Accuracy of minimally invasive percutaneous thoracolumbar pedicle screws using 2D fluoroscopy: a retrospective review through 3D CT analysis

Winder, Mark J.; Gilhooly, Paul

doi:10.21037/jss.2017.06.05

Cited by 23 publications

(16 citation statements)

References 32 publications

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“…Misplaced screws are not only biomechanically disadvantageous but also carry an increased risk for neurological deficit, vascular damage, and morbidity [1][2][3]. Advances in imaging and navigation such as fluoroscopic guidance have improved the accuracy of screw placement in the spine, yet significantly increased the amount of radiation exposure to the patient, surgeon, and operating room (OR) staff [4,5].…”

Section: Introductionmentioning

confidence: 99%

Navigated robotic assistance results in improved screw accuracy and positive clinical outcomes: an evaluation of the first 54 cases

Benech¹,

Perez²,

Benech³

et al. 2019

J Robotic Surg

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Computer-aided navigation and robotic guidance systems have become widespread in their utilization for spine surgery. A recent innovation combines these two advances, which theoretically provides accuracy in spinal screw placement. This study describes the cortical and pedicle screw accuracy for the first 54 cases where navigated robotic assistance was used in a surgical setting. This is a retrospective chart review of the initial 54 patients undergoing spine surgery with pedicle and cortical screws using robotic guidance with navigation. A computed tomography (CT)-based Gertzbein and Robbins System (GRS) was used to classify pedicle screw accuracy. Screw tip, tail, and angulation offsets were measured using image overlay analysis. Screw malposition, reposition, and return to operating room rates were collected. 1 of the first 54 cases was a revision surgery and was excluded from the study. Ten screws were placed without the robot due to surgeon discretion and were excluded for the data analysis of 292 screws. Only 0.68% (2/292) of the robot-assisted screws was repositioned based on surgeon discretion. Based on the GRS CT-based grading, 98.3% (287/292) were graded A or B, 1.0% (3/292) screws were graded C, and only 0.7% (2/292) screws was graded D. The average offset from preoperative plan to actual final placement was 1.9 mm from the tip, 2.3 mm from the tail, and 2.8° of angulation. In the first 53 cases, 292 screws placed with navigated robotic assistance resulted in a high level of accuracy (98.3%), adequate screw offsets from planned trajectory, and zero complications.

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Section: Introductionmentioning

confidence: 99%

Navigated robotic assistance results in improved screw accuracy and positive clinical outcomes: an evaluation of the first 54 cases

Benech¹,

Perez²,

Benech³

et al. 2019

J Robotic Surg

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“…However, the complication of pedicle screw misplacement is concerning with the freehand approach, especially in thoracic and cervical spine region. Winder et al reported that a misplacement rate of thoracic pedicle screws is 14.67% (12). Amiot et al reported…”

Section: Discussionmentioning

confidence: 99%

Design of a 3D navigation template to guide the screw trajectory in spine: a step-by-step approach using Mimics and 3-Matic software

Feng¹,

Li²,

Phan³

et al. 2018

J Spine Surg

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Rapid development of 3D printing techniques has led to the design of navigation templates to assist with accurate insertion of pedicle screws in last decades. However, there are still without the precise step-by-step methods to design 3D navigation templates from computed tomography (CT) images. Our present article provides a detailed protocol to allow the readers or researchers to obtain the 3D navigation template easily, and assist with pedicle screw insertion in their future research and surgery. Using 3D navigation template-assisted pedicle screw fixation in spine surgery is low cost and can decrease the radiation exposure to both patients and surgeons.

