Use of intraoperative fluoroscopy for the safe placement of C2 laminar screws: technical note

Engler, John A.; Smith, Michael L.

doi:10.1007/s00586-015-4165-x

Cited by 8 publications

(6 citation statements)

References 16 publications

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“…8,12,13,17,21,24,28,29,33,35 Injury to the vertebral artery has been reported to range between 0% and 8.2% 24 for posterior fixation techniques. Spinal navigation procedures promise to reduce the risk of posterior instrumentation techniques; 2,5,7,16,19,26,30,32,37 however, different navigation strategies suffer from inaccurate registration because of technical drawbacks and the instability of the pathology. 5,34 Applying intraoperative CT for navigation strategies may overcome these drawbacks since referencing is performed after positioning and reducing the unstable C1-2 pathology and thus improving accuracy.…”

Section: Discussionmentioning

confidence: 99%

“…Current techniques include the use of an intraoperative 3D fluoroscopy system aiming for autoregistration of the C1-2 segment or preoperative navigation CT scanning with subsequent surface matching to navigate the C1-2 segment. 2,5,7,11,16,19,26,30,32 Three-dimensional fluoroscopy systems suffer from an inaccurate registration process that imposes significant risk to cervical applications. 5,34 Preoperative navigation CT, which is usually performed with the patient supine, may be critical as the unstable pathol-ogy usually leads to different spinal alignment once the patient is positioned prone for surgery.…”

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confidence: 99%

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Spinal navigation for posterior instrumentation of C1–2 instability using a mobile intraoperative CT scanner

Czabanka¹,

Haemmerli²,

Hecht³

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVESpinal navigation techniques for surgical fixation of unstable C1–2 pathologies are challenged by complex osseous and neurovascular anatomy, instability of the pathology, and unreliable preoperative registration techniques. An intraoperative CT scanner with autoregistration of C-1 and C-2 promises sufficient accuracy of spinal navigation without the need for further registration procedures. The aim of this study was to analyze the accuracy and reliability of posterior C1–2 fixation using intraoperative mobile CT scanner–guided navigation.METHODSIn the period from July 2014 to February 2016, 10 consecutive patients with instability of C1–2 underwent posterior fixation using C-2 pedicle screws and C-1 lateral mass screws, and 2 patients underwent posterior fixation from C-1 to C-3. Spinal navigation was performed using intraoperative mobile CT. Following navigated screw insertion in C-1 and C-2, intraoperative CT was repeated to check for the accuracy of screw placement. In this study, the accuracy of screw positioning was retrospectively analyzed and graded by an independent observer.RESULTSThe authors retrospectively analyzed the records of 10 females and 2 males, with a mean age of 80.7 ± 4.95 years (range 42–90 years). Unstable pathologies, which were verified by fracture dislocation or by flexion/extension radiographs, included 8 Anderson Type II fractures, 1 unstable Anderson Type III fracture, 1 hangman fracture Levine Effendi Ia, 1 complex hangman-Anderson Type III fracture, and 1 destructive rheumatoid arthritis of C1–2. In 4 patients, critical anatomy was observed: high-riding vertebral artery (3 patients) and arthritis-induced partial osseous destruction of the C-1 lateral mass (1 patient). A total of 48 navigated screws were placed. Correct screw positioning was observed in 47 screws (97.9%). Minor pedicle breach was observed in 1 screw (2.1%). No screw displacement occurred (accuracy rate 97.9%).CONCLUSIONSpinal navigation using intraoperative mobile CT scanning was reliable and safe for posterior fixation in unstable C1–2 pathologies with high accuracy in this patient series.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Spinal navigation for posterior instrumentation of C1–2 instability using a mobile intraoperative CT scanner

Czabanka¹,

Haemmerli²,

Hecht³

et al. 2017

Journal of Neurosurgery: Spine

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“…Even though this technique was effective with only offthe-shelf equipment, radiation exposure to operators and patients was still inevitable 23,28 . In summary, many studies have attempted to modify the axial translaminar screw fixation or use auxiliary equipment, but the drawbacks are plentiful.…”

Section: Advantagesmentioning

confidence: 99%

“…There have been several attempts by many researchers to address these issues. Unfortunately, no matter how much we improve Wright's technology or turn to other assistive technologies, there are still plentiful drawbacks 19 , 20 , 21 , 22 , 23 . For example, the three‐dimensional fluoroscopy‐based image guidance technique as an assistive technology requires expensive equipment and complex operation.…”

