Power versus manual pedicle tract preparation: a multi-center study of early adopters

Skaggs, David L.; Compton, Edward; Vitale, Michael G.; Garg, Sumeet; Stone, Jennifer A.; Fletcher, Nicholas D.; Illingworth, Kenneth D.; Kim, Hee Jin; Ball, Jacob; Kim, Eun Bi; Keil, Lukas G.; Harris, Hilary; Shah, Sachin; Andras, Lindsay M.

doi:10.1007/s43390-021-00347-x

Cited by 6 publications

(9 citation statements)

References 19 publications

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“…While this accuracy rate is lower than the 98.6% rate reported in the presented study, it must be acknowledged that Yan et al only considered thoracic pedicle screws in the analysis, which are at greater risk of perforation because of both intrinsic (smaller dimensions) and pathologic (pedicle dysplasia in scoliotic patients) pedicle anatomy in this region. The 0.072% revision per screw rate in our cohort is line with the reported rate in other power-assisted studies, ranging from 0 to 0.14% [14][15][16].…”

Section: Discussionsupporting

confidence: 92%

“…Among spinal surgeons, there has been a recent trend toward the use of power for pedicle tract preparation and screws placement [14][15][16]. In fact, there are some advantages that make power appealing compared to the manual technique: shorter screw insertion phase [16], shorter fluoroscopy time [14], reduced wobble phenomenon [17], lower rates of screw failure [14] and of revision per screw [15].…”

Section: Discussionmentioning

confidence: 99%

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Freehand power-assisted pedicle screw placement in scoliotic patients: results on 5522 consecutive pedicle screws

et al. 2022

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Pedicle screws is the current gold standard in spine surgery, achieving a solid tricolumnar fixation which is unreachable by wires and hooks. The freehand technique is the most widely adopted for pedicle screws placing. While freehand technique has been classically performed with manual tools, there has been a recent trend toward the use of power tools. However, placing a pedicle screw remains a technically demanding procedure with significant risk of complications. The aim of this article is to retrospectively evaluate safety and accuracy of free-hand power-assisted pedicle screw placement in a cohort of patients who underwent correction and fusion surgery for scoliosis (both idiopathic and non-idiopathic) in our department. A retrospective review of all patients with scoliosis who underwent surgery and received a postoperative CT scan in our department in a 9-year period was undertaken. Screw density, number and location of pedicle screws were measured using pre and postoperative full-length standing and lateral supine side-bending radiographs. Then, postoperative CT scan was used to assess the accuracy of screw placement according to Gertzbein-Robbins scale. Malpositioned screws were divided according to their displacement direction. Finally, intra and postoperative neurological complications and the need for revision of misplaced screws were recorded. A total of 205 patients were included, with a follow-up of 64.9 ± 38.67 months. All constructs were high density (average density 1.97 ± 0.04), and the average number of fusion levels was 13.72 ± 1.97. A total of 5522 screws were placed: 5308 (96.12%) were grade A, 141 (2.5%) grade B, 73 (1.32%) grade C. Neither grade D nor grade E trajectories were found. The absolute accuracy (grade A) rate was 96.12% (5308/5522) and the effective accuracy (within the safe zone, grade A + B) was 98.6% (5449/5522). Of the 73 misplaced screws (grade C), 59 were lateral (80.80%), 8 anterior (10.95%) and 6 medial (8.22%); 58 were in convexity, while 15 were in concavity (the difference was not statistically significant, p = 0.33). Intraoperatively, neither neurological nor vascular complications were recorded. Postoperatively, 4 screws needed revision (0.072% of the total): Power-assisted pedicle screw placing may be a safe an accurate technique in the scoliosis surgery, both of idiopathic and non-idiopathic etiology. Further, and higher quality, research is necessary in order to better assess the results of this relatively emerging technique.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Freehand power-assisted pedicle screw placement in scoliotic patients: results on 5522 consecutive pedicle screws