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“…On the other hand, comparison of maldirected screws (classes 2 and 3 collectively) between the two groups confirmed a statistically high significant difference in the number of maldirected screws per patient (P<0.001). Idler et al, 10 Mark et al, 15 and Tsuang et al, 14 reported better results regarding the number of cortical breaches complicating percutaneous lumbar screws placements with an overall accuracy of 98.47%, 97.7% and 94.1% respectively while Spitz et al, 13 reported an overall accuracy of 96.7%. On the other hand, Mohi Eldin et al, 11 reported an accuracy rate that was comparable to that reported in the current study (79.4% versus 81.25 % respectively) regarding the percutaneous group.…”

Section: Discussionmentioning

confidence: 99%

“…Screw misplacement carries the risk of having an inadequate construct, unintended durotomy and, moreover, an incidence of inadvertent neurological injury of 1%-11%. 5,12,15 Currently, there are three methods for pedicle screw placement: the free hand, the fluoroscopy guided open and the percutaneous techniques with the fluoroscopy guided open technique being the most frequently used one. 3,7,16 The traditional open technique has been always believed to have the disadvantage of extensive paraspinal muscles dissection and retraction for exposure of the necessary bony landmarks that may be a direct cause of more blood loss and a prolonged postoperative hospital stay and recovery time especially from pain.…”

Section: Introductionmentioning

confidence: 99%

“…4 Today, the percutaneous technique is gaining more popularity for treatment of an expanding variety of spinal pathologies. 6,13,15 However, the lack of direct visualization of bony landmarks and tactile feedback may be considered a challenge for accurate screw placement that can be, in part, overcome by the inevitable increased use of image guidance with its inherent risk of higher radiation exposure. 5 Despite being reported safe and accurate, percutaneous pedicle screw insertion is still being investigated in comparison to the traditional open technique.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of Screw Placement in Lumbar Transpedicular Fixation: A Comparative Study between Open and Percutaneous Techniques Using a Novel Classification Model

Elayouty

Morad

Salem

2017

Egyptian Spine Journal

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Background Data:In the late fifties of the last century, Boucher described posterior pedicle screw placement for the first time for treatment of a diversity of spinal pathologies. Currently, there are three methods for pedicle screw placement: the free hand, the fluoroscopy guided open and the percutaneous techniques. Despite being reported safe and accurate, percutaneous pedicle screw insertion is still being investigated in comparison to the traditional open technique. Purpose: In this study, the authors are trying to find out if there was any superiority of one technique regarding accuracy of screw placement. Study Design: This is a retrospective comparative study designed to assess the accuracy of screw placement in the sagittal plane in patients who underwent lumbar transpedicular fixation by open versus percutaneous techniques. Patients and Methods: Patients were categorized into two groups: group A including patients who underwent open surgery and group B patients who underwent percutaneous fixation. Each screw was categorized according to the sagittal plane into one of the following classes: Class 0: with no cortical penetration at all, Class 1: with a single cortical penetration denoting accepted entry point and trajectory, Class 2: with 2 cortices penetration violating the lateral cortex of the pedicle and/or the vertebral body and Class 3: with 3 cortices penetration and a medially maldirected trajectory violating the roof and floor of the lateral recess. Results: The current study included 51 patients distributed as 28 patients (55 %) in group A and 23 patients (45 %) in group B. A total of 262 screws were investigated with 134 (51.15 %) screws in group A and 128 (48.85 %) screws in group B. Cross tabulation of raw data of different screw type distribution among the two patients' groups preliminarily revealed a quite favorable screws position among group A patients with 94.77% of screws in class 1, 4.48% in class 2 and 0.75% of screws in class 3 compared to 81.25%, 12.5% and 6.25% respectively in group B of patients. However, statistical analysis using Chi Square test for individual screws' groups related to specific pedicles failed to show any significant difference with each one of the pertinent P-values>0.05. On the other hand, comparison of maldirected screws (classes 2 and 3 collectively) between the two groups confirmed a statistically high significant difference in the

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Accuracy of minimally invasive percutaneous thoracolumbar pedicle screws using 2D fluoroscopy: a retrospective review through 3D CT analysis

Cited by 23 publications

References 32 publications

Navigated robotic assistance results in improved screw accuracy and positive clinical outcomes: an evaluation of the first 54 cases

Navigated robotic assistance results in improved screw accuracy and positive clinical outcomes: an evaluation of the first 54 cases

Design of a 3D navigation template to guide the screw trajectory in spine: a step-by-step approach using Mimics and 3-Matic software

Accuracy of Screw Placement in Lumbar Transpedicular Fixation: A Comparative Study between Open and Percutaneous Techniques Using a Novel Classification Model

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