Comparison of Cranial Facet Joint Violation Rates Between Open and Percutaneous Pedicle Screw Placement Using Intraoperative 3-D CT (O-arm) Computer Navigation

Yson, Sharon C.; Sembrano, Jonathan N.; Sanders, Peter C.; Santos, Edward Rainier G; Ledonio, Charles Gerald T.; Polly, David W.

doi:10.1097/brs.0b013e31827ecbf1

Cited by 93 publications

(67 citation statements)

References 27 publications

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“…Therefore, pedicle screw fixation and lamina posterolateral bone graft fusion during operation are not reliable for the stability maintenance of the integral spinal column, namely that strengthening the stability of the posterior column merely has no noticeable effect on the stability of the anterior and central columns. Plain CT scanning images of the fracture at the long-term follow-up show that the empty intravertebral cavity is always present (19,20). As vertebral stability is mainly involved in the anterior middle spine (accounting for ∼60%), performing posterolateral fusion during surgery is not reliable and is ineffective for the stabilization of the anterior middle spine.…”

Section: Discussionmentioning

confidence: 99%

Posterior internal fixation plus vertebral bone implantation under navigational aid for thoracolumbar fracture treatment

Zhou

Kong

Zhao

et al. 2013

Experimental and Therapeutic Medicine

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The aim of this study was to investigate the method of posterior thoracolumbar vertebral pedicle screw reduction and fixation combined with vertebral bone implantation via the affected vertebral body under navigational aid for the treatment of thoracolumbar fractures. The efficacy of the procedure was also measured. Between June 2005 and March 2011, posterior thoracolumbar vertebral pedicle screw reduction and fixation plus artificial bone implantation via the affected vertebral pedicle under navigational aid was used to treat 30 patients with thoracolumbar fractures, including 18 males and 12 females, ranging in age from 21 to 57 years. Compared with the values prior to surgery, intraspinal occupation, vertebral height ratio and Cobb angle at the follow-up were significantly improved. At the long-term follow-up, the postoperative Cobb angle loss was <1° and the anterior vertebral body height loss was <2 mm. Posterior thoracolumbar vertebral pedicle screw reduction and fixation combined with vertebral bone implantation via the affected vertebral body under navigational aid may increase the accuracy and safety of surgery, and it is an ideal method of internal implantation. Bone implantation via the affected vertebral body may increase vertebral stability.

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Section: Discussionmentioning

confidence: 99%

Posterior internal fixation plus vertebral bone implantation under navigational aid for thoracolumbar fracture treatment

Zhou

Kong

Zhao

et al. 2013

Experimental and Therapeutic Medicine

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“…26 This may be related to the fact that an accurate intraoperative CT scan may allow the surgeon to project the virtual screw trajectory in all 3 planes and adjust the entry point and direction based on pseudo-real-time feedback. However, another study on patients undergoing TLIF did not find a similar benefit with the use of O-arm navigation.…”

Section: 6mentioning

confidence: 99%

Use of anteroposterior view fluoroscopy for targeting percutaneous pedicle screws in cases of spinal deformity with axial rotation

