Bicortical Versus Unicortical Pedicle Screws in Direct Vertebral Rotation

Bezer, Murat; Ketencı, İsmail Emre; Saygı, Baransel; Kiyak, Görkem

doi:10.1097/bsd.0b013e31825dd542

Cited by 16 publications

(20 citation statements)

References 39 publications

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“…Loosening and dislodging of the screw directly affect internal fixation strength, which in turn determines the success of the operation. [3,4,10,11] To increase the internal fixation strength of the pedicle screw in patients with osteoporosis, clinicians wisely use bone cement augmentation, cortical bone channels, and expandable pedicle screw fixation. However, these techniques significantly increase the risk of nerve injury and the operation time, as well as the amount of bleeding.…”

Section: Discussion 41pedicle Screw Bi-cortical Insertion Significancementioning

confidence: 99%

How to improve the safety of bicortical pedicle screw insertion in the thoracolumbar veterbrae with osteoporotic: Analysis base on three-dimensional CT reconstruction of patients in prone position

Hou

Chu

et al. 2019

Preprint

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Background: Three-dimensional CT reconstruction of prone position could measure the relative position between the Great vessels and the thoracolumbar vertebrae. The Great vessels positions of the thoracic and lumbar segments were studied to improve the accuracy of pedicle screw insertion, reduce the risk of vascular injury. Methods: Twenty-four adults participated in the present study. Three-dimensional reconstruction of thoracolumbar (T9–L3) CT was performed in the prone and supine positions. The relative distance between the arteriovenous vessels and vertebrae distance (AVD/VVD) was obtained, respectively. The relative position angle of the arteriovenous vessel and the vertebral body was calculated as ∠AOY/∠VOY. Self-controlled experiments were carried out in the prone and supine positions. The data obtained were analyzed using SPSS 22.0 statistical software. Results: With regard to AVD, The AVD of the T12 was the smallest,> 3.2 mm. The difference among the T9, T10, L2 level was statistically significant (P < 0.05). And AVD was greater in the prone position than in the supine position; while the value of ∠AOY is the descending from T9-L3 gradually, there were statistically significant differences in ∠AOY between T9-T12, L2 and L3 in prone and supine position (P < 0.05). The aorta in the prone position was closer to the midline than that of the supine position, varying from 0°to 30°near the Y axis. With regard to VVD, there was no significant difference in contrast between the prone and supine positions (P≥0.05), and the VVD was the smallest in the L3 level> 5.4 mm. Conclusion: The pre-vertebral position of the aorta may change from T9 to L3 due to changes in body position. When the T9-L3 thoracolumbar spine disease was treated with pedicle screw double cortical fixation, the screw was safe and reliable within a range of≤ 3 mm when broken the pre-cortex .The three-dimensional reconstruction of prone position CT could be used to more accurately assess the relative position of the vertebral body and the blood vessel.

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Section: Discussion 41pedicle Screw Bi-cortical Insertion Significancementioning

confidence: 99%

How to improve the safety of bicortical pedicle screw insertion in the thoracolumbar veterbrae with osteoporotic: Analysis base on three-dimensional CT reconstruction of patients in prone position

Hou

Chu

et al. 2019

Preprint

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“…Krag et al 11 recommended insertion of pedicle screws between 80 and 100 % of the chord length for optimal resistance to pullout forces. Optimal sized pedicle screws also provide improved resistance to cyclic loading and derotational forces 12,13 . In order to perform the maneuvers for the correcti-on of scoliosis more effectively and safely, a strong screw-vertebra interface with optimally long pedicle screws is essential.…”

Section: Discussionmentioning

confidence: 99%

Pedicle morphometry of thoracic and lumbar vertebrae in adolescent idiopathic scoliosis

Ketencı¹,

Yanık²,

Erdem³

2018

MMJ

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In adolescent idiopathic scoliosis surgery (AIS) thorough knowledge of the morphometry of deformed vertebrae is important for safe pedicle screw instrumentation and correction of deformities. This study aimed to evaluate the morphometry of each vertebra in AIS patients based on chord length (CL), transverse pedicle width (TPW) and transverse pedicle angle (TPA). Preoperative thoracolumbar computed tomography (CT) images of 81 AIS patients that were retrospectively evaluated. Mean age of the patients was 15.1 years, while 64 of them were female and 17 were male. Digital measurements of CL, TPW and TPA were performed for concave and convex pedicles of all thoracic and lumbar levels. Values of concave and convex sides were compared. CL was shortest at T1 and longest at L5. CL values on the concave side were higher than those on the convex side with significant difference at T9 and L3 levels (p<0.05). Consistently smaller TPW values were measured on the concave side, however significant difference was only found at T8 and T9 levels (p<0.05). Narrowest pedicles were observed at T5 level. Highest and lowest values of TPA were observed at T1 and T12 levels respectively. Values were higher on the concave side with significant difference at T7, T8 and L3 levels (p<0.05). Concave pedicles are generally longer, thinner and more medially inclined in the transverse plane. These findigs are distinct in the apical region but may show variations among patients. Routine preoperative CT examination can give important information about the individual bone structure of each patient.

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“…There are some limitations in our study. Depending on our clinical experience and experimental studies, we used bipedicular screws up to the T3 level to distribute pull-out force on as many screws as possible (25) . However, we are unable to make a statement about the necessity of bipedicular screw placement of all levels.…”

Section: Study Limitationsmentioning

confidence: 99%

Deformity Correction in Severe Ankylosing Spondylitis With Combined Osteotomies

Kiyak¹,

Bezer²

2020

jtss

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Objective: To evaluate the effects of single-level lumbar decancellation osteotomy combined with multiple level polysegmental posterior osteotomies involving the whole thoracal spine in severe ankylosing spondylitis. Materials and Methods: Between 2008 and 2017, 14 patients (12 men and two women) were included in the study. The indication for surgery was a progressive loss of horizontal sight due to whole spine kyphosis (chin-brow angle over 90°). The mean age at the time of operation was 47 years. Preoperatively and postoperatively, the cobb angle was measured on standing lateral radiographs of the whole spine. The chin-brow angle correction was recorded. Results: The mean surgical time was 281 minutes, and the average blood loss was 1870 mL. Preoperative mean chin-brow angle was 97.5°. Postoperative chin-brow angle was 18° (p<0.0001). The preoperative mean thoracic cobb angle was 69°, and the postoperative thoracic cobb angle was 37.5° (p<0.0001). The preoperative mean lumbar lordosis angle was-1.2°, and the postoperative mean lumbar lordosis angle was-29° (p<0.0001). There were no major perioperative and postoperative complications. Two patients had minor wound healing problems. Bone healing was satisfactory in all patients. Three patients had a loss of correction in thoracal regions of 5, 7, and 8 degrees at the final follow-up visit. Reduction losses were acceptable, and we did not plan any revision surgeries. Conclusion: Our study showed that this surgical method is as effective as two-level lumbar osteotomies used in severe cases and is also a safer procedure as the latter.

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Bicortical Versus Unicortical Pedicle Screws in Direct Vertebral Rotation

Cited by 16 publications

References 39 publications

How to improve the safety of bicortical pedicle screw insertion in the thoracolumbar veterbrae with osteoporotic: Analysis base on three-dimensional CT reconstruction of patients in prone position

How to improve the safety of bicortical pedicle screw insertion in the thoracolumbar veterbrae with osteoporotic: Analysis base on three-dimensional CT reconstruction of patients in prone position

Pedicle morphometry of thoracic and lumbar vertebrae in adolescent idiopathic scoliosis

Deformity Correction in Severe Ankylosing Spondylitis With Combined Osteotomies

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