Template guided cervical pedicle screw instrumentation

Farshad, Mazda; Spirig, José Miguel; Winkler, Elin; Suter, Daniel; Farshad‐Amacker, Nadja A.; Jarvers, Jan-Sven; Tschöke, Stefan; Heyde, Christoph-Eckhard; Calek, Anna-Katharina

doi:10.1016/j.xnsj.2022.100120

Cited by 3 publications

(8 citation statements)

References 29 publications

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“…A preoperative CT scan is used to 3D print a guide that fits the patient anatomy. These methods have recently begun to be studied in clinical applications and have largely concentrated on open cervical fixation 9 . A small retrospective study of 12 patients indicated a malplacement rate of 4.7% across 86 screws, but larger studies need to verify these results 9 .…”

Section: Discussionmentioning

confidence: 99%

“…These methods have recently begun to be studied in clinical applications and have largely concentrated on open cervical fixation 9 . A small retrospective study of 12 patients indicated a malplacement rate of 4.7% across 86 screws, but larger studies need to verify these results 9 . Percutaneous approaches are challenging with PSI, but researchers have proposed pre‐imaging markers to anchor the guide 26 .…”

Section: Discussionmentioning

confidence: 99%

“…In any case, the costs of using robots are likely an impediment to adoption, while the radiation of registration remains a concern 7 . Patient‐Specific Instrumentation (PSI) is an alternative technique where 3D printed drilling guides are fitted to the patient's anatomy with a malplacement rate of 4.7% 9 . While these methods continue to be investigated, they have not yet achieved widespread adoption 9 .…”

Section: Introductionmentioning

confidence: 99%

“…Patient‐Specific Instrumentation (PSI) is an alternative technique where 3D printed drilling guides are fitted to the patient's anatomy with a malplacement rate of 4.7% 9 . While these methods continue to be investigated, they have not yet achieved widespread adoption 9 . They may present unique challenges regarding production considerations, manufacturing costs, and difficulties adapting to intraoperative findings 10 .…”

Section: Introductionmentioning

confidence: 99%

“…9 While these methods continue to be investigated, they have not yet achieved widespread adoption. 9 They may present unique challenges regarding production considerations, manufacturing costs, and difficulties adapting to intraoperative findings. 10 The main motivation for the work presented here, therefore, is to address and overcome the performance, cost and radiation concerns associated with existing techniques.…”

mentioning

confidence: 99%

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Design of an ultrasound‐emitting drill guide for freehand pedicle screw navigation

MacLean,

Street,

Hodgson

2023

Robotics Computer Surgery

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BackgroundAccurate pedicle screw placement in spinal surgery is critical as inaccuracies can lead to morbidity and suboptimal outcomes. Navigation and robotics have reduced malplacement rates, but their adoption is limited by high costs, learning curves, surgical time, and radiation. The authors propose an ultrasound‐emitting and self‐localising drill guide for precise screw placement that overcomes the limitations of current techniques.Materials and MethodsThe preliminary configuration analysis involves systematically varying design parameters and assessing localization performance using lumbar spine MRI based simulations. The authors evaluate localization techniques based on accuracy and optimization capture range.ResultsResults suggest that feasible designs can accurately estimate position. A promising design features a 5 mm radius cannula with ten 35mm‐long ultrasound strips, 32 elements per strip, and a fanned‐out emission profile. A multi‐start active‐set optimization algorithm with six initial estimates ensures reliable and efficient localization.ConclusionsThe simulation suggests that the proposed design can achieve sufficient localization accuracy for pedicle screw navigation. These findings will guide the fabrication of a novel ultrasound‐emitting drill guide for further evaluation and physical testing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Design of an ultrasound‐emitting drill guide for freehand pedicle screw navigation

MacLean,

Street,

Hodgson

2023

Robotics Computer Surgery

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Accurate Placement and Revisions for Cervical Pedicle Screws Placed With or Without Navigation: A Systematic Review and Meta-Analysis

Bindels,

Dronkers,

Smits

et al. 2023

Global Spine Journal

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Study Design Systematic review and meta-analysis. Objectives To evaluate the accuracy of placement for cervical pedicle screws with and without the use of spinal navigation. Methods A structured search was conducted in electronic databases without any language or date restrictions. Eligible studies reported the proportion of accurately placed cervical pedicle screws measured on intraoperative or postoperative 3D imaging, and reported whether intraoperative navigation was used during screw placement. Randomized Studies (MINORS) criteria were used to evaluate the methodological quality of how accuracy was assessed for cervical pedicle screws. Results After screening and critical appraisal, 4697 cervical pedicle screws from 18 studies were included in the meta-analysis. The pooled proportion for cervical pedicle screws with a breach up to 2 mm was 94% for navigated screws and did not differ from the pooled proportion for non-navigated screws (96%). The pooled proportion for cervical pedicle screws placed completely in the pedicle was 76% for navigated screws and did not differ from the pooled proportion for non-navigated screws (82%). Intraoperative screw reposition rates and screw revision rates as a result of postoperative imaging also did not differ between navigated and non-navigated screw placement. Conclusions This systematic review and meta-analysis found that the use of spinal navigation systems does not significantly improve the accuracy of placement of cervical pedicle screws compared to screws placed without navigation. Future studies evaluating intraoperative navigation for cervical pedicle screw placement should focus on the learning curve, postoperative complications, and the complexity of surgical cases.

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Bone density optimized pedicle screw insertion

Tsagkaris,

Calek,

Fasser

et al. 2023

Front. Bioeng. Biotechnol.

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Background: Spinal fusion is the most common surgical treatment for the management of degenerative spinal disease. However, complications such as screw loosening lead to painful pseudoarthrosis, and are a common reason for revision. Optimization of screw trajectories to increase implant resistance to mechanical loading is essential. A recent optimization method has shown potential for determining optimal screw position and size based on areas of high bone elastic modulus (E-modulus).Aim: The aim of this biomechanical study was to verify the optimization algorithm for pedicle screw placement in a cadaveric study and to quantify the effect of optimization. The pull-out strength of pedicle screws with an optimized trajectory was compared to that of a traditional trajectory.Methods: Twenty-five lumbar vertebrae were instrumented with pedicle screws (on one side, the pedicle screws were inserted in the traditional way, on the other side, the screws were inserted using an optimized trajectory).Results: An improvement in pull-out strength and pull-out strain energy of the optimized screw trajectory compared to the traditional screw trajectory was only observed for E-modulus values greater than 3500 MPa cm3. For values of 3500 MPa cm3 or less, optimization showed no clear benefit. The median screw length of the optimized pedicle screws was significantly smaller than the median screw length of the traditionally inserted pedicle screws, p < 0.001.Discussion: Optimization of the pedicle screw trajectory is feasible, but seems to apply only to vertebrae with very high E-modulus values. This is likely because screw trajectory optimization resulted in a reduction in screw length and therefore a reduction in the implant-bone interface. Future efforts to predict the optimal pedicle screw trajectory should include screw length as a critical component of potential stability.

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Template guided cervical pedicle screw instrumentation

Cited by 3 publications

References 29 publications

Design of an ultrasound‐emitting drill guide for freehand pedicle screw navigation

Design of an ultrasound‐emitting drill guide for freehand pedicle screw navigation

Accurate Placement and Revisions for Cervical Pedicle Screws Placed With or Without Navigation: A Systematic Review and Meta-Analysis

Bone density optimized pedicle screw insertion

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