How to improve the safety of bicortical pedicle screw insertion in the thoracolumbar vertebrae: analysis base on three-dimensional CT reconstruction of patients in the prone position

Xu, Chao; Hou, Qingxian; Chu, Yan-chen; Huang, Xian; Yang, Wenjiu; Ma, Jing; Wang, Zhijie

doi:10.1186/s12891-020-03473-1

Cited by 6 publications

(7 citation statements)

References 33 publications

(39 reference statements)

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“…In order to place BPSs precisely, the depth and angle of screw must be planned before operation. Previous studies [10,21] indicate that the safe distance rage of the BPSs protruding tips should be maintained within the 5mm. This is essential for the secure use of BPSs to improve the strength of xation.…”

Section: Discussionmentioning

confidence: 99%

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The Study of Distance Changes Between Lumbar Bi-Cortical Pedicle Screws and Anterior Large Vessels in Patients with Lumbar Spondylolisthesis

Zhao

Wan

Han

et al. 2021

Preprint

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Objective: This paper was a anatomical radiographic study of distance between lumbar bi-cortical pedicle screws (BPSs) and anterior large vessels (ALVs) in patients with lumbar spondylolisthesis, and to provide clinical basis for evaluating the safety of bi-cortical pedicle screw implantation during lumbar spondylolisthesis.Methods: Complete Computed tomography (CT) data of 104 patients with grade I lumbar spondylolisthesis (L4 52 and L5 52) and 107 non-spondylolisthesis patients (control group) were collected in this study. The distances between lumbar 4,5(L4,5) and sacrum 1(S1) BPSs and ALVs (abdominal aorta, inferior vena cava, left and right common iliac artery, internal and external iliac artery) were respectively measured at different transverse screw angles (TSAs) (L4:5°,10°; L5:10°,15°; S1:0°,5°,10°) and analyzed by SPSS (v25.0). There were three types of distances from the anterior vertebral cortex (AVC) to the ALVs (DAVC-ALV): DAVC-ALV N, DAVC-ALV ≥ 0.50 cm, and DAVC-ALV < 0.50 cm; these different distances represented non-contact, distant and close ALV respectively.Results: We calculated the incidences of large vessels damage at different TSAs and provided the appropriate angle of screw implantation. In non-spondylolisthesis group, in L4, the appropriate left TSA was 5°, and the incidence of the close ALV was 4.62%. In S1, the appropriate left TSA was 0° and the incidence of the close ALV was 22.4%, while the appropriate right TSA was 10° and the incidence of the close ALV was 17.8%. In L4 spondylolisthesis group, in L4, the appropriate left TSA was 5°, and the incidence of the close ALV was 3.8%. In L5 spondylolisthesis group, in S1, the appropriate left TSA was 0° and the incidence of the close ALV was 19.2%, while the appropriate right TSA was 10° and the incidence of the close ALV was 21.2%. The use of BPS was not appropriate on the right side of either L4 or on the either side of L5 both in spondylolisthesis and control group. In patients with lumbar 4 spondylolisthesis, the incidences of large vessels damage were less than the control group in both L4 and 5. In patients with lumbar 5 spondylolisthesis, the incidences of large vessels damage were less than the control group in L5, while there were no significant difference in S1.Conclusion: It is very important that considering the anatomical relationship between the AVC and the ALVs while planning BPSs. The use of BPS do not apply to every lumbar vertebra. In patients with lumbar spondylolisthesis and non-spondylolisthesis patients, the incidences of large vessels damage are different.

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Section: Discussionmentioning

confidence: 99%

“…Secondly, if necessary, patient should undergo a computed tomography angiography (CTA) examination before operation, which can be used to identify the angle and depth of the BPS. Third and last, it can be considered safe when the protruding tip of the pedicle screws to be less than 3 mm [10].…”

Section: Discussionmentioning

confidence: 99%

The Study of Distance Changes Between Lumbar Bi-Cortical Pedicle Screws and Anterior Large Vessels in Patients with Lumbar Spondylolisthesis

Zhao

Wan

Han

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…In order to place BPSs precisely, the depth and angle of screw must be planned before operation. Previous studies [ 23 , 24 ] indicate that the safe distance rage of the BPSs protruding tips should be maintained within the 5 mm. This is essential for the secure use of BPSs to improve the strength of fixation.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The study of distance changes between lumbar bi-cortical pedicle screws and anterior large vessels in patients with lumbar spondylolisthesis

