Alternative Pedicle Screw Design via Biomechanical Evaluation

With the recent increase in the elderly population, many people suffer from spinal diseases, and, accordingly, spinal fusion surgery using pedicle screws has been widely applied to treat them. However, most research on pedicle screw design has been focused on the test results rather than the behavior of the screws and vertebrae. In this study, a design platform with a series of biomechanical tests and analyses were presented for pedicle screw improvement and evaluation. The platform was then applied to an alternative hybrid screw design with quadruple and double threads. An experimental apparatus was developed to investigate the bending strength of the screw, and several tests were performed based on the ASTM F1717 standard. In the experiments, it was confirmed that the alternative pedicle screw has the highest bending strength. To examine the stress distribution of pedicle screws, finite element models were established, through which it was found that the proposed pedicle screw has sufficient mechanical safety to make it acceptable for spinal fusion treatment. Finally, we conclude that the platform has good potential for the design and evaluation of pedicle screws, and the alternative dual screw design is one of the best options for spinal fusion surgery.

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Precision and accuracy of consumer-grade motion tracking system for pedicle screw placement in pediatric spinal fusion surgery

Medical Engineering & Physics ◽

10.1016/j.medengphy.2017.05.003 ◽

2017 ◽

Vol 46 ◽

pp. 33-43 ◽

Cited By ~ 3

Author(s):

Andrew Chan ◽

Janelle Aguillon ◽

Doug Hill ◽

Edmond Lou

Keyword(s):

Spinal Fusion ◽

Pedicle Screw ◽

Motion Tracking ◽

Tracking System ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Fusion Surgery ◽

Spinal Fusion Surgery ◽

Precision And Accuracy ◽

Motion Tracking System

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4A-6 Ultrasound Guided Placement of Pedicle Screws in Spinal Fusion Surgery

2007 IEEE Ultrasonics Symposium Proceedings ◽

10.1109/ultsym.2007.64 ◽

2007 ◽

Cited By ~ 3

Author(s):

M. Mujagic ◽

H.J. Ginsberg ◽

R.S.C. Cobbold

Keyword(s):

Spinal Fusion ◽

Pedicle Screws ◽

Ultrasound Guided ◽

Fusion Surgery ◽

Spinal Fusion Surgery

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Accuracy of Pedicle Screw Placement Methods in Pediatrics and Adolescents Spinal Surgery: A Systematic Review and Meta-Analysis

Global Spine Journal ◽

10.1177/21925682211003552 ◽

2021 ◽

pp. 219256822110035

Author(s):

Brigita De Vega ◽

Aida Ribera Navarro ◽

Alexander Gibson ◽

Deepak M. Kalaskar

Keyword(s):

Systematic Review ◽

Spinal Fusion ◽

Pedicle Screw ◽

Meta Analysis ◽

Three Dimensional ◽

Bias Assessment ◽

Fusion Surgery ◽

Spinal Fusion Surgery ◽

Evidence Quality ◽

Comprehensive Search

Study Design: Systematic review and meta-analysis. Objective: Various methods of pedicle screw (PS) placement in spinal fusion surgery existed, which can be grouped into conventional freehand (FH), modified freehand (MF), and image-guided methods (including fluoroscopy-based navigation (FL), computed tomography-based navigation (CT-nav), robot-assisted (RA), and ultrasound-guided (UG)). However, the literature showed mixed findings regarding their accuracy and complications. This review aimed to discover which method of PS placement has the highest accuracy and lowest complication rate in pediatric and adolescent spinal fusion surgery. Methods: A comprehensive search in MEDLINE (PubMed), EMBASE (OVID), CENTRAL, and Web of Science was conducted until May 2020 by 2 independent reviewers, followed by bias assessment with ROB 2 and ROBINS-I tools and quantification with meta-analysis. Overall evidence quality was determined with GRADE tool. Results: Four RCTs and 2 quasi-RCTs/CCTs comprising 3,830 PS placed in 291 patients (4-22 years old) were analyzed. The lowest accuracy was found in FH (78.35%) while the highest accuracy was found in MF (95.86%). MF was more accurate than FH (OR 3.34 (95% CI, 2.33-4.79), P < .00 001, I2 = 0%). Three-dimensional printed drill template (as part of MF) was more accurate than FH (OR 3.10 (95% CI, 1.98-4.86), P < .00 001, I2 = 14%). Overall, complications occurred in 5.84% of the patients with 0.34% revision rate. Complication events in MF was lower compared to FH (OR 0.47 (95% CI, 0.10-2.15), P = .33, I2 = 0%). Conclusions: Meta-analysis shows that MF is more accurate than FH in pediatric and adolescent requiring PS placement for spinal fusion surgery.

