Accuracy Of Pedicle Screw Fixation Research Articles

Ultrasound propagation characteristics within the bone tissue of miniature ultrasound probes: implications for the spinal navigation of pedicle screw placement.

The accuracy of pedicle screw fixation is crucial for patient safety. Traditional navigation methods based on computed tomography (CT) imaging have several limitations. Therefore, this study aimed to investigate the ultrasonic propagation characteristics of bone tissue and their relationship with CT imaging results, as well as the potential application of ultrasound navigation in pedicle screw fixation. The study used three bovine spine specimens (BSSs) and five human vertebral allograft bones (HABs) to progressively decrease the thickness of the cancellous bone layer, simulating the process of pedicle screw perforation. Five unfocused miniature ultrasound probes with frequencies of 2.2, 2.5, 3, 12, and 30 MHz were employed for investigating the ultrasonic propagation characteristics of cancellous and cortical bone through ultrasound transmission and backscatter experiments. The CT features of the bone tissue was obtained with the Skyscan 1174 micro-CT scanner (Bruker, Billerica, MA, USA). The experimental results demonstrated that low-frequency (2-3 MHz) ultrasound effectively penetrated the cancellous bone layer up to a depth of approximately 5 mm, with an attenuation coefficient below 10 dB/cm. Conversely, high-frequency (12 MHz) ultrasound exhibited significant signal attenuation in cancellous bone, reaching up to 55.8 dB/cm. The amplitude of the backscattered signal at the cancellous bone interface exhibited a negative correlation with the bone sample thickness (average r=-0.84), meaning that as the thickness of the cancellous bone layer on the cortical bone decreases, the backscattered signal amplitude gradually increases (P<0.05). Upon reaching the cortical bone interface, there was a rapid surge in echo signal amplitude, up to 8 times higher. Meanwhile, the statistical results indicated a significant correlation between the amplitude of the echo signal and the micro-CT scanning results of bone trabecular structure. Theoretically, using multiple ultrasonic probes (≥3) and regions of interest (ROIs) (≥5) has the potential to provide surgeons with early warning signals for pedicle perforation based on three or more successive increases in echo signal amplitude or a sudden substantial increase. The statistical results indicate a significant correlation between the amplitude of the echo signal and the micro-CT scanning results of bone trabeculae, suggesting the potential use of ultrasound as opposed to CT for real-time intraoperative bone navigation.

EVALUATION OF CLINICAL OUTCOMES AND ACCURACY IN TRANSPEDICULAR SCREW FIXATION USING INTRAOPERATIVE CT-GUIDED NAVIGATION FOR LUMBAR SPONDYLOLISTHESIS

The use of intraoperative navigation and robotic surgery for minimally invasive lumbar fusion has been increasing over the past decade. The aim of this study is to evaluate postoperative clinical outcomes, intraoperative parameters, and accuracy of pedicle screw insertion guided by intraoperative navigation in patients undergoing lumbar interbody fusion for spondylolisthesis. Patients who underwent posterior lumbar fusion interbody using intraoperative 3D navigation since December 2021 were included. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Short Form Health Survey-36 (SF-36) were assessed preoperatively and postoperatively at 1, 3, and 6 months. Screw placement accuracy, measured by Gertzbein and Robbins classification, and facet joint infringement, measured by Yson classification, were assessed by intraoperative Cone Beam CT scans performed at the end of instrumentation. Finally, operation time, intraoperative blood loss, hospital stay, and screw insertion time were evaluated. This study involved 50 patients with a mean age of 63.7 years. VAS decreased from 65.8±23 to 20±22 (p&lt;.01). ODI decreased from 35.4%±15 to 11.8%±14 (p&lt;.01). An increase of SF-36 from 51.5±14 to 76±13 (p&lt;.01) was demonstrated. The accuracy of “perfect” and “clinically acceptable” pedicle screw fixation was 89.5% and 98.4%, respectively. Regarding facet violation, 96.8% of the screws were at grade 0. Finally, the average screw insertion time was 4.3±2 min, hospital stay was 4.2±0.8 days, operation time was 205±53 min, and blood loss was 169±107 ml. Finally, a statistically significant correlation of operation time with hospital stay, blood loss and placement time per screw was found. We demonstrated excellent results for accuracy of pedicle screw fixation and violation of facet joints. VAS, ODI and SF-36 showed statistically significant improvements from the control at one month after surgery.Navigation with intraoperative 3D images represents an effective system to improve operative performance in the surgical treatment of spondylolisthesis.