Ahmad¹,

Wang²

2014

SPI

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Object Over the past decade percutaneous pedicle screws have become popular for the minimally invasive treatment of spinal disorders. However, until the last 5 years the presence of a significant spinal deformity was regarded as a relative contraindication for percutaneous instrumentation. Recent advances in surgical technique and intraoperative technology have made percutaneous fixation in complex spinal pathologies more commonplace. The authors report their experience using a parsimonious method for uniplanar fluoroscopic targeting of pedicles in challenging cases. Methods The authors performed a retrospective analysis of patients with adult spinal deformity who underwent percutaneous pedicle screw instrumentation from 2008 to 2013. Cases were included if a spiral slice postoperative CT scan was obtained. All cases had a minimum of 10° of axial rotation and typically had additional accompanying anatomical abnormalities. Screws were assessed for any pedicle violations as well as any impingement of the surrounding facet joints. Results A total of 410 pedicle screws were placed in 36 patients with an average 6.4 levels of instrumentation per patient. The mean age was 67 years (range 44–86 years) and there were 25 females. Of the 410 screws, 29 (7.1%) had some medial or lateral pedicle violation. Of these, 15 (3.7%) were Grade 1, 6 (1.4%) were Grade 2, and 8 (2.0%) were Grade 3 violations. Of the Grade 3 violations, 2 each were at the L-4, L-5, and S-1 levels, and 1 each was at the T-10 and L-1 levels. Two of the patients had symptoms and both underwent screw repositioning, one during the same admission and the other in a delayed fashion. Both were at the L-5 and S-1 levels with anatomically highly medialized pedicles. There were no motor deficits, and both removals were for numbness. Of the 72 screws at the proximal end of the construct, there were 6 facet violations (8.3%). Four (5.6%) of these were Grade 1, 1 (1.4%) was Grade 2, and 1 (1.4%) was Grade 3. Conclusions The anteroposterior fluoroscopic technique can be effectively used by spinal surgeons to cannulate the pedicles in patients with rotational deformities. The complication rate in this challenging population is acceptable and is in accordance with the existing literature. However, caution should be used at L-5 and S-1 when the pedicle is narrow and highly medialized, rendering an indistinct medial wall on anteroposterior imaging.

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“…Even with perfect fluoroscopic images, a slightly poor choice of entry site or too much medial angulations can result in a violation. A thorough review of the literature demonstrates that it is unclear whether open or percutaneous pedicle screw placement results in more facet violations [13][14][15][16]. Moshirfar et al [17] evaluated 204 patients who underwent open screw placement and found that 24% of the cases had cranial facet joint violations.…”

Section: Discussionmentioning

confidence: 99%

Superior Facet Joint Violations in Single Level Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion: A Comparative Study

et al. 2020

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To compare the incidence of iatrogenic superior facet joint violation (SFV) in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open TLIF (OPEN-TLIF) at a single lower lumbar fusion level and to evaluate the patient and surgical factors influencing the outcome. Overview of Literature: Iatrogenic SFV is a significant risk factor for adjacent segment disease (ASD). Blind screw placement technique in MIS-TLIF contributes to the increasing incidence of iatrogenic SFV which can be influenced by several other potential factors. There are only limited studies comparing the incidence of iatrogenic SFV in MIS-TLIF and OPEN-TLIF. Methods: In total, 225 cases (450 top screws; MIS-TIFL, 120; OPEN-TILF, 105) undergoing single-level lower lumbar fusion were included in the study. Postoperative computed tomography grading system was used to evaluate iatrogenic SFV. Patient and surgical factors such as age, body mass index, top-screw level, side of the top screw, depth of the spine, and superior facet joint angle (SFA) were analyzed in iatrogenic SFV and non-violation groups to determine their influence on iatrogenic SFV. The clinical outcomes in both groups were assessed preoperatively and postoperatively. Results: The overall incidence of iatrogenic SFV and high-grade violations was higher in MIS-TLIF (41.25%) than in OPEN-TLIF (30.4%). In both groups, bivariate analysis showed a significantly greater incidence of the iatrogenic SFV in patients aged <60 years and those with obesity, top pedicle screws at L4, right-sided top screws, SFA >35°, and depth of the spine >50 mm. Conclusions: This study demonstrated that the incidence of iatrogenic SFV is greater in MIS-TLIF than in OPEN-TLIF at a single lower lumbar level. MIS-TLIF is effective for lumbar degenerative disease; however, the incidence of iatrogenic SFV was higher. Patient and surgical factors must be considered to protect the facet joints in both TLIF methods to avoid ASD.

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Comparison of Cranial Facet Joint Violation Rates Between Open and Percutaneous Pedicle Screw Placement Using Intraoperative 3-D CT (O-arm) Computer Navigation

Abstract: 4.

Cited by 93 publications

References 27 publications

Posterior internal fixation plus vertebral bone implantation under navigational aid for thoracolumbar fracture treatment

Posterior internal fixation plus vertebral bone implantation under navigational aid for thoracolumbar fracture treatment

Use of anteroposterior view fluoroscopy for targeting percutaneous pedicle screws in cases of spinal deformity with axial rotation

Superior Facet Joint Violations in Single Level Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion: A Comparative Study

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