Objective. To analyze the safety and accuracy of pedicle screw placement in the subaxial cervical and upper thoracic spine using patient-specific 3D navigation templates.Material and Methods. The study included 16 patients who underwent transpedicular implantation of screws in the subaxial cervical and upper thoracic vertebrae using patient-specific 3D navigation templates. A total of 88 screws were installed. All patients underwent preoperative CT angiography to assess visualization of the vertebral artery. Customized vertebral models and navigation templates were created using 3D printing technology. Models and templates were sterilized and used during surgery. The results of screw implantation, as well as the safety and accuracy of the placement, were assessed by postoperative CT.Results. The average deviation from the planned trajectory was 1.8 ± 0.9 mm. Deviation was estimated as class 1 (<2 mm) for 57 (64.77 %) screws, class 2 (2–4 mm) for 29 (32.95 %), and class 3 for two (2.27 %). The safety of screw implantation of grade 0 (the screw is completely inside the bone structure) was in 79 (89.77 %) cases, of grade 1 (<50 % of the screw diameter perforates the bone) – in 5 (5.68 %), and of grade 3 – in 2 (2.27 %).Conclusion. Using 3D navigation templates is an affordable and safe method of installing pedicle screws in the cervical and upper thoracic spine. The method can be used as an alternative to intraoperative CT navigation.
Subcortical screw placement is currently performed using frontal view fluoroscopy or intraoperative O-arm navigation system. The emergence of a novel technique for spinal navigation based on individual navigation templates created using 3D printing technology determines the need to study their safety and effectiveness in subcortical implantation.
The aim of the study
was to evaluate and compare the efficacy of subcortical implantation of pedicle screws in the lumbar spine using individual navigation templates versus intraoperative fluoroscopy.
Materials and Methods
The study was based on the analysis of treatment results in 39 patients who underwent surgery with subcortical implantation of 130 screws using the MidLIF technique. In group 1, navigation templates were used, in group 2 — intraoperative fluoroscopic control. Comparative analysis of implantation correctness and time, the total operation time, and radiation load was performed.
Results
The mean distance between the screw and the cortical plate recorded in the groups ranged within 1.20–3.97 mm, without statistically significant difference (p>0.05). The mean time of pedicle screw implantation was 137.0 [115.25; 161.50] s in group 1 and 314.0 [183.50; 403.25] s in group 2. The total operation time was reduced from 173.0 [155.0; 192.25] min in group 2 to 119.0 [108.0; 128.75] min in group 1. The average of 1.0 [1.0; 2.0] X-ray image was performed to place one screw in group 1, while it was 12.0 [10.0; 13.25] in group 2. The differences between the groups in terms of implantation time and radiation load were statistically significant (p<0.05).
Conclusion
Compared with intraoperative fluoroscopy, the use of individual navigation templates for subcortical implantation of pedicle screws provides their correct positioning with a significant reduction in both operation time and radiation load at similar safety.
Objective. To present a clinical case of arachnoiditis ossificans associated with syringomyelia and a brief literature review with an emphasis on its etiology, pathogenesis and methods of diagnosis and treatment.Material and Methods. A clinical case of a 68-year-old patient with symptomatic arachnoiditis ossificans is described. The diagnosis was established on the basis of the results of intraoperative biopsy, histological examination of the resected fragment and confirmed in the postoperative period using CT of the spinal cord, multislice CT myelography, etc. Analysis of the course of the pathology raised the following questions: diagnostic criteria and optimal tactics for treating this disease. A brief review of cases of arachnoiditis ossificans described in the literature for the period from 1982 to the present is given.Results. A review of cases of ossifying arachnoiditis described in the literature showed that today there is no single tactic for diagnosing and treating this disease. In most cases, the diagnosis is established intraoperatively (65 % of analyzed cases). At the preoperative stage, CT provides reliable visualization of ossification. When choosing therapy, it is necessary to be based on the severity of the clinical picture, the degree of ossification of the arachnoid membrane and the presence of concomitant pathology of the affected spinal cord department (such as syringomyelia).Conclusion. The presence of a growing neurological deficit should be considered an indication for surgical treatment of patients with arachnoiditis ossificans. The goals of surgery should include decompression of neural structures and restoration of normal cerebrospinal fluid circulation.
Determination of optimal design of navigation templates for transpedicular implantation in the cervical and thoracic spine: results of cadaveric studies
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