The feasibility and efficacy of computer-assisted screw inserting planning in the surgical treatment for severe spinal deformity: a prospective study

Zhang, Yiqi; Hai, Yong; Yang, Jincai; Yin, Peng; Han, Chaofan; Liu, Jingwei; Zhou, Lijin

doi:10.1186/s12893-022-01711-y

Cited by 2 publications

(3 citation statements)

References 38 publications

(32 reference statements)

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“…In the present study, coronal and sagittal alignment changed substantially during the traction process. A detailed and personalized surgical plan for screw placement should be made preoperatively in order to achieve solid fixation and to avoid catastrophic neurological deficits 38,39 . The post-traction CT scans showed the altered pedicle orientation with correction along with the improved lung volumes.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Pulmonary Function After Halo-Pelvic Traction for Severe and Rigid Kyphoscoliosis Utilizing CT with 3D Reconstruction

Zhou,

Zhang,

Yang

et al. 2023

Journal of Bone and Joint Surgery

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Background: The purpose of the present study was to evaluate changes in pulmonary function, caused by preoperative halo-pelvic traction (HPT) for the treatment of extremely severe and rigid kyphoscoliosis, with use of 3-dimensional computed tomography (3D-CT) reconstruction and pulmonary function tests (PFTs). Methods: Twenty-eight patients with severe and rigid scoliosis (Cobb angle, >100°) underwent preoperative HPT and staged posterior spinal fusion. CT, radiographic assessment, and PFT were performed during pre-traction and post-traction visits. The changes in total lung volume were evaluated with use of 3D-CT reconstruction, and the changes in pulmonary function were evaluated with PFTs at each time point. Differences were analyzed with use of 2-tailed paired Student t tests, and correlations were analyzed with use of Spearman rank tests. Results: None of the patients had pulmonary complications during traction, and all radiographic spinal measurements improved significantly after HPT. The main Cobb angle was corrected from 143.30° ± 20.85° to 62.97° ± 10.83° between the pre-traction and post-traction evaluations. Additionally, the C7-S1 distance was lengthened from 280.48 ± 39.99 to 421.26 ± 32.08 mm between the pre-traction and post-traction evaluations. Furthermore, 3D lung reconstruction demonstrated a notable increase in total lung volume (TLV) (from 1.30 ± 0.25 to 1.83 ± 0.37 L) and maximum lung height (from 176.96 ± 27.44 to 202.31 ± 32.45 mm) between the pre-traction and post-traction evaluations. Moreover, PFTs showed that total lung capacity (TLC) improved between the pre-traction and post-traction evaluations (from 2.06 ± 0.32 to 2.98 ± 0.82 L) and that the changes in T1-T12 distance and maximum lung height were correlated with changes in TLV (p = 0.0288 and p = 0.0007, respectively). Conclusions: The application of HPT is a safe and effective method for improving pulmonary function in patients with extremely severe and rigid scoliosis before fusion surgery. The TLV as measured with CT-based reconstruction was greatly increased after HPT, mainly because of the changes in thoracic height. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Pulmonary Function After Halo-Pelvic Traction for Severe and Rigid Kyphoscoliosis Utilizing CT with 3D Reconstruction

Zhou,

Zhang,

Yang

et al. 2023

Journal of Bone and Joint Surgery

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“…However, the accuracy of pedicle screw placement is controversial. 7,[12][13][14][15] Since surgical experience is closely related to the accuracy of freehand screw placement, advanced surgeons prefer to use classical freehand techniques to achieve good results. [16][17][18] This study aimed to: (i) propose a common anatomical point and trajectory; (ii) compare the differences between different modalities of manual technique; and (iii) compare physicians with different clinical experiences to determine the accuracy of this manual technique.…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, techniques such as intraoperative fluoroscopy, intraoperative CT, image‐assisted navigation, and robotic guidance systems have been used to improve screw placement. However, the accuracy of pedicle screw placement is controversial 7,12–15 . Since surgical experience is closely related to the accuracy of freehand screw placement, advanced surgeons prefer to use classical freehand techniques to achieve good results 16–18 …”

Section: Introductionmentioning

confidence: 99%

Detection of Common Anatomical Landmarks and Vertical Trajectories for Freehand Pedicle Screw Placement

Wang,

Zhang,

Sun

et al. 2023

Orthopaedic Surgery

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Objective: It is clinically important for pedicle screws to be placed quickly and accurately. Misplacement of pedicle screws results in various complications. However, the incidence of complications varies greatly due to the different professional titles of physicians and surgical experience. Therefore, physicians must minimize pedicle screw dislocation. This study aims to compare the three nail placement methods in this study, and explore which method is the best for determining the anatomical landmarks and vertical trajectories. Methods: This study involved 70 patients with moderate idiopathic scoliosis who had undergone deformity correction surgery between 2018 and 2021. Two spine surgeons used three techniques (preoperative computed tomography scan [CTS], visual inspection-X-freehand [XFH], and intraoperative detection [ID] of anatomical landmarks) to locate pedicle screws. The techniques used include visual inspection for 287 screws in 21 patients, preoperative planning for 346 screws in 26 patients, and intraoperative probing for 309 screws in 23 patients. Observers assessed screw conditions based on intraoperative CT scans (Grade A, B, C, D).Results: There were no significant differences between the three groups in terms of age, sex, and degree of deformity. We found that 68.64% of screws in the XFH group, 67.63% in the CTS group, and 77.99% in the ID group were placed within the pedicle margins (grade A). On the other hand, 6.27% of screws in the XFH group, 4.33% in the CTS group, and 6.15% in the ID group were considered misplaced (grades C and D). The results show that the total amount of upper thoracic pedicle screws was fewer, meanwhile their placement accuracy was lower. The three methods used in this study had similar accuracy in intermediate physicians (P > 0.05). Compared with intermediate physicians, the placement accuracy of three techniques in senior physicians was higher. The intraoperative detection group was better than the other two groups in the good rate and accuracy of nail placement (P < 0.05). Conclusion:Intraoperative common anatomical landmarks and vertical trajectories were beneficial to patients with moderate idiopathic scoliosis undergoing surgery. It is an optimal method for clinical application.

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The feasibility and efficacy of computer-assisted screw inserting planning in the surgical treatment for severe spinal deformity: a prospective study

Cited by 2 publications

References 38 publications

Evaluation of Pulmonary Function After Halo-Pelvic Traction for Severe and Rigid Kyphoscoliosis Utilizing CT with 3D Reconstruction

Evaluation of Pulmonary Function After Halo-Pelvic Traction for Severe and Rigid Kyphoscoliosis Utilizing CT with 3D Reconstruction

Detection of Common Anatomical Landmarks and Vertical Trajectories for Freehand Pedicle Screw Placement

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