Screw perforation features in 129 consecutive patients performed computer-guided cervical pedicle screw insertion

Uehara, Mariko; Takahashi, J.; Ikegami, Shota; Mukaiyama, Keijiro; Kuraishi, Shugo; Shimizu, Masayuki; Futatsugi, Toshimasa; Ogihara, Nobuhide; Hashidate, Hiroyuki; Hirabayashi, Hiroki; Kato, Hiroyuki

doi:10.1007/s00586-014-3502-9

Cited by 47 publications

(31 citation statements)

References 18 publications

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“…But not all the results about using the navigation in CPSs placement were optimistic. Uehara et al (15)inserted the CPSs by using a CT-based navigation system during operations. The results showed that the combined rate of grades 2 and 3 perforations was 20.0 % (116/579).…”

Section: Discussionmentioning

confidence: 99%

The"slide technique"-a novel free-hand method of subaxial cervical pedicle screw placement

Liu

Shen

et al. 2020

Preprint

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Background: Cervical Pedicle Screw(CPS) placement is a challenging work due to the high risk of neurovascular complications. Although there have been several different free-hand or navigation assisted techniques for CPS placement, perforations may occur during screw insertion, especially lateral perforation. The objective of this manuscript is to describe a novel free-hand technique for subaxial CPS placement (C3–C7) and to evaluate if it decreases the chances of perforation.Methods: Thirty-two patients undergoing surgery with CPS instrumentation (C3–C7) at our institute between June 2017 and December 2018 were included in this study. All the patients had cervical trauma, and pedicle screw insertion was performed according to the free-hand “slide technique”. The lamina, lateral mass and facet joint of the target area were exposed and the optimal entry point was found on the lateral mass posterior surface. A pedicular probe was then inserted and gently advanced. During the pedicle probe insertion, the cortex of the medial margin of the pedicle acted as a slide to permit the safe insertion of the screw. If the pedicle screw pathway was intact, the screw of the appropriate size was carefully placed. Three-dimensional (3D) CT imaging reconstruction was performed in all the patients after surgery, and screw perforations were graded with the Gertzbein-Robbins classification.Results: A total of 257 CPSs (C3-7) were inserted, of which 41 CPSs were in C3, 61 CPSs were in C4, 55 CPSs were in C5, 53 CPSs were in C6, and 47 CPSs were in C7. The diameter and length of CPSs were 3.5 mm and 22-26 mm respectively. According to the Gertzbein-Robbins classification, grade 0, 231 screws; grade 1, 19 screws; and grade 2, 7 screws. No neurovascular complications occurred stemming from malpositioning of pedicle screws. Among perforated screws (26 screws), there were 16 lateral perforations, 5 medical perforations, and 4 inferior perforations.Conclusions: The initial usage result shows the “slide technique” is a safe, effective and cost-effective technique for pedicle screw placement in the cervical spine. This is the first report of such a technique. We recommend its use though further studies are needed.

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Section: Discussionmentioning

confidence: 99%

The"slide technique"-a novel free-hand method of subaxial cervical pedicle screw placement

Liu

Shen

et al. 2020

Preprint

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“…Several reports have described the efficacy of intraoperative 3D navigation systems to aid in the placement of cervical pedicle screws [21–23]. A clinical study by Richter et al [21] noted that the prevalence of pedicle perforations was 8.6% in a conventional treatment group and 3.0% in a 3D navigation group.…”

Section: Discussionmentioning

confidence: 99%

A Modified Personalized Image-Based Drill Guide Template for Atlantoaxial Pedicle Screw Placement: A Clinical Study

