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Phang SY, McCulloch C, Barrett C. Predicting metalwork following posterior fixation of thoracolumbar fractures. Br J Neurosurg 2025; 39:326-332. [PMID: 37608626 DOI: 10.1080/02688697.2023.2249550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/21/2022] [Accepted: 08/13/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Surgical fusion through posterior instrumentation and pedicle screw placement is a long established method for stabilising traumatic spinal fractures. Post-surgical complications include infection and metal work failure, the most common aetiology of which is pedicle screw fracture. Metal work failure rates vary from 15% to 60%. Research relating to factors which predict metal work failure in post-traumatic thoracolumbar spinal fixation is lacking. This study aimed to identify potential risk factors for metalwork failure in patients who had posterior fixation for traumatic thoracolumbar spine fractures. METHODS This retrospective cohort analysis was conducted by interrogating the hospital database for neurosurgical post-traumatic thoracolumbar fixation cases between 2015 and 2018 with at least 2 years follow up. Data was collected through electronic medical notes and PACS. Nineteen different patient factors (gender, age, mechanism of injury, presence of concomitant injury spinal or extra-spinal injury, pedicle cross-sectional area, pedicle cancellous bone density, pedicle total bone density, vertebral body bone density, erector spinae muscle density and lumbar spine subcutaneous fat thickness, Charlson comorbidity index, fracture location, surgical approach, long/short segment fixation, whether decompression was done, whether the index level was fixed, and presence of wound infection) were compared. RESULTS We identified 92 patients with 97 operations, and 9 cases of metal work failure. Two factors were statistically significantly associated with metal work failure: Post-operative wound infection (p = 0.029) and lumbar spine fat thickness (p = 0.024). The relative risk calculated in patients with a wound infection was 3.76. Lumbar spine fat thickness was on average 11.9 mm greater than patients not experiencing metal work failure. CONCLUSIONS This study has identified two factors associated with increased rates of metal work failure: Post-operative wound infection and lumbar spine fat thickness. When assessing surgical candidates these factors may be incorporated into surgical planning.
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Affiliation(s)
- See Yung Phang
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, Scotland
| | - Cullen McCulloch
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, Scotland
| | - Christopher Barrett
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, Scotland
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De Biase G, Gruenbaum BF, Bojaxhi E, Patterson JS, Sabetta K, Quinones-Hinojosa A, Abode-Iyamah K. Awake Minimally Invasive Surgery Transforaminal Lumbar Interbody Fusion Under Spinal Anesthesia: Screw Placement Accuracy and 1 Year Follow-Up. World Neurosurg 2025; 194:123478. [PMID: 39577632 DOI: 10.1016/j.wneu.2024.11.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2024] [Revised: 11/12/2024] [Accepted: 11/13/2024] [Indexed: 11/24/2024]
Abstract
OBJECTIVE We assessed the accuracy of pedicle screws placed during awake minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF) under spinal anesthesia and analyzed outcomes at the 1-year follow-up. METHODS We included patients who underwent awake MIS-TLIF under spinal anesthesia at an academic center from February 2020 to February 2022. The Gertzbein-Robbins classification was used for screw accuracy rating. RESULTS A total of 100 pedicle screws were inserted in 24 patients, with the most common level being L4-5. Median age was 63.5 ± 16.5 (interquartile range) years, 42% male, median body mass index 28 ± 6 kg/m2, and median American Society of Anesthesiologists class was 2 ± 1. Two patients underwent a 2-level fusion, and 22 patients underwent a 1-level fusion. Median estimated blood loss was 35 ± 25 mL, median length of stay was 0 ± 1 day, with 54% of patients going home on the day of surgery, and the only intraoperative complication was 1 durotomy. Median procedure time was 112 ± 23.5 minutes, and median operating room time (including the spinal block) was 159.5 ± 32.7 minutes; 67% of the screws were placed with navigation, and 33% were robotic-assisted (Mazor X); 99% of the screws were Gertzbein Robins grade A, and 1% grade E. At the 1 year follow-up, computed tomography showed no evidence of pseudarthrosis, and all patients reported improvement in their presenting symptoms. CONCLUSIONS Our study shows a high accuracy (99%) of pedicle screw placement in patients undergoing awake MIS-TLIF under spinal anesthesia and significant improvement of their symptoms at 1-year follow-up.
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Affiliation(s)
- Gaetano De Biase
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Elird Bojaxhi
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Katherine Sabetta
- Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, USA
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Dhake P, Shinde S, Aphale S. Effect of Lumbar Spinal Stabilization Exercises Along With Neural Tissue Mobilization on Pain and Spinal Dysfunction in Failed Back Surgery Syndrome. Cureus 2024; 16:e72396. [PMID: 39583442 PMCID: PMC11586110 DOI: 10.7759/cureus.72396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Accepted: 10/25/2024] [Indexed: 11/26/2024] Open
Abstract
Background Failed back surgery syndrome (FBSS) mainly involves back pain radiating to the lower limb after back-related surgeries. It can develop various complications around the operation site and its surrounding area. This study evaluates the effect of lumbar spinal stabilization exercises and neural tissue mobilization on pain and spinal dysfunction in FBSS. Objectives To study the impact of lumbar spinal stabilization exercises and neural tissue mobilization on pain and spinal dysfunction in FBSS. To compare the impact of lumbar spinal stabilization exercises and neural tissue mobilization with conventional therapy on pain and spinal dysfunction in FBSS. Methods The study included 76 participants aged 45-60 with back pain radiating to lower limbs after back-related surgeries within the past six months. Participants were randomly assigned to either a conventional treatment group (Group A) or an experimental exercise program group (Group B). The treatment duration was six weeks and data were analyzed by a paired t-test for within-group analysis and an unpaired t-test for between-group analysis. Results Both groups A and B showed significant differences in all three outcome measures. However, Group B showed extremely significant improvement (<0.0001) in outcome measures, including pain, lumbar muscle strength by manual muscle testing, and modified Oswestry index assessment compared to Group A. Conclusion Both conventional and experimental groups showed a significant impact on the pain and level of function in failed back surgery syndrome patients. However, lumbar stabilization exercises along with neural tissue mobilization (Group B) showed a more pronounced impact on all outcomes such as pain reduction and improvement in lumbar flexor, rotator, and extensor muscle strength and modified Oswestry index compared to the conventional treatment group (Group A).
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Affiliation(s)
- Pradnya Dhake
- Department of Musculoskeletal Sciences, Krishna College of Physiotherapy, Krishna Vishwa Vidyapeeth Deemed to be University, Karad, IND
| | - Sandeep Shinde
- Department of Musculoskeletal Sciences, Krishna College of Physiotherapy, Krishna Vishwa Vidyapeeth Deemed to be University, Karad, IND
| | - Sawani Aphale
- Department of Musculoskeletal Sciences, Krishna College of Physiotherapy, Krishna Vishwa Vidyapeeth Deemed to be University, Karad, IND
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Kanhangad MP, Srinivasa V, Thirugnanam B, Soni A, Kashyap A, Vidyadhara A, Rao SK. Robotic spine systems: overcoming surgeon experience in pedicle screw accuracy: a prospective study. Asian Spine J 2024; 18:663-672. [PMID: 39434223 PMCID: PMC11538820 DOI: 10.31616/asj.2024.0191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 08/09/2024] [Accepted: 08/11/2024] [Indexed: 10/23/2024] Open
Abstract
STUDY DESIGN Prospective single-center study. PURPOSE To compare the accuracy of pedicle screws placed by freehand and under fluoroscopy and robotic assistance with intraoperative image acquisition. OVERVIEW OF LITERATURE Pedicle screws are the most commonly used spinal anchors owing to their ability to stabilize all three spinal columns. Various techniques such as freehand, fluoroscopy-assisted, and navigation-assisted pedicle screw placements have been used with varying degrees of accuracy. Most studies on robotic-assisted pedicle screw placement have utilized preoperatively acquired computed tomography scans. To our knowledge, this is the only study in the literature that compared freehand with fluoroscopy-guided and robotic-assisted pedicle screw insertion with freehand and fluoroscopy. METHODS In this prospective study, a total of 1,120 pedicle screws were placed in the freehand group (n=175), 1,250 in the fluoroscopyassisted group (n=172), and 1,225 in the robotic-assisted group (n=180). Surgical parameters and screw accuracy were analyzed between the three groups. The preoperative plan overlapped with the postoperative O-arm scan to determine if the screws were executed as planned. RESULTS The frequency of clinically acceptable screw placement (Gertzbein-Robbins grades A and B) in the freehand, fluoroscopy-assisted, and robotic-assisted groups were 97.7%, 98.6%, and 99.34%, respectively. With robotic assistance, an experience-neutralizing effect implied that surgeons with varying levels of experience achieved comparable pedicle screw accuracy, blood loss, O-arm time, robot time, and time per screw. No significant difference in these parameters was found between surgeries commencing before and after 2 PM. No significant differences were noted between the planned and executed screw trajectories in the robotic-assisted group irrespective of surgical experience. CONCLUSIONS The third-generation robotic-assisted pedicle screw placement system used in conjunction with intraoperative threedimensional O-arm imaging consistently demonstrates safe and accurate screw placement with an experience-neutralizing effect.
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Affiliation(s)
- Madhava Pai Kanhangad
- Manipal Institute of Robotic Spine Surgery, Manipal Comprehensive Spine Care Centre, Manipal Hospital, Bangalore,
India
- Department of Orthopaedics, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal,
India
| | - Vidyadhara Srinivasa
- Manipal Institute of Robotic Spine Surgery, Manipal Comprehensive Spine Care Centre, Manipal Hospital, Bangalore,
India
- Department of Orthopaedics, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal,
India
| | - Balamurugan Thirugnanam
- Manipal Institute of Robotic Spine Surgery, Manipal Comprehensive Spine Care Centre, Manipal Hospital, Bangalore,
India
| | - Abhishek Soni
- Manipal Institute of Robotic Spine Surgery, Manipal Comprehensive Spine Care Centre, Manipal Hospital, Bangalore,
India
| | - Anjana Kashyap
- Department of Spine Anesthesia, Manipal Comprehensive Spine Care Center, Manipal Hospital, Bangalore,
India
- Department of Anesthesiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal,
India
| | - Alia Vidyadhara
- Department of Spine Anesthesia, Manipal Comprehensive Spine Care Center, Manipal Hospital, Bangalore,
India
| | - Sharath Kumar Rao
- Department of Orthopaedics, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal,
India
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Chen Y, Yang J, Liang J, Wu W. The optimal introversion angle and length of pedicle screw to avoid L1-S1 vascular damage. BMC Surg 2024; 24:194. [PMID: 38907190 PMCID: PMC11191234 DOI: 10.1186/s12893-024-02483-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 06/14/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND posterior pedicle screw fixation is common method, one of the most severe complications is iatrogenic vascular damage, no report investigated association of different introversion angles (INTAs) and length of pedicle screw. The aims were to investigate the optimal introversion angle and length of pedicle screw for improving the safety of the operation, and to analyze the differences of vascular damage types at L1-S1. METHODS Lumbar CT imaging data from110 patients were analyzed by DICOM software, and all parameters were measured by new Cartesian coordinate system, INTAs (L1-L5:5°,10°,15°,S1: 0°, 5°,10°,15°), DO-AVC (the distance between the origin (O) with anterior vertebral cortex (AVC)), DAVC-PGVs (the distance between AVC and the prevertebral great vessels (PGVs)), DO-PGVs (the distance between the O and PGVs). At different INTAs, DAVC-PGVs were divided into four grades: Grade III: DAVC-PGVs ≤ 3 mm, Grade II: 3 mm < DAVC-PGVs ≤ 5 mm, Grade I: DAVC-PGVs > 5 mm, and N: the not touching PGVs. RESULTS The optimal INTA was 5° at L1-L3, the left was 5° and the right was 15° at L4, and screw length was less than 50 mm at L1-L4. At L5, the left optimal INTA was 5° and the right was 10°, and screw length was less than 45 mm. The optimal INTA was 15° at S1, and screw length was less than 50 mm. However, screw length was less than 40 mm when the INTA was 0° or 5° at S1. CONCLUSIONS At L5-S1, the risk of vascular injury is the highest. INTA and length of the pedicle screw in lumbar operation are closely related. 3 mm interval of screw length may be more preferable to reduce vascular damage.
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Affiliation(s)
- Ying Chen
- Yichang Central People's Hospital Hubei, Hubei, China
| | - Junyi Yang
- Department of Orthopedics, The First College of Clinical Medical Science, China Three Gorges University, Hubei, China
| | - Jie Liang
- Department of Orthopedics, The First College of Clinical Medical Science, China Three Gorges University, Hubei, China
- Yichang Central People's Hospital Hubei, Hubei, China
| | - Weifei Wu
- Department of Orthopedics, The First College of Clinical Medical Science, China Three Gorges University, Hubei, China.
- Yichang Central People's Hospital Hubei, Hubei, China.
