Screw Placement Research Articles

Accuracy of Orthodontic Anchor Screw Placement Using a 3D-Printed Surgical Guide.

Background Although radiographs and computed tomography (CT) images are reviewed before temporary anchorage device (TAD) implantation, implantation of TADs exactly as planned is difficult. This study aimed to evaluate the accuracy of TAD implantation using an original surgical guide fabricated using cone-beam CT data and computer-aided design software. Methodology The studyparticipants included six experienced orthodontists who had implanted ≥20 TADs, and six inexperienced orthodontists who had never implanted a TAD. Maxillary dental typodont models with radiopaque tooth crowns and roots were used. A total of four TADs were implanted on the buccal sides: between the second bicuspid and first molars and between the first and second molars bilaterally. The accuracy of TAD implantation was examined in two groups: in 12 dental typodont models, TAD implantation was performed using a surgical guide (guide group), and in 12 dental typodont models, TAD implantation was performed without a surgical guide (freehand group). All dental typodont models implanted a total of 96 TADs.The TAD position was evaluated using the CT coordinate system and 3D image measurement software. Using the long axis of the TAD as a reference, the distance between the coronal and apical ends of the implanted TAD and those of the planned TAD, i.e., the ideal implantation position, was measured in both groups along the x, y, and z axes. The medians of the values were compared between the groups. Additionally, the presence of root contact was compared between the experienced and inexperienced orthodontists. Results On the x-axis, the linear deviations (median) of the coronal and apical ends of the TAD in the freehand group were 1.06 mm and 1.36 mm, respectively. In contrast, in the guide group, the deviations were 0.65 mm and 0.90 mm, respectively, and the difference was statistically significant (p = 0.002 and p = 0.005, respectively). On the y-axis, the deviations in the freehand group were 1.13 mm and 1.08 mm, respectively. In contrast, the deviations in the guide group were 0.71 mm and 0.79 mm, respectively, and only the coronal deviations were significantly different between the groups (p = 0.006). On the z-axis, the deviations in the freehand group were 1.44 mm and 1.86 mm, respectively. In contrast, the deviations in the guide group were 0.75 mm and 1.16 mm, respectively, and the difference was statistically significant (p = 0.006 and p = 0.002, respectively). Conclusions The use of a surgical guide allowed for more accurate TAD implantation. Additionally, TAD implantation using a guide prevented root damage.

Pedicle screw placement in the cervical vertebrae using augmented reality-head mounted displays: a cadaveric proof-of-concept study

BackgroundThe accurate and safe positioning of cervical pedicle screws is crucial. While augmented reality (AR) use in spine surgery has previously demonstrated clinical utility in the thoracolumbar spine, its technical feasibility in the cervical spine remains less explored. PurposeThe objective of this study was to assess the precision and safety of AR-assisted pedicle screw placement in the cervical spine. Study DesignIn this experimental study, 5 cadaveric cervical spine models were instrumented from C3 to C7 by 5 different spine surgeons. The navigation accuracy and clinical screw accuracy were evaluated. MethodsPostprocedural CT scans were evaluated for clinical accuracy by 2 independent neuroradiologists using the Gertzbein-Robbins scale. Technical precision was assessed by calculating the angular trajectory (°) and linear screw tip (mm) deviations in the axial and sagittal planes from the virtual pedicle screw position as recorded by the AR-guided platform during the procedure compared to the actual pedicle screw position derived from postprocedural imaging. ResultsA total of forty-one pedicle screws were placed in 5 cervical cadavers, with each of the 5 surgeons navigating at least 7 screws. Gertzbein-Robbins grade of A or B was achieved in 100% of cases. The mean values for tip and trajectory errors in the axial and sagittal planes between the virtual versus actual position of the screws was less than 3 mm and 30°, respectively (p<.05). None of the cervical screws violated the cortex by more than 2 mm or displaced neurovascular structures. ConclusionsAR-assisted cervical pedicle screw placement in cadavers demonstrated clinical accuracy comparable to existing literature values for image-guided navigation methods for the cervical spine. Clinical SignificanceThis study provides technical and clinical accuracy data that supports clinical trialing of AR-assisted subaxial cervical pedicle screw placement.

A Network Meta-Analysis Comparing the Efficacy and Safety of Pedicle Screw Placement Techniques Using Intraoperative Conventional, Navigation, Robot-Assisted, and Augmented Reality Guiding Systems.