et al. 2022

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“…Skaggs et al reviewed over 22,000 pedicle screws placed using a flexible drill bit and found a 0.03% rate of screw misplacement requiring revision. 1 Baky compared 112 patients with AIS who underwent PSF using a fluoroscopically assisted approach to 107 patients managed with the assistance of a CT-based navigation system and found a 3.6% incidence of screw revision in the fluoroscopically assisted technique compared to 0% in the navigation-based group. 2 Gonzalez et al evaluated 40 patients undergoing robotically assisted pedicle screw placement and found a 98.7% accuracy rate with no neurological injuries.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Blood Pressure Management for Patients Undergoing Spinal Fusion for Pediatric Spinal Deformity

Fletcher¹,

Ghag²,

Hedequist³

et al. 2023

Journal of the Pediatric Orthopaedic Society of North America

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Posterior spinal instrumentation and fusion has become the gold standard for definitive management of children and adolescents with spinal deformity. Despite continued innovations designed to improve the safety profile of this complex surgical undertaking, spinal cord injury and resulting loss of neurologic function remain a rare but devastating risk. The increasing power of instrumentation combined with more aggressive correction strategies puts the spinal cord at particular risk due to traction. While the surgeon has the luxury of complex neuromonitoring techniques to alert the team in the presence of a neurologic change during surgery, maintenance of spinal cord perfusion throughout surgery and in the early postoperative period should be considered to avoid spinal cord ischemia as it accommodates to its new position after deformity correction. This manuscript represents recommendations of the POSNA Quality, Value, and Safety spine committee for optimization of blood pressure in the perioperative period.

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“…A recent multicenter study of early adopters demonstrated the safety of this technique in 22,209 screws across six institutions. 1 As we have taught this technique to fellow surgeons throughout the world, inevitably the question would always arise, "Do you let your residents do that?". The answer was always an emphatic, YES.…”

Section: Introductionmentioning

confidence: 99%

Simulation Training in Pedicle Preparation and Screw Insertion in Pediatric Spinal Deformity

Johnson¹,

Skaggs²,

Illingworth³

2022

Journal of the Pediatric Orthopaedic Society of North America

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Pedicle screw segmental instrumentation has become the gold standard for spinal deformity correction for both the pediatric and adult populations. The thought of placing screws through tiny boney channels in the spinal column can be a daunting task for trainees. The goal in spine surgery instrumentation is similar to other orthopaedic subspecialities—safe passage of screws through the bone. Yet, the potential consequences of pedicle breaches and malpositioned instruments/screws are what give pedicle preparation and screw insertion an appropriately heightened sense of care and apprehension. Important anatomical structures lie around the pedicles of the spine, with the spinal cord, nerve roots, epidural veins, lungs, kidneys, and major vessels being just some of the structures that lurk outside of the spine’s osseous anatomy. In 2007, we implemented power pedicle screw preparation and screw insertion to improve safety for both the surgeon and patient. A recent multicenter study of early adopters demonstrated the safety of this technique in 22,209 screws across six institutions. As we have taught this technique to fellow surgeons throughout the world, inevitably the question would always arise, “Do you let your residents do that?”. The answer was always an emphatic, YES. However, we began to explore ways in which we could improve our trainees’ education on pedicle screw insertion, both manual and power, given the complexity of the osseous anatomy in pediatric spinal deformity cases.

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Power versus manual pedicle tract preparation: a multi-center study of early adopters

Cited by 6 publications

References 19 publications

Freehand power-assisted pedicle screw placement in scoliotic patients: results on 5522 consecutive pedicle screws

Freehand power-assisted pedicle screw placement in scoliotic patients: results on 5522 consecutive pedicle screws

Perioperative Blood Pressure Management for Patients Undergoing Spinal Fusion for Pediatric Spinal Deformity

Simulation Training in Pedicle Preparation and Screw Insertion in Pediatric Spinal Deformity

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