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Yuan S, Chen R, Zang L, Wang A, Fan N, Du P, Xi Y, Wang T. Development of a software system for surgical robots based on multimodal image fusion: study protocol. Front Surg 2024; 11:1389244. [PMID: 38903864 PMCID: PMC11187239 DOI: 10.3389/fsurg.2024.1389244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/29/2024] [Indexed: 06/22/2024] Open
Abstract
Background Surgical robots are gaining increasing popularity because of their capability to improve the precision of pedicle screw placement. However, current surgical robots rely on unimodal computed tomography (CT) images as baseline images, limiting their visualization to vertebral bone structures and excluding soft tissue structures such as intervertebral discs and nerves. This inherent limitation significantly restricts the applicability of surgical robots. To address this issue and further enhance the safety and accuracy of robot-assisted pedicle screw placement, this study will develop a software system for surgical robots based on multimodal image fusion. Such a system can extend the application range of surgical robots, such as surgical channel establishment, nerve decompression, and other related operations. Methods Initially, imaging data of the patients included in the study are collected. Professional workstations are employed to establish, train, validate, and optimize algorithms for vertebral bone segmentation in CT and magnetic resonance (MR) images, intervertebral disc segmentation in MR images, nerve segmentation in MR images, and registration fusion of CT and MR images. Subsequently, a spine application model containing independent modules for vertebrae, intervertebral discs, and nerves is constructed, and a software system for surgical robots based on multimodal image fusion is designed. Finally, the software system is clinically validated. Discussion We will develop a software system based on multimodal image fusion for surgical robots, which can be applied to surgical access establishment, nerve decompression, and other operations not only for robot-assisted nail placement. The development of this software system is important. First, it can improve the accuracy of pedicle screw placement, percutaneous vertebroplasty, percutaneous kyphoplasty, and other surgeries. Second, it can reduce the number of fluoroscopies, shorten the operation time, and reduce surgical complications. In addition, it would be helpful to expand the application range of surgical robots by providing key imaging data for surgical robots to realize surgical channel establishment, nerve decompression, and other operations.
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Affiliation(s)
| | | | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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ElSheikh MO, Makia MA, Yahia MA, Arnaout MM. Unilateral pedicle screw fixation with interbody fusion in lumbar degenerative disease. INTERDISCIPLINARY NEUROSURGERY 2024; 36:101850. [DOI: 10.1016/j.inat.2023.101850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2025] Open
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Aydin E, Schenk P, Jacobi A, Mendel T, Klauke F, Ullrich BW. Percutaneous reduction of thoracolumbar fractures using monoaxial screws: Comparison of two instruments based on initial reduction and loss of reduction. BRAIN & SPINE 2024; 4:102778. [PMID: 38584864 PMCID: PMC10995800 DOI: 10.1016/j.bas.2024.102778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 04/09/2024]
Abstract
Introduction Percutaneous techniques for the surgical treatment of vertebral fractures are constantly progressing. There are different biomechanics involved. Research question Two percutaneous, monoaxial fixation systems with different reduction tools were analyzed in relation to their reduction capacity. Additionally, the impact of anterior fusion, fracture severity and bone quality on reduction and loss of reduction were examined. Material and methods 117 cases were retrospectively included in the monocentric study. The subsample (N = 53) with complete data at follow-up times was used to analyze the influence of anterior fusion. The dependencies on fracture severity and bone quality were determined using Spearman and Pearson correlation. Results Both systems achieved equally good reduction (9° mean, 95%-CI: 8°-11°, p < 0.001). Anterior fused patients showed not significant (p = 0.057) less loss of reduction over time. Fracture severity had neither an influence on reduction or loss of reduction. Bone quality was positively correlated with greater amount of reduction and less loss of reduction. Early reduction within two days correlated with a greater amount of reduction (p = 0.006). Screw diameters and the patient's weight had no influence on loss of reduction. Complications occurred only in "V2" group. Discussion and conclusion Both systems are equivalent in reduction ability. The additional anterior fusion did not result in significantly lower reduction losses. The subsample being small, is a limitation. Good bone quality correlates with better initial reduction and less reduction loss. A preoperative bone density measurement can lead to optimization of surgical techniques.
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Affiliation(s)
- Esra Aydin
- Department of Internal Medicine – Cardiology, DRK Kliniken Köpenick, Berlin, Germany
| | - Philipp Schenk
- Department of Science, Research and Education, BG Klinikum Bergmannstrost Halle gGmbH, 06112, Halle, Germany
| | - Arija Jacobi
- Department of Orthopedic and Trauma Surgery, DIAKO Ev. Diakonie-Krankenhaus gGmbH, 28239, Bremen, Germany
| | - Thomas Mendel
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle, Germany
- Clinic for Trauma, Hand and Reconstructive Surgery, University Hospital Halle, Martin Luther University Halle-Wittenberg, Germany
| | - Friederike Klauke
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle, Germany
| | - Bernhard Wilhelm Ullrich
- Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle, Germany
- Clinic for Trauma, Hand and Reconstructive Surgery, University Hospital Halle, Martin Luther University Halle-Wittenberg, Germany
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Hwang YH, Ha BJ, Kim HC, Lee BH, Park JY, Chin DK, Yi S. A Propensity Score-Matched Cohort Study Comparing 3 Different Spine Pedicle Screw Fixation Methods: Freehand, Fluoroscopy-Guided, and Robot-Assisted Techniques. Neurospine 2024; 21:83-94. [PMID: 38569633 PMCID: PMC10992644 DOI: 10.14245/ns.2448036.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE This study aimed to compare the accuracy of robotic spine surgery and conventional pedicle screw fixation in lumbar degenerative disease. We evaluated clinical and radiological outcomes to demonstrate the noninferiority of robotic surgery. METHODS This study employed propensity score matching and included 3 groups: robot-assisted mini-open posterior lumbar interbody fusion (PLIF) (robotic surgery, RS), c-arm guided minimally invasive surgery transforaminal lumbar interbody fusion (C-arm guidance, CG), and freehand open PLIF (free of guidance, FG) (54 patients each). The mean follow-up period was 2.2 years. The preoperative spine condition was considered. Accuracy was evaluated using the Gertzbein-Robbins scale (GRS score) and Babu classification (Babu score). Radiological outcomes included adjacent segmental disease (ASD) and mechanical failure. Clinical outcomes were assessed based on the visual analogue scale, Oswestry Disability Index, 36-item Short Form health survey, and clinical ASD rate. RESULTS Accuracy was higher in the RS group (p < 0.01) than in other groups. The GRS score was lower in the CG group, whereas the Babu score was lower in the FG group compared with the RS group. No significant differences were observed in radiological and clinical outcomes among the 3 groups. Regression analysis identified preoperative facet degeneration, GRS and Babu scores as significant variables for radiological and clinical ASD. Mechanical failure was influenced by the GRS score and patients' age. CONCLUSION This study showed the superior accuracy of robotic spine surgery compared with conventional techniques. When combined with minimally invasive surgery, robotic surgery is advantageous with reduced ligament and muscle damage associated with traditional open procedures.
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Affiliation(s)
- Yoon Ha Hwang
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong-Jin Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Hyung Cheol Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Byung Ho Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Yoon Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Kyu Chin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
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Zhu Z, Hu S, Zeng W, Cen S, Liu Y, Zhang W, Shi B. Effect of L5 spinal canal type on pedicle screw placement based on CT imaging: a retrospective clinical study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:298-306. [PMID: 37659047 DOI: 10.1007/s00586-023-07904-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/03/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The objective of this study was to investigate the optimal entry point and pedicle camber angle for L5 pedicle screws of different canal types. METHODS CT imaging data were processed by Mimics for simulated pedicle screw placement, and PD (Pedicle diameter), PCA (Pedicle camber angle), LD (Longitudinal distance), TD (Transverse distance), and PBG (Pedicle screw breach grade) were measured. Then they were divided into the Round group and Trefoil group according to the type of spinal canal. When comparing PD, PCA, LD, TD, and PBG, the two sides of the pedicle were compared separately, so they were first divided into the round-type pedicle group and the trefoil-type pedicle group. RESULTS In the round-type pedicle group (n = 134) and the trefoil-type pedicle group (n = 264), there was no significant difference in PD and LD, but there was a significant difference in PCA between the two groups (t = - 4.072, P < 0.05). A statistically significant difference in the distance of the Magerl point relative to the optimal entry point (t = - 3.792, P < 0.05), and the distance of the Magerl point relative to the optimal entry point was greater in the trefoil-type pedicle group than in the round-type pedicle group. CONCLUSION The optimal entry point for L5 is more outward than the Magerl point, and the Trefoil spinal canal L5 is more outwardly oriented than the Round spinal canal L5, with a greater angle of abduction during pedicle screw placement.
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Affiliation(s)
- Zhemin Zhu
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Shengxuan Hu
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Weibo Zeng
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Shuizhong Cen
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Yubin Liu
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Wei Zhang
- Department of Bone and Joint, Panyu Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China.
| | - Benchao Shi
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China.
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Budwany R, Fishman MA, Abd-Elsayed A, Falowski SM. Posterior spinal fusion. SPINAL FUSION TECHNIQUES 2024:59-62. [DOI: 10.1016/b978-0-323-88223-1.00015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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12
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Avrumova F, Abel F, Zelenty WD, Goldman SN, Lebl DR. Prospective Comparison of Two Robotically Navigated Pedicle Screw Instrumentation Techniques. J Robot Surg 2023; 17:2711-2719. [PMID: 37606872 DOI: 10.1007/s11701-023-01694-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023]
Abstract
This study aimed to compare screw accuracy and incidence of skive between two robotically navigated instrumented techniques in posterior spine fusion surgery: manual anti-skive instrumentation with an anti-skive cannula (ASC) and the use of a navigated, high-speed drill (HSD). Over a 3-year period, consecutive patients are undergoing RNA posterior fusion surgery with either ASC (n = 53) or HSD (n = 63). Both groups met a value of approximately 292 screws in our analysis (296 ASC, 294 HSD), which was determined by a biostatistician at an academic institution. Screw accuracy and skive was analyzed using preoperative CT and intraoperative three-dimensional (3D) fluoroscopy. Among 590 planned robotically inserted pedicle screws (296 ASC, 294 HSD), 245 ASC screws (82.8%) and 283 HSD screws (96.3%) were successfully inserted (p < 0.05). Skive events occurred in 4/283 (1.4%) HSD screws and 15/245 (6.2%) ASC screws (p < 0.05). HSD screws showed better accuracy in the axial and sagittal planes, being closer to planned trajectories in all directions except cranial deviation (p < 0.05). Additionally, HSD had a significantly lower time per screw (1.9 ± 1.0 min) compared to ASC (3.2 ± 2.0 min, p < 0.001). No adverse clinical effects were observed. The HSD technique showed significant improvements in time and screw accuracy compared to ASC. Biplanar fluoroscopy and 3D imaging resulted in significantly lower radiation exposure and time compared to ASC. These significant findings in the HSD group may be attributed to the lower occurrence of malpositioned screws, leading to a decrease in the need for second authentication. This represents a notable iterative improvement of the RNA platform.
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Affiliation(s)
- Fedan Avrumova
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Frederik Abel
- Department of Radiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - William D Zelenty
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Samuel N Goldman
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Darren R Lebl
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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13
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Jiang K, Hersh AM, Bhimreddy M, Weber-Levine C, Davidar AD, Menta AK, Routkevitch D, Alomari S, Judy BF, Lubelski D, Weingart J, Theodore N. Learning Curves for Robot-Assisted Pedicle Screw Placement: Analysis of Operative Time for 234 Cases. Oper Neurosurg (Hagerstown) 2023; 25:482-488. [PMID: 37578266 DOI: 10.1227/ons.0000000000000862] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/07/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Robot-assisted pedicle screw placement is associated with greater accuracy, reduced radiation, less blood loss, shorter hospital stays, and fewer complications than freehand screw placement. However, it can be associated with longer operative times and an extended training period. We report the initial experience of a surgeon using a robot system at an academic medical center. METHODS We retrospectively reviewed all patients undergoing robot-assisted pedicle screw placement at a single tertiary care institution by 1 surgeon from 10/2017 to 05/2022. Linear regression, analysis of variance, and cumulative sum analysis were used to evaluate operative time learning curves. Operative time subanalyses for surgery indication, number of levels, and experience level were performed. RESULTS In total, 234 cases were analyzed. A significant 0.19-minute decrease in operative time per case was observed (r = 0.14, P = .03). After 234 operations, this translates to a reduction in 44.5 minutes from the first to last case. A linear relationship was observed between case number and operative time in patients with spondylolisthesis (-0.63 minutes/case, r = 0.41, P < .001), 2-level involvement (-0.35 minutes/case, r = 0.19, P = .05), and 4-or-more-level involvement (-1.29 minutes/case, r = 0.24, P = .05). This resulted in reductions in operative time ranging from 39 minutes to 1.5 hours. Continued reductions in operative time were observed across the learning, experienced, and expert phases, which had mean operative times of 214, 197, and 146 minutes, respectively ( P < .001). General proficiency in robot-assisted surgery was observed after the 20th case. However, 67 cases were required to reach mastery, defined as the inflection point of the cumulative sum curve. CONCLUSION This study documents the long-term learning curve of a fellowship-trained spine neurosurgeon. Operative time significantly decreased with more experience. Although gaining comfort with robotic systems may be challenging or require additional training, it can benefit surgeons and patients alike with continued reductions in operative time.
