Cervical Pedicle Screws: Conventional Versus Computer-Assisted Placement of Cannulated Screws

Richter, Marcus; Cakir, Balkan; Schmidt, René

doi:10.1097/01.brs.0000182275.31425.cd

Cited by 201 publications

(175 citation statements)

References 35 publications

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“…At review, 48 papers were excluded as they did not meet the inclusion criteria (Table 1). Thus, 23 publications [5,6,8,9,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] were analysed in this paper (Table 2; 2 randomised controlled trials, 12 case-control studies and 9 case series). Three studies were in German language and remaining 20 studies were in English.…”

Section: Resultsmentioning

confidence: 99%

“…Six studies [12,13,19,24,26,30] reported follow-up period ranging from 15 to 34 months, while one study followed the patients to clinical and radiological bony fusion [16], but none reported on rate of fusion achieved.…”

Section: Fusion Ratementioning

confidence: 99%

“…The reported pedicle screw misplacement in historical spinal literature can be as high as [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39].8% [1][2][3], but only a small number leads to complications (neurological, vascular or visceral injuries). But these complications can be potentially life and limb threatening.…”

Section: Introductionmentioning

confidence: 99%

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Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws

et al. 2010

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A number of studies have shown increased accuracy of pedicle screw placement in spine with the help of computer-assisted navigation. The literature is lacking in regard to functional benefit derived from this technique. The aim of this systematic review was to look at the functional outcomes following computer-assisted pedicle screw placement in spine. A 'Dialog Datastar' search was used using optimized search strategy covering the period from 1950 to July 2009; 23 papers were finally included which met our inclusion criteria. We report on a total of 1,288 patients with 5,992 pedicle screws. The comparison of neurological complications in two groups demonstrated an odds ratio of 0.25 (95% CI 0.06, 1.14) in favour of using navigation for pedicle screw insertion (p = 0.07). Comparative trials demonstrated a significant advantage in terms of accuracy of navigation over conventional pedicle screw insertion with a relative risk of 1.12 (95% CI 1.09, 1.15) (p \ 0.00001). Navigation does not show statistically significant benefit in reducing neurological complications and there was insufficient data in the literature to infer a conclusion in terms of fusion rate, pain relief and health outcome scores.

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Section: Resultsmentioning

confidence: 99%

Section: Fusion Ratementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws

et al. 2010

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“…Although computer-assisted navigation has been used in craniofacial surgery, joint arthroplasty, trauma, and spine surgery [1,4,7,8] for some time, its application in orthopaedic bone tumor surgery is more recent [2,3,5,6,9]. To date, there is no software designed specifically for surgery on long bone and pelvic tumors.…”

Section: Introductionmentioning

confidence: 99%

Computer-assisted Navigation in Bone Tumor Surgery: Seamless Workflow Model and Evolution of Technique

Ying-Lee

Mak

2010

Clinical Orthopaedics &Amp; Related Research

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Background Computer-assisted navigation was recently introduced to aid the resection of musculoskeletal tumors. However, it has not always been possible to directly navigate the osteotomy with real-time manipulation of available surgical tools. Registration techniques vary, although most existing systems use some form of surface matching. Questions/purposes We developed and evaluated a workflow model of computer-assisted bone tumor surgery and evaluated (1) the applicability of currently available software to different bones; (2) the accuracy of the navigated excision; and (3) the accuracy of a new registration technique of fluoro-CT matching. Methods Our workflow involved detailed preoperative planning with CT-MRI image fusion, three-dimensional mapping of the tumor, and planning of the resection plane. Using the workflow model, we reviewed 15 navigation procedures in 12 patients, including four with joint-saving resections and three with custom implant reconstructions. Intraoperatively, registration was performed with either paired points and surface matching (Group 1, n = 10) or a new technique of fluoro-CT image matching (Group 2, n = 5). All osteotomies were performed under direct computer navigation. Postoperatively, each case was evaluated for histologic margin and gross measurement of the achieved surgical margin. Results The margins were free from tumor in all resected specimens. In the Group 1 procedures, the correlation between preoperative planned margins and actual achieved margins was 0.631, whereas in Group 2 procedures (fluoro-CT matching), the correlation was 0.985. Conclusions Our findings suggest computer-assisted navigation is accurate and useful for bone tumor surgery. The new registration technique using fluoro-CT matching may allow more accurate resection of margins.

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“…However, this technique has a potential risk of nerve root, spinal cord and vertebral artery injury due to a small corridor of safe screw placement [31,39,41], recent clinical studies demonstrate that relevant complications do not occur frequently [2,9,11,15,18,24,26,29,47,48]. The axis of the cervical pedicles to the sagittal midline plane vary between 25 and 60°and makes a wide exposure of the spine necessary [14].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous instrumentation of the cervical and cervico-thoracic spine using pedicle screws: preliminary clinical results and analysis of accuracy

et al. 2011

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The pedicle screw instrumentation represents the most rigid construct of the cervical and cervicothoracic spine and in spite of the risks to neurovascular structures clinical relevant complications do not occur frequently. The steep angles of the cervical pedicles result in a wide surgical exposure with extensive muscular trauma. The objective of this study was the evaluation of the accuracy of cervical pedicle screw insertion through a minimally invasive technique to reduce access-related muscular trauma. Therefore, percutaneous transpedicular instrumentation of the cervical and cervicothoracic spine was performed in 15 patients using fluoroscopy. All instrumentations from C2 to Th4 were inserted bilaterally through 2 to 3-cm skin and fascia incisions even in multilevel procedures and the rods were placed by blunt insertion through the incision. Thin-cut CT scan was used postoperatively to analyze pedicle violations. 76.4% of 72 screws were placed accurately. Most pedicle perforations were seen laterally towards the vertebral artery. Critical breaches [2 mm or narrowing of the transversal foramen occurred in 12.5% of screws; however, no revision surgery for screw displacement was needed in the absence of clinical symptoms. No conversion from percutaneous to open surgery was necessary. It was concluded that percutaneous transpedicular instrumentation of the cervical spine is a surgically demanding technique and should be reserved for experienced spine surgeons. The indications are limited to instrumentation-only procedures or in combination with anterior treatment, but with the potential to minimize access-related morbidity.

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Cervical Pedicle Screws: Conventional Versus Computer-Assisted Placement of Cannulated Screws

Cited by 201 publications

References 35 publications

Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws

Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws

Computer-assisted Navigation in Bone Tumor Surgery: Seamless Workflow Model and Evolution of Technique

Percutaneous instrumentation of the cervical and cervico-thoracic spine using pedicle screws: preliminary clinical results and analysis of accuracy

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