Does the Full Power-Assisted Technique Used in Pedical Screw Placement Affect the Safety and Efficacy of Adolescent Idiopathic Scoliosis Surgery?

Huang, Yan; Jiang, Dengxu; Xu, Liang; Liu, Zhen; Sun, Xu; Sha, Shifu; Qiu, Yong; Zhu, Zezhang

doi:10.1016/j.wneu.2018.04.047

Cited by 11 publications

(20 citation statements)

References 20 publications

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“…However, due to the serious spine degenerative problem in the elderly people, the consistent and accurate insertion of lumbar pedicle screws i still a challenge for spine surgeons. Compared to the younger group, it is thought that the risk of the failure and nerve injury of posterior pedicle screw placement is significantly higher in the elderly people [12]. However, for burst lumbar fractures and patients with symptoms of severe nerve injury, open surgery still makes an indispensable role for fully decompression of vertebral canal.…”

Section: Resultsmentioning

confidence: 99%

Treating Lumbar Fracture Using the Mixed Reality Technique

Zhang

et al. 2021

BioMed Research International

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The mixed reality (MR) technique has recently been widely used in the orthopedic surgery with satisfactory results reported. However, few studies have focused on the application of MR in the Lumbar fracture (LF). In this retrospective study, our aim is to analyze some findings by investigating the feasibility of MR applied to lumbar fracture treatment. Posterior vertebrectomy has been operated on 7 patients. The MR–based intraoperative three-dimensional image-guided navigation system (MITINS) was used to assist implantation of pedicle screws. The feasibility and safety of pedicle screw implantation were assessed by postsurgery radiography. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were used to assess the pain level and recovery situation before and after surgery. 57 pedicle screws were safely and precisely placed into three-dimensional lumbar models by using MITINS. No screw was found outside the pedicle of the models, and it was not necessary for the X-ray to provide extra locative information during the operation with the use of MITINS. In summary, the application of MITINS is feasible, safe, and accurate while the lumbar fracture surgery is processing, providing satisfactory assistance for spine surgeons.

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Section: Resultsmentioning

confidence: 99%

Treating Lumbar Fracture Using the Mixed Reality Technique

Zhang

et al. 2021

BioMed Research International

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“…Overall, a shortage of information in some aspects caused unclear/moderate risk of bias in 5 out of 6 trials, whereas one trial conducted by Yan et al was judged as having a high risk of bias due to measurement of the outcome. 11 The postoperative CT scan evaluation to assess the accuracy of PS in this trial was 5 mm thick; meanwhile, the ideal CT scan thickness for spine evaluation is 1-2 mm. 26 The definition of pedicle breach and safe zone (in relation to the risk of injuring vital structures) differed among trials.…”

Section: Qualitative Assessmentmentioning

confidence: 96%

“…The conventional freehand (FH) relies solely on anatomical landmarks; thus requiring adequate knowledge and experience from the spine surgeon through a higher learning curve. 7 We define modified freehand (MF) when the surgeon utilizes non-imaging technology such as 3-dimensional (3D) printed anatomic models, 8 3D printed drill template, 9 electronic conductivity, 10 full-power assisted (FPA), 11 or electromyography (EMG) 12 to assist PS placement. Whereas, image-guided techniques utilize either fluoroscopy-based navigation (FL), intraoperative computed tomography/CT-based navigation (CT-nav), robotic-assisted (RA), 13 or ultrasound (UG) 14 to help the surgeon visualize the screw position.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Pedicle Screw Placement Methods in Pediatrics and Adolescents Spinal Surgery: A Systematic Review and Meta-Analysis

Vega

Navarro

Gibson

et al. 2021

Global Spine Journal

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Study Design: Systematic review and meta-analysis. Objective: Various methods of pedicle screw (PS) placement in spinal fusion surgery existed, which can be grouped into conventional freehand (FH), modified freehand (MF), and image-guided methods (including fluoroscopy-based navigation (FL), computed tomography-based navigation (CT-nav), robot-assisted (RA), and ultrasound-guided (UG)). However, the literature showed mixed findings regarding their accuracy and complications. This review aimed to discover which method of PS placement has the highest accuracy and lowest complication rate in pediatric and adolescent spinal fusion surgery. Methods: A comprehensive search in MEDLINE (PubMed), EMBASE (OVID), CENTRAL, and Web of Science was conducted until May 2020 by 2 independent reviewers, followed by bias assessment with ROB 2 and ROBINS-I tools and quantification with meta-analysis. Overall evidence quality was determined with GRADE tool. Results: Four RCTs and 2 quasi-RCTs/CCTs comprising 3,830 PS placed in 291 patients (4-22 years old) were analyzed. The lowest accuracy was found in FH (78.35%) while the highest accuracy was found in MF (95.86%). MF was more accurate than FH (OR 3.34 (95% CI, 2.33-4.79), P < .00 001, I2 = 0%). Three-dimensional printed drill template (as part of MF) was more accurate than FH (OR 3.10 (95% CI, 1.98-4.86), P < .00 001, I2 = 14%). Overall, complications occurred in 5.84% of the patients with 0.34% revision rate. Complication events in MF was lower compared to FH (OR 0.47 (95% CI, 0.10-2.15), P = .33, I2 = 0%). Conclusions: Meta-analysis shows that MF is more accurate than FH in pediatric and adolescent requiring PS placement for spinal fusion surgery.

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“…Yan et al [ 23 ] designed a prospective randomized controlled trial to compare full power-assisted (FPA) and manual technique in 105 AIS cases. In their FPA technique, they adopted a 2.0 mm drill bit, with a slow rotation (2–3 rotations/s) to create the tract, followed by the synchronous expanding and tapping with a 3.2 mm drill bit; finally, the screw was inserted using the same power drill.…”

Section: Safetymentioning

confidence: 99%

“…For pedicle tract preparation, the Authors use a power drill, set in ream mode, with a 2.7 mm tip, following a funnel trajectory. Some others Authors prefer to use a 2 mm bit [ 18 , 23 , 32 ] which, due to its high flexibility, tends to bend as it encounters hard cortical bone, self-centering into soft cancellous bone (Fig. 3 ).…”

Section: Our Experience: Technical Tips and Tricks Critical Aspectsmentioning

confidence: 99%

Power-assisted pedicle screws placement: Is it as safe and as effective as manual technique? Narrative review of the literature and our technique

et al. 2021

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Pedicle screws are the gold standard in spine surgery, allowing a solid tricolumnar fixation which is unmatched by hooks and wires. The freehand technique is the most widely adopted for pedicle screws placing. While freehand technique has been classically performed with manual tools, there has been a recent trend toward the use of power tools. The aim of this review is to summarize and expose potential risks and advantages of power pedicle screws placing. The literature showed that the use of power tools offers an acceptable safety profile, comparable to manual technique. With an adequate training, the power technique may speed up the screw placing, reduce the fluoroscopy time and the physical stress to the spine surgeon. Regarding differences in pull-out strength between power and manual techniques, the literature is still uncertain and inconsistent, both in clinical and preclinical studies. The choice between the use of power and manual freehand pedicle screws placing is still based on the surgeon’s own preference.

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Does the Full Power-Assisted Technique Used in Pedical Screw Placement Affect the Safety and Efficacy of Adolescent Idiopathic Scoliosis Surgery?

Cited by 11 publications

References 20 publications

Treating Lumbar Fracture Using the Mixed Reality Technique

Treating Lumbar Fracture Using the Mixed Reality Technique

Accuracy of Pedicle Screw Placement Methods in Pediatrics and Adolescents Spinal Surgery: A Systematic