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Affiliation(s)
- Kelly Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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14
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Ye S, Chen YZ, Zhong LJ, Yu CZ, Zhang HK, Hong Y. TINAVI robot-assisted one-stage anteroposterior surgery in lateral position for severe thoracolumbar fracture dislocation: A case report. World J Clin Cases 2023; 11:5358-5364. [PMID: 37621589 PMCID: PMC10445060 DOI: 10.12998/wjcc.v11.i22.5358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/22/2023] [Accepted: 07/10/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The combined anterior/posterior approach appears to be capable of reconstructing spinal stability, correcting thoracolumbar deformity, and promoting neural recovery in severe thoracolumbar fracture dislocation. However, this type of operation requires changing the body position during the procedure, resulting in a lengthy operation time. As a universal surgical robot, TINAVI robot has achieved good surgical results in clinical surgery. But to our knowledge, no reports describing TINAVI robot-assisted single lateral position anteroposterior surgery for thoracolumbar fracture dislocation. CASE SUMMARY We describe a case of a 16-year-old female patient with severe thoracolumbar fracture and dislocation underwent surgery assisted by the TINAVI robot. A one-stage combined anterior and posterior operation was performed on a severe thoracolumbar fracture dislocation using the TINAVI robot, and the operation was completed in right lateral position. CONCLUSION The TINAVI robot-assisted one-stage anterior and posterior surgery in right lateral position for severe thoracolumbar fracture and dislocation is both safe and effective.
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Affiliation(s)
- Sen Ye
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Yan-Zhen Chen
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Ling-Jian Zhong
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Chang-Zhang Yu
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Han-Kun Zhang
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Yang Hong
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
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15
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Ye S, Chen YZ, Zhong LJ, Yu CZ, Zhang HK, Hong Y. TINAVI robot-assisted one-stage anteroposterior surgery in lateral position for severe thoracolumbar fracture dislocation: A case report. World J Clin Cases 2023; 11:5352-5358. [DOI: 10.12998/wjcc.v11.i22.5352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/22/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The combined anterior/posterior approach appears to be capable of reconstructing spinal stability, correcting thoracolumbar deformity, and promoting neural recovery in severe thoracolumbar fracture dislocation. However, this type of operation requires changing the body position during the procedure, resulting in a lengthy operation time. As a universal surgical robot, TINAVI robot has achieved good surgical results in clinical surgery. But to our knowledge, no reports describing TINAVI robot-assisted single lateral position anteroposterior surgery for thoracolumbar fracture dislocation.
CASE SUMMARY We describe a case of a 16-year-old female patient with severe thoracolumbar fracture and dislocation underwent surgery assisted by the TINAVI robot. A one-stage combined anterior and posterior operation was performed on a severe thoracolumbar fracture dislocation using the TINAVI robot, and the operation was completed in right lateral position.
CONCLUSION The TINAVI robot-assisted one-stage anterior and posterior surgery in right lateral position for severe thoracolumbar fracture and dislocation is both safe and effective.
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Affiliation(s)
- Sen Ye
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Yan-Zhen Chen
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Ling-Jian Zhong
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Chang-Zhang Yu
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Han-Kun Zhang
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
| | - Yang Hong
- Department of Spine Surgery, Xingguo Hospital Affiliated to Gannan Medical College, Ganzhou 342400, Jiangxi Province, China
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Yamada T, Hasegawa T, Yamato Y, Yoshida G, Banno T, Arima H, Oe S, Mihara Y, Ushirozako H, Ide K, Watanabe Y, Nakai K, Kurosu K, Matsuyama Y. Characteristics of pedicle screw misplacement using freehand technique in degenerative scoliosis surgery. Arch Orthop Trauma Surg 2023; 143:1861-1867. [PMID: 35194658 DOI: 10.1007/s00402-022-04380-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 02/05/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to estimate the accuracy of pedicle screw (PS) placement in degenerative scoliosis surgery, characterize a patient population with PS misplacement, and analyze the association between misplaced PS vector and lumbar coronal curve. METHODS In this study, 122 patients (average age 68.6 years), who underwent corrective and decompression surgery, were selected retrospectively. PS accuracy was evaluated in the thoracic to lumbar spine. We identified characteristics of misplacement in each patient. Screw positions were categorized into grade A, entirely in the pedicle; grade B, < 2 mm breach; grade C, 2-4 mm breach; and grade D, > 4 mm breach using postoperative computed tomography. RESULTS The mean preoperative lumbar coronal curve was 32.3 ± 18.4°, and the number of fused vertebrae was 8.9 ± 2.8. A total of 2032 PS were categorized as follows: grade A, 1897 PS (93.3%); grade B, 67 (3.3%); grade C, 26 (1.3%); and grade D, 43 (2.1%). One PS (grade D), inserted at T5, needed surgery for removal due to neurological deficit. The misplacement group (grades C and D) had a significantly stronger lumbar coronal curve and apical vertebral rotation than the accuracy group (grades A and B). Misplaced PS vector (direction and degree) was significantly correlated with inserted vertebral rotation. Grade D misplacement was distributed mainly around the transitional vertebra of the lumbar curve. CONCLUSIONS The accuracy of PS insertion in the thoracic to lumbar spine was high in DS surgery, but the need for care was highlighted in the transitional vertebra.
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Affiliation(s)
- Tomohiro Yamada
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan.
| | - Tomohiko Hasegawa
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Yu Yamato
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Go Yoshida
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Tomohiro Banno
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Hideyuki Arima
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Shin Oe
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka, Japan
| | - Yuki Mihara
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Hiroki Ushirozako
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Koichiro Ide
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Yuh Watanabe
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Keiichi Nakai
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Kenta Kurosu
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan
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17
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Degulmadi D, Dave B, Krishnan A, Rai RR, Mayi S, Chintam CR. 'Higher the grade-smaller the pedicle': a study of pedicle dimensional variations in 100 cases of high grade lytic spondylolisthesis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:455-461. [PMID: 35767112 DOI: 10.1007/s00586-022-07277-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To measure the pedicle dimensions in high grade lytic spondylolisthesis (HGL) and to classify them, which helps the spine surgeon in proper selection of pedicle screws. METHODS A study of CT scans in 100 consecutive patients between Jan 2017 and April 2021 diagnosed as single-level HGL on standing radiographs. Pedicle height (PH), Pedicle width (PW), Differential pedicle height (DPH), Screw length (SL) and Transverse pedicle angle (TPA) were measured and analyzed. PH and PW were classified into four grades as-grade A less than 5.0 mm, grade B between 5.0 and 6.0 mm, grade C between 6.0 and 7.0 mm, and grade D above 7.0 mm. RESULTS 5 males and 95 females with mean age of 49.1 years. PH in 44% lytic vertebra were grade A, B (less than 6 mm) and the rest 56% had grade C, D (greater than 6 mm). PH averaged 6.6 mm in grade 3 HGL, 5.61 mm in grade 4 HGL. Change in PW, SL and TPA was not statistically significant with regards to grade or level of listhesis. A total of 37 cases were noted to have DPH (25 cases had a difference < 2 mm and 12 had a difference > 2 mm). CONCLUSION 44% of the PH in lytic vertebra was grade A and B (less than 6 mm) that stresses the importance of pre-op CT assessment and planning the appropriate screw dimensions. Change in PH was statistically significant with regards to the grade of listhesis (P-value < 0.01). Differential pedicle height also need to be looked for.
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Affiliation(s)
| | - Bharat Dave
- Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - Ajay Krishnan
- Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - Ravi Ranjan Rai
- Stavya Spine Hospital and Research Institute, Ahmedabad, India
| | - Shivanand Mayi
- Stavya Spine Hospital and Research Institute, Ahmedabad, India
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18
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Chiu YC, Yang SC, Kao YH, Tu YK. Percutaneous Sacroplasty for Symptomatic Sacral Pedicle Screw Loosening. Indian J Orthop 2023; 57:96-101. [PMID: 36660492 PMCID: PMC9789267 DOI: 10.1007/s43465-022-00773-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/07/2022] [Indexed: 11/25/2022]
Abstract
Background This study aimed to evaluate the efficacy of fluoroscopy-guided percutaneous sacroplasty in patients with sacral pedicle screws loosening after instrumented spinal fusion. Methods We retrospectively reviewed the medical records of 18 patients who underwent percutaneous sacroplasty to treat sacral pedicle screws loosening from January 2016 to December 2019. Imaging studies, visual analog scale (VAS), length of hospital stay, and complications were recorded. The clinical outcomes based on the Oswestry disability index (ODI) and the modified Brodsky's criteria (MBC) were also evaluated to determine the efficacy of percutaneous sacroplasty. Results All patients had undergone at least 1 year of follow-up in our institute (range, 12-24 months). The average VAS score was 5.6 (range, 4-7) before surgery and decreased to 1.7 (range, 1-3) at the final visit. All patients were discharged on the next day after surgery. No patients experienced complications, such as cement leakage, deep infection, or neurologic deterioration. All patients achieved good or excellent outcomes based on the MBC. The ODI scores improved from 51.8 preoperatively to 25.6 postoperatively. Conclusion Percutaneous sacroplasty was an effective treatment approach for relieving the patient's symptoms caused by sacral pedicle screws loosening and could be a valuable treatment alternative to extensive revision surgery. Level of clinical evidence IV.
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Affiliation(s)
- Yen-Chun Chiu
- Department of Orthopedic Surgery, E-Da Hospital, I-Shou University, No. 1, E-Da Road, Kaohsiung City, 82445 Taiwan, ROC
| | - Shih-Chieh Yang
- Department of Orthopedic Surgery, E-Da Hospital, I-Shou University, No. 1, E-Da Road, Kaohsiung City, 82445 Taiwan, ROC
| | - Yu-Hsien Kao
- Department of Orthopedic Surgery, E-Da Hospital, I-Shou University, No. 1, E-Da Road, Kaohsiung City, 82445 Taiwan, ROC
| | - Yuan-Kun Tu
- Department of Orthopedic Surgery, E-Da Hospital, I-Shou University, No. 1, E-Da Road, Kaohsiung City, 82445 Taiwan, ROC
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19
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Sayed D, Grider J, Strand N, Hagedorn JM, Falowski S, Lam CM, Tieppo Francio V, Beall DP, Tomycz ND, Davanzo JR, Aiyer R, Lee DW, Kalia H, Sheen S, Malinowski MN, Verdolin M, Vodapally S, Carayannopoulos A, Jain S, Azeem N, Tolba R, Chang Chien GC, Ghosh P, Mazzola AJ, Amirdelfan K, Chakravarthy K, Petersen E, Schatman ME, Deer T. The American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain. J Pain Res 2022; 15:3729-3832. [PMID: 36510616 PMCID: PMC9739111 DOI: 10.2147/jpr.s386879] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety. Objective The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders. Methods The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented. Results After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain. Conclusion The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.
