scholarly journals Določanje velikosti in vstavitvene trajektorije pedikularnih vijakov v računalniškotomografskih (CT) slikah deformacij prsne hrbtenice: primerjava ročnega in računalniško podprtega predoperacijskega načrtovanja

2017 ◽  
Vol 85 (11-12) ◽  
Author(s):  
Dejan Knez ◽  
Janez Mohar ◽  
Robert Janez Cirman ◽  
Boštjan Likar ◽  
Franjo Pernuš ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Preoperative Planning ◽  
Sagittal Plane ◽  
Pedicle Screws ◽  
Ct Images ◽  
Screw Placement ◽  
Computer Assisted ◽  
Pedicle Screw Placement ◽  
Pull Out ◽  
Significant Difference

Background: Vertebral fixation by pedicle screw placement is the most frequently applied fixation technique in spinal surgery. In this retrospective study we present a comparison of manual and computer-assisted preoperative planning of pedicle screw placement in three-dimensional (3D) computed tomography (CT) images of deformities in the thoracic spine.Methods: Manual planning of the pedicle screw size and trajectory was performed by two orthopedic surgeons using a dedicated software for preoperative planning of surgical procedures, while computer-assisted planning was performed by automated image processing and analysis techniques through the optimization of screw fastening strength. The size (diameter and length) and trajectory (pedicle crossing point, inclination in the sagittal plane, inclination in the axial plane) were obtained for 316 pedicle screws from 3D CT images of 17 patients with thoracic spinal deformities.Results: the analysis of pedicle screw parameters, obtained by two manual and one computer-assisted planning, indicated a statistically significant difference in the screw size (p < 0.05) and trajectory (p < 0.001). Computer-assisted planning proposed wider (p < 0.05) and longer (p < 0.001) screws with a higher (p < 0.001) normalized fastening strength.Conclusions: The comparison revealed consistency between manual and computer-assisted planning of the pedicle screw size and trajectory, except for the screw inclination in the sagittal plane, as manual planning followed more the straight-forward while computer-assisted planning followed more the anatomical insertion technique. While being faster, more repeatable and more reliable than manual planning, computer-assisted planning was also linked with a higher screw fastening strength and consequently a higher screw pull-out strength.

Clinical accuracy of three-dimensional fluoroscopy-based computer-assisted cervical pedicle screw placement: a retrospective comparative study of conventional versus computer-assisted cervical pedicle screw placement

2010 ◽  
Vol 13 (5) ◽  
pp. 606-611 ◽  
Author(s):  
Yoshimoto Ishikawa ◽  
Tokumi Kanemura ◽  
Go Yoshida ◽  
Zenya Ito ◽  
Akio Muramoto ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Three Dimensional ◽  
Screw Placement ◽  
Computer Assisted ◽  
Pedicle Screw Placement ◽  
Cervical Pedicle Screw ◽  
Retrospective Clinical Study ◽  
Significant Difference ◽  
Cervical Pedicle ◽  
Grade 3

Object The authors performed a retrospective clinical study to evaluate the feasibility and accuracy of cervical pedicle screw (CPS) placement using 3D fluoroscopy-based navigation (3D FN). Methods The study involved 62 consecutive patients undergoing posterior stabilization of the cervical spine between 2003 and 2008. Thirty patients (126 screws) were treated using conventional techniques (CVTs) with a lateral fluoroscopic view, whereas 32 patients (150 screws) were treated using 3D FN. Screw positions were classified into 4 grades based on the pedicle wall perforations observed on postoperative CT. Results The prevalence of perforations in the CVT group was 27% (34 screws): 92 (73.0%), 12 (9.5%), 6 (4.8%), and 16 (12.7%) for Grade 0 (no perforation), Grade 1 (perforation < 1 mm), Grade 2 (perforation ≥ 1 and < 2 mm), and Grade 3 (perforation ≥ 2 mm), respectively. In the 3D FN group, the prevalence of perforations was 18.7% (28 screws): 122 (81.3%), 17 (11.3%), 6 (4%), and 5 (3.3%) for Grades 0, 1, 2, and 3, respectively. Statistical analysis showed no significant difference in the prevalence of Grade 1 or higher perforations between the CVT and 3D FN groups. A higher prevalence of malpositioned CPSs was seen in Grade 2 or higher (17.5% vs 7.3%, p < 0.05) in the 3D FN group and Grade 3 (12.7% vs 7.3%, p < 0.05) perforations in the CVT group. The ORs for CPS malpositioning in the CVT group were 2.72 (95% CI 1.16–6.39) in Grade 2 or higher perforations and 3.89 (95% CI 1.26–12.02) in Grade 3 perforations. Conclusions Three-dimensional fluoroscopy-based navigation can improve the accuracy of CPS insertion; however, severe CPS malpositioning that causes injury to the vertebral artery or neurological complications can occur even with 3D FN. Advanced techniques for the insertion of CPSs and the use of modified insertion devices can reduce the risk of a malpositioned CPS and provide increased safety.