Studies were reviewed and collected to compare different image guidance systems for pedicle screw placement (PSP) regarding accuracy and safety outcomes. Included were conventional, navigation, robot-assisted, and recent technology such as augmented reality (AR) guiding systems. This network meta-analysis obtained human comparative studies and randomized controlled trials (RCTs) regarding PSP found in 3 databases (Cochrane, PubMed, and Scopus). Data extraction for accuracy, safety, and clinical outcomes were collected. The network meta-analysis was analyzed, and a surface under the cumulative ranking curve (SUCRA) was used to rank the treatment for all outcomes. The final 61 studies, including 13 RCTs and 48 non-RCTs, were included in the meta-analysis. These studies included a total of 17,023 patients and 35,451 pedicle screws. The surface under the cumulative ranking curve ranking demonstrated the supremacy of robotics in almost all accuracy outcomes except for the facet joint violation. Regarding perfect placement, the risk difference for AR was 19.1 (95% CI: 8.1-30.1), which was significantly higher than the conventional method. The robot-assisted and navigation systems had improved outcomes but were not significantly different in accuracy vs the conventional technique. There was no statistically significant difference concerning safety or clinical outcomes. The accuracy of PSP achieved by robot-assisted technology was the highest, whereas the safety and clinical outcomes of the different methods were comparable. The recent AR technique provided better accuracy compared with navigation and conventional methods.

Navigation and 3D-imaging in pelvic ring surgery: a systematic review of prospective comparative studies.

Few literature reviews have been published focusing on navigation, robotic or pre-operative planning using 3D-imaging technology (3D-printing, 3D-planning). To our knowledge, no reviews have been performed to assess and compare all these modalities together versus control groups (conventional fluoroscopy) through high Randomized Control Trials (RCTs) and Prospective Control Studies (PCSs). The aim of this study was to assess and compare 3D-imaging technologies from pre-operative planning to per-operative navigation and robotic in the management of pelvic ring fractures through high level studies. A literature search was performed using PubMed, the Cochrane library and Google scholar using keywords up to December 2023. Only prospective comparative studies (RCT and PCS) were included. A total of 341 articles were identified, 39 articles were selected for full-text analysis leaving 7 articles included in this literature systematic review. A trend towards improved precision in screw placement and reduction of radiation exposure without consequences in term of functional outcomes have been identified. No conclusions can be extrapolated regarding operative time and blood loss except for robotic which improve these parameters because robotic arm assistance help surgeons to correctly follow the planning based on 2D-fluoroscopy. Surgery duration and radiation dose are significantly reduced with robotic-arm assistance for the same reasons. With navigation the results have to be nuanced according to the experience of the surgical team. Interest of navigation is emphasized in sacral dysmorphism in comparison with conventional fluoroscopy. This highlights the benefits of navigation for ilio-sacral screw placement in difficult cases and less experimented teams. High level studies which assess and compare 3D-imaging technologies from pre-operative planning to per-operative navigation and robotic in the management of pelvic ring fractures are low. To date and according to the present high level literature, navigation and 3D-technologies in pelvic ring surgery should be recommended for difficult cases. Systematic review of Level II studies.

C2 pedicle screw insertion assisted by mobilization of the vertebral artery in cases with high-riding vertebral artery

ObjectiveTo describe the feasibility, safety and efficacy of mobilization of the vertebral artery for C2 pedicle screws in cases with the high-riding vertebral artery (HRVA). MethodsDuring the period January 2020 to September 2022, fifteen patients underwent posterior occipitocervical fixation in our department. All patients had unilateral HRVA on at least one side that prohibited the insertion of C2 pedicle screws. There were 2 males and 13 females aged 47 ± 11.9 years (range: 17–64 years). After the correction of the vertical dislocation during the operation, the C2 pedicle screw insertion and occipitocervical fixation and fusion were performed using the vertebral artery mobilization technique. A routine three-dimensional reconstructed CT examination was executed to confirm the trajectory of C2 pedicle screws post-operation, and a CT angiography examination was performed when necessary. Neurological function was assessed using the Japanese Orthopedic Association (JOA) scale. The preoperative and postoperative JOA score and the main radiological measurements, including anterior atlantodental interval (ADI), the distance of odontoid tip above Chamberlain line, and clivus-canal angle (CCA), were collected and compared by paired t-test. ResultsAll 15 patients had atlas assimilation, among which 12 patients had C2–C3 fusion (Klippel-Feil syndrome). Mobilization of the HRVA was successfully completed, and C2 pedicle screws were then fulfilled after the vertebral artery was protected. There was no injury to the vertebral artery during the operation. Meanwhile, no severe surgical complications such as cerebral infarction or aggravated neurological dysfunction occurred during the perioperative period. Satisfactory C2 pedicle screw placement and reduction were reached in all 15 patients. All the patients achieved bone fusion 6 months after surgery. No looseness and shift of internal fixation or reduction loss was observed during the follow-up period. Compared to the preoperative, the postoperative JOA score and the main radiological measurements were remarkably improved and statistically significant. ConclusionsC2 pedicle screw insertion assisted by mobilization of the vertebral artery is safe and considerably effective, providing a choice for internal fixation in cases with high-riding vertebral arteries.