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Affiliation(s)
- Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA,Correspondence: Dawood Sayed, The University of Kansas Health System, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA, Tel +1 913-588-5521, Email
| | - Jay Grider
- University of Kentucky, Lexington, KY, USA
| | - Natalie Strand
- Interventional Pain Management, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Steven Falowski
- Functional Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | - Christopher M Lam
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Vinicius Tieppo Francio
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Nestor D Tomycz
- AHN Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Rohit Aiyer
- Interventional Pain Management and Pain Psychiatry, Henry Ford Health System, Detroit, MI, USA
| | - David W Lee
- Physical Medicine & Rehabilitation and Pain Medicine, Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA
| | - Hemant Kalia
- Rochester Regional Health System, Rochester, NY, USA,Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Soun Sheen
- Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA
| | - Mark N Malinowski
- Adena Spine Center, Adena Health System, Chillicothe, OH, USA,Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Michael Verdolin
- Anesthesiology and Pain Medicine, Pain Consultants of San Diego, San Diego, CA, USA
| | - Shashank Vodapally
- Physical Medicine and Rehabilitation, Michigan State University, East Lansing, MI, USA
| | - Alexios Carayannopoulos
- Department of Physical Medicine and Rehabilitation, Rhode Island Hospital, Newport Hospital, Lifespan Physician Group, Providence, RI, USA,Comprehensive Spine Center at Rhode Island Hospital, Newport Hospital, Providence, RI, USA,Neurosurgery, Brown University, Providence, RI, USA
| | - Sameer Jain
- Interventional Pain Management, Pain Treatment Centers of America, Little Rock, AR, USA
| | - Nomen Azeem
- Department of Neurology, University of South Florida, Tampa, FL, USA,Florida Spine & Pain Specialists, Riverview, FL, USA
| | - Reda Tolba
- Pain Management, Cleveland Clinic, Abu Dhabi, United Arab Emirates,Anesthesiology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - George C Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA, USA,Center for Regenerative Medicine, University Southern California, Los Angeles, CA, USA
| | | | | | | | - Krishnan Chakravarthy
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, San Diego, CA, USA,Va San Diego Healthcare, San Diego, CA, USA
| | - Erika Petersen
- Department of Neurosurgery, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA,Department of Population Health - Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Timothy Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
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20
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A superior articular process morphology of 5th lumbar vertebra prone to screws placement failure: an anatomical study of 299 patients. J Orthop Surg Res 2022; 17:505. [PMID: 36434721 PMCID: PMC9694565 DOI: 10.1186/s13018-022-03403-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/13/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSES This study aimed to investigate whether the morphology of the superior articular processes of L5 vertebra affected the accuracy of pedicle screw placement by reviewing 299 patients who had undergone L5 pedicle screw fixation over the past 12 months and measuring relevant parameters. METHODS We retrospectively analyzed patients who underwent L5 vertebra fixation at our spine surgery department from October 20, 2020 to October 20, 2021. Patients with spondylolisthesis, spondylolysis, and scoliosis were excluded. Parameters associated with the superior articular process were analyzed, including Mammillary process-Spinal canal Distance (MCD), Inter-Facet Distance (IFD), Inter-Pedicle Distance (IPD), Zygapophysial Joints Angle (ZJA), Superior Articular Width, and Lateral Recess Transverse Diameter. The L5 vertebral body was reconstructed by Mimics 21.0, and the simulated L5 screws were inserted at multiple entry points to measure the Maximum Safe Transverse Angle (STAmax). RESULTS A total of 299 patients who underwent L5 vertebra fixation with 556 pedicle screws were analyzed. An MCD < 6 mm was associated with a significant increase in screw placement failure rate and decrease in ZJA. The MCD was positively correlated with IFD. No significant change in IPD was observed. Mimics software analysis showed that the STAmax decreased with a decrease of MCD. When WBV < 6 mm, 93% of the trans-mammillary vertical line was located within 50% of the pedicle. CONCLUSIONS The superior articular process tended to narrow the spinal canal and exhibit a steep and a "cloverleaf" morphology when the MCD was < 6 mm. This morphology increased the risk of operator mis-judgement resulting in screw placement failure. Assessment of the relationship between the trans-mammillary vertical line and the pedicle represents a simple method to predict abnormal morphology of the superior articular process before surgery.
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21
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Tovar MA, Dowlati E, Zhao DY, Khan Z, Pasko KBD, Sandhu FA, Voyadzis JM. Robot-assisted and augmented reality-assisted spinal instrumentation: a systematic review and meta-analysis of screw accuracy and outcomes over the last decade. J Neurosurg Spine 2022; 37:299-314. [PMID: 35213837 DOI: 10.3171/2022.1.spine211345] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The use of technology-enhanced methods in spine surgery has increased immensely over the past decade. Here, the authors present the largest systematic review and meta-analysis to date that specifically addresses patient-centered outcomes, including the risk of inaccurate screw placement and perioperative outcomes in spinal surgeries using robotic instrumentation and/or augmented reality surgical navigation (ARSN). METHODS A systematic review of the literature in the PubMed, EMBASE, Web of Science, and Cochrane Library databases spanning the last decade (January 2011-November 2021) was performed to present all clinical studies comparing robot-assisted instrumentation and ARSN with conventional instrumentation techniques in lumbar spine surgery. The authors compared these two technologies as they relate to screw accuracy, estimated blood loss (EBL), intraoperative time, length of stay (LOS), perioperative complications, radiation dose and time, and the rate of reoperation. RESULTS A total of 64 studies were analyzed that included 11,113 patients receiving 20,547 screws. Robot-assisted instrumentation was associated with less risk of inaccurate screw placement (p < 0.0001) regardless of control arm approach (freehand, fluoroscopy guided, or navigation guided), fewer reoperations (p < 0.0001), fewer perioperative complications (p < 0.0001), lower EBL (p = 0.0005), decreased LOS (p < 0.0001), and increased intraoperative time (p = 0.0003). ARSN was associated with decreased radiation exposure compared with robotic instrumentation (p = 0.0091) and fluoroscopy-guided (p < 0.0001) techniques. CONCLUSIONS Altogether, the pooled data suggest that technology-enhanced thoracolumbar instrumentation is advantageous for both patients and surgeons. As the technology progresses and indications expand, it remains essential to continue investigations of both robotic instrumentation and ARSN to validate meaningful benefit over conventional instrumentation techniques in spine surgery.
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Affiliation(s)
- Matthew A Tovar
- 1School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Ehsan Dowlati
- 2Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - David Y Zhao
- 2Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Ziam Khan
- 3Center for Bioinformatics and Computational Biology, University of Maryland, Baltimore County, Baltimore, Maryland; and
| | - Kory B D Pasko
- 4Georgetown University School of Medicine, Washington, DC
| | - Faheem A Sandhu
- 2Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
| | - Jean-Marc Voyadzis
- 2Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC
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22
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Yan K, Zhang Q, Tian W. Comparison of accuracy and safety between second-generation TiRobot-assisted and free-hand thoracolumbar pedicle screw placement. BMC Surg 2022; 22:275. [PMID: 35840958 PMCID: PMC9288055 DOI: 10.1186/s12893-022-01723-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/11/2022] [Indexed: 01/02/2023] Open
Abstract
Background Robot-assisted spine surgery aims to improve the accuracy of screw placement. We compared the accuracy and safety between a novel robot and free hand in thoracolumbar pedicle screw placement. Methods Eighty patients scheduled to undergo robot-assisted (40 patients) and free-hand (40 patients) pedicle screw placement were included. The patients’ demographic characteristics, radiographic accuracy, and perioperative outcomes were compared. The accuracy of screw placement was based on cortical violation and screw deviation. Safety outcomes mainly included operative time, blood loss, revision, and complications. Results A total of 178 and 172 screws were placed in the robot-assisted and free-hand groups, respectively. The rate of perfect screw position (grade A) was higher in the robot-assisted group than in the free-hand group (91.0% vs. 75.6%; P < 0.001). The rate of clinically acceptable screw position (grades A and B) was also higher in the robot-assisted group than in the free-hand group (99.4% vs. 90.1%; P < 0.001). The robot-assisted group had significantly lower screw deviation than the free-hand group [1.46 (0.94, 1.95) mm vs. 2.48 (1.09, 3.74) mm, P < 0.001]. There was no robot abandonment in the robot-assisted group. No revision was required in any of the groups. Conclusions Robot-assisted pedicle screw placement is more accurate than free-hand placement. The second-generation TiRobot–assisted thoracolumbar pedicle screw placement is an accurate and safe procedure. Trial registration retrospectively registered
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Affiliation(s)
- Kai Yan
- Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31, Xinjiekou East St, Xicheng District, Beijing, 100035, China.,Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, 100035, China
| | - Qi Zhang
- Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31, Xinjiekou East St, Xicheng District, Beijing, 100035, China.,Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, 100035, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, No. 31, Xinjiekou East St, Xicheng District, Beijing, 100035, China. .,Research Unit of Intelligent Orthopedics, Chinese Academy of Medical Sciences, Beijing, 100035, China.
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23
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Comparison of robot-assisted versus fluoroscopy-assisted minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar spinal diseases: 2-year follow-up. J Robot Surg 2022; 17:473-485. [PMID: 35788970 DOI: 10.1007/s11701-022-01442-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Abstract
This study was performed to prospectively compare the clinical and radiographic outcomes between robot-assisted minimally invasive transforaminal lumbar interbody fusion (RA MIS-TLIF) and fluoroscopy-assisted minimally invasive transforaminal lumbar interbody fusion (FA MIS-TLIF) in patients with degenerative lumbar spinal diseases. One hundred and twenty-three patients with lumbar degenerative diseases (lumbar spinal stenosis with instability and spondylolisthesis [degenerative spondylolisthesis or isthmic spondylolisthesis]) who underwent MIS-TLIF in our hospital were included in this study. Sixty-one patients underwent RA MIS-TLIF (Group A) and 62 patients underwent FA MIS-TLIF (Group B). Group A was further divided into Subgroup AI (46 single-level procedures) and Subgroup AII (15 double-level procedures). Group B was further divided into Subgroup BI (45 single-level procedures) and Subgroup BII (17 double-level procedures). The clinical outcome parameters were the visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, operative time, number of intraoperative fluoroscopies, blood loss, postoperative hospital stay, and postoperative complications. The radiographic change measures were the accuracy of screw placement, facet joint violation (FJV), fusion status, and change in disc height at the proximal adjacent segment at the 2-year follow-up. There were no significant differences in the VAS and ODI scores, blood loss, or postoperative hospital stay between Groups A and B (p > 0.05). The operative time was longer in Group A than B (p = 0.018). The operative time was longer in Subgroup AI than BI (p = 0.001). However, there was no significant difference between Subgroups AII and BII (p > 0.05). There was no significant difference in the number of intraoperative fluoroscopies for patients between Groups A and B (p > 0.05). Although the number of intraoperative fluoroscopies for patients was significantly higher in Subgroup AI than BI (p = 0.019), there was no significant difference between Subgroups AII and BII (p > 0.05). The number of intraoperative fluoroscopies for the surgeon was significantly lower in Group A than B (p < 0.001). For surgeons, the difference in the average number of intraoperative fluoroscopies between Subgroups AI and AII was 2.98, but that between Subgroups BI and BII was 10.73. In Group A, three guide pins exhibited drift and one patient developed a lateral wall violation by a pedicle screw. One pedicle screw perforated the anterior wall of the vertebral body and another caused an inner wall violation in Group B. The rate of a perfect screw position (grade A) was higher in Group A than B (p < 0.001). However, there was no significant difference in the proportion of clinically acceptable screws (grades A and B) between the two groups. The mean FJV grade was significantly higher in Group B than A (p < 0.001). During at 2-year postoperative follow-up, there was no significant difference in the fusion status between the two groups (p > 0.05); however, the decrease in disc height at the proximal adjacent segment was significantly less in Group A than B (p < 0.001). Robot-assisted percutaneous pedicle screw placement is a safer and more accurate alternative to conventional freehand fluoroscopy-assisted percutaneous pedicle screw insertion in MIS-TLIF.
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24
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Deviating from the Recommended Torque on Set Screws Can Reduce the Stability and Fatigue Life of Pedicle Screw Fixation Devices. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060808. [PMID: 35744071 PMCID: PMC9228452 DOI: 10.3390/medicina58060808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/28/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Using an appropriate torque to tighten set screws ensures the long-term stability of spinal posterior fixation devices. However, the recommended torque often varies between different devices and some devices do not state a recommended torque level. The purpose of this study is to evaluate the effect of set screw torque on the overall construct stability and fatigue life. Materials and Methods: Two commercial pedicle screw systems with different designs for the contact interface between the set screw and rod (Group A: plane contact, Group B: line contact) were assembled using torque wrenches provided with the devices to insert the set screws and tighten to the device specifications. The axial gipping capacity and dynamic mechanical stability of each bilateral construct were assessed in accordance with ASTM F1798 and ASTM F1717. Results: Increasing or decreasing the torque on the set screw by 1 Nm from the recommended level did not have a significant effect on the axial gripping capacity or fatigue strength of Group A (p > 0.05). For Group B, over-tightening the set screw by 1 Nm did cause a significant reduction in the fatigue strength. Conclusions: Excessive torque can damage the rod surface and cause premature failure. When insertion using a manual driver is preferred, a plane contact interface between the set screw and rod can reduce damage to the rod surface when the set screw is over-torqued.
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25
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Said E, Abdel-Wanis ME, Ameen M, Sayed AA, Mosallam KH, Ahmed AM, Tammam H. Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Global Spine J 2022; 12:990-1002. [PMID: 33977761 PMCID: PMC9344525 DOI: 10.1177/21925682211016426] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES Arthrodesis has been a valid treatment option for spinal diseases, including spondylolisthesis and lumbar spinal stenosis. Posterolateral and posterior lumbar interbody fusion are amongst the most used fusion techniques. Previous reports comparing both methods have been contradictory. Thus, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to establish substantial evidence on which fusion method would achieve better outcomes. METHODS Major databases including PubMed, Embase, Web of Science and CENTRAL were searched to identify studies comparing outcomes of interest between posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF). We extracted data on clinical outcome, complication rate, revision rate, fusion rate, operation time, and blood loss. We calculated the mean differences (MDs) for continuous data with 95% confidence intervals (CIs) for each outcome and the odds ratio with 95% confidence intervals (CIs) for binary outcomes. P < 0.05 was considered significant. RESULTS We retrieved 8 studies meeting our inclusion criteria, with a total of 616 patients (308 PLF, 308 PLIF). The results of our analysis revealed that patients who underwent PLIF had significantly higher fusion rates. No statistically significant difference was identified in terms of clinical outcomes, complication rates, revision rates, operation time or blood loss. CONCLUSIONS This systematic review and meta-analysis provide a comparison between PLF and PLIF based on RCTs. Although PLIF had higher fusion rates, both fusion methods achieve similar clinical outcomes with equal complication rate, revision rate, operation time and blood loss at 1-year minimum follow-up.
