Three‐dimensional image‐guided placement of percutaneous pedicle screws without the use of biplanar fluoroscopy or Kirschner wires: technical note

Nottmeier, Eric W.; Fenton, Douglas S.

doi:10.1002/rcs.359

Cited by 17 publications

(12 citation statements)

References 41 publications

(48 reference statements)

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“…19,25,42,44,47,49 In the present study using the K-wireless percutaneous screw system with biplanar fluoroscopy, 87 of 90 screws were placed within the confines of the pedicle for an overall breach rate of 3.3%, which is consistent with other published reports. 30,32,36,39,42,44,47,49 In further examining the 3 pedicle breaches, 2 were less than 2 mm. It has been demonstrated that in the lumbar spine, there is a 2-mm "safe zone" that represents the epidural space in which there is little risk to the spinal cord or cauda equina.…”

Section: 83441mentioning

confidence: 97%

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Percutaneous “K-wireless” pedicle screw fixation technique: an evaluation of the initial experience of 100 screws with assessment of accuracy, radiation exposure, and procedure time

Spitz¹,

Sandhu²,

Voyadzis³

2015

SPI

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OBJECT Percutaneous pedicle screws are used to provide rigid internal fixation in minimally invasive spinal procedures and generally require the use of Kirchner wires (or K-wires) as a guide for screw insertion. K-wires can bend, break, advance, or pull out during the steps of pedicle preparation and screw insertion. This can lead to increased fluoroscopic and surgical times and potentially cause neurological, vascular, or visceral injury. The authors present their experience with a novel “K-wireless” percutaneous pedicle screw system that eliminates the inherent risks of K-wire use. METHODS A total of 100 screws were placed in 28 patients using the K-wireless percutaneous screw system. Postoperative dedicated spinal CT scans were performed in 25 patients to assess the accuracy of screw placement. Screw placement was graded A through D by 2 independent radiologists: A = within pedicle, B = breach < 2 mm, C = breach of 2–4 mm, and D = breach > 4 mm. Screw insertion and fluoroscopy times were also recorded in each case. Clinical complications associated with screw insertion were documented. RESULTS A total of 100 K-wireless percutaneous pedicle screws were placed into the lumbosacral spine in 28 patients. Postoperative CT was performed in 25 patients, thus the placement of only 90 screws was assessed. Eighty-seven screws were placed within the pedicle confines (Grade A), and 3 violated the pedicle (2 Grade B [1 lateral, 1 medial] and 1 Grade D [medial]) for an overall accuracy rate of 96.7%. One patient required reoperation for screw repositioning due to a postoperative L-5 radiculopathy secondary to a Grade D medial breach at L-5. This patient experienced improvement of the radiculopathy after reoperation. Average screw insertion and fluoroscopy times were 6.92 minutes and 22.7 seconds per screw, respectively. CONCLUSIONS The results of this study demonstrate that the placement of K-wireless percutaneous pedicle screws is technically feasible and can be performed accurately and safely with short procedure and fluoroscopy times.

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Section: 83441mentioning

confidence: 97%

“…1,21,30 The use of fluoroscopy exposes the patient, surgeon, and operating room staff to ionizing radiation. In fact, fluoroscopically assisted open thoracolumbar pedicle-screw placement exposes the spine surgeon to radiation dose rates up to 10-12 times greater than other, nonspinal musculoskeletal procedures.…”

Section: 83441mentioning

confidence: 99%

Percutaneous “K-wireless” pedicle screw fixation technique: an evaluation of the initial experience of 100 screws with assessment of accuracy, radiation exposure, and procedure time

Spitz¹,

Sandhu²,

Voyadzis³

2015

SPI

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“…10 Moreover, these K-wires may break or bend during the procedure, reducing the accuracy of cannulated screw placement and possibly damaging equipment. 21 None of the patients in our study, who were treated without K-wires, suffered intraoperative or postoperative vascular or neurological complications. Only one screw was malpositioned in this series, as a result of a suboptimal trajectory during placement, and there was no need for repositioning.…”

Section: Discussionmentioning

confidence: 73%

Percutaneous pedicle screw placement with computer-navigated mapping in place of Kirschner wires