scholarly journals Charactor of Modality and Resident Level in Pedicle Screw Accuracy and Neurosurgical Education

2018 ◽  
Vol 2 (1) ◽  
pp. 01-04
Author(s):  
Anbis El Hakim
Keyword(s):  
Pedicle Screw ◽  
Medical Center ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Computer Assisted ◽  
Training Methods ◽  
Pedicle Screw Placement ◽  
Starting Point ◽  
Grade 3 ◽  
Efficient Learning

Objective: Evolving pressure on surgical education necessitates safe and efficient learning of techniques. We evaluated the effect of training year using anatomic, percutaneous fluoroscopy guided and computer navigated techniques on the accuracy of pedicle screw placement to attempt to determine if different modalities may be better suited for different levels of training. Methods: All instrumented thoracic and lumbar cases performed at Detroit Medical Center by the Neurosurgery Service between August 2012 and June 2013 were included.Cases had hardware verified by post-operative CT. Hardware placement was graded according to Mirza SK et al., grade 0 (within pedicle), grade 1 (< 2 mm breach), grade 2 (> 2 mm breach) , and grade 3 (extrapedicular). Pedicle screws were reviewed independently by a resident and attending surgeon. Rates of pedicle breach, EBL, length of case, pedicle size and pedicle starting point were all reviewed. Pedicles were analyzed on PACS system in axial views, using sagittal views to identify the correct level. Results: A total of 306 pedicle screws were evaluated in 36 patients. The overall rate of accurate pedicle screw placement among residents defined as Grade 0 or 1 placement was 86.8%.Fluoroscopically placed screws had significantly less breaches than anatomic screws 11% vs 20% (p = 0.03). Fluoroscopic cases had significantly less medial breeches (20%) than anatomic (50%) (p < 0.05) and computer assisted cases (73%) (p < 0.05). EBL values for fluoroscopic, anatomic and Body Tom cases were 425 cc, 720 cc, and 816 cc respectively. Resident level was found to be inversely proportional to breech rate (R squared 0.45). We did not see any clear difference in breach rate for resident level in different modalities. Conclusion: Supervised neurosurgical residents can place pedicle screws within published rates of acceptable breach. Interestingly our study revealed an inverse relationship between resident experience and pedicle screw accuracy. Fluoroscopic placement of pedicle screws compared to computer assisted and anatomic techniques results in lower medial breach rate and may be better suited for junior level residents.

scholarly journals Application of a Novel Attachable Magnetic Nerve Stimulating Probe in Intraoperative Lumbar Pedicle Screw Placement: A Porcine Model Study

2021 ◽  
Vol 11 (17) ◽  
pp. 7801
Author(s):  
Tae Sik Goh ◽  
Sung-Chan Shin ◽  
Hyun-Keun Kwon ◽  
Eui-Suk Sung ◽  
Se Bin Jun ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Porcine Model ◽  
Lumbar Vertebrae ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Lumbar Spine Surgery ◽  
Pedicle Screw Placement ◽  
Significant Difference ◽  
Screw Malpositioning ◽  
Lumbar Pedicle

Pedicle screw instrumentation is a fundamental technique in lumbar spine surgery. However, several complications could occur when placing a pedicle screw, the most serious being damage to the neural structures. We developed an attachable magnetic nerve stimulating probe used for triggered electromyography (t-EMG) to avoid these. This study aimed to investigate the efficacy of this probe for intraoperative neuromonitoring (ION) during lumbar pedicle screw placement in a porcine model. Forty pedicle screws were inserted bilaterally into the pedicles of the fourth and fifth lumbar vertebrae of five pigs; 20 were inserted typically into the pedicle without nerve damage (Group A), and the other 20 were inserted through the broken medial wall of the pedicle to permit contact with the neural structures (Group B). We measured the triggered threshold for pedicle screw placement through the conventional nerve probe and our newly developed magnetic probe. There was no significant difference in the triggered threshold between the two instruments (p = 0.828). Our newly developed magnetic stimulating probe can be attached to a screwdriver, thus preventing real-time screw malpositioning and making it practical and equally safe. This probe could become indispensable in revision spine surgeries with severe adhesions or endoscopic spine surgeries.

scholarly journals Which of MIS-TLIF and TLIF Can Leads to Better Pedicle Screws Placement Accuracy and Clinical Outcomes with Navigation Guidance?