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Affiliation(s)
- Elsayed Said
- Department of Orthopedics and
Traumatology, Qena Faculty of Medicine, South Valley
University, Egypt
| | - Mohamed E. Abdel-Wanis
- Department of Orthopedics and
Traumatology, Sohag Faculty of Medicine, Sohag
University, Egypt
| | - Mohamed Ameen
- Department of Orthopedics and
Traumatology, Qena Faculty of Medicine, South Valley
University, Egypt
| | - Ali A. Sayed
- Department of Orthopedics and
Traumatology, Qena Faculty of Medicine, South Valley
University, Egypt
| | - Khaled H. Mosallam
- Department of Orthopedics and
Traumatology, Qena Faculty of Medicine, South Valley
University, Egypt
| | - Ahmed M. Ahmed
- Department of Orthopedics and
Traumatology, Qena Faculty of Medicine, South Valley
University, Egypt,Ahmed M. Ahmed, Department of Orthopedics
and Traumatology, Qena faculty of medicine, South Valley University, Kilo 6
Qena-Safaga highway, Qena 83523, Egypt.
| | - Hamdy Tammam
- Department of Orthopedics and
Traumatology, Qena Faculty of Medicine, South Valley
University, Egypt
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Deer TR, Grider JS, Pope JE, Lamer TJ, Wahezi SE, Hagedorn JM, Falowski S, Tolba R, Shah JM, Strand N, Escobar A, Malinowski M, Bux A, Jassal N, Hah J, Weisbein J, Tomycz ND, Jameson J, Petersen EA, Sayed D. Best Practices for Minimally Invasive Lumbar Spinal Stenosis Treatment 2.0 (MIST): Consensus Guidance from the American Society of Pain and Neuroscience (ASPN). J Pain Res 2022; 15:1325-1354. [PMID: 35546905 PMCID: PMC9084394 DOI: 10.2147/jpr.s355285] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Methods Results Discussion Conclusion
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Affiliation(s)
- Timothy R Deer
- Centers for Pain Relief, Charleston, WV, USA
- Correspondence: Timothy R Deer, The Spine and Nerve Centers of the Virginias, 400 Court Street, Suite 100, Charleston, WV, 25301, USA, Tel +1 304 347-6141, Email
| | - Jay S Grider
- UK HealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | | | - Tim J Lamer
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Sayed E Wahezi
- Montefiore Medical Center, SUNY-Buffalo, Buffalo, NY, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Steven Falowski
- Director Functional Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | - Reda Tolba
- Pain Management Department, Anesthesiology Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Jay M Shah
- SamWell Institute for Pain Management, Colonia, NJ, USA
| | - Natalie Strand
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Alex Escobar
- Department of Anesthesiology and Pain Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | | | - Anjum Bux
- Bux Pain Management, Lexington, KY, USA
| | | | - Jennifer Hah
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, USA
| | | | - Nestor D Tomycz
- Department of Neurological Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Erika A Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Dawood Sayed
- Pain Medicine, Multidisciplinary Pain Fellowship, The University of Kansas Health System, Kansas City, KS, USA
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Yu CC, Carreon LY, Glassman SD, Brown ME, Daniels CL, Polly DW, Gum JL. Propensity-Matched Comparison of 90-Day Complications in Robotic-Assisted Versus Non-Robotic Assisted Lumbar Fusion. Spine (Phila Pa 1976) 2022; 47:195-200. [PMID: 34839310 DOI: 10.1097/brs.0000000000004288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective single center propensity-matched observational cohort study that included patients who underwent 1- to 3-level lumbar fusion surgery for degenerative conditions. OBJECTIVE To compare 90-day complication rates between robotic-assisted and non-robotic-assisted lumbar spinal fusions in propensity-matched cohorts. SUMMARY OF BACKGROUND DATA A recent administrative database (PearlDiver) study reported increased 30-day complications with the utilization of robotic-assisted enabling technology. METHODS Of 146 robotic-assisted cases that met inclusion criteria, 114 were successfully propensity matched to 114 patients from 214 cases who had 1 to 3 level lumbar fusion without robotic assistance based on age, sex, body mass index, smoking status, American Society of Anesthesiologist grade, number of surgical levels, primary versus revision, and surgical approach (posterior-only or anterior-posterior). We excluded tumor, trauma, infection, or deformity cases. Outcomes included surgical and medical (major/minor) complications at intraoperative, immediately postoperative, 30- and 90-day postoperative intervals, including reoperations, and readmissions within 90 days. RESULTS All cause intraoperative complication rates were similar between non-robotic-assisted (5.3%) and robotic-assisted groups (10.5%, P = 0.366). Immediate postoperative medical complication rate was also similar between non-robotic-assisted (6.1%) and robotic-assisted groups (1.8%, P = 0.089). Thirty-day complication rates, 90-day complication rates, reoperation rates, and readmission rates showed no difference between non-robotic-assisted and robotic-assisted groups. There was no difference between return to OR for infection between the cohorts (non-robotic-assisted: 6 [5%] vs. robotic-assisted: 1 [0.8%], P = 0.119). There was however improved length of stay (LOS) in the robotic-assisted group compared with non-robotic-assisted group (2.5 vs. 3.17 days, P = 0.018). CONCLUSION In propensity-matched cohorts, patients undergoing 1- to 3-level robotic-assisted posterior lumbar fusion for degenerative conditions did not have increased 90-day complication rate, and had a shorter length of stay compared with non-robotic-assisted patients. There findings differ from a prior administrative database study as the robotic-assisted group in the current study had 0% return to OR for malpositioned screws and 0.8% return to OR for infection.Level of Evidence: 2.
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Affiliation(s)
| | | | | | | | | | - David W Polly
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN
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Mourad K, Hasanain AA, Sakr SA, Elkatatny AAM. Management of Complications of Posterior Lumber Spine Fixation for Spondylolithesis. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This study was aiming at identifying the varieties, causes, treatment and prevention of post lumbar instrumental fixation complications, which was done on a study population of 50 cases, without stratification on bases of sex or age, excluding the patients with known chronic debilitating diseases. Regarding the patients’ population, our demographics shows a clear role of obesity in the pathogenesis of spondylolisthesis in general, regardless of age or sex, the mean BMI was above 30, and this does indeed agree with most studies as mentioned before. Analyzing our results, we found the most affected levels to be L4-5, and L5-S1, which coincides with other studies discussed before, we also found significant dominance of back pain as a presenting complaint, while neurological deficits were rare, by analyzing the etiologies of pathological findings in our patients we found isthmic lythesis followed by spondylolisthesis as the most common etiologies respectively among the studied population.Regarding the positive finding requiring further management in our study, the most common finding was failed prosthesis, and adjacent segment failure, other less frequent findings include Sacroiliac dysfunction, posterior cage migration, screw malpostioning, infection, Dural tear, CSF leak, pseudarthrosis, and one patient with pseudo-meningocele.32 patients (64%) were managed surgically, while the other 18 patients (36%) were managed conservatively, 40 patients had improved complaints, while 10 cases didn’t improve, our results should be seen in the light that our sample size was small, which can be a great limiting factor.
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Warren JM, Hey LA, Mazzoleni AP. A finite element study of the relationship between upper body weight and the loads experienced by the human lumbosacral spine, and fusion instrumentation, in a standing upright posture. BIOMEDICAL ENGINEERING ADVANCES 2021. [DOI: 10.1016/j.bea.2021.100023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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30
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Yu J, Zhang Q, Fan MX, Han XG, Liu B, Tian W. Learning curves of robot-assisted pedicle screw fixations based on the cumulative sum test. World J Clin Cases 2021; 9:10134-10142. [PMID: 34904083 PMCID: PMC8638049 DOI: 10.12998/wjcc.v9.i33.10134] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/29/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In robot-assisted (RA) spine surgery, the relationship between the surgical outcome and the learning curve remains to be evaluated.
AIM To analyze the learning curve of RA pedicle screw fixation (PSF) through fitting the operation time curve based on the cumulative summation method.
METHODS RA PSFs that were initially completed by two surgeons at the Beijing Jishuitan Hospital from July 2016 to March 2019 were analyzed retrospectively. Based on the cumulative sum of the operation time, the learning curves of the two surgeons were drawn and fit to polynomial curves. The learning curve was divided into the early and late stages according to the shape of the fitted curve. The operation time and screw accuracy were compared between the stages.
RESULTS The turning point of the learning curves from Surgeons A and B appeared in the 18th and 17th cases, respectively. The operation time [150 (128, 188) min vs 120 (105, 150) min, P = 0.002] and the screw accuracy (87.50% vs 96.30%, P = 0.026) of RA surgeries performed by Surgeon A were significantly improved after he completed 18 cases. In the case of Surgeon B, the operation time (177.35 ± 28.18 min vs 150.00 ± 34.64 min, P = 0.024) was significantly reduced, and the screw accuracy (91.18% vs 96.15%, P = 0.475) was slightly improved after the surgeon completed 17 RA surgeries.
CONCLUSION After completing 17 to 18 cases of RA PSFs, surgeons can pass the learning phase of RA technology. The operation time is reduced afterward, and the screw accuracy shows a trend of improvement.
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Affiliation(s)
- Jie Yu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Qi Zhang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Ming-Xing Fan
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Xiao-Guang Han
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Bo Liu
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
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31
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Zhao L, Wan C, Han S, Li B, Zheng S. The study of distance changes between lumbar bi-cortical pedicle screws and anterior large vessels in patients with lumbar spondylolisthesis. BMC Musculoskelet Disord 2021; 22:920. [PMID: 34724945 PMCID: PMC8561981 DOI: 10.1186/s12891-021-04811-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This paper was a anatomical radiographic study of distance between lumbar bi-cortical pedicle screws (BPSs) and anterior large vessels (ALVs) in patients with lumbar spondylolisthesis, and to provide clinical basis for evaluating the safety of bi-cortical pedicle screw implantation during lumbar spondylolisthesis. METHODS Complete Computed tomography (CT) data of 104 patients with grade I lumbar spondylolisthesis (L4 52 and L5 52) and 107 non-spondylolisthesis patients (control group) were collected in this study. The distances between lumbar 4,5(L4,5) and sacrum 1(S1) BPSs and ALVs (abdominal aorta, inferior vena cava, left and right common iliac artery, internal and external iliac artery) were respectively measured at different transverse screw angles (TSAs) (L4:5°,10°; L5:10°,15°; S1:0°,5°,10°) and analyzed by SPSS (v25.0). There were three types of distances from the anterior vertebral cortex (AVC) to the ALVs (DAVC-ALV): DAVC-ALV N, DAVC-ALV ≥ 0.50 cm, and DAVC-ALV < 0.50 cm; these different distances represented non-contact, distant and close ALV respectively. RESULTS We calculated the incidences of screw tip contacting large vessels at different TSAs and provided the appropriate angle of screw implantation. In non-spondylolisthesis group, in L4, the appropriate left TSA was 5°, and the incidence of the close ALV was 4.62%. In S1, the appropriate left TSA was 0° and the incidence of the close ALV was 22.4%, while the appropriate right TSA was 10° and the incidence of the close ALV was 17.8%. In L4 spondylolisthesis group, in L4, the appropriate left TSA was 5°, and the incidence of the close ALV was 3.8%. In L5 spondylolisthesis group, in S1, the appropriate left TSA was 0° and the incidence of the close ALV was 19.2%, while the appropriate right TSA was 10° and the incidence of the close ALV was 21.2%. The use of BPS was not appropriate on the right side of L4 or on the either side of L5 both in spondylolisthesis and control group. In patients with lumbar 4 spondylolisthesis, the incidences of screw tip contacting large vessels were less than the control group in both L4 and 5. In patients with lumbar 5 spondylolisthesis, the incidences of screw tip contacting large vessels were less than the control group in L5, while there were no significant difference in S1. CONCLUSION It is very important that considering the anatomical relationship between the AVC and the ALVs while planning BPSs. The use of BPS does not apply to every lumbar vertebra. In patients with lumbar spondylolisthesis and non-spondylolisthesis patients, the incidences of screw tip contacting large vessels are different.
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Affiliation(s)
- Li Zhao
- Department of Cardiovascular surgery, Nanfang Hospital of Southern Medical University, Guangzhou, 510000, Guangdong, China
| | - Chenguang Wan
- Department of Neurosurgery, Tianjin First Central Hospital, Tianjin, 300000, China
| | - Shuhong Han
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical College, Chengde, 067000, Hebei, China
| | - Baofeng Li
- Department of Orthopedics, General Hospital of Southern Theater Command of PLA, The first School of Clinical Medicine, Southern Medical University, Guangzhou, 510000, China.
| | - Shaoyi Zheng
- Department of Cardiovascular surgery, Nanfang Hospital of Southern Medical University, Guangzhou, 510000, Guangdong, China.