Single-position oblique lumbar interbody fusion with navigation: improved efficiency and screw accuracy compared to dual-position with fluoroscopy

Dual-position oblique lumbar interbody fusion with fluoroscopy (D-OLIF) requires repositioning the patient to a prone position for pedicle screw insertion. Recently, single-position surgery with navigation has been introduced. However, there are concerns regarding pedicle screw accuracy and achieving appropriate sagittal balance in single-position OLIF with navigation (S-OLIF). The purpose of this study is to evaluate the clinical and radiological outcomes of S-OLIF compared to D-OLIF. A retrospective analysis was conducted on 102 patients who underwent single-level OLIF at a single institution. The patients were divided into two groups: 55 in the S-OLIF group and 47 in the D-OLIF group. The numeric rating scale for back and leg, Oswestry disability index, and walking distance improvements showed no significant difference. However, the EuroQol 5-dimension 5-level index showed higher improvement in the S-OLIF (P = 0.029). The segmental lordosis, lumbar lordosis, and C7 sagittal vertical axis showed no significant difference. S-OLIF had significantly fewer cases of pedicle screw malposition (P = 0.045). Additionally, the surgery time was shorter in the S-OLIF (P = 0.002). In conclusion, S-OLIF exhibited clinical and radiological outcomes comparable to D-OLIF, with the added advantages of reduced surgery time and enhanced accuracy in pedicle screw placement.

Does Routine Post-Operative Use of Drainage in Minimally Invasive Lumbar Spine Surgery Offer Better Results?

Objective: The advantages of minimally invasive spine surgery (MISS) in lumbar degenerative diseases have been well described (less tissue damage, shorter hospital stay, better results in pain assessment). One aspect that has not yet been studied enough is the usage of a post-operative drain in MISS. The aim of this study was to determine whether drainage in MISS is necessary or not and what advantages or disadvantages its use offers. Materials - Methods: We conducted a systematic review of the published literature, searching articles published on Pubmed and Embasse until December 1st 2022, regarding MISS in the lumbar region and post-operative drain usage. Our inclusion criteria were original articles written in English and articles using minimally invasive techniques (usage of tubular retractors along with an endoscope or microscope, paramedian incision, percutaneous screw placement). 42 articles were assessed, and after careful examination and duplication exclusion, 26 research papers were included. Usage, type and duration of postoperative drainage, length of hospital stay, ambulation time and complications were extracted, and relevant results were pooled. Results: The majority of the included articles (80.7 %) reported using a negative-pressure post-operative drain tube. Drains were removed either 48 hours after surgery or when the drainage volume was less than 50ml/24h. Hospital stays and time to ambulation were shorter in cases where drainage was not used. There was no difference in complications between cases where drainage was used and those that it was not. Conclusion: The rationale behind post-operative drainage in MISS is to protect from surgical site infections and hematoma creation. Based on our study there is no evidence to support this hypothesis. On the contrary, our results suggest that the drawbacks of using a drain (pain, discomfort, anxiety, inconvenience of mobilisation, prolongation of hospitalisation) outweigh the advantages, thus making the routine use of postoperative drainage in MISS unnecessary.

Robotic Spine Surgery: Systematic Review of Common Error Types and Best Practices.

Robotic systems have emerged as a significant advancement in the field of spine surgery. They offer improved accuracy in pedicle screw placement and reduce intraoperative complications, hospital length of stay, blood loss, and radiation exposure. As the use of robotics in spine surgery continues to grow, it becomes imperative to understand common errors and challenges associated with this new and promising technology. Although the reported accuracy of robot-assisted pedicle screw placement is very high, the current literature does not capture near misses or incidental procedural errors that might have been managed during surgery or did not alter treatment of patients. We evaluated errors that occur during robot-assisted pedicle screw insertion and identify best practices to minimize their occurrence. In this systematic review, we characterized 3 types of errors encountered during robot-assisted pedicle screw insertion-registration errors, skiving, and interference errors-that have been reported in the literature. Our search yielded 13 relevant studies reporting robot-assisted screw errors. Nine studies reported registration errors, with 60% of failed screws in those studies caused by registration issues. Seven studies highlighted skiving errors; 26.8% of the failed screws in those studies were caused by skiving. Finally, interference errors were reported in 4 studies, making up 19.5% of failed screws. On the basis of these findings, we suggest best practices-including close attention to preoperative planning, patient positioning, image registration, and equipment selection-to minimize the occurrence of these errors. Awareness of how errors occur may increase the safety of this technology.

