tumors (four), vertebral osteomyelitis (two), or postoperative causes (41). Pseudoarthrodesis due to failure of a prior fusion was present in 37 cases. The 55 men and 49 women (mean age 47 years, range 18 to 87 years) all presented with severe back pain. Signs or symptoms of neural compression were noted in 96 patients. Surgery consisted of neural decompression, internal fixation, and autogenous iliac bone grafting. Spondylolistheses were fused in situ, without reduction; otherwise, major spinal deformities were corrected. A total of 516 pedicle screws were placed. The mean extent of fusion was 2.7 motion segments (range one to six motion segments). A 96% fusion rate was obtained with a mean follow-up period of 20 months. There were no operative deaths. Major complications included one spinal epidural hematoma, three isolated nerve root deficits (two transient, one permanent), and three wound infections (two deep, one superficial). Instrument failure eventually developed in 18 patients; nine were asymptomatic with a solid fusion and did not require further treatment and the other nine were symptomatic or had a pseudoarthrosis and required operative revision. Pedicle screw-rod fixation offers biomechanical advantages compared to other forms of internal fixation for the lumbar spine. It enables short-segment fixation with preservation of lumbar lordosis and adjacent normal motion segments. This technique provides a highly successful method to obtain arthrodesis, even with prior pseudoarthrosis.

Surgical approach to anterior compression in the upper thoracic spine

2002 ◽  
Vol 97 (3) ◽  
pp. 337-442 ◽  
Author(s):  
Ho Jun Seol ◽  
Chun Kee Chung ◽  
Hyun Jib Kim
Keyword(s):  
Thoracic Spine ◽  
Clinical Status ◽  
Spinal Tumor ◽  
Neurological Deficits ◽  
Content Type ◽  
Upper Thoracic Spine ◽  
Metastatic Spinal Tumor ◽  
Upper Thoracic ◽  
Fine Print

Object. The anterior upper thoracic spine (T1–3) is difficult to access because most neurosurgeons are unfamiliar with the anatomy. This study was performed to evaluate the different surgical options by retrospectively analyzing data on operations performed for anterior upper thoracic compression at the authors' institution. Methods. Eighteen patients underwent surgery between November 1993 and May 2001. There were eight men and 10 women; their mean age was 55 years (range 28–80 years). All patients presented with pain and/or neurological deficits. The causes of anterior compression were diverse, although metastatic spinal tumor was most common. The approach chosen was primarily dictated by the axial involvement of the lesion. Anterior approaches, mainly the transmanubrium approach, were performed in six and posterior approaches in 12. In all cases except one, in which only an iliac bone graft was placed, instrumentation was used. The mean follow-up period was 11.4 months (range 1–57 months). One postoperative death occurred. Postoperative follow-up imaging studies, especially plain radiography, demonstrated no instrumentation failure. Improvement was shown in eight patients, an aggravation of symptoms in one, and stable clinical status in eight. Conclusions. Decompression may be achieved on the anterior side of the upper thoracic spine if the operative approach is scrupulously chosen; this choice involves consideration of the locations of the lesion, the nature of the primary disease, and the surgery-related risk.

Monostotic fibrous dysplasia of the thoracic spine: clinopathological description and follow up

2004 ◽  
Vol 100 (4) ◽  
pp. 378-381 ◽  
Author(s):  
Mehmet Arazi ◽  
Onder Guney ◽  
Mustafa Ozdemir ◽  
Omer Uluoglu ◽  
Nuket Uzum
Keyword(s):  
Fibrous Dysplasia ◽  
Thoracic Spine ◽  
Histopathological Examination ◽  
En Bloc Resection ◽  
Spinal Tumors ◽  
En Bloc ◽  
Content Type ◽  
Thoracic Spinal ◽  
Fine Print

✓ The authors report the case of a 53-year-old woman with monostotic fibrous dysplasia of the thoracic spine. The patient presented with a 1-month history of pain in the thoracic spinal region. En bloc resection of the lesion was successfully performed via a transthoracic approach, and a histopathological examination confirmed the diagnosis of fibrous dysplasia. At 24-month follow-up examination, pain and vertebral instability were absent. The findings in this case illustrate that, although very rare, monostotic fibrous dysplasia of the thoracic spine should be considered in the differential diagnosis of spinal tumors. Although a consensus for management of this disease has not been achieved, the authors recommend radical removal of all involved bone as well as internal fixation or bone graft—assisted fusion to achieve long-term stabilization.

scholarly journals Novel free-hand T1 pedicle screw method: Review of 44 consecutive cases

2014 ◽  
Vol 05 (04) ◽  
pp. 349-354 ◽  
Author(s):  
Mark A. Rivkin ◽  
Jessica F. Okun ◽  
Steven S. Yocom
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Pedicle Screws ◽  
High Rate ◽  
Imaging Modalities ◽  
Neurological Deficits ◽  
Upper Thoracic Spine ◽  
Starting Point ◽  
Grade 3 ◽  
Upper Thoracic