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32
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Clinical and patient-reported outcomes after robot-assisted short-segment lumbar fusion with a minimum 1-year follow-up. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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33
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Lucas LG, Lucas VPCL, Sylvain P, Agathe N, Marc-Antoine R, Laurie S, Wafa S. Biomechanical comparative evaluation of percutaneous fixations with vertebral expansion for vertebral compression fractures: an experimental and finite element study. Comput Methods Biomech Biomed Engin 2021; 25:487-498. [PMID: 34342248 DOI: 10.1080/10255842.2021.1959919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study uses in vitro experiments and validated finite element models (FEM) to analyze the effect of posterior fixation, alone or associated with expandable device (ED) and/or cement. 3-dimensional FEMs of intact, fractured and instrumented spine were built and compared with experimental load-displacement curves. FEM ranges of motion were within the experimental corridors. Stresses appeared sensitive to both implant configuration and fracture severity with a stress reduction up to 84%. The FEM highlighted that for a same instrumental strategy, different biomechanical performances were observed according to fracture severity. When bone continuity is altered, both ED and cement may be needed.
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Affiliation(s)
- Le Gallo Lucas
- Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - V P C Lima Lucas
- Institut de Biomecanique Humaine Georges Charpak, Paris, France.,Instituto Politécnico Rua Bonfim, Universidade Estadual do Rio de Janeiro, Nova Friburgo, RJ, Brazil
| | - Persohn Sylvain
- Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - Nérot Agathe
- Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - Rousseau Marc-Antoine
- Department of Orthopaedic Surgery, Hopital Bichat-Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Simon Laurie
- Department of Orthopaedic Surgery, Hopital Bichat-Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Skalli Wafa
- Institut de Biomecanique Humaine Georges Charpak, Paris, France
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Mao JZ, Khan A, Soliman MAR, Levy BR, McGuire MJ, Starling RV, Hess RM, Agyei JO, Meyers JE, Mullin JP, Pollina J. Use of the Scan-and-Plan Workflow in Next-Generation Robot-Assisted Pedicle Screw Insertion: Retrospective Cohort Study and Literature Review. World Neurosurg 2021; 151:e10-e18. [PMID: 33684584 DOI: 10.1016/j.wneu.2021.02.119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report our experience using the scan-and-plan workflow and review current literature on surgical efficiency, safety, and accuracy of next-generation robot-assisted (RA) spine surgery. METHODS The records of patients who underwent RA pedicle screw fixation were reviewed. The accuracy of pedicle screw placement was determined based on the Ravi classification system. To evaluate workflow efficiency, 3 demographically matched cohorts were created to analyze differences in time per screw placement (defined as operating room [OR] time divided by number of screws placed). Group A had <4 screws placed, Group B had 4 screws placed, and Group C had >4 screws placed. Intraoperative errors and postoperative complications were collected to elucidate safety. RESULTS Eighty-four RA cases (306 pedicle screws) were included for analysis. The mean number of screws placed was 2.1 ± 0.3 in Group A and 6.4 ± 1.2 in Group C; 4 screws were placed in Group B patients. The accuracy rate (Ravi grade I) was 98.4%. Screw placement time was significantly longer in Group A (101 ± 37.7 minutes) than Group B (50.5 ± 25.4 minutes) or C (43.6 ± 14.7 minutes). There were no intraoperative complications, robot failures, or in-hospital complications requiring a return to the OR. CONCLUSIONS The scan-and-plan workflow allowed for a high degree of accuracy. It was a safe method that provided a smooth and efficient OR workflow without registration errors or robotic failures. After the placement of 4 pedicle screws, the per-screw time remained constant. Further studies regarding efficiency and utility in multilevel procedures are necessary.
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Affiliation(s)
- Jennifer Z Mao
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA; Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Mohamed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA; Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt; Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Bennett R Levy
- George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Matthew J McGuire
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA
| | - Robert V Starling
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Ryan M Hess
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Justice O Agyei
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Joshua E Meyers
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.
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Peck JH, Cadel E, Palepu V, Ferrell BM, Warner CH. Mechanical performance of thoracolumbosacral pedicle screw systems: An analysis of data submitted to the Food and Drug Administration. J Biomech 2021; 125:110551. [PMID: 34182324 DOI: 10.1016/j.jbiomech.2021.110551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/24/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022]
Abstract
Thoracolumbosacral pedicle screw systems (TPSSs) are spinal implants commonly utilized to stabilize the spine as an adjunct to fusion for a variety of spinal pathologies. These systems consist of components including pedicle screws, rods, hooks, and various connectors that allow the surgeon to create constructs that can be affixed to a wide range of spinal anatomy. During the development and regulatory clearance process, TPSSs are subjected to mechanical testing such as static and dynamic compression bending per ASTM F1717, axial and torsional grip testing per ASTM F1798, and foam block pullout testing per ASTM F543. In this study, design and mechanical testing data were collected from 200 premarket notification (510(k)) submissions for TPSSs submitted to FDA between 2007 and 2018. Data were aggregated for the most commonly performed mechanical tests, and analyses were conducted to assess differences in performance based on factors such as component type, dimensions, and materials of construction. Rod material had a significant impact on construct stiffness in static compression bending testing with cobalt chromium rods being significantly stiffer than titanium rods of the same diameter. Pedicle screw type had an impact on compression bending yield strength with monoaxial screws having significantly higher yield strength as compared to polyaxial or uniplanar screws. Axial and torsional gripping capacities between components and the rods were significantly lower for cross-connectors than the other component types. The aggregated data presented here can be utilized for comparative purposes to aid in the development of future TPSSs.
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Affiliation(s)
- Jonathan H Peck
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Product Evaluation and Quality, Office of Orthopedic Devices, Silver Spring, MD 20993, USA.
| | - Eileen Cadel
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Product Evaluation and Quality, Office of Orthopedic Devices, Silver Spring, MD 20993, USA
| | - Vivek Palepu
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Science and Engineering Laboratories, Division of Applied Mechanics, Silver Spring, MD 20993, USA
| | - Brittany M Ferrell
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Product Evaluation and Quality, Office of Orthopedic Devices, Silver Spring, MD 20993, USA
| | - Charles H Warner
- U.S. Food and Drug Administration, Center for Devices and Radiological Health, Office of Product Evaluation and Quality, Office of Orthopedic Devices, Silver Spring, MD 20993, USA
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Borni M, Belmabrouk H, Kammoun B, Boudawara MZ. Evaluation of functional outcomes of lumbar and lumbosacral isthmic and degenerative spondylolisthesis treated surgically. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Avrumova F, Morse KW, Heath M, Widmann RF, Lebl DR. Evaluation of K-wireless robotic and navigation assisted pedicle screw placement in adult degenerative spinal surgery: learning curve and technical notes. JOURNAL OF SPINE SURGERY 2021; 7:141-154. [PMID: 34296026 DOI: 10.21037/jss-20-687] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/12/2021] [Indexed: 11/06/2022]
Abstract
Background K-wireless robotic pedicle screw instrumentation with navigation is a new technology with large potential. Barriers to adoption are added registration time with robotic-navigated system and reliable screw positioning. Understanding the learning curve and limitations is crucial for successful implementation. The purpose of this study was to describe a learning curve of k-wireless robotic assisted pedicle screw placement with navigation and compare to conventional techniques. Methods A retrospective review of prospectively collected data of 65 consecutive adult patients underwent robotic-navigated posterior spinal fusion by a single spine surgeon. Registration, screw placement, and positioning times were recorded. All patients underwent intra-operative 3D fluoroscopy and screw trajectory was compared to pre-operative CT. Results A total of 364 instrumented pedicles were planned robotically, 311 (85.4%) were placed robotically; 17 screws (4.7%) converted to k-wire, 21 (5.8%) converted to freehand, and 15 (4.1%) planned freehand. Of the 311 robotically placed pedicle screws, three dimensional fluoroscopic imaging showed 291 (93.5%) to be GRS Grade A in the axial plane (fully contained within the pedicle) and 281 (90.4%) were GRS Grade A in the sagittal plane. All breached screw deviations from plan were identified on 3D fluoroscopy during surgery and repositioned and confirmed by additional 3d fluoroscopy scan. Reasons for conversion included morphology of starting point (n=18), soft tissue pressure (n=9), hypoplastic pedicles (n=6), obstructive reference pin placement (n=2), and robotic arm issues (n=1). Seventeen (5.5%) critical breaches (≥2-4 mm) were recorded in 11 patients, 9 (2.9%) critical breaches were due to soft tissue pressure causing skive. Two patients experienced 6 (1.9%) critical breaches from hypoplastic pedicles, and 3 (0.9%) unplanned lateral breaches were found in another patient. One patient (0.3%) experienced skive due to morphology and spinal instability from isthmic spondylolisthesis. Imaging showed 143 screws placed medially to plan (1.2±0.9 mm), 170 lateral (1.2±1.1 mm), 193 screws caudal (1.0±0.6 mm) and 117 cranial (0.6±0.5 mm). No adverse clinical sequelae occurred from implantation of any screw. Conclusions The learning curve showed improvement in screw times for the first several cases. Understanding the learning curve and situations where the robotic technique may be suboptimal can help guide the surgeon safe and effectively for adoption, as well as further refine these technologies.
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Affiliation(s)
- Fedan Avrumova
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Kyle W Morse
- Academic Training, Hospital for Special Surgery, New York, NY, USA
| | - Madison Heath
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Roger F Widmann
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Darren R Lebl
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
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Falowski SM, Mangal V, Pope J, Patel A, Coleman M, Kendall D, Brouillette R, Fishman MA. Multicenter Retrospective Review of Safety and Efficacy of a Novel Minimally Invasive Lumbar Interspinous Fusion Device. J Pain Res 2021; 14:1525-1531. [PMID: 34103977 PMCID: PMC8180294 DOI: 10.2147/jpr.s304957] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/30/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Several treatment options exist for those with spinal stenosis, as well as degenerative changes. This series evaluates the use of an interspinous fixation (ISF) device as performed by interventional pain physicians. Methods This is a retrospective analysis identifying 32 patients with the diagnosis of lumbar degenerative disc disease with secondary diagnosis of lumbar spinal stenosis being treated with ISF with Aurora Spine Zip Interspinous Spacer. Serious adverse events, specifically nerve injury, hematoma, infection, and death, were analyzed quantitatively for reported complications within 90 days from the procedure. In addition, VAS was analyzed for patient reported outcomes. Results Adverse event rate was 0% with no incidences of reoperation, or device removal. Estimated blood loss was recorded as less than 50 cc for all patients. The preoperative pain assessment demonstrated an average pain score of 8.1 and a postoperative pain score of 2.65 equating to a percentage pain reduction of 67%. Conclusion This case series demonstrates the success and safety of ISF being performed by interventional pain physicians in an outpatient setting. It is a valuable tool in the treatment of moderate to severe lumbar spinal stenosis and degenerative disc disease that has decreased morbidity and significant efficacy.
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Affiliation(s)
| | - Vipul Mangal
- National Spine and Pain, National Harbor, MD, USA
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Wang KC, Yang DH, Chang KI, Hsu WT, Chang CY, Wang CY, Yang YP, Chien CS, Yang MY, Shen CC. Using percutaneous parapedicle screw vertebroplasty to treat transpedicle screw loosening. J Chin Med Assoc 2021; 84:517-522. [PMID: 33496511 DOI: 10.1097/jcma.0000000000000490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pedicle screw loosening (PSL) is a postsurgical complication of spinal fusion surgery that can result in morbidity. The aim of this study was to evaluate the efficacy and safety of percutaneous parapedicle screw vertebroplasty (PPSV) for pain reduction and motility improvement in patients with PSL. METHODS The postsurgical solid inter-body fusion with inter-body bone mass formation of 32 patients who underwent lumbar-sacrum spinal fusion surgery was confirmed with plain films and CT scans. Each patient had one or two screws with symptomatic PSL and was treated with PPSV. All the patients were then followed up for 12 to 24 months. The visual analog scale (VAS) and Roland-Morris Disability Questionnaire (RMDQ) were used to evaluate each patient before the operation, after the operation, and during the follow-up period. RESULTS A total of 32 patients with a total of 47 screws with PSL were treated with PPSV and experienced different results in terms of pain reduction (with the mean VAS score dropping from 7.97 ± 0.74 to 2.34 ± 1.59, p < 0.001) and motility improvement (with the mean RMDQ score dropping from 16.75 ± 1.84 to 7.21 ± 4.08, p < 0.001). The motility improvement was significantly correlated with pain reduction (r = 0.42, p = 0.018), with the mean follow-up period being 19.3 ± 6.2 months (range: 8-36 months). However, five patients who experienced moderate improvements had eventually received a revision operation after undergoing PPSV. CONCLUSION The PPSV procedure is effective and safe for the reduction of pain and improvement of life quality in patients with PSL. It can thus be considered as a possible option for the revision of spinal fusion surgery.