Zhao

Wan

Han

et al. 2021

BMC Musculoskelet Disord

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Objective This paper was a anatomical radiographic study of distance between lumbar bi-cortical pedicle screws (BPSs) and anterior large vessels (ALVs) in patients with lumbar spondylolisthesis, and to provide clinical basis for evaluating the safety of bi-cortical pedicle screw implantation during lumbar spondylolisthesis. Methods Complete Computed tomography (CT) data of 104 patients with grade I lumbar spondylolisthesis (L4 52 and L5 52) and 107 non-spondylolisthesis patients (control group) were collected in this study. The distances between lumbar 4,5(L4,5) and sacrum 1(S1) BPSs and ALVs (abdominal aorta, inferior vena cava, left and right common iliac artery, internal and external iliac artery) were respectively measured at different transverse screw angles (TSAs) (L4:5°,10°; L5:10°,15°; S1:0°,5°,10°) and analyzed by SPSS (v25.0). There were three types of distances from the anterior vertebral cortex (AVC) to the ALVs (DAVC-ALV): DAVC-ALV N, DAVC-ALV ≥ 0.50 cm, and DAVC-ALV < 0.50 cm; these different distances represented non-contact, distant and close ALV respectively. Results We calculated the incidences of screw tip contacting large vessels at different TSAs and provided the appropriate angle of screw implantation. In non-spondylolisthesis group, in L4, the appropriate left TSA was 5°, and the incidence of the close ALV was 4.62%. In S1, the appropriate left TSA was 0° and the incidence of the close ALV was 22.4%, while the appropriate right TSA was 10° and the incidence of the close ALV was 17.8%. In L4 spondylolisthesis group, in L4, the appropriate left TSA was 5°, and the incidence of the close ALV was 3.8%. In L5 spondylolisthesis group, in S1, the appropriate left TSA was 0° and the incidence of the close ALV was 19.2%, while the appropriate right TSA was 10° and the incidence of the close ALV was 21.2%. The use of BPS was not appropriate on the right side of L4 or on the either side of L5 both in spondylolisthesis and control group. In patients with lumbar 4 spondylolisthesis, the incidences of screw tip contacting large vessels were less than the control group in both L4 and 5. In patients with lumbar 5 spondylolisthesis, the incidences of screw tip contacting large vessels were less than the control group in L5, while there were no significant difference in S1. Conclusion It is very important that considering the anatomical relationship between the AVC and the ALVs while planning BPSs. The use of BPS does not apply to every lumbar vertebra. In patients with lumbar spondylolisthesis and non-spondylolisthesis patients, the incidences of screw tip contacting large vessels are different.

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“…Незважаючи на біомеханічну доцільність, бікортикальна транспедикулярна фіксація має обмежене застосування через низку причин. По-перше, вихід гвинта за межі вентральної поверхні тіла хребця пов'язаний з ризиком ушкодження великих судин [43]. На думку деяких авторів, цей ризик дещо перебільшений.…”

Section: результати та їх обговоренняunclassified

Surgical management of traumatic irreducible spondyloptosis of thoracolumbar junction

Nekhlopochyn¹,

Verbov²,

Cheshuk³

et al. 2021

Ukr Neurosurg J

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Introduction. The thoracolumbar junction is the most common location of traumatic spinal injuries. It accounts for 50-60% of all thoracic and lumbar spine injuries. Spondyloptosis is rather rare, but one of the most severe types of traumatic injury, that is characterized by a severe damage of spinal axis in one or more planes. Traumatic spondyloptosis is classified as reducible and irreducible, depending on the possibility of intraoperative restoration of the spinal axis without resection of the damaged vertebra. Objective. To determine the optimal surgical technique for traumatic irreducible spondyloptosis of thoracolumbar junction. Materials and methods. A retrospective analysis of the patients’ database treated at the Romodanov Neurosurgery Institute, Ukraine was performed over the past 4 years (2017 to 2020) to identify all cases with traumatic irreducible spondyloptosis of the thoracolumbar junction. Results. Treatment outcomes of five patients aged 18 to 52 years (mean age 31.2 years) were analyzed. The minimum period from the moment of injury to surgery was 14 days, the maximum was 3 months and 2 days (on average 42.2 days). At the time of admission all patients had a neurological deficit that corresponds to the functional class A on the American spine injury associatin ASIA scale of severity of spinal cord injury. The TLICS (Thoracolumbar injury classification and severity) score was 8 points. All the patients had the injury of lateral spondyloptosis: in three cases as an isolated displacement only in the coronal plane, in two – as a combined one - in the coronal and sagittal plane. Surgical intervention in all cases was performed from the posterior approach. As a body replacement system in 2 patients, a vertical cylindrical implant (Mesh) was used, in 3 patients - a telescopic body replacing implant. The method of bicortical implantation of pedicle screws was applied. The transpedicular system was strengthened by two cross links of the rod-to-rod type. In all cases the restoration of spinal axis was achieved in both the coronal and sagittal planes. Follow-up examinations were carried out 2, 6 and 12-18 months of the postoperative period. Regression of neurological disorders was registered in two patients, in one case to ASIA B, in the other to ASIA C. Conclusions. Isolated posterior approach has demonstrated high efficacy in the surgical management of traumatic irreducible spondyloptosis of the thoracolumbar junction both in restoring the axis of the spine and in ensuring the stability of fusion.

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How to improve the safety of bicortical pedicle screw insertion in the thoracolumbar vertebrae: analysis base on three-dimensional CT reconstruction of patients in the prone position

Cited by 6 publications

References 33 publications

The Study of Distance Changes Between Lumbar Bi-Cortical Pedicle Screws and Anterior Large Vessels in Patients with Lumbar Spondylolisthesis

The Study of Distance Changes Between Lumbar Bi-Cortical Pedicle Screws and Anterior Large Vessels in Patients with Lumbar Spondylolisthesis

The study of distance changes between lumbar bi-cortical pedicle screws and anterior large vessels in patients with lumbar spondylolisthesis

Surgical management of traumatic irreducible spondyloptosis of thoracolumbar junction

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