Transpedicular Screw Placement

Assaker, R.; Reyns, Nicolar; Vinchon, Matthieu; Demondion, Xavier; Louis, Etienne

doi:10.1097/00007632-200110010-00024

Cited by 106 publications

(16 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In fact, the results suggested a trend toward greater inaccuracy with the EMF navigation system. Similar results have been reported in another study [13], but this is not a universal finding [2, 3]. Kosmopoulos and Schizas [21] noted similar findings in the thoracic group in their meta-analysis.…”

Section: Discussionsupporting

confidence: 88%

“…Such exposure is associated with significant amounts of blood loss [17], as well as paraspinal muscular injury, which has been associated with postoperative back pain [18, 19]. The accuracy of placement of pedicle screws has been shown to be improved with the use of frameless stereotaxic image guidance in most [2, 3, 21, 23] but not all [13] studies. Adoption of image-guided surgical techniques has been limited to date amid concerns of increased operative time and complexity of the technology [2].…”

Section: Introductionmentioning

confidence: 99%

“…The accuracy of placement of pedicle screws has been shown to be improved with the use of frameless stereotaxic image guidance in most [2, 3, 21, 23] but not all [13] studies. Adoption of image-guided surgical techniques has been limited to date amid concerns of increased operative time and complexity of the technology [2]. Recently, developments in percutaneous pedicle screw fixation offer a less traumatic approach resulting in less damage to the surrounding musculature, decreased blood loss, and decreased recovery time [15, 16, 20].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Minimally invasive percutaneous transpedicular screw fixation: increased accuracy and reduced radiation exposure by means of a novel electromagnetic navigation system

et al. 2010

View full text Add to dashboard Cite

BackgroundMinimally invasive percutaneous pedicle screw instrumentation methods may increase the need for intraoperative fluoroscopy, resulting in excessive radiation exposure for the patient, surgeon, and support staff. Electromagnetic field (EMF)-based navigation may aid more accurate placement of percutaneous pedicle screws while reducing fluoroscopic exposure. We compared the accuracy, time of insertion, and radiation exposure of EMF with traditional fluoroscopic percutaneous pedicle screw placement.Methods Minimally invasive pedicle screw placement in T8 to S1 pedicles of eight fresh-frozen human cadaveric torsos was guided with EMF or standard fluoroscopy. Set-up, insertion, and fluoroscopic times and radiation exposure and accuracy (measured with post-procedural computed tomography) were analyzed in each group.ResultsSixty-two pedicle screws were placed under fluoroscopic guidance and 60 under EMF guidance. Ideal trajectories were achieved more frequently with EMF over all segments (62.7% vs. 40%; p = 0.01). Greatest EMF accuracy was achieved in the lumbar spine, with significant improvements in both ideal trajectory and reduction of pedicle breaches over fluoroscopically guided placement (64.9% vs. 40%, p = 0.03, and 16.2% vs. 42.5%, p = 0.01, respectively). Fluoroscopy time was reduced 77% with the use of EMF (22 s vs. 5 s per level; p < 0.0001) over all spinal segments. Radiation exposure at the hand and body was reduced 60% (p = 0.058) and 32% (p = 0.073), respectively. Time for insertion did not vary between the two techniques.ConclusionsMinimally invasive pedicle screw placement with the aid of EMF image guidance reduces fluoroscopy time and increases placement accuracy when compared with traditional fluoroscopic guidance while adding no additional time to the procedure.

show abstract

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Minimally invasive percutaneous transpedicular screw fixation: increased accuracy and reduced radiation exposure by means of a novel electromagnetic navigation system

et al. 2010

View full text Add to dashboard Cite

show abstract

“…A computer-guided surgical navigation system has been reported to improve the accuracy of screw placement [5,13,16] but these systems are cumbersome and time-consuming and some, based on the preoperative CT imaging, have no utility following the reduction of a fracture and/or a dislocation. Furthermore, owing to their high cost and user unfriendliness, these systems are not installed in most hospitals.…”