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Affiliation(s)
- Kai-Chun Wang
- Department of Orthopaedic and Spinal Surgery, Taichung Veterans General Hospital, Puli Branch, Taichung, Taiwan, ROC
| | - Deng-Ho Yang
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Taichung Armed-Forces General Hospital, Taichung, Taiwan, ROC
- Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ku-I Chang
- Department of Orthopaedic and Spinal Surgery, Da-Li Jan-Ai Hospital, Taichung, Taiwan, ROC
- Department of Healthcare Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
| | - Wei-Tzu Hsu
- Department of Orthopaedic and Spinal Surgery, Taichung Veterans General Hospital, Puli Branch, Taichung, Taiwan, ROC
| | - Chih-Yen Chang
- Department of Medical Education and Research, Jen-Ai Hospital, Taichung, Taiwan, ROC
- Department of Elderly Care, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
| | - Chien-Ying Wang
- Institute of Pharmacology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Trauma, Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Ping Yang
- Institute of Pharmacology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chian-Shiu Chien
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Meng-Yin Yang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Neurosurgery, Da-Li Jan-Ai Hospital, Taichung, Taiwan, ROC
- Department of Surgery/Neurosurgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- College of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
| | - Chiung-Chyi Shen
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Physical Therapy, Hung Kuang University, Taichung, Taiwan, ROC
- Basic Medical Education Center, Central Taiwan University of Science and Technology, Taichung, Taiwan, ROC
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McKenzie DM, Westrup AM, O'Neal CM, Lee BJ, Shi HH, Dunn IF, Snyder LA, Smith ZA. Robotics in spine surgery: A systematic review. J Clin Neurosci 2021; 89:1-7. [PMID: 34119250 DOI: 10.1016/j.jocn.2021.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/13/2021] [Accepted: 04/04/2021] [Indexed: 12/20/2022]
Abstract
Robotic systems to assist with pedicle screw placement have recently emerged in the field of spine surgery. Here, the authors systematically reviewed the literature for evidence of these robotic systems and their utility. Thirty-four studies that reported the use of spinal instrumentation with robotic assistance and met inclusion criteria were identified. The outcome measures gathered included: pedicle screw accuracy, indications for surgery, rates of conversion to an alternative surgical method, radiation exposure, and learning curve. In our search there were five different robotic systems identified. All studies reported accuracy and the most commonly used accuracy grading scale was the Gertzbein Robbins scale (GRS). Accuracy of clinically acceptable pedicle screws, defined as < 2 mm cortical breech, ranged from 80% to 100%. Many studies categorized indications for robotic surgery with the most common being degenerative entities. Some studies reported rates of conversion from robotic assistance to manual instrumentation due to many reasons, with robotic failure as the most common. Radiation exposure data revealed a majority of studies reported less radiation using robotic systems. Studies looking at a learning curve effect with surgeon use of robotic assistance were not consistent across the literature. Robotic systems for assistance in spine surgery have continued to improve and the accuracy of pedicle screw placement remains superior when compared to free-hand technique, however rates of manual conversion are significant. Currently, these systems are successfully employed in various pathological entities where trained spine surgeons can be safe and accurate regardless of robotic training.
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Affiliation(s)
- Daniel M McKenzie
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Alison M Westrup
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Christen M O'Neal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Benjamin J Lee
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Helen H Shi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Laura A Snyder
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Zachary A Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Oshtory R, Harris JA, Patel PD, Mirabile BA, Bucklen BS. Lumbar Intervertebral Spacer With Cement Augmentation of Endplates and Integrated Screws as a Fixation Device in an Osteoporotic Model: An In Vitro Kinematic and Load-to-Failure Study. Int J Spine Surg 2021; 15:324-333. [PMID: 33900990 DOI: 10.14444/8042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Integrated lateral lumbar interbody fusion (LLIF) devices have been shown to successfully stabilize the spine and avoid complications related to posterior fixation. However, LLIF has increased subsidence risk in osteoporotic patients. Cement augmentation through cannulated pedicle screws enhances pedicle fixation and cage-endplate interface yet involves a posterior approach. Lateral application of cement with integrated LLIF fixation has been introduced and requires characterization. The present study set out to evaluate kinematic and load-to-failure properties of a novel cement augmentation technique with an integrated LLIF device, alone and with unilateral pedicle fixation, compared with bilateral pedicle screws and nonintegrated LLIF (BPS + S). METHODS Twelve specimens (L3-S1) underwent discectomy at L4-L5. Specimens were separated into 3 groups: (1) BPS + S; (2) polymethyl methacrylate (PMMA) augmentation, integrated LLIF, and unilateral pedicle screws (PMMA + UPS + iS); and (3) PMMA and integrated LLIF (PMMA + iSA) without posterior fixation. Flexion-extension, lateral bending, and axial rotation were applied. A compressive load was applied to L4-L5 segments until failure. An analysis was performed (P < .05). RESULTS Operative constructs significantly reduced motion relative to intact specimens in all motion planes (P < .05). BPS + S provided the most stability, reducing motion by 71.6%-86.4%, followed by PMMA + UPS + iS (68.1%-79.4%) and PMMA + iSA (62.9%-81.9%); no significant differences were found (P > .05). PMMA + UPS + iS provided the greatest resistance to failure (2290 N), followed by PMMA + iSA (1970 N) and BPS + S (1390 N); no significant differences were observed (P > .05). CONCLUSIONS Cement augmentation of vertebral endplates via the lateral approach with integrated LLIF moderately improved cage-endplate strength compared to BPS + S in an osteoporotic model; unilateral pedicle fixation further improved failure load. Reconstruction before and after application of unilateral pedicle screws and rods was biomechanically equivalent to anteroposterior reconstruction. Overall, initial results suggest that integrated LLIF with cement augmentation may be a viable alternative in the presence of osteoporosis.
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Affiliation(s)
| | - Jonathan A Harris
- Musculoskeletal Education and Research Center (MERC), a Division of Globus Medical, Inc, Audubon, Pennsylvania
| | - Pavan D Patel
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | - Belin A Mirabile
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, Indiana
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center (MERC), a Division of Globus Medical, Inc, Audubon, Pennsylvania
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Faulkner JE, Khalifeh K, Hara J, Ozgur B. Interspinous Process (ISP) Devices in Comparison to the Use of Traditional Posterior Spinal Instrumentation. Cureus 2021; 13:e13886. [PMID: 33868850 PMCID: PMC8043769 DOI: 10.7759/cureus.13886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 11/05/2022] Open
Abstract
A systematic literature review was conducted on studies comparing interspinous process (ISP) devices to traditional methods of posterior spinal instrumentation (pedicle screw-rod construct), in terms of indications of use, complications, pain assessment, estimated blood loss, length of hospital stay, reoperation rates, and return to work. The objective was to analyze, evaluate and summarize the current published literature on the proposed efficacy and clinical and surgical long-term outcomes of the ISP device in comparison to the traditional posterior spinal instrumentation (pedicle screw-rod construct). The ISP device is a minimally invasive and less disruptive alternative to traditional methods of posterior spinal instrumentation (pedicle screw-rod construct). However, very few published literature studies to date have reported the comparison of ISPs in terms of efficacy and clinical and surgical outcomes, to traditional posterior spinal instrumentation. A systematic literature review was performed in PubMed and Google Scholar to evaluate the results of published research that meet the defined inclusion and exclusion criteria and to analyze clinical indications and surgical outcomes of the ISP device compared to traditional methods of posterior spinal instrumentation (pedicle screw-rod construct). Inclusion criteria included keywords such as "ISP device, ISP, posterior spinal instrumentation, pedicle screw fixation, bilateral pedicle screws, interbody fusion with posterior spinal instrumentation, lumbar spinal stenosis, and posterior lumbar stability." No exclusion criteria keywords were included in this literature review. ISPs provide a high degree of spinal stability in multiple planes, including a decreased range of motion restriction in flexion-extension, and comparable results to bilateral pedicle screw (BPS) in axial rotation. The use of the ISP device in adjunct with an interbody fusion, ensures less estimated operative blood loss (EBL), shorter operative time, less bony exposure without the need for extensive soft tissue or muscle retraction, a decrease in the rate of pseudoarthrosis, and a shorter length of hospital stay (LOHS) when compared to the traditional posterior instrumentation (pedicle screw-rod construct). Based on the various published literature reviews noted throughout this research paper, it is safe to conclude, that an ISP device that is accompanied by interbody fusion, including posterior approaches posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF); anterior approaches such as anterior interbody fusion (ALIF), and lateral approaches including direct lateral interbody fusion (DLIF), lateral lumbar interbody fusion (LLIF), extreme lateral interbody fusion (XLIF), is considered a credible and an effective minimally invasive option for the treatment of mild to moderate lumbar stenosis and stable low-grade spondylolisthesis (less than two) when compared to the traditional posterior spinal instrumentation of a pedicle screw-rod construct. Surgeons that are relatively new to the ISP technologies for spinal instrumentation would likely benefit from more clinical and surgical evidence of safety and efficacy in published peer-reviewed medical literature. Further clinical trials are needed to manifest the efficacy of ISPs regarding postoperative outcomes when compared to traditional posterior instrumentation techniques (pedicle screw-rod construct) with adjunct interbody fusions.
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Affiliation(s)
- Jordan E Faulkner
- Neurological Surgery, Hoag Memorial Hospital, Newport Beach, USA
- Neurosurgery, ONE Brain and Spine Center, Irvine, USA
| | | | - Junko Hara
- Neurosurgery, Pickup Family Neurosciences Institute, Newport Beach, USA
| | - Burak Ozgur
- Neurosurgery, Hoag Memorial Hospital, Newport Beach, USA
- Neurosurgery, Pickup Family Neurosciences Institute, Newport Beach, USA
- Neurosurgery, ONE Brain and Spine Center, Irvine, USA
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Fan W, Guo LX, Zhao D. Posterior Lumbar Interbody Fusion Versus Transforaminal Lumbar Interbody Fusion: Finite Element Analysis of the Vibration Characteristics of Fused Lumbar Spine. World Neurosurg 2021; 150:e81-e88. [PMID: 33647495 DOI: 10.1016/j.wneu.2021.02.094] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Previous studies have investigated biomechanical characteristics of the lumbar spine after different types of lumbar interbody fusion surgery under static loadings. However, very few have dealt with the whole-body vibration (WBV) condition that is typically present in vehicles. The aim of this study was to compare the influence of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) on dynamic responses of the fused lumbar spine to vertical WBV. METHODS The PLIF and TLIF procedures with bilateral pedicle screw fixation at L4-L5 level were simulated by modifying a previously validated intact lumbar L1-S1 finite element model. The PLIF and TLIF models were subjected to a sinusoidal vertical load with a compressive follower preload, and computed for transient dynamic analysis. The obtained dynamic responses for the models at the fused and adjacent levels were collected and compared. RESULTS The results showed that the contact force between endplate and cage was higher in the PLIF model than in the TLIF model, indicating that PLIF allowed for higher compressive load across the anterior structure. At fused L4-L5 level, the TLIF led to a higher stress in the endplate and posterior BPSF system than the PLIF. At adjacent L3-L4 level and L5-S1 level, the computed dynamic responses, in terms of stress and deformation, for the PLIF and TLIF models showed very few differences. CONCLUSIONS This study may be helpful to quantify dynamic mechanical properties of the fused lumbar spine, and better understand biomechanical differences between the PLIF and TLIF procedures during vibration.
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Affiliation(s)
- Wei Fan
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China.
| | - Li-Xin Guo
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China
| | - Dan Zhao
- Department of Medicine, Liaoning Special Education Teachers College, Shenyang, China; School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang, China
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De Biase G, Gassie K, Garcia D, Abode-Iyamah K, Deen G, Nottmeier E, Chen S. Perioperative Comparison of Robotic-Assisted Versus Fluoroscopically Guided Minimally Invasive Transforaminal Lumbar Interbody Fusion. World Neurosurg 2021; 149:e570-e575. [PMID: 33549930 DOI: 10.1016/j.wneu.2021.01.133] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Robotic surgical systems have been developed to improve spine surgery accuracy. Studies have found significant reductions in screw revision rates and radiation exposure with robotic assistance compared with open surgery. The aim of the present study was to compare the perioperative outcomes between robot-assisted (RA) and fluoroscopically guided (FG) minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) performed by a single surgeon. METHODS The present retrospective cohort study analyzed all patients with lumbar degenerative disease who had undergone MI-TLIF by a single surgeon from July 2017 to March 2020. One group had undergone FG MI-TLIF and one group had undergone RA MI-TLIF. RESULTS Of the 101 patients included in the present study, 52 had undergone RA MI-TLIF and 49, FG MI-TLIF. We found no statistically significant differences in the operative time (RA, 241 ± 69.3 minutes; FG, 246.2 ± 56.3 minutes; P = 0.681). The mean radiation time for the RA group was 32.8 ± 28.8 seconds, and the mean fluoroscopy dose was 31.5 ± 30 mGy. The RA radiation exposure data were compared with similar data for the FG MI-TLIF group in a previous study (59.5 ± 60.4 mGy), with our patients' radiation exposure significantly lower (P = 0.035). The postoperative complications and rates of surgical revision were comparable. CONCLUSIONS Our results have demonstrated that RA MI-TLIF provides perioperative outcomes comparable to those with FG MI-TLIF. A reduced radiation dose to the patient was observed with RA compared with FG MI-TLIF. No differences were noted between the RA and FG cohorts in operative times, complication rates, revision rates, or length of stay.
