Preliminary Results of Minimally Invasive Decompression, TLIF and Percutaneous Pedicle Screw Insertion in Stenotic Spondylolisthesis with Severe Facet Joint Osteoarthritis

Object This study was conducted to assess the in vivo safety and accuracy of percutaneous lumbar pedicle screw placement using the owl's-eye view of the pedicle axis and a new guidance technology system that facilitates orientation of the C-arm into the appropriate fluoroscopic view and the pedicle cannulation tool in the corresponding trajectory. Methods A total of 326 percutaneous pedicle screws were placed from L-3 to S-1 in 85 consecutive adult patients. Placement was performed using simple coaxial imaging of the pedicle with the owl's-eye fluoroscopic view. NeuroVision, a new guidance system using accelerometer technology, helped align the C-arm trajectory into the owl's-eye view and the cannulation tool in the same trajectory. Postoperative fine-cut CT scans were acquired to assess screw position. Medical records were reviewed for complications. Results Five of 326 screws breached a pedicle cortex—all breaches were less than 2 mm—for an accuracy rate of 98.47%. Five screws violated an adjacent facet joint. All were at the S-1 superior facet and included in a fusion. No screw violated an adjacent mobile facet or disc space. There were no cases of new or worsening neurological symptoms or deficits for an overall clinical accuracy of 100%. Conclusions The owl's-eye technique of coaxial pedicle imaging with the C-arm fluoroscopy, facilitated by NeuroVision, is a safe and accurate means by which to place percutaneous pedicle screws for degenerative conditions of the lumbar spine. This is the largest series reported to use the oblique or owl's-eye projection for percutaneous pedicle screw insertion. The accuracy of percutaneous screw insertion with this technique meets or exceeds that of other reported clinical series or techniques.

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Minimally invasive guidewireless, navigated pedicle screw placement: a technical report and case series

Neurosurgical FOCUS ◽

10.3171/2017.5.focus17200 ◽

2017 ◽

Vol 43 (2) ◽

pp. E9 ◽

Cited By ~ 8

Author(s):

Brandon W. Smith ◽

Jacob R. Joseph ◽

Michael Kirsch ◽

Mary Oakley Strasser ◽

Jacob Smith ◽

...

Keyword(s):

Minimally Invasive ◽

Pedicle Screw ◽

Kirschner Wire ◽

Case Series ◽

Pedicle Screws ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Minimally Invasive Spinal Surgery ◽

Screw Insertion ◽

Percutaneous Pedicle Screw

OBJECTIVEPercutaneous pedicle screw insertion (PPSI) is a mainstay of minimally invasive spinal surgery. Traditionally, PPSI is a fluoroscopy-guided, multistep process involving traversing the pedicle with a Jamshidi needle, placement of a Kirschner wire (K-wire), placement of a soft-tissue dilator, pedicle tract tapping, and screw insertion over the K-wire. This study evaluates the accuracy and safety of PPSI with a simplified 2-step process using a navigated awl-tap followed by navigated screw insertion without use of a K-wire or fluoroscopy.METHODSPatients undergoing PPSI utilizing the K-wire–less technique were identified. Data were extracted from the electronic medical record. Complications associated with screw placement were recorded. Postoperative radiographs as well as CT were evaluated for accuracy of pedicle screw placement.RESULTSThirty-six patients (18 male and 18 female) were included. The patients’ mean age was 60.4 years (range 23.8–78.4 years), and their mean body mass index was 28.5 kg/m2 (range 20.8–40.1 kg/m2). A total of 238 pedicle screws were placed. A mean of 6.6 pedicle screws (range 4–14) were placed over a mean of 2.61 levels (range 1–7). No pedicle breaches were identified on review of postoperative radiographs. In a subgroup analysis of the 25 cases (69%) in which CT scans were performed, 173 screws were assessed; 170 (98.3%) were found to be completely within the pedicle, and 3 (1.7%) demonstrated medial breaches of less than 2 mm (Grade B). There were no complications related to PPSI in this cohort.CONCLUSIONSThis streamlined 2-step K-wire–less, navigated PPSI appears safe and accurate and avoids the need for radiation exposure to surgeon and staff.

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Facet Joint Violation by Thoracolumbar Percutaneous Pedicle Screw and Its Effect on Progression of Facet Joint Osteoarthritis

Asian Spine Journal ◽

10.31616/asj.2021.0224 ◽

2021 ◽

Author(s):

Takeshi Sasagawa

Keyword(s):

Pedicle Screw ◽

Facet Joint ◽

Facet Joint Osteoarthritis ◽

Percutaneous Pedicle Screw ◽

Facet Joint Violation

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Accuracy of augmented reality surgical navigation for minimally invasive pedicle screw insertion in the thoracic and lumbar spine with a new tracking device

The Spine Journal ◽

10.1016/j.spinee.2019.12.009 ◽

2020 ◽

Vol 20 (4) ◽

pp. 629-637 ◽

Cited By ~ 5

Author(s):

Simon Peh ◽

Anindita Chatterjea ◽

Julian Pfarr ◽

Jost Philipp Schäfer ◽

Matthias Weuster ◽

...

Keyword(s):

Lumbar Spine ◽

Augmented Reality ◽

Minimally Invasive ◽

Pedicle Screw ◽

Surgical Navigation ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Thoracic And Lumbar Spine ◽

Tracking Device

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The Barrow Biomimetic Spine: Face, Content, and Construct Validity of a 3D-Printed Spine Model for Freehand and Minimally Invasive Pedicle Screw Insertion

Global Spine Journal ◽

10.1177/2192568218824080 ◽

2019 ◽

Vol 9 (6) ◽

pp. 635-641 ◽

Cited By ~ 2

Author(s):

Michael A. Bohl ◽

Rohit Mauria ◽

James J. Zhou ◽

Michael A. Mooney ◽

Joseph D. DiDomenico ◽

...

Keyword(s):

Minimally Invasive ◽

Construct Validity ◽

Pedicle Screw ◽

Surgical Training ◽

Screw Insertion ◽

Training Models ◽

3 Dimensional ◽

Pedicle Screw Insertion ◽

The Face ◽

Spine Model

Study Design: Description and evaluation of a novel surgical training platform. Objectives: The purpose of this study was to investigate the face, content, and construct validity of 5 novel surgical training models that simulate freehand and percutaneous (minimally invasive surgery [MIS]) pedicle screw placement. Methods: Five spine models were developed by residents: 3 for freehand pedicle screw training (models A-C) and 2 for MIS pedicle screw training (models D and E). Attending spine surgeons evaluated each model and, using a 20-point Likert-type scale, answered survey questions on model face, content, and construct validity. Scores were statistically evaluated and compared using means, standard deviations, and analysis of variance between models and between surgeons. Results: Among the freehand models, model C demonstrated the highest overall validity, with mean face (15.67 ± 5.49), content (19.17 ± 0.59), and construct (18.83 ± 0.24) validity all measuring higher than the other freehand models. For the MIS models, model D had the highest validity scores (face, content, and construct validity of 11.67 ± 3.77, 18.17 ± 2.04, and 17.00 ± 3.46, respectively). The 3 freehand models differed significantly in content validity scores ( P = .002) as did the 2 MIS models ( P < .001). The testing surgeons’ overall validity scores were significantly different for models A ( P = .005) and E ( P < .001). Conclusions: A 3-dimensional-printed spine model with incorporated bone bleeding and silicone rubber soft tissue was scored as having very high content and construct validity for simulating freehand pedicle screw insertion. These data has informed the further development of several surgical training models that hold great potential as educational adjuncts in surgical training programs.

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