Repeat surgical interventions following “definitive” instrumentation and fusion for idiopathic scoliosis: a 30-year update

Jamnik, Adam A.; Datcu, Anne-Marie; Lachmann, Emily; Patibandla, Sahiti D.; Thornberg, David; Jo, Chan-hee; Morris, William Z.; Ramo, Brandon; Johnson, Megan

doi:10.1007/s43390-023-00742-6

Cited by 4 publications

(5 citation statements)

References 24 publications

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“…Another non-consecutive multicenter retrospective review reported 0.26% incidence of both neurologic injury and misplaced instrumentation [ 7 ]. A single-center retrospective review of all pediatric patients who underwent spinal fusion over a 30-year period revealed a 1.1% incidence of UPROR related to malpositioned pedicle screws, neurological changes, or pneumothorax (presumably related to implants) [ 43 ]. Meta-analyses report overall accuracy rates between 90.6% and 94.9% for freehand and freehand navigation techniques [ 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

“…Collectively, these studies provide useful baseline data for accuracy and revision rates for pedicle screws using non-robotic techniques. The retrospective and non-consecutive nature of the pediatric multicenter database studies limit their utility for comparison with consecutive series of computer-navigated surgical accuracy in vivo and single-center consecutive case reviews [ 5 , 19 , 20 , 26 , 27 , 32 , 33 , 38 – 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…We recognize that only a subset of accuracy errors in pedicle screw placement result in patient harm. However, improvements to accuracy, precision, and reliability of pedicle screw placement using robotically assisted surgical navigation have the potential to reduce the incidence of patient harm by decreasing the 0.26% incidence of UPROR secondary to malpositioned pedicle screws [ 6 , 7 , 43 ]. A standardized, systematic approach to the reporting of pedicle screw accuracy with computer-assisted pedicle screw insertion techniques using standardized nomenclature as well as a screw-centric 3D coordinate system is vital.…”

Section: Discussionmentioning

confidence: 99%

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Fully automated determination of robotic pedicle screw accuracy and precision utilizing computer vision algorithms

Groisser,

Thakur,

Hillstrom

et al. 2024

J Robotic Surg

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Historically, pedicle screw accuracy measurements have relied on CT and expert visual assessment of the position of pedicle screws relative to preoperative plans. Proper pedicle screw placement is necessary to avoid complications, cost and morbidity of revision procedures. The aim of this study was to determine accuracy and precision of pedicle screw insertion via a novel computer vision algorithm using preoperative and postoperative computed tomography (CT) scans. Three cadaveric specimens were utilized. Screw placement planning on preoperative CT was performed according to standard clinical practice. Two experienced surgeons performed bilateral T2–L4 instrumentation using robotic-assisted navigation. Postoperative CT scans of the instrumented levels were obtained. Automated segmentation and computer vision techniques were employed to align each preoperative vertebra with its postoperative counterpart and then compare screw positions along all three axes. Registration accuracy was assessed by preoperatively embedding spherical markers (tantalum beads) to measure discrepancies in landmark alignment. Eighty-eight pedicle screws were placed in 3 cadavers’ spines. Automated registrations between pre- and postoperative CT achieved sub-voxel accuracy. For the screw tip and tail, the mean three-dimensional errors were 1.67 mm and 1.78 mm, respectively. Mean angular deviation of screw axes from plan was 1.58°. For screw mid-pedicular accuracy, mean absolute error in the medial–lateral and superior–inferior directions were 0.75 mm and 0.60 mm, respectively. This study introduces automated algorithms for determining accuracy and precision of planned pedicle screws. Our accuracy outcomes are comparable or superior to recent robotic-assisted in vivo and cadaver studies. This computerized workflow establishes a standardized protocol for assessing pedicle screw placement accuracy and precision and provides detailed 3D translational and angular accuracy and precision for baseline comparison.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Fully automated determination of robotic pedicle screw accuracy and precision utilizing computer vision algorithms

Groisser,

Thakur,

Hillstrom

et al. 2024

J Robotic Surg

View full text Add to dashboard Cite

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“…A study by Jamnik et al [18] found a greater than 50% decrease in overall complication rate of patients treated in 2013-2019 compared to those treated in 2008-2012, suggesting that surgery for AIS is continuing to improve in treatment efficacy and patient safety. Interestingly, this decrease was due to decreases in rates of postoperative infection and symptomatic instrumentation, rather than the rate of complications due to pseudarthrosis and instrumentation failures, which have remained unchanged [18].…”

Section: Complications and Reasons For Revisionmentioning

confidence: 99%

Revision of Surgery for Adolescent Idiopathic Scoliosis: Reasons, Treatments, and Clinical Management with Case Examples

Lenke,

Lee,

Hassan

2024

JCM

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Adolescent idiopathic scoliosis (AIS) is a curvature of the spine that develops in children ages 10–18 and can be attributed to unknown causes. The Lenke AIS classification system provides a template to classify these deformities by curve type paired with recommended operative treatments. Treatment of this patient population has been associated with low complication rates and overall surgical success. Nonetheless, a fraction of patients remain susceptible to revision surgery. This manuscript will focus on the aspects of AIS surgery, highlighting case examples, the different treatment approaches, complication rates, and primary reasons for revision surgery and associated outcomes.

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“…While minor curves can be treated conservatively, curves that exceed 50–60 degrees are frequently treated by instrumented spinal fusion surgery. While these surgeries are invasive, they offer a durable correction and generally acceptable long-term outcomes [ 3 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Dosing Cefazolin for Surgical Site Infection Prophylaxis in Adolescent Idiopathic Scoliosis Surgery: Intermittent Bolus or Continuous Infusion?—A Pilot Study

Yu,

Dooley,

Woods

et al. 2024

JCM

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Background: Cefazolin may minimize the risk of surgical site infection (SSI) following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Cefazolin dosing recommendations vary and there is limited evidence for achieved tissue concentrations. Methods: We performed a randomized, controlled, prospective pharmacokinetic pilot study of 12 patients given cefazolin by either intermittent bolus (30 mg/kg every 3 h) or continuous infusion (30 mg/kg bolus followed by 10/mg/kg per hour) during PSF for AIS. Results: Patients were well matched for demographic and perioperative variables. While total drug exposure, measured as area-under-the-curve (AUC), was similar in plasma for bolus and infusion dosing, infusion dosing achieved greater cefazolin exposure in subcutaneous and muscle tissue. Using the pharmacodynamic metric of time spent above minimal inhibitory concentration (MIC), both bolus and infusion dosing performed well. However, when targeting a bactericidal concentration of 32 µg/mL, patients in the bolus group spent a median of 1/5 and 1/3 of the typical 6 h operative time below target in subcutaneous and muscle tissue, respectively. Conclusions: We conclude that intraoperative determination of cefazolin tissue concentrations is feasible and both bolus and infusion dosing of cefazolin achieve concentrations in excess of typical MICs. Infusion dosing appears to more consistently achieve bactericidal concentrations in subcutaneous and muscle tissues.

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Repeat surgical interventions following “definitive” instrumentation and fusion for idiopathic scoliosis: a 30-year update

Cited by 4 publications

References 24 publications

Fully automated determination of robotic pedicle screw accuracy and precision utilizing computer vision algorithms

Fully automated determination of robotic pedicle screw accuracy and precision utilizing computer vision algorithms

Revision of Surgery for Adolescent Idiopathic Scoliosis: Reasons, Treatments, and Clinical Management with Case Examples

Dosing Cefazolin for Surgical Site Infection Prophylaxis in Adolescent Idiopathic Scoliosis Surgery: Intermittent Bolus or Continuous Infusion?—A Pilot Study

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