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Affiliation(s)
- Gaetano De Biase
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Kelly Gassie
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Diogo Garcia
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Gordon Deen
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Eric Nottmeier
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Selby Chen
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.
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Comparative analysis of clinical factors associated with pedicle screw pull-out during or immediately after surgery between intraoperative cone-beam computed tomography and postoperative computed tomography. BMC Musculoskelet Disord 2021; 22:55. [PMID: 33422036 PMCID: PMC7797098 DOI: 10.1186/s12891-020-03916-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors. Methods This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis. Results Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval 1.12–10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out. Conclusions Our findings suggest that age, number of fused segments, presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.
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Bae IS, Bak KH, Chun HJ, Ryu JI, Park SJ, Lee SJ. Biomechanical analysis of a newly developed interspinous process device conjunction with interbody cage based on a finite element model. PLoS One 2020; 15:e0243771. [PMID: 33306706 PMCID: PMC7732105 DOI: 10.1371/journal.pone.0243771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/27/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose This study aimed to investigate the biomechanical effects of a newly developed interspinous process device (IPD), called TAU. This device was compared with another IPD (SPIRE) and the pedicle screw fixation (PSF) technique at the surgical and adjacent levels of the lumbar spine. Materials and methods A three-dimensional finite element model analysis of the L1-S1 segments was performed to assess the biomechanical effects of the proposed IPD combined with an interbody cage. Three surgical models—two IPD models (TAU and SPIRE) and one PSF model—were developed. The biomechanical effects, such as range of motion (ROM), intradiscal pressure (IDP), disc stress, and facet loads during extension were analyzed at surgical (L3-L4) and adjacent levels (L2-L3 and L4-L5). The study analyzed biomechanical parameters assuming that the implants were perfectly fused with the lumbar spine. Results The TAU model resulted in a 45%, 49%, 65%, and 51% decrease in the ROM at the surgical level in flexion, extension, lateral bending, and axial rotation, respectively, when compared to the intact model. Compared to the SPIRE model, TAU demonstrated advantages in stabilizing the surgical level, in all directions. In addition, the TAU model increased IDP at the L2-L3 and L4-L5 levels by 118.0% and 78.5% in flexion, 92.6% and 65.5% in extension, 84.4% and 82.3% in lateral bending, and 125.8% and 218.8% in axial rotation, respectively. Further, the TAU model exhibited less compensation at adjacent levels than the PSF model in terms of ROM, IDP, disc stress, and facet loads, which may lower the incidence of the adjacent segment disease (ASD). Conclusion The TAU model demonstrated more stabilization at the surgical level than SPIRE but less stabilization than the PSF model. Further, the TAU model demonstrated less compensation at adjacent levels than the PSF model, which may lower the incidence of ASD in the long term. The TAU device can be used as an alternative system for treating degenerative lumbar disease while maintaining the physiological properties of the lumbar spine and minimizing the degeneration of adjacent segments.
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Affiliation(s)
- In-Suk Bae
- Department of Neurosurgery, Eulji University Eulji Hospital, Nowon-gu, Republic of Korea
| | - Koang-Hum Bak
- Department of Neurosurgery, Hanyang University Medical Center, Seongdong-gu, Seoul, Republic of Korea
- * E-mail:
| | - Hyoung-Joon Chun
- Department of Neurosurgery, Hanyang University Medical Center, Seongdong-gu, Seoul, Republic of Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Republic of Korea
| | - Sung-Jae Park
- R&D Center, GS medical Co, Ltd, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Sung-Jae Lee
- Department of Biomedical Engineering, College of Biomedical Science& Engineering, Inje University, Gimhae-si, Gyeongsangnam-do, Republic of Korea
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Caelers IJMH, Rijkers K, van Kuijk SMJ, van Santbrink H, de Bie RA, van Hemert WLW. Neurological events due to pedicle screw malpositioning with lateral fluoroscopy-guided pedicle screw insertion. J Neurosurg Spine 2020; 33:806-811. [PMID: 32823268 DOI: 10.3171/2020.5.spine20550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The risk of novel postoperative neurological events due to pedicle screw malpositioning in lumbar fusion surgery is minimized by using one of the several image-guided techniques for pedicle screw insertion. These techniques for guided screw insertion range from intraoperative fluoroscopy to intraoperative navigation. A practical technique consists of anatomical identification of the screw entry point followed by lateral fluoroscopy used for guidance during insertion of the screw. This technique is available in most clinics and is less expensive than intraoperative navigation. However, the safety of lateral fluoroscopy-guided pedicle screw placement with regard to novel postoperative neurological events due to screw malposition has been addressed only rarely in the literature. In this study the authors aimed to determine the rate of novel postoperative neurological events due to intraoperative and postoperatively established screw malpositioning during lateral fluoroscopy-assisted screw insertion. METHODS Included patients underwent lateral fluoroscopy-assisted lumbosacral screw insertion between January 2012 and August 2017. The occurrence of novel postoperative neurological events was analyzed from patient files. In case of an event, surgical reports were screened for the occurrence of intraoperative screw malposition. Furthermore, postoperative CT scans were analyzed to identify and describe possible screw malposition. RESULTS In total, 246 patients with 1079 screws were included. Novel postoperative neurological events were present in 36 patients (14.6%). In 8 of these 36 patients (3.25% of the total study population), the neurological events could be directly attributed to screw malposition. Screw malpositioning was caused either by problematic screw insertion with immediate screw correction (4 patients) or by malpositioned screws for which the malposition was established postoperatively using CT scans (4 patients). Three patients with screw malposition underwent revision surgery without subsequent symptom relief. CONCLUSIONS Lateral fluoroscopy-assisted lumbosacral screw placement results in low rates of novel postoperative neurological events caused by screw malposition. In the majority of patients suffering from novel postoperative neurological events, these events could not be attributed to screw malpositioning, but rather were due to postoperative neurapraxia of peripheral nerves, neuropathy, or intraoperative traction of nerve roots.
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Affiliation(s)
- Inge J M H Caelers
- 1CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Limburg
- 2Department of Neurosurgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, Limburg
| | - Kim Rijkers
- 2Department of Neurosurgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, Limburg
- 3Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Limburg
| | - Sander M J van Kuijk
- 4Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, Limburg
| | - Henk van Santbrink
- 1CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Limburg
- 2Department of Neurosurgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, Limburg
- 3Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Limburg
| | - Rob A de Bie
- 1CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Limburg
- 5Department of Epidemiology, Maastricht University, Maastricht, Limburg; and
| | - Wouter L W van Hemert
- 6Department of Orthopedic Surgery, Zuyderland Medical Center, Sittard-Geleen/Heerlen, Limburg, The Netherlands
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Davis CM, Grant CA, Izatt MT, Askin GN, Labrom RD, Adam CJ, Pearcy MJ, Little JP. Characterization of progressive changes in pedicle morphometry and neurovascular anatomy during growth in adolescent idiopathic scoliosis versus adolescents without scoliosis. Spine Deform 2020; 8:1193-1204. [PMID: 32557264 DOI: 10.1007/s43390-020-00160-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/08/2020] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES Investigate the progressive changes in pedicle morphometry and the spatial relationship between the pedicles and neurovascular structures in patients with AIS during growth. Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional spine deformity. AIS pedicles are known to be asymmetrical when compared to adolescents without scoliosis. Defining the anatomical changes occurring progressively in scoliosis as it increases with time and growth is essential for understanding the pathophysiology of scoliosis and for treatment planning. MRI is the ideal method to study the growing spine without ionising radiation. METHODS 24 females with AIS (mean 12.6 years, right sided main thoracic curves) and 20 non-scoliotic females (mean 11.5 years) were selected from an ongoing database. Participants underwent two 3D MRI scans (3 T scanner, T1, 0.5 mm isotropic voxels) approximately 1 year apart (AIS: mean 1.3 ± 0.05 years, control: mean 1.0 ± 0.1 years). The pedicle width, chord length, pedicle height, transverse pedicle angle, sagittal pedicle angle, distance from vertebrae to aorta and distance from pedicle to dural sac were measured from T5 to T12. Inter- and intra-observer variability was assessed. RESULTS From scans 1-2 in the AIS group, the dural sac became closer to the left pedicle (p < 0.05, T6, T8-T10 and T12) while the distance from the vertebrae to the aorta increased (p < 0.05, T6-T10). No significant changes in these measurements were observed in the non-scoliotic group. Between scans, the AIS chord length and transverse pedicle angle increased on the left side around the apex (p < 0.05) creating asymmetries not seen in the non-scoliotic cohort. The mean pedicle height increased symmetrically in the non-scoliosis cohort (p < 0.05) and asymmetrically in the AIS group with the right side growing faster than the left at T6-T7 (p < 0.05). CONCLUSION Asymmetrical growth patterns occur in the vertebral posterior elements of AIS patients compared to the symmetrical growth patterns found in the non-scoliotic participants. LEVEL OF EVIDENCE Level II prospective comparative study.
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Affiliation(s)
- Colin M Davis
- Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane, QLD, 4101, Australia.,Queensland Children's Hospital, Brisbane, Australia
| | - Caroline A Grant
- Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane, QLD, 4101, Australia
| | - Maree T Izatt
- Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane, QLD, 4101, Australia
| | - Geoffrey N Askin
- Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane, QLD, 4101, Australia.,Queensland Children's Hospital, Brisbane, Australia
| | - Robert D Labrom
- Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane, QLD, 4101, Australia.,Queensland Children's Hospital, Brisbane, Australia
| | - Clayton J Adam
- Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane, QLD, 4101, Australia
| | - Mark J Pearcy
- Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane, QLD, 4101, Australia
| | - J Paige Little
- Biomechanics and Spine Research Group, Institute of Health and Biomedical Innovation at Centre for Children's Health Research, Queensland University of Technology and Mater Health Services, Level 5, 62 Graham Street, South Brisbane, QLD, 4101, Australia.
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Deng B, Hong HN, Feng XB, Hong ZH, Cai GP, Hong D. Psoas hematoma as a rare complication of posterior lumbar interbody fusion: a case report. BMC Surg 2020; 20:279. [PMID: 33176755 PMCID: PMC7661274 DOI: 10.1186/s12893-020-00942-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background Psoas hematoma rarely occurs in patients with spondylolisthesis who undergo posterior lumbar interbody fusion (PLIF) surgery. Case presentation Here we reported a case of a 57-year-old male patient diagnosed with spondylolisthesis who underwent PLIF at the local hospital. Seven days post-surgery, abdominal pain occurred, and the pain in the right lower limb gradually increased. The computerized tomography (CT) indicated a formation of hematoma around the psoas muscle. Digital-subtraction angiography (DSA) suggested a vascular injury, a rupture of the right segmental artery of the lumbar vertebral level 4. The patient then received DSA vascular embolization, after which the lower lumbar segmental artery active bleeding was stopped. One month after discharge, the abdominal hematoma was gradually absorbed, and the pain in the waist, leg, and abdomen disappeared. Conclusion Symptoms such as abdominal pain, abdominal distension, and exacerbation of lower limb pain, may suggest the occurrence of psoas hematoma after PLIF. DSA vascular embolization is suggested as the first treatment approach for this type of complication.
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Affiliation(s)
- Bo Deng
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, 317000, China
| | - Hai Nan Hong
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, 317000, China
| | - Xin Bing Feng
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, 317000, China
| | - Zheng Hua Hong
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, 317000, China.
| | - Guo Ping Cai
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, 317000, China
| | - Dun Hong
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, 317000, China
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O'Connor TE, O'Hehir MM, Khan A, Mao JZ, Levy LC, Mullin JP, Pollina J. Mazor X Stealth Robotic Technology: A Technical Note. World Neurosurg 2020; 145:435-442. [PMID: 33059080 DOI: 10.1016/j.wneu.2020.10.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Minimally invasive techniques in spine surgery have continued to advance as robotic technology has evolved over several generations. Although traditional techniques for placing pedicle screws are still widespread in practice, newer technology has increased the reliability of accurately placing instrumentation with smaller incisions and subsequent decreased length of stay. Additionally, advancements in planning software have improved the ability to align posterior instrumentation to assist with rod placement on multilevel constructs. METHODS This paper describes the surgical techniques and operative workflow for placing pedicle screws with the latest robotic technology. The robotic platform, registration, surgical planning, and placement of instrumentation are discussed in detail. Advantages of the Mazor X Stealth Edition compared with the previous generation robot include obviating the need for K wires and eliminating the need for a percutaneous pin, as navigation is integrated into the robot. RESULTS Our use of this new technology has been encouraging. Using the techniques described in this paper, the first 90 pedicle screws placed with the Mazor X Stealth Edition robot yielded 100% grade A accuracy on the Gertzbein-Robbins scale confirmed on immediate postoperative CT. There were no complications experienced in any case. CONCLUSIONS In our experience, this robotic technology has the potential to improve patient outcomes and is associated with advanced surgical planning compared with more traditional techniques.
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Affiliation(s)
- Timothy E O'Connor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.
| | - Mary Margaret O'Hehir
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Jennifer Z Mao
- Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA; Department of Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Lauren C Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
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