Multimodal Applications of 3D-Navigation in Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: Impacts on Precision, Accuracy, Complications, and Radiation Exposure.

Three-dimensional (3D)-navigation in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) is an evolving procedure. It is used not only for its accuracy of pedicle screw fixation but also for other major steps in transforaminal lumbar interbody fusion. Multimodal outcomes of this procedure are very limited in the literature. The purpose of this study was to examine the application of 3D-navigation in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Patients who underwent single-level MI-TLIF using 3D-navigation between January 2017 and July 2019 were evaluated for navigation setting time, radiation exposure, volume of nucleus pulposus excised, cage placement, accuracy of pedicle screw placement, and cranial facet-joint violation. One hundred and two patients with a mean age of 60.2 years met the inclusion criteria. The mean presetting time of navigation was 46.65 ± 9.45 minutes. Radiation exposure, fluoroscopy use, and fluoroscopy time were 15.54 ± 0.65 mGy, 4.43 ± 0.87 Gy.cm², and 97.6 ± 11.67 seconds, respectively. The mean amount of nucleus pulposus excised from all quadrants was quantified. The cage was centrally placed in 87 patients, with 95.4% showing a Grade 0 pedicle breach and 94.6% showing Grade 0 cranial facet-joint violation. Registration and setting up 3D-navigation takes additional time. The amount of exposure to the patient is much less compared to routine computed tomography, and, importantly, the operating team is protected from radiation. Navigated MI-TLIF has high rates of accuracy with regard to placement of percutaneous pedicle screws and cages with the added advantage of protection of the cranial facet-joint.

Evaluation of the accuracy of mobile cone-beam computed tomography after spinal instrumentation surgery

Purpose: Pedicle screw fixation provides 3-column stabilization, multidimensional control, and a higher rate of interbody fusion. Although computed tomography (CT) is recommended for the postoperative assessment of pedicle screw fixation, its use is limited due to the radiation exposure dose. The purpose of this preliminary retrospective study was to assess the clinical usefulness of low-dose mobile cone-beam CT (CBCT) for the postoperative evaluation of pedicle screw fixation. Methods: The author retrospectively reviewed postoperative mobile CBCT images of 15 patients who underwent posterior pedicle screw fixation for spinal disease from November 2019 to April 2020. Pedicle screw placement was assessed for breaches of the bony structures. The breaches were graded based on the Heary classification. Results: The patients included 11 men and four women, and their mean age was 66±12 years. Of the 122 pedicle screws, 34 (27.9%) were inserted in the thoracic segment (from T7 to T12), 82 (67.2%) in the lumbar segment (from L1 to L5), and six (4.9%) in the first sacral segment. Although there were metal-related artifacts, the image of the screw position (according to Heary classification) after surgery could be assessed using mobile CBCT at all levels (T7–S1). Conclusions: Mobile CBCT was accurate in determining the location and integrity of the pedicle screw and identifying the surrounding bony structures. In the postoperative setting, mobile CBCT can be used as a primary modality for assessing the accuracy of pedicle screw fixation and detecting postoperative complications.

Accuracy of pedicle screw fixation in lumbar spine by freehand technique studied postoperatively by computed tomography

Background: Spinal stabilization using pedicle screw has been widely used in spinal surgery for the management of various pathologies. Aims: We aimed to assess the accuracy of pedicle screw fixation in the lumbar spine by freehand technique studied by postoperative computed tomography (CT) scan. Setting and Design: This prospective observational study was carried out in a tertiary healthcare facility specializing in managing spine deformities. Materials and Methods: The study involved 55 patients with 253 pedicle screws. The accuracy of pedicle screws is determined by calculating breaches in the cortex based on a postoperative CT scan done on three weeks’ postoperative follow-up (on suture removal) and confirming by the index surgeon. Postoperative CT was done in all the patients to evaluate implant position within the first month after surgery. Statistical Analysis: Chi-squared test was used to find the statistical significance. Results: In this study, the accuracy of the pedicle screw in the fixation of the lumbar spine was 95.25%, and the incidence of pedicle breaches was 4.75%. The left breach was comparatively higher than the right breach (5.51% vs. 3.96%). Among 12 breaches of the pedicle trajectory, 7 (58.33%) breaches as compared to the 5 (41.66%) on the left side (P = 0.99). Conclusion: In conclusion, CT scan is a reliable and effective method for postoperative assessment of spinal pedicle screw placement.