Section: Introductionmentioning

confidence: 99%

Wright's Technique with the Addition of Visualized Axial Cortical Windows in Odontoid Fractures

Wang

Jin

Shao

et al. 2021

Orthopaedic Surgery

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This study sought to investigate and evaluate a modified axial translaminar screw fixation for treating odontoid fractures. We performed a retrospective study at Wenzhou Medical University Affiliated Second Hospital between March 2016 and June 2018. We retrospectively collected and analyzed the medical records of 23 cases with odontoid fractures. All patients were identified as type II odontoid fractures without neurological deficiency and serious diseases following the classification of Anderson. The average age, gender ratio, and body mass index (BMI) were 54.3 AE 11.1 years, 12 men to 11 women, and 22.6 AE 2.4 kg/m 2 , respectively. Patients in this study accepted screw fixation using our modified axial translaminar screw fixation combined with atlas pedicle or lateral mass screw fixation. Within the technique, a small cortical "window" was dug in the middle of the axial contralateral lamina, such that the screws in the lamina were visualized to prevent incorrectly implanting the posterior spinal canal through the visualized "window." A total of 46 bone screws were accurately inserted into the axial lamina without using fluoroscopy. The length of all translaminar screws ranged between 26 and 30 mm, while the diameter was 3.5 mm. During the followup survey, the visual analog scale (VAS) and neck disability index (NDI) were measured. We provide a simple modification of Wright's elegant technique with the addition of "visualized windows" at the middle of the axial lamina. In all patients, screws were inserted accurately without bony breach and the screw angle was 56.1 AE 3.0 . Mean operative time was 102 AE 28 min with an average blood loss of 50 AE 25 mL. Postoperative hemoglobin and mean length of hospital stay were 12.0 AE 1.4 g/dL and 10.4 AE 3.4 days, respectively. The average follow-up time of all cases was 14.7 months and no internal fixation displacement, loosening, or breakage was found. All patients with odontoid fractures reported being satisfied with the treatment during the recheck period and good clinical outcomes were observed. At 1, 6, and 12 months, NDI and VAS showed that the symptoms of neck pain and limitations of functional disability improved significantly during follow-up. Our results suggest that the modified translaminar screw fixation technique can efficiently treat Anderson type II odontoid fracture, followed by the benefits of less soft tissue dissection, simple operation, no fluoroscopy, and accurate placement of screws.

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“…In this type of surgery, an artificial reconstruction of the spine’s stability is performed by introducing a transpedicular screw–rod system into the spine [ 4 ]. The precise placement of the pedicle screws is one of the most intricate tasks because deviations from the targeted trajectory can result in injuries of the spinal cord, nerve roots or blood vessels [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Usability of Graphical Visualizations on a Tool-Mounted Interface for Spine Surgery

et al. 2021

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Screw placement in the correct angular trajectory is one of the most intricate tasks during spinal fusion surgery. Due to the crucial role of pedicle screw placement for the outcome of the operation, spinal navigation has been introduced into the clinical routine. Despite its positive effects on the precision and safety of the surgical procedure, local separation of the navigation information and the surgical site, combined with intricate visualizations, limit the benefits of the navigation systems. Instead of a tech-driven design, a focus on usability is required in new research approaches to enable advanced and effective visualizations. This work presents a new tool-mounted interface (TMI) for pedicle screw placement. By fixing a TMI onto the surgical instrument, physical de-coupling of the anatomical target and navigation information is resolved. A total of 18 surgeons participated in a usability study comparing the TMI to the state-of-the-art visualization on an external screen. With the usage of the TMI, significant improvements in system usability (Kruskal–Wallis test p < 0.05) were achieved. A significant reduction in mental demand and overall cognitive load, measured using a NASA-TLX (p < 0.05), were observed. Moreover, a general improvement in performance was shown by means of the surgical task time (one-way ANOVA p < 0.001).

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Use of intraoperative fluoroscopy for the safe placement of C2 laminar screws: technical note

Abstract: Use of intraoperative fluoroscopy is an easy and safe method for the placement of C2 laminar screws. Given its use of readily available equipment, this method can be implemented without significant pre-planning, or as an impromptu salvage maneuver.

Cited by 8 publications

References 16 publications

Spinal navigation for posterior instrumentation of C1–2 instability using a mobile intraoperative CT scanner

Spinal navigation for posterior instrumentation of C1–2 instability using a mobile intraoperative CT scanner

Wright's Technique with the Addition of Visualized Axial Cortical Windows in Odontoid Fractures

Usability of Graphical Visualizations on a Tool-Mounted Interface for Spine Surgery

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