Section: Discussionmentioning

confidence: 99%

Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope

et al. 2009

View full text Add to dashboard Cite

Cervical pedicle screw fixation is an effective procedure for stabilising an unstable motion segment; however, it has generally been considered too risky due to the potential for injury to neurovascular structures, such as the spinal cord, nerve roots or vertebral arteries. Since 1995, we have treated 144 unstable cervical injury patients with pedicle screws using a fluoroscopy-assisted pedicle axis view technique. The purpose of this study was to investigate the efficacy of this technique in accurately placing pedicle screws to treat unstable cervical injuries, and the ensuing clinical outcomes and complications. The accuracy of pedicle screw placement was postoperatively examined by axial computed tomography scans and oblique radiographs. Solid posterior bony fusion without secondary dislodgement was accomplished in 96% of all cases. Of the 620 cervical pedicle screws inserted, 57 (9.2%) demonstrated screw exposure (\50% of the screw outside the pedicle) and 24 (3.9%) demonstrated pedicle perforation ([50% of the screw outside the pedicle). There was one case in which a probe penetrated a vertebral artery without further complication and one case with transient radiculopathy. Pre-and postoperative tracheotomy was required in 20 (13.9%) of the 144 patients. However, the tracheotomies were easily performed, because those patients underwent posterior surgery alone without postoperative external fixation. The placement of cervical pedicle screws using a fluoroscopy-assisted pedicle axis view technique provided good clinical results and a few complications for unstable cervical injuries, but a careful surgical procedure was needed to safely insert the screws and more improvement in imaging and navigation system is expected.

show abstract

“…Many methods can be used to place an internal screw; some surgeons prefer to place the pedicle screw by free hand, referring to the anatomic landmarks (Kim et al, 2004; Miekisiak et al, 2015; Modi et al, 2008). To improve the accuracy of screw placement, or to place the screw percutaneously, various supporting methods, such as the use of an intra-operative C-arm X-ray monitor, and O-arm monitor and CT, have been studied (Assaker et al, 2001; Chiu et al, 2015; Tjardes et al, 2010). These methods had obvious advantages in the accuracy of screw placement, especially in the context of abnormal spinal structure or for surgeries at the thoracic level (Mason et al, 2014; Tian et al, 2011; Tian & Xu, 2009).…”

Section: Discussionmentioning

confidence: 99%

Improving the trajectory of transpedicular transdiscal lumbar screw fixation with a computer-assisted 3D-printed custom drill guide

Shao

Wang

Lin

et al. 2017

PeerJ

View full text Add to dashboard Cite

Transpedicular transdiscal screw fixation is an alternative technique used in lumbar spine fixation; however, it requires an accurate screw trajectory. The aim of this study is to design a novel 3D-printed custom drill guide and investigate its accuracy to guide the trajectory of transpedicular transdiscal (TPTD) lumbar screw fixation. Dicom images of thirty lumbar functional segment units (FSU, two segments) of L1–L4 were acquired from the PACS system in our hospital (patients who underwent a CT scan for other abdomen diseases and had normal spine anatomy) and imported into reverse design software for three-dimensional reconstructions. Images were used to print the 3D lumbar models and were imported into CAD software to design an optimal TPTD screw trajectory and a matched custom drill guide. After both the 3D printed FSU models and 3D-printed custom drill guide were prepared, the TPTD screws will be guided with a 3D-printed custom drill guide and introduced into the 3D printed FSU models. No significant statistical difference in screw trajectory angles was observed between the digital model and the 3D-printed model (P > 0.05). Our present study found that, with the help of CAD software, it is feasible to design a TPTD screw custom drill guide that could guide the accurate TPTD screw trajectory on 3D-printed lumbar models.

show abstract

Transpedicular Screw Placement

Cited by 106 publications

References 20 publications

Minimally invasive percutaneous transpedicular screw fixation: increased accuracy and reduced radiation exposure by means of a novel electromagnetic navigation system

Minimally invasive percutaneous transpedicular screw fixation: increased accuracy and reduced radiation exposure by means of a novel electromagnetic navigation system

Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope

Improving the trajectory of transpedicular transdiscal lumbar screw fixation with a computer-assisted 3D-printed custom drill guide

Contact Info

Product

Resources

About