Sparse Representation for Different Animal Vertebra Classification along the Fixation Trajectory of Pedicle Screw

Pedicle screw (PS) implantation is an ideal method for the treatment of severe multilevel vertebral instability. The key problem is the accuracy of PS fixation. In this paper, the spectrum of different tissues along the fixation trajectory of PS is studied to tackle the accuracy problem. Fresh porcine vertebrae, bovine vertebrae, and ovine vertebrae were measured by using the near-infrared spectrum (NIRs) device to obtain the reflected spectrum from these vertebrae. Along the fixation trajectory of PS, the classification method based on the sparse representation-based classifier (SRC) was applied to different vertebral tissues (cortical bones and cancellous bones). Considering the large amount of spectral data, sparse preserving projection (SPP) was applied to improve the performance of SRC. The proposed method based on the SPP method for dimensionality reduction and the SRC method for tissue recognition was first used in vertebrae classification and showed superior performance compared with other classification methods, such as SVM and 1NN. The results gained from this project are vital significant to the development of hi-tech medical instruments with independent intellectual property rights.

Accuracy and reliability of spinal navigation: An analysis of over 1000 pedicle screws

PurposeTo estimate the rate of pedicle screw malpositioning associated with placing pedicle screws using intraoperative computed tomography (CT)-guided spinal navigation. MethodsWe analysed the records of 219 patients who underwent pedicle screw fixation using O-arm-based navigation. Screw placement accuracy was evaluated on intraoperative CT scans acquired after pedicle screw insertion. Breaches were graded according to the Gertzbein classification (grade 0–III). ResultsOf 1152 pedicle screws included, 47 had pedicle violations noted on intraoperative CT. Pedicle screw violation was noted for 17 of 241 screws placed in the cervical spine (overall breach rate, 7.05%; 3.73% and 3.3% with grade I and II, respectively), for 11 of 300 screws placed in the thoracic spine (overall breach rate, 3.67%; 2%, 1%, and 0.67% with grade I, II, and III, respectively), and for 22 of 611 screws placed in the lumbar spine (overall breach rate, 3.6%; 2.29% and 0.82% with grade I and II, respectively). The rate of accuracy of pedicle screw fixation was 93%, 96.33%, and 96.4% for the cervical, thoracic, and lumbar spine, respectively. ConclusionsUsing O-arm-based intra-operative three-dimensional scans for navigation can improve the reliability, accuracy, and safety of pedicle screw placement, reducing the risk for reoperation and hospitalization due to implant-related complications. Further improvement may be achieved by adequate consideration of potential sources of errors.

Efficacy and Safety of Atlantoaxial Fluoroscopy-guided Pedicle Screw Fixation in Patients Younger Than 12 Years: A Radiographic and Clinical Assessment.

A retrospective clinical study. The aim of this study was to evaluate the efficacy and safety of fluoroscopy-guided atlantoaxial pedicle screw fixation in patients younger than 12 years. C1-C2 pedicle screw fixation is a widely accepted treatment method for atlantoaxial dislocation (AAD). However, data regarding its use for atlantoaxial fusion (AAF) in children are limited. Thirty-six consecutive patients younger than 12 years underwent C1-C2 pedicle screw fixation for AAD between 2007 and 2017. Anatomical parameters of the C1 pedicle were measured on preoperative computed tomography (CT). Accuracy of pedicle screw fixation was assessed on postoperative CT using the following definitions: Type I, screw threads completely within the bone; Type II, less than half the diameter of the screw violating the surrounding cortex; and Type III, clear violation of the transverse foramen or spinal canal. Demographic, surgical, radiation dose, and clinical data were recorded. Patients underwent 144 screw fixations (67 C1 pedicle screws, 68 C2 pedicle screws, 5 C1 lateral mass screws, and 4 C-2 laminar screws) for a variety of pediatric AADs, with 36.5 ± 8.5 months of follow-up. Among the 135 pedicle screws, 96.3% were deemed "safe" (Type I or II) and 80.7% (109/135) of the screws were rated as being ideal (Type I); five screws (3.7%) were identified as unacceptable (Type III). Average estimated blood loss (EBL) was 92 mL, and the average total radiation exposure during the operation was 6.2 mGy (in the final 26 cases). There were no neurovascular injuries. All patients showed radiographic stability and symptom resolution. C1-C2 pedicle screw fixation under fluoroscopy is safe and effective for the treatment of AAD in children younger than 12 years. However, it may be technically challenging owing to the special anatomical features of children and should be performed by experienced surgeons. 3.