ABSTRACT Summary of Background Data: Multilevel posterior cervical instrumented fusions are becoming more prevalent in current practice. Biomechanical characteristics of the cervicothoracic junction may necessitate extending the construct to upper thoracic segments. However, fixation in upper thoracic spine can be technically demanding owing to transitional anatomy while suboptimal placement facilitates vascular and neurologic complications. Thoracic instrumentation methods include free-hand, fluoroscopic guidance, and CT-based image guidance. However, fluoroscopy of upper thoracic spine is challenging secondary to vertebral geometry and patient positioning, while image-guided systems present substantial financial commitment and are not readily available at most centers. Additionally, imaging modalities increase radiation exposure to the patient and surgeon while potentially lengthening surgical time. Materials and Methods: Retrospective review of 44 consecutive patients undergoing a cervicothoracic fusion by a single surgeon using the novel free-hand T1 pedicle screw technique between June 2009 and November 2012. A starting point medial and cephalad to classic entry as well as new trajectory were utilized. No imaging modalities were employed during screw insertion. Postoperative CT scans were obtained on day 1. Screw accuracy was independently evaluated according to the Heary classification. Results: In total, 87 pedicle screws placed were at T1. Grade 1 placement occurred in 72 (82.8%) screws, Grade 2 in 4 (4.6%) screws and Grade 3 in 9 (10.3%) screws. All Grade 2 and 3 breaches were <2 mm except one Grade 3 screw breaching 2-4 mm laterally. Only two screws (2.3%) were noted to be Grade 4, both breaching medially by less than 2 mm. No new neurological deficits or returns to operating room took place postoperatively. Conclusions: This modification of the traditional starting point and trajectory at T1 is safe and effective. It attenuates additional bone removal or imaging modalities while maintaining a high rate of successful screw placement compared to historical controls.

Chondroblastoma of the lumbar spine

2005 ◽  
Vol 2 (5) ◽  
pp. 596-600 ◽  
Author(s):  
Raphaël Vialle ◽  
Antoine Feydy ◽  
Ludovic Rillardon ◽  
Carla Tohme-Noun ◽  
Philippe Anract ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Local Recurrence ◽  
Osteolytic Lesion ◽  
Radicular Pain ◽  
Appendicular Skeleton ◽  
Lumbar Region ◽  
Content Type ◽  
Anterior Posterior ◽  
Fine Print

✓ Chondroblastoma is a benign cartilaginous neoplasm that generally affects the appendicular skeleton. Twenty-six cases of spinal chondroblastoma have been reported in the past 50 years, only six of which were located in the lumbar region. The authors report two cases involving this exceptional location. In both patients, low-back pain, in the absence of radicular pain, was the presenting symptom. In both cases, plain radiography and computerized tomography scanning revealed an osteolytic lesion surrounded by marginal sclerosis. Magnetic resonance imaging allowed the authors to study the tumor's local extension. Examination of a percutaneous fluoroscopy-guided biopsy sample revealed the following typical histological features of chondroblastoma: chondroid tissue, focally alternating with cellular areas, and no nuclear atypia or pleomorphism. To reduce the risk of local recurrence, vertebrectomy and anterior—posterior fusion were performed in both cases. In one case, a structural lumbar scoliosis was corrected during the posterior procedure. There was no postoperative complication. No recurrence was observed during the 3- to 6-year follow-up period. The surgery-related results were deemed successful. Although exceptional, the diagnosis of chondroblastoma is possible in lesions involving the lumbar spine. Other spinal locations are described in the literature, and frequency of recurrence is stressed. A vertebrectomy is advised to reduce the risk of local recurrence.

Beta—tricalcium phosphate as a substitute for autograft in interbody fusion cages in the canine lumbar spine

2002 ◽  
Vol 97 (3) ◽  
pp. 350-354 ◽  
Author(s):  
Takashiro Ohyama ◽  
Yoshichika Kubo ◽  
Hiroo Iwata ◽  
Waro Taki
Keyword(s):  
Lumbar Spine ◽  
Tricalcium Phosphate ◽  
Interbody Fusion ◽  
Donor Site ◽  
Posterolateral Approach ◽  
Content Type ◽  
Spine Model ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. An interbody fusion cage has been introduced for cervical anterior interbody fusion. Autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies. Thus, donor site—related complications can still occur. In this study a synthetic ceramic, β—tricalcium phosphate (TCP), was examined as a substitute for autograft bone in a canine lumbar spine model. Methods. In 12 dogs L-1 to L-4 vertebrae were exposed via a posterolateral approach, and discectomy and placement of interbody fusion cages were performed at two intervertebral disc spaces. One cage was filled with autograft (Group A) and the other with TCP (Group B). The lumbar spine was excised at 16 weeks postsurgery, and biomechanical, microradiographic, and histological examinations were performed. Both the microradiographic and histological examinations revealed that fusion occurred in five (41.7%) of 12 operations performed in Group A and in six (50%) of 12 operations performed in Group B. The mean percentage of trabecular bone area in the cages was 54.6% in Group A and 53.8% in Group B. There were no significant intergroup differences in functional unit stiffness. Conclusions. Good histological and biomechanical results were obtained for TCP-filled interbody fusion cages. The results were comparable with those obtained using autograft-filled cages, suggesting that there is no need to harvest iliac bone or to use allo- or xenografts to increase the interlocking strength between the cage and vertebral bone to achieve anterior cervical interbody fusion.

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