Jiang

Tan

et al. 2017

Med Sci Monit

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BackgroundAtlantoaxial posterior pedicle screw fixation has been widely used for treatment of atlantoaxial instability (AAI). However, precise and safe insertion of atlantoaxial pedicle screws remains challenging. This study presents a modified drill guide template based on a previous template for atlantoaxial pedicle screw placement.Material/MethodsOur study included 54 patients (34 males and 20 females) with AAI. All the patients underwent posterior atlantoaxial pedicle screw fixation: 25 patients underwent surgery with the use of a modified drill guide template (template group) and 29 patients underwent surgery via the conventional method (conventional group). In the template group, a modified drill guide template was designed for each patient. The modified drill guide template and intraoperative fluoroscopy were used for surgery in the template group, while only intraoperative fluoroscopy was used in the conventional group.ResultsOf the 54 patients, 52 (96.3%) completed the follow-up for more than 12 months. The template group had significantly lower intraoperative fluoroscopy frequency (p<0.001) and higher accuracy of screw insertion (p=0.045) than the conventional group. There were no significant differences in surgical duration, intraoperative blood loss, or improvement of neurological function between the 2 groups (p>0.05).ConclusionsBased on the results of this study, it is feasible to use the modified drill guide template for atlantoaxial pedicle screw placement. Using the template can significantly lower the screw malposition rate and the frequency of intraoperative fluoroscopy.

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“…In their study, 9 pedicle screw breaches were encountered with no vertebral artery injury, as the vertebral artery does not occupy the complete foramen transversarium and mild breach would not usually cause complications. On the contrary, Uehara et al reported that a perforation of more than 50% of the screw diameter in the preoperative CT navigation procedure was observed at the highest frequency at C4 and at the lowest frequency at C3 and C6 71) .…”

Section: Surgery-related Complicationsmentioning

confidence: 94%

“…Pedicle Breach and Complications Yukawa et al 75 (X rays -oblique views) NCB: 10.3% CB: 4% Neo et al 51 (Abumi technique) C: 25% Kotani et al 65 Free hand C: 6.7% CAS C: 1.2% Karaikovic et al 57 NCB: 9.7% (Funnel technique) CB: 7.1% Ludwig et al 53 Surface landmarks NCB: 21.9%, CB: 65.5% Laminoforaminotomy NCB: 15.4%, CB: 39.6% CAS NCB: 13.4%, CB: 10.6% Richter et al 67 Conventional C: 8.6% CAS C: 3% Yoshimoto et al 78 NCB: 7.3% CB: 3.7% Ito et al 79 C: 2.8% (CAS) Ishikawa et al 66 Conventional C: 27% CAS C: 18.7% Nakashima et al 73 C: 5.9% Uehara et al 71 NCB: 20.0%, CB: 6.7% NCB, non-critical breach; CB, critical breach; C, complications…”

Section: Authorsmentioning

confidence: 99%

A Review of the Historical Evolution, Biomechanical Advantage, Clinical Applications, and Safe Insertion Techniques of Cervical Pedicle Screw Fixation

Tukkapuram

Abumi

Ito

2019

Spine Surg Relat Res

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Cervical spine instrumentation is evolving with an aim of stabilizing traumatic and non-traumatic cases of the cervical spine with a beneficial reduction, better biomechanical strength, and a strong construct with minimal intraoperative, as well as immediate and late postoperative complications. The evolution from interspinous wiring till cervical pedicle screws has changed the outlook in treating the cervical spine pathologies with maximum 3D stability, decreasing the duration of postoperative immobilization and hospital stay. Some complications associated with the use of cervical pedicle screw can be catastrophic. This review article discusses the morphometry of cervical pedicle; indications, biomechanical superiority, tricks, and pitfalls of cervical pedicle screw; complications and technical advancements in targeting safe surgery; and future directions of cervical pedicle screw instrumentation.

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Screw perforation features in 129 consecutive patients performed computer-guided cervical pedicle screw insertion

Abstract: Careful insertion of pedicle screws is necessary, especially at C3 to C5, even when using a CT-based navigation system. Pedicle screws tend to be laterally perforated.

Cited by 47 publications

References 18 publications

The"slide technique"-a novel free-hand method of subaxial cervical pedicle screw placement

The"slide technique"-a novel free-hand method of subaxial cervical pedicle screw placement

A Modified Personalized Image-Based Drill Guide Template for Atlantoaxial Pedicle Screw Placement: A Clinical Study

A Review of the Historical Evolution, Biomechanical Advantage, Clinical Applications, and Safe Insertion Techniques of Cervical Pedicle Screw Fixation

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