2021 ◽  
Author(s):  
JiaBin Liu ◽  
JunLong Wu ◽  
Rui Zuo ◽  
ChangQing Li ◽  
Chao Zhang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Pedicle Screws ◽  
Entry Point ◽  
Screw Placement ◽  
Transfusion Rate ◽  
Pedicle Screw Placement ◽  
Multifidus Muscle ◽  
Lower Accuracy ◽  
Significant Difference

Abstract Background Although previous studies have suggested that navigation can improve the accuracy of pedicle screw placement, there are still few studies comparing navigation-assisted transforaminal lumbar interbody fusion (TLIF) and navigation-assisted minimally-invasive TLIF (MIS-TLIF). The pedicle screw insertion entry point of navigation-assisted MIS-TLIF may be deflected from the planned entry point due to uneven bone-surface, which may result in misplacement. The purpose of this study was to explore the pedicle screws accuracy and clinical consequences of MIS-TLIF and TLIF both under O-arm navigation to determine which surgical method is better.MethodsA retrospective study of 54 patients who underwent single-segment navigation-assisted MIS-TLIF (NM-TLIF) or navigation-assisted TLIF (N-TLIF) was conducted. In addition to the patient's demographic characteristics, intraoperative indicators and complications, the ODI and VAS scores were recorded and analyzed preoperatively, at 1, 6, 12 months and at the final follow-up postoperatively. The clinical accuracy and absolute accuracy of pedicle screw placement was assessed by postoperative CT. Multifidus muscle injury were evaluated by T2-weighted MRI.ResultsCompared with N-TLIF, NM-TLIF was more advantageous in the incision length, intraoperative blood loss, drainage volume, time before ambulation, length of hospital stays, blood transfusion rate and analgesia rate (p<0.05). The ODI and VAS for low back pain scores were better than those of N-TLIF at 1 month and 6 months after surgery (p<0.05). There was no significant difference in the screw clinical qualitative accuracy (97.3% vs. 96.2%, p>0.05). The absolute quantitative accuracy results show that the axial translational error, sagittal translational error and sagittal angle error of NM-TLIF group are significantly greater than that in N-TLIF group (P<0.05). The mean T2-weighted signal intensity of multifidus muscle in the NM-TLIF group was significantly lower than that in the N-TLIF group (P<0.05)ConclusionsCompared with N-TLIF, NM-TLIF has more minimally invasive advantages, it does not yield a lower accuracy of screw placement and can achieve better symptom relief in the middle stage of postoperative recovery. However，more attention on real-time adjustment should be paid to pedicle insertion in NM-TLIF, rather than just following the entry point and trajectory of the intraoperative plan.

The effect of simulation training on resident proficiency in thoracolumbar pedicle screw placement using computer-assisted navigation

2021 ◽  
Vol 34 (1) ◽  
pp. 127-134
Author(s):  
Andrew M. Gardeck ◽  
Xuan Pu ◽  
Qiuyu Yang ◽  
David W. Polly ◽  
Kristen E. Jones
Keyword(s):  
Pedicle Screw ◽  
Orthopedic Surgery ◽  
Simulation Training ◽  
Spinal Instrumentation ◽  
Screw Placement ◽  
Computer Assisted ◽  
Pedicle Screw Placement ◽  
Assisted Navigation ◽  
Significant Difference ◽  
Standardized Curriculum

OBJECTIVEResidency work-hour restrictions necessitate efficient, reproducible training. Simulation training for spinal instrumentation placement shows significant benefit to learners’ subjective and objective proficiency. Cadaveric laboratories are most effective but have high cost and low availability. The authors’ goal was to create a low-cost, efficient, reproducible spinal instrumentation placement simulation curriculum for neurosurgery and orthopedic surgery residents using synthetic models and 3D computer-assisted navigation, assessing subjective and objective proficiency with placement of thoracolumbar pedicle screws.METHODSFifteen neurosurgery and orthopedic surgery residents participated in a standardized curriculum with lecture followed by two separate sessions of thoracolumbar pedicle screw placement in a synthetic spine model utilizing 3D computer-assisted navigation. Data were collected on premodule experience, time and accuracy of screw placement, and both subjective and objective ratings of proficiency.RESULTSFifteen of 15 residents demonstrated improvement in subjective (Physician Performance Diagnostic Inventory Scale [PPDIS]) and 14 in objective (Objective Structured Assessment of Technical Skills [OSATS]) measures of proficiency in navigated screw placement with utilization of this curriculum (p < 0.001 for both), regardless of the number of cases of previous experience using thoracolumbar spinal instrumentation. Fourteen of 15 residents demonstrated decreased time per screw placement from session 1 to session 2 (p = 0.006). There was no significant difference in pedicle screw accuracy between session 1 and session 2.CONCLUSIONSA standardized curriculum using synthetic simulation training for navigated thoracolumbar pedicle screw placement results in significantly improved resident subjective and objective proficiency. Development of a nationwide competency curriculum using simulation training for spinal instrumentation placement should be considered for safe, efficient resident training.