Gianaris

Helbig

Horn

2013

SPI

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Object Percutaneous pedicle screw insertion techniques are commonly used to treat a variety of spinal disorders. Typically, Kirschner (K)-wires are used to guide the insertion of taps and screws during placement since the normal anatomical landmarks are not visualized. The use of K-wires adds risks, such as vascular and nerve injuries as well as increased radiation exposure given the use of fluoroscopy. The authors describe a series of patients who had percutaneous pedicle screws placed using a new computer-assisted navigation technique without the need for K-wires. Methods Minimally invasive percutaneous pedicle screw placement in the thoracic and lumbar spine was performed in a consecutive series of 15 patients for a variety of spinal pathologies. Intraoperative 3D CT images were obtained and used with a computer-assisted navigation system to insert an awl-tap into each pedicle. The tap location in the pedicle was marked with the navigation software, and the awl-tap was then removed. The navigation system was used to identify each landmark to insert the pedicle screw. Connecting rods were then inserted percutaneously under fluoroscopic guidance. Postoperative CT scans were obtained in each patient to evaluate screw placement. Results On postprocedure scanning, only 1 screw had a minor lateral and superior breach that was asymptomatic. To date, there have been no hardware failures. Conclusions Percutaneous pedicle screws can be placed effectively and safely without the use of K-wires.

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“…The use of cbCT-based image guidance for percutaneous pedicle screw placement has been reported. 1,12,25 Obviously, the surgeon is not exposed to radiation during screw placement in open or minimally invasive cbCT-based, image-guided spinal surgery, as the surgeon is navigating from the intraoperative cbCT scan, and no active fluoroscopy is used.…”

Section: Discussionmentioning

confidence: 99%

Operating room radiation exposure in cone beam computed tomography–based, image-guided spinal surgery

Nottmeier¹,

Pirris²,

Edwards³

et al. 2013

SPI

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Object Surgeon and operating room (OR) staff radiation exposure during spinal surgery is a concern, especially with the increasing use of multiplanar fluoroscopy in minimally invasive spinal surgery procedures. Cone beam computed tomography (cbCT)–based, 3D image guidance does not involve the use of active fluoroscopy during instrumentation placement and therefore decreases radiation exposure for the surgeon and OR staff during spinal fusion procedures. However, the radiation scatter of a cbCT device can be similar to that of a standard 64-slice CT scanner and thus could expose the surgeon and OR staff to radiation during image acquisition. The purpose of the present study was to measure radiation exposure at several unshielded locations in the OR when using cbCT in conjunction with 3D image-guided spinal surgery in 25 spinal surgery cases. Methods Five unshielded badge dosimeters were placed at set locations in the OR during 25 spinal surgery cases in which cbCT-based, 3D image guidance was used. The cbCT device (O-ARM) was used in conjunction with the Stealth S7 image-guided platform. The radiology department analyzed the badge dosimeters after completion of the last case. Results Fifty high-definition O-ARM spins were performed in 25 patients for spinal registration and to check instrumentation placement. Image-guided placement of 124 screws from C-2 to the ileum was accomplished without complication. Badge dosimetry analysis revealed minimal radiation exposure for the badges 6 feet from the gantry in the area of the anesthesiology equipment, as well as for the badges located 10–13 feet from the gantry on each side of the room (mean 0.7–3.6 mrem/spin). The greatest radiation exposure occurred on the badge attached to the OR table within the gantry (mean 176.9 mrem/spin), as well as on the control panel adjacent to the gantry (mean 128.0 mrem/spin). Conclusions Radiation scatter from the O-ARM was minimal at various distances outside of and not adjacent to the gantry. Although the average radiation exposure at these locations was low, an earlier study, undertaken in a similar fashion, revealed no radiation exposure when the surgeon stood behind a lead shield. This simple precaution can eliminate the small amount of radiation exposure to OR staff in cases in which the O-ARM is used.

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Three‐dimensional image‐guided placement of percutaneous pedicle screws without the use of biplanar fluoroscopy or Kirschner wires: technical note

Cited by 17 publications

References 41 publications

Percutaneous “K-wireless” pedicle screw fixation technique: an evaluation of the initial experience of 100 screws with assessment of accuracy, radiation exposure, and procedure time

Percutaneous “K-wireless” pedicle screw fixation technique: an evaluation of the initial experience of 100 screws with assessment of accuracy, radiation exposure, and procedure time

Percutaneous pedicle screw placement with computer-navigated mapping in place of Kirschner wires

Operating room radiation exposure in cone beam computed tomography–based, image-guided spinal surgery

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