Magnetic Resonance Imaging After Pedicular Screw Fixation of the Spine

Ebraheim, Nabil A.; Savolaine, Edward R.; Stitgen, Stuart H.; Jackson, William T.

doi:10.1097/00003086-199206000-00016

Cited by 23 publications

(5 citation statements)

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“…Spinal constructs implanted in people using titanium and stainless steel screws have been compared biomechanically and support the use of titanium alloy implants . However, whereas titanium alloy screws performed similarly to stainless steel screws in our study, their clinically more relevant advantage is likely the superior MRI and CT resolution with decreased interference compared to stainless steel implants . Our results support use of titanium screws in a monocortical construct, which should increase the versatility of postoperative imaging and improve spinal cord assessment because of improved MRI compatibility.…”

Section: Discussionsupporting

confidence: 64%

Biomechanical Comparison Between Bicortical Pin and Monocortical Screw/Polymethylmethacrylate Constructs in the Cadaveric Canine Cervical Vertebral Column

et al. 2013

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ObjectiveTo compare biomechanical stiffness of cadaveric canine cervical spine constructs stabilized with bicortical stainless steel pins and polymethylmethacrylate (PMMA), monocortical stainless steel screws with PMMA, or monocortical titanium screws with PMMA. Study DesignBiomechanical cadaver study. AnimalsEighteen canine cervical vertebral columns (C2-C7) were collected from skeletally mature dogs (weighing 22-32 kg). MethodsSpecimens were radiographed and examined by dual energy X-ray absorptiometry. Stiffness of the unaltered C4-C5 intervertebral motion unit was measured in extension, flexion and lateral bending using non-destructive 4-point bend testing. Specimens were then stabilized by (1) bicortical stainless steel pins/PMMA, (2) monocortical stainless steel screws/PMMA, or (3) monocortical titanium screws/PMMA. Mechanical testing was repeated and stiffness data from unaltered specimens and the 3 treatment groups were compared.

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Section: Discussionsupporting

confidence: 64%

Biomechanical Comparison Between Bicortical Pin and Monocortical Screw/Polymethylmethacrylate Constructs in the Cadaveric Canine Cervical Vertebral Column

et al. 2013

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“…It can be assumed that a standard of practice is to use CT to assess postoperative screw positions, as shown in our previous review [ 4 ] and the present survey. CT offer the ability to visualize the bony anatomy of the vertebrae and to assess in all directions whether a screw is malpositioned, with lower artifact levels than MRI [ 6 ]. Therefore, our recommended scoring system includes a category of scores based on the location and size of the breach observed on axial CT cuts.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Assessment of Pedicle Screws and Management of Breaches: A Survey among Canadian Spine Surgeons and a New Scoring System

et al. 2018

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Study DesignThis study was designed as a survey amongst Canadian spine surgeon to determine a scoring system to standardize pedicle screw placement assessment.PurposeThis study aimed to obtain and analyze the opinions of spine surgeons regarding the assessment of pedicle screw accuracy, with the goal of establishing clinical guidelines for interventions for malpositioned pedicle screws.Overview of LiteratureAccurate placement of pedicle screws is challenging, and misalignment can lead to various complications. To date, there is no recognized gold standard for assessing pedicle screw placement accuracy. The literature is lacking studies attempting to standardize pedicle screw placement accuracy assessment.MethodsA survey of the clinical methods and imaging criteria that are used for assessing pedicle screw placement accuracy was designed and sent to orthopedic and neurosurgery spine surgeons from the Canadian Spine Society for their anonymous participation.ResultsThirty-five surgeons completed the questionnaire. The most commonly used modalities for assessing pedicle screw position postoperatively were plain X-rays (97%) and computed tomography (CT, 97%). In both symptomatic and asymptomatic patients, the most and least worrisome breaches were medial and anterior breaches, respectively. The majority of surgeons tended not to re-operate on asymptomatic breaches. More than 60% of surgeons would re-operate on patients with new-onset pain and a ≤4-mm medial or inferior breach in both thoracic and lumbar regions. If a patient experienced sensory loss and a breach on CT, in either the thoracic or lumbar levels, 90% and 70% of the surgeons would re-operate for a medial breach and an inferior breach, respectively.ConclusionsPostoperative clinical presentation and imaging findings are crucial for interpreting aberrant pedicle screw placement. This study presents a preliminary scoring system for standardizing the classification of pedicle screws.

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“…In one series, the titanium implants of 14 out in 15 patients allowed uncompromised imaging of the spine, with only minimal artifact production, and the titanium implants caused local signal void without the surrounding image deterioration that was characteristic of the stainless steel implants [13]. Ebraheim et al concluded that the use of the titanium implants permitted high-quality MR imaging of the spinal canal contents [2]. We obtained the same results as Hachiya et al, in that the T1-weighted images had less artifact than T2-weighted images [6].…”

Section: Discussionmentioning

confidence: 99%