scholarly journals Thoracic, Lumbar, and Sacral Pedicle Screw Placement Using Stryker-Ziehm Virtual Screw Technology and Navigated Stryker Cordless Driver 3: Technical Note

2018 ◽  
Author(s):  
Praveen Satarasinghe ◽  
D. Kojo Hamilton ◽  
Michael Jace Tarver ◽  
Robert J. Buchanan ◽  
Michael T. Koltz
Keyword(s):  
Pedicle Screw ◽  
Three Dimensional ◽  
Pedicle Screws ◽  
Technical Note ◽  
Screw Placement ◽  
Computer Assisted ◽  
Anatomical Landmarks ◽  
Pedicle Screw Placement ◽  
Intraoperative Ct ◽  
Spine Stabilization

Object. Utilization of pedicle screws (PS) for spine stabilization is common in spinal surgery. With reliance on visual inspection of anatomical landmarks prior to screw placement, the free-hand technique requires a high level of surgeon skill and precision. Three-dimensional (3D) computer-assisted virtual neuronavigation improves the precision of PS placement and minimize steps. Methods. Twenty-three patients with degenerative, traumatic, or neoplastic pathologies received treatment via a novel three-step PS technique that utilizes a navigated power driver in combination with virtual screw technology. 1) Following visualization of neuroanatomy using intraoperative CT, a navigated 3-mm match stick drill bit was inserted at anatomical entry point with screen projection showing virtual screw. 2) Navigated Stryker Cordless Driver with appropriate tap was used to access vertebral body through pedicle with screen projection again showing virtual screw. 3) Navigated Stryker Cordless Driver with actual screw was used with screen projection showing the same virtual screw. One hundred and forty-four consecutive screws were inserted using this three-step, navigated driver, virtual screw technique. Results. Only 1 screw needed intraoperative revision after insertion using the three-step, navigated driver, virtual PS technique. This amounts to a 0.69% revision rate. One hundred percent of patients had intraoperative CT reconstructed images to confirm hardware placement. Conclusions. Pedicle screw placement utilizing the Stryker-Ziehm neuronavigation virtual screw technology with a three step, navigated power drill technique is safe and effective.

Percutaneous pedicle screw placement with computer-navigated mapping in place of Kirschner wires

2013 ◽  
Vol 19 (5) ◽  
pp. 608-613 ◽  
Author(s):  
Thomas J. Gianaris ◽  
Gregory M. Helbig ◽  
Eric M. Horn
Keyword(s):  
Pedicle Screw ◽  
Navigation System ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Computer Assisted ◽  
Anatomical Landmarks ◽  
Pedicle Screw Placement ◽  
Assisted Navigation ◽  
Percutaneous Pedicle Screw ◽  
K Wires

Object Percutaneous pedicle screw insertion techniques are commonly used to treat a variety of spinal disorders. Typically, Kirschner (K)-wires are used to guide the insertion of taps and screws during placement since the normal anatomical landmarks are not visualized. The use of K-wires adds risks, such as vascular and nerve injuries as well as increased radiation exposure given the use of fluoroscopy. The authors describe a series of patients who had percutaneous pedicle screws placed using a new computer-assisted navigation technique without the need for K-wires. Methods Minimally invasive percutaneous pedicle screw placement in the thoracic and lumbar spine was performed in a consecutive series of 15 patients for a variety of spinal pathologies. Intraoperative 3D CT images were obtained and used with a computer-assisted navigation system to insert an awl-tap into each pedicle. The tap location in the pedicle was marked with the navigation software, and the awl-tap was then removed. The navigation system was used to identify each landmark to insert the pedicle screw. Connecting rods were then inserted percutaneously under fluoroscopic guidance. Postoperative CT scans were obtained in each patient to evaluate screw placement. Results On postprocedure scanning, only 1 screw had a minor lateral and superior breach that was asymptomatic. To date, there have been no hardware failures. Conclusions Percutaneous pedicle screws can be placed effectively and safely without the use of K-wires.

Variability Analysis of Manual and Computer-Assisted Preoperative Thoracic Pedicle Screw Placement Planning

Spine ◽  
2018 ◽  
Vol 43 (21) ◽  
pp. 1487-1495 ◽  
Author(s):  
Dejan Knez ◽  
Janez Mohar ◽  
Robert J. Cirman ◽  
Boštjan Likar ◽  
Franjo Pernuš ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Placement ◽  
Computer Assisted ◽  
Pedicle Screw Placement ◽  
Variability Analysis ◽  
Thoracic Pedicle Screw
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