Reliability of the Planned Pedicle Screw Trajectory versus the Actual Pedicle Screw Trajectory using Intra-operative 3D CT and Image Guidance.

Technological advances, including navigation, have been made to improve safety and accuracy of pedicle screw fixation. We evaluated the accuracy of the virtual screw placement (Stealth projection) compared to actual screw placement (intra-operative O-Arm) and examined for differences based on the distance from the reference frame. A retrospective evaluation of prospectively collected data was conducted from January 2013 to September 2013. We evaluated thoracic and lumbosacral pedicle screws placed using intraoperative O-arm and Stealth navigation by obtaining virtual screw projections and intraoperative O-arm images after screw placement. The screw trajectory angle to the midsagittal line and superior endplate was compared in the axial and sagittal views, respectively. Percent error and paired t-test statistics were then performed. Thirty-one patients with 240 pedicle screws were analyzed. The mean angular difference between the virtual and actual image in all screws was 2.17° ± 2.20° on axial images and 2.16° ± 2.24° on sagittal images. There was excellent agreement between actual and virtual pedicle screw trajectories in the axial and sagittal plane with ICC = 0.99 (95%CI: 0.992-0.995) (p<0.001) and ICC= 0.81 (95%CI: 0.759-0.855) (p<0.001) respectively. When comparing thoracic and lumbar screws, there was a significant difference in the sagittal angulation between the two distributions. No statistical differences were found distance from the reference frame. The virtual projection view is clinically accurate compared to the actual placement on intra-operative CT in both the axial and sagittal views. There is slight imprecision (~2°) in the axial and sagittal planes and a minor difference in the sagittal thoracic and lumbar angulation, although these did not affect clinical outcomes. In general, we find that pedicle screw placement using intraoperative cone beam CT and navigation to be accurate and reliable, and as such have made it a routine part of our spine practice. This study was approved by the University of Minnesota IRB (#1303E30544).

Accuracy and Safety Assessment of Pedicle Screw Placement Using the Rapid Prototyping Technique in Severe Congenital Scoliosis

The application of rapid prototyping (RP) technique for improving accuracy of pedicle screw placement in congenital scoliosis is described in this study. To compare the accuracy and safety of pedicle screw placement in congenital scoliosis using the RP technique versus the conventional fluoroscopy. Maldeveloped vertebral components in congenital scoliosis leads to prolonged operation time and higher rate of screw misplacement. RP technique can enhance preoperative and perioperative planning. No data are available on the accuracy of pedicle screw fixation using the RP technique. Sixty-two consecutive patients with hemivertebra had undergone posterior-only hemivertebra resection. Pedicle screws were implanted either by the conventional intraoperative fluoroscopy technique (C-arm group; n=28) or the RP technique (RP group; n=34). Accuracy of pedicle screw placement was compared by postoperative computed tomographic scan. Seventy of 677 inserted screws were found to be misplaced, showing an overall accuracy of 89.7% (90.8% in the thoracic spine and 87.4% in the lumbar spine). In the C-arm group, 86.1% (167 of 194) and 82.0% (82 of 100) of screws were accurately placed in the thoracic and lumbar spine, respectively. While in the RP group, the respective screw placement accuracies were 94.4% (238 of 252) and 91.6% (120 of 131). In the C-arm and the RP groups, 94.8% (279 of 294) and 97.9% (375 of 383) of the screws were within the safety zone, respectively. Compared with the fluoroscopy method, the RP-assisted technique showed a shorter operation time and higher scoliosis correction rate. No neurovascular-related complication was observed with this technique during the study. The application of RP technique in congenital scoliosis can reduce the operation time, the risk of screw misplacement and its consequent complications. The use of RP technique in congenital scoliosis is safe and efficacious.