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Effects of age on perioperative complications of extensive multilevel thoracolumbar spinal fusion surgery

Journal of Neurosurgery Spine ◽

10.3171/2009.10.spine08741 ◽

2010 ◽

Vol 12 (4) ◽

pp. 402-408 ◽

Cited By ~ 36

Author(s):

Jordan M. Cloyd ◽

Frank L. Acosta ◽

Colleen Cloyd ◽

Christopher P. Ames

Keyword(s):

Postoperative Complications ◽

Elderly Patients ◽

Spinal Fusion ◽

Perioperative Complications ◽

Intraoperative Complications ◽

The Elderly ◽

Complication Rates ◽

Fusion Surgery ◽

Spinal Fusion Surgery

Object The elderly compose a substantial proportion of patients presenting with complex spinal pathology. Several recent studies have suggested that fusion of 4 or more levels increases the risk of perioperative complications in elderly patients. Therefore, the purpose of this study was to analyze the effects of age in persons undergoing multilevel (≥ 5 levels) thoracolumbar fusion surgery. Methods A retrospective review of all hospital records, operative reports, and clinic notes was conducted for 124 consecutive patients who underwent surgery between 2000 and 2007 with an average follow-up of 3.5 years and a minimum follow-up of 1.2 years. The most frequent preoperative diagnoses included scoliosis, tumor, osteomyelitis, vertebral fracture, and degenerative disc disease with stenosis. Complications were classified as intraoperative and major and minor postoperative as well as the need for revision surgery. Multivariate logistic regression analysis was used to determine the effects of age and other potentially prognostic factors. Results After controlling for other factors, increasing age was associated with an elevated risk for major postoperative complications (OR 1.04, 95% CI 1.00–1.10) as were increasing levels of fusion (OR 1.5, 95% CI 1.1–2.1) and male sex (OR 4.6, 95% CI 1.3–16.2). In patients 65 years of age or older, rates of intraoperative complications, major and minor postoperative complications, and reoperation were 14.1, 23.4, 29.7, and 26.6%, respectively. The number of comorbidities was associated with a greater risk for perioperative complications in elderly patients (OR 1.8, 95% CI 1.1–2.8). Conclusions Age is a positive risk factor for major postoperative complications in extensive thoracolumbar spinal fusion surgery. Complication rates in the elderly are high, and good clinical judgment and careful patient selection are needed before performing extensive thoracolumbar reconstruction in older persons.

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Ultrasound Guided Pedicle Screw Entry Point Identification for Spinal Fusion Surgery

10.29007/chdq ◽

2019 ◽

Author(s):

Xiao Qi ◽

Michael Vives ◽

Ilker Hacihaliloglu

Keyword(s):

Spinal Fusion ◽

Pedicle Screw ◽

Identification Accuracy ◽

Automatic Identification ◽

Navigation Systems ◽

Accurate Identification ◽

Fusion Surgery ◽

Screw Insertion ◽

Spinal Fusion Surgery

Accurate identification of the location the vertebra and corresponding pedicle is critical during pedicle screw insertion for percutaneous spinal fusion surgery. Currently, two dimensional (2D) fluoroscopy based navigation systems have extensive usage in spinal fusion surgery. Relying on 2D projection images for screw guidance results in high misplacement rates. Furthermore, fluoroscopy-based guidance exposes the surgical staff and patient to harmful ionizing radiation. Real-time non-radiation-based ultrasound (US) is a potential alternative to intra-operative fluoroscopy. However, accurate interpretation of noisy US data and manual operation of the transducer during data collection remains a challenge. In this work we investigate the potential of using multi-modal deep convolutional neural network (CNN) architectures for fully automatic identification of vertebra level and pedicle from US data. Our proposed network achieves 93.54% vertebra identification accuracy on in vivo US data collected from 27 subjects.

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