Screw placement through a higher medial portal provides better initial stability in arthroscopic ACL tibial avulsion fracture fixation: a finite element analysis

ObjectiveThe objective of this study was to investigate the initial stability of different screw placements in arthroscopic anterior cruciate ligament (ACL) tibial avulsion fracture fixation.MethodsA three-dimensional knee model at 90° flexion was utilized to simulate type III ACL tibial avulsion fracture and arthroscopic screw fixation through different portals, namely the central transpatellar tendon portal (CTP), anterolateral portal (ALP), anteromedial portal (AMP), lateral parapatellar portal (LPP), medial parapatellar portal (MPP), lateral suprapatellar portal (LSP), medial suprapatellar portal (MSP). A shear force of 450 N was applied to the finite element models at 30° flexion to simulate the failure condition. The displacement of the bony fragment and the volume of the bone above 25,000 µ-strain (damaged bone volume) were calculated around the screw path.ResultsWhen the screw was implanted through CTP, the displacement of the bony fragment reached the maximum displacement which was 1.10 mm and the maximum damaged bone volume around the screw path was 148.70 mm3. On the other hand, the minimum displacement of the bony fragment was 0.45 mm when the screw was implanted through LSP and MSP. The minimum damaged bone volume was 14.54 mm3 around the screw path when the screw was implanted through MSP.ConclusionScrews implanted through a higher medial portal generated less displacement of the bony fragment and a minimum detrimental strain around the screw path. The findings are clinically relevant as they provide biomechanical evidence on optimizing screw placement in arthroscopic ACL tibial avulsion fracture fixation.

The accuracy of intraoperative O-arm imaging in assessing thoracolumbar pedicle screws placement

The accuracy of intraoperative O-arm imaging in assessing thoracolumbar pedicle screws placement

One year "ADAPT system" use for proximal femoral fracture osteosynthesis with intramedullary nail . A case control study.

Proximal femoral fractures (PFF) are a significant health concern among the elderly, often leading to complications and high mortality rates. Intramedullary nailing is widely considered the most effective treatment for lateral proximal femoral fractures (LPFF), with the Tip Apex Distance (TAD) being a crucial predictor of surgical success. This study aimed to compare outcomes between patients treated with and without the ADAPT (ADAptive Positioning Technology) system, which aids in the precise placement of the cephalic screw. A retrospective analysis was conducted on 97 patients with intertrochanteric fractures treated in 2022. Patients were divided into two groups: those treated with the ADAPT system (group I, n=34) and those treated without it (group II, n=63). Fractures were classified according to AO/OTA classification. The primary outcomes measured were operative time, cephalic screw angle, TAD, and incidence of lag screw cut-out. Statistical analyses included chi-square tests and t-tests, with significance set at P < 0.05. The ADAPT system did not significantly reduce TAD (18.21 mm in the ADAPT group vs.19.94 mm in the control group, p=0.149). Operative times were similar between the groups. The incidence of lag screw cut-out was low in both groups, with no significant differences. The study confirmed a strong correlation between higher TAD and increased risk of screw cut-out, underscoring the importance of precise screw placement. Computer-assisted surgery, such as the ADAPT system, aims to enhance the accuracy of cephalic screw placement. In this study, the ADAPT system didn't demonstrate a statistically significant advantage in reducing TAD or preventing screw cut-out. Nevertheless, the critical role of TAD in preventing fixation failure was reaffirmed, emphasising the need for precise surgical techniques. While the ADAPT system did not show a significant advantage in reducing TAD or preventing screw cut-out in this study, the importance of achieving optimal TAD in cephalomedullary nailing was reinforced. Future research should continue to explore the role of computer-assisted systems in enhancing surgical accuracy and improving outcomes for patients with LPFF.

Biomechanical effects of posterior lumbar interbody fusion with vertical placement of pedicle screws compared to traditional placement.

The pedicle screw technique is widely employed for vertebral body fixation in the treatment of spinal disorders. However, traditional screw placement methods require the dissection of paraspinal muscles and the insertion of pedicle screws at specific transverse section angles (TSA). Larger TSA angles require more force to pull the muscle tissue, which can increase the risk of surgical trauma and ischemic injury to the lumbar muscles. To study the feasibility of zero-degree TSA vertical pedicle screw technique in the lumbosacral segment. Finite element models of vertebral bodies and pedicle screw-rod systems were established for the L4-S1 spinal segments. A standard axial load of 500 N and a rotational torque of 10 N/m were applied. Simulated screw pull-out experiment was conducted to observe pedicle screw resistance to pull-out, maximum stress, load-displacement ratio, maximum stress in vertebral bodies, load-displacement ratio in vertebral bodies, and the stress distribution in pedicle screws and vertebral bodies. Differences between the 0-degree and 17-degree TSA were compared. At 0-degree TSA, the screw pull-out force decreased by 11.35% compared to that at 17-degree TSA (P < 0.05). At 0-degree and 17-degree TSA, the stress range in the screw-rod system was 335.1-657.5 MPa and 242.8-648.5 MPa, separately, which were below the fracture threshold for the screw-rod system (924 MPa). At 0-degree and 17-degree TSA, the stress range in the vertebral bodies was 68.45-78.91 MPa and 39.08-72.73 MPa, separately, which were below the typical bone yield stress range for vertebral bodies (110-125 MPa). At 0-degree TSA, the load-displacement ratio for the vertebral bodies and pedicle screws was slightly lower compared to that at 17-degree TSA, indicating slightly lower stability (P < 0.05). The safety and stability of 0-degree TSA are slightly lower, but the risks of screw-rod system fracture, vertebral body fracture, and rupture are within acceptable limits.

Advantages of using template guides in children for the correction of congenital spinal deformities and thoracic anomalies

BACKGROUND: In children, progressive congenital deformities of the thoracic spine combined with thoracic anomalies require surgical intervention to correct the curvature and prevent further progression during the child’s growth. Surgical correction of congenital deformity caused by segmentation disorders of the lateral surfaces of the vertebral bodies with unilateral rib synostosis aims at full correction of the existing curvature using the transpedicular spinal system and is an effective and reliable treatment option for these patients. However, this technology requires precise and correct installation of the supporting elements of the metal structure to exclude possible irreversible complications. A solution is the use of template guides in the installation of the support elements of the spinal metal structure. AIM: This study aimed to conduct a comparative analysis of the results of using template guides for the placement of transpedicular screws with the free-hand method in children during surgical correction of congenital spinal deformities combined with thoracic anomalies. MATERIALS AND METHODS: The results of surgical treatment of 20 patients, aged 3–9 years, were analyzed retrospectively to compare the time and accuracy of spinal metal support element placement with and without the use of template guides. The data collected included demographic information, time of bone canal formation, accuracy of spinal transpedicular screw placement, and various complications. RESULTS: Compared with the free-hand method, the use of template guides in the surgical correction of congenital spinal deformities combined with thoracic anomalies in children reduces the time of bone canal formation and increases the accuracy of metal screw placement. These results confirm the efficacy and safety of using template guides during spinal surgery in children with these congenital malformations. CONCLUSIONS: The use of template guides is an effective and reliable method of inserting transpedicular metal screws in the correction of congenital spinal deformities combined with thoracic anomalies in children, which increases the accuracy of implantation of support elements and reduces the surgical time. These results confirm the necessity of using template guides in the correction of congenital spinal deformities in children.

A comparison of ultrasound volume navigation, O-arm navigation, and X-ray guidance for screw placement in minimally invasive transforaminal lumbar interbody fusion: a randomized controlled trial.

To compare the differences between Ultrasound Volume Navigation (UVN), O-arm Navigation, and conventional X-ray fluoroscopy-guided screw placement in Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) surgeries. A total of 90 patients who underwent MIS-TLIF due to lumbar disc herniation from January 2022 to January 2023 were randomly assigned to the UVN group, O-arm group, and X-ray group. UVN, O-arm navigation, and X-ray guidance were used for screw placement in the respective groups, while the remaining surgical procedures followed routine MIS-TLIF protocols. Intraoperative data including average single screw placement time, total radiation dose, and average effective radiation dose per screw were recorded and calculated. On the 10th day after surgery, postoperative X-ray and CT examinations were conducted to assess screw placement accuracy and facet joint violation. There were no significant differences in general characteristics among the three groups, ensuring comparability. Firstly, the average single screw placement time in the O-arm group was significantly shorter than that in the UVN group and X-ray group (P<0.05). Secondly, in terms of total radiation dose during surgery, for single-level MIS-TLIF, the O-arm group had a significantly higher radiation dose compared to the UVN group and X-ray group (P<0.05). However, for multi-level MIS-TLIF, the X-ray group had a significantly higher radiation dose than the O-arm group and UVN group (P<0.05). In terms of average single screw radiation dose, the O-arm group and X-ray group were similar (P>0.05), while the UVN group was significantly lower than the other two groups (P<0.05). Furthermore, no significant differences were found in screw placement assessment grades among the three groups (P>0.05). However, in terms of facet joint violation rate, the UVN group (10.3%) and O-arm group (10.7%) showed no significant difference (P>0.05), while the X-ray group (26.7%) was significantly higher than both groups (P<0.05). Moreover, in the UVN group, there were significant correlations between average single screw placement time and placement grade with BMI index (r = 0.637, P<0.05; r = 0.504, P<0.05), while no similar significant correlations were found in the O-arm and X-ray groups. UVN-guided screw placement in MIS-TLIF surgeries demonstrates comparable efficiency, visualization, and accuracy to O-arm navigation, while significantly reducing radiation exposure compared to both O-arm navigation and X-ray guidance. However, UVN may be influenced by factors like obesity, limiting its application.

Awake Robotic Minimally Invasive Transforaminal Lumbar Interbody Fusion Under Spinal Anesthesia: A Prospective Study with 1-Year Follow-up

We describe our protocol and outcomes of awake robotic minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) under spinal anesthesia. We conducted a prospective study of 10 consecutive patients undergoing awake robotic single-level MIS-TLIF with the Mazor X robot. We prospectively collected patient-reported outcomes (back and leg pain visual analog scale and Oswestry Disability Index) preoperatively at 1-month and 1-year follow-ups and assessed fusion and screw placement accuracy with a 1-year computed tomography (CT) scan. Median age was 61 years (interquartile range [IQR]= 57.7-66). Median body mass index was 27 kg/m2. No intraoperative complications were reported. Most (9/10) patients were discharged home, and 50% discharged on the day of surgery. Median length of stay was 16.5 hours (IQR= 5-35.5). Median follow-up was 12.5 months (IQR= 12-13.5), with 9 patients having at least 12-month follow-up, with CT scans documenting good screw placement (Gertzbein-Robbins grade A) and solid bony fusion. Median preoperative back pain visual analog scale score was 7.8 (IQR= 6.9-8) versus 1.5 (IQR= 0-3.2) at 1-month post operation, P < 0.01, and 0 (IQR= 0-1) at 1-year follow-up, P < 0.01; median preoperative leg pain 8 (IQR= 7.4-8) versus 0 (IQR= 0-1.2) at 1-month post operation, P < 0.01, and 0 (IQR= 0-2) at 1-year follow-up, P < 0.01; median preoperative Oswestry Disability Index 47.5 (IQR= 27.8-57.5) versus 4 (IQR= 0-16) at 1-month postoperation, P < 0.01, and 0 (IQR= 0-7) at 1-year follow-up, P < 0.01. Median preoperative disk height of the index level was 8 mm (IQR= 2.4-9.5) versus 11.4 mm (IQR= 9.2-11.2) postoperatively,P < 0.01. Median preoperative lordosis of the index level was 5 degrees (IQR= 3.4-8.5) versus 10.1 degrees (7.3-12.2) postoperatively, P < 0.01. Our study showed significant improvement in patient-reported outcomes at 1-month and 1-year follow-ups after awake robotic MIS-TLIF, as well as solid bony fusion on CT scans.

Comparison of robot-assisted versus fluoroscopy-guided transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases: a systematic review and meta-analysis of randomized controlled trails and cohort studies

BackgroundAs an emerging technology in robot-assisted (RA) surgery, the potential benefits of its application in transforaminal lumbar interbody fusion (TLIF) lack substantial support from current evidence.ObjectiveWe aimed to investigate whether the RA TLIF is superior to FG TLIF in the treatment of lumbar degenerative disease.MethodsWe systematically reviewed studies comparing RA versus FG TLIF for lumbar degenerative diseases through July 2022 by searching PubMed, Embase, Web of Science, CINAHL (EBSCO), Chinese National Knowledge Infrastructure (CNKI), WanFang, VIP, and the Cochrane Library, as well as the references of published review articles. Both cohort studies (CSs) and randomized controlled trials (RCTs) were included. Evaluation criteria included the accuracy of percutaneous pedicle screw placement, proximal facet joint violation (FJV), radiation exposure, duration of surgery, estimated blood loss (EBL), and surgical revision. Methodological quality was assessed using the Cochrane risk of bias and ROBINS-I Tool. Random-effects models were used, and the standardized mean difference (SMD) was employed as the effect measure. We conducted subgroup analyses based on surgical type, the specific robot system used, and the study design. Two investigators independently screened abstracts and full-text articles, and the certainty of evidence was graded using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach.ResultsOur search identified 539 articles, of which 21 met the inclusion criteria for quantitative analysis. Meta-analysis revealed that RA had 1.03-folds higher “clinically acceptable” accuracy than FG (RR: 1.0382, 95% CI: 1.0273–1.0493). And RA had 1.12-folds higher “perfect” accuracy than FG group (RR: 1.1167, 95% CI: 1.0726–1.1626). In the case of proximal FJV, our results indicate a 74% reduction in occurrences for patients undergoing RA pedicle screw placement compared to those in the FG group (RR: 0.2606, 95%CI: 0.2063- 0.3293). Seventeen CSs and two RCTs reported the duration of time. The results of CSs suggest that there is no significant difference between RA and FG group (SMD: 0.1111, 95%CI: -0.391–0.6131), but the results of RCTs suggest that the patients who underwent RA-TLIF need more surgery time than FG (SMD: 3.7213, 95%CI: 3.0756–4.3669). Sixteen CSs and two RCTs reported the EBL. The results suggest that the patients who underwent RA pedicle screw placement had fewer EBL than FG group (CSs: SMD: -1.9151, 95%CI: -3.1265–0.7036, RCTs: SMD: -5.9010, 95%CI: -8.7238–3.0782). For radiation exposure, the results of CSs suggest that there is no significant difference in radiation time between RA and FG group (SMD: -0.5256, 95%CI: -1.4357–0.3845), but the patients who underwent RA pedicle screw placement had fewer radiation dose than FG group (SMD: -2.2682, 95%CI: -3.1953–1.3411). And four CSs and one RCT reported the number of revision case. The results of CSs suggest that there is no significant difference in the number of revision case between RA and FG group (RR: 0.4087,95% CI 0.1592–1.0495). Our findings are limited by the residual heterogeneity of the included studies, which may limit the interpretation of the results.ConclusionIn TLIF, RA technology exhibits enhanced precision in pedicle screw placement when compared to FG methods. This accuracy contributes to advantages such as the protection of adjacent facet joints and reductions in intraoperative radiation dosage and blood loss. However, the longer preoperative preparation time associated with RA procedures results in comparable surgical duration and radiation time to FG techniques. Presently, FG screw placement remains the predominant approach, with clinical surgeons possessing greater proficiency in its application. Consequently, the integration of RA into TLIF surgery may not be considered the optimal choice.Systematic review registrationPROSPERO CRD42023441600.

Influence of age on pelvic inlet and outlet radiographic views

Background. Unstable fractures of the posterior pelvic ring represent a pressing concern in trauma surgery. Minimally invasive osteosynthesis techniques have gained widespread acceptance in contemporary practice. Accurate radiographic visualization is a critical component for the precise and successful placement of iliosacral and transsacral screws. Obtaining and accurately interpreting X-ray images can pose challenges in specific clinical situations, particularly those involving age-related skeletal changes. The aim of the study is to assess the influence of the patient’s age on the measures of pelvic radiographic inlet and outlet views angles for performing a sacral fracture fixation using cannulated screws. Methods. A retrospective analysis of CT data was conducted on 106 patients with posterior pelvic ring injuries requiring cannulated screw fixation. Preoperative CT scans were reconstructed into sagittal projections. We performed construction and measurement of the true inlet angle, super-inlet angle, pelvic outlet angle, sacral concavity angle, promontory angle, S1 and S2 outlet view angles. Statistical correlation between sacral tilt angle and the patient’s age was assessed. Results. A two-step cluster analysis divided the patient cohort into two groups with significant differences in pelvic outlet angles and age (N1 = 64, N2 = 42). Statistically significant differences were found between the two clusters in all the studied parameters: median values of true pelvic inlet angles were 27.2° [23.2-32.2] and 18.2° [11.4-26.6] respectively (p0.001); super-inlet angles were 42.5° [39.3-47.8] and 36.2° [28.7-42.8] respectively (p0.001); promontory angles were 128.1° [123.3-133.2] and 122.1° [115.6-129.3] respectively (p = 0.003); pelvic outlet angles were 62.6° [58.4-69.6] and 50.3° [45.9-53.5] respectively (p0.001); S1 outlet angles were 51.8° [48.9-56.5] and 46.8° [43.1-50.2] respectively (p0.001); S2 outlet angles were 40.8° [37.3-44.6] and 35.7° [30.9-38.6] respectively (p0.001); the mean of the sacral concavity angles was 174.8°±10.5 and 152.1°±38.2 respectively (p0.001); and the main age was 41.6±18.7 and 69.2±16.1 years respectively (p0.001). A statistically significant inverse correlation between age and pelvic tilt angle (ρ = 0.534; p0.001) was found. A novel diagnostic method for identifying sacral dysmorphism using angle measurement within the S1 bone corridor is presented. The sacrum was considered dysmorphic if the angle was equal to or less than 5°. Conclusions. As the patient’s age increases by one year, pelvic outlet angle decreases by 26°. If pelvic inlet angles are equal to or less than 14.45°, the difficulties in visualizing S1 and S2 outlet views during surgery are to be expected. The median of angles difference before and after anterior sacral tilt correction using a coccyx pad was 9.4° with interquartile range from 7.8° to 11°. Significant anatomical variations in posterior pelvic ring structure were observed among the study cohort. Preoperative CT sagittal reconstructions allow appropriate planning of intraoperative visualization considering expected intraoperative radiographic inlet and outlet views.

Pengaruh Angin Terhadap Tata Letak dan Jumlah Sekrup Konstruksi Baja Ringan Berdasarkan SNI-7971- 2013

Light weight steel material has experienced rapid development in the construction. However, there are still many costruction failures on light weight steel, resulting in cost loss. The failure of light steel structures often occurs at the connections. The connection tool on milld steel is usually using a self-drilling screw. The research location is at Aceh One Stop Integrated Service and Investment Service Building (DPMPTSP) Aceh. The problem in this study is the placement and number of screws on the lightweight steel roof structure in the field which is carried out for each member according to the code, and the effect of wind load on the placement and number of screws on the lightweight steel roof structure. This study aims to determine the effect of the placement and number of screws on the lightweight steel roof structure. The scope of this research of problems including the placement and number of screws on the lightweight steel roof structure. The standars used in the design of light steel structures in this study is SNI 7971 2013 and the loading planning standars using SNI 03 1727 1989. Calculation steps using the LRFD method for steel structure design regulated in SNI 03 1729 2002. Based on the results, it is obtained that the number and placement of the screws in the field are different from those obtained in the calculation. From the calculations, it is obtained from the recapitulation, dead loads with a maximum value of 123.07 kg, live loads with a maximum load of 30.1 6 kg, and for compressed air and suction loads with a maximum load of 180 kg. the maximum design force value is 1241.33 kg and the screws bearing resistance value is 256.752 kg. the number of screws is obtained where the the value of the design force is divided by the value of the bearing resistance, on each member obtained 1screw, 2 screws, 3 screws, 4 screws, and 5 screws. Whilst it is found for each member in the field using 3 screws.

Fully automated determination of robotic pedicle screw accuracy and precision utilizing computer vision algorithms

Historically, pedicle screw accuracy measurements have relied on CT and expert visual assessment of the position of pedicle screws relative to preoperative plans. Proper pedicle screw placement is necessary to avoid complications, cost and morbidity of revision procedures. The aim of this study was to determine accuracy and precision of pedicle screw insertion via a novel computer vision algorithm using preoperative and postoperative computed tomography (CT) scans. Three cadaveric specimens were utilized. Screw placement planning on preoperative CT was performed according to standard clinical practice. Two experienced surgeons performed bilateral T2–L4 instrumentation using robotic-assisted navigation. Postoperative CT scans of the instrumented levels were obtained. Automated segmentation and computer vision techniques were employed to align each preoperative vertebra with its postoperative counterpart and then compare screw positions along all three axes. Registration accuracy was assessed by preoperatively embedding spherical markers (tantalum beads) to measure discrepancies in landmark alignment. Eighty-eight pedicle screws were placed in 3 cadavers’ spines. Automated registrations between pre- and postoperative CT achieved sub-voxel accuracy. For the screw tip and tail, the mean three-dimensional errors were 1.67 mm and 1.78 mm, respectively. Mean angular deviation of screw axes from plan was 1.58°. For screw mid-pedicular accuracy, mean absolute error in the medial–lateral and superior–inferior directions were 0.75 mm and 0.60 mm, respectively. This study introduces automated algorithms for determining accuracy and precision of planned pedicle screws. Our accuracy outcomes are comparable or superior to recent robotic-assisted in vivo and cadaver studies. This computerized workflow establishes a standardized protocol for assessing pedicle screw placement accuracy and precision and provides detailed 3D translational and angular accuracy and precision for baseline comparison.

Analysis of the therapeutic efficacy of robot-assisted percutaneous screw fixation in the minimally invasive treatment of pelvic fractures.

To compare the therapeutic efficacy of robot-assisted and manual screw placement techniques for the treatment of pelvic fractures. This study included patients with pelvic fractures admitted to our orthopedic department between January 2020 and January 2022. They were randomly assigned to either the robot-assisted group or the control group. Various parameters, including surgical duration, intraoperative bleeding, fluoroscopy frequency, postoperative pain, length of hospitalization, postoperative hematological indices, postoperative functional scores, and postoperative complications, were compared between the two groups. There were no significant differences in age, sex, body mass index, and preoperative hematological parameters between the two groups. The robot-assisted group exhibited significantly shorter surgical duration, lower fluoroscopy frequencies, lower postoperative pain scores, and shorter length of hospitalization compared to the control group. At 3 and 6 months postoperatively, patients in the robot-assisted group demonstrated significantly higher Majeed functional scores in comparison to the control group. However, there were no significant differences in Majeed scores at 12 months postoperatively. Moreover, there were no significant differences in postoperative complications between the two groups. Robot-assisted minimally invasive treatment of pelvic fractures using hollow screws effectively reduced surgical duration, mitigated intraoperative bleeding and postoperative pain, shortened hospital stays, and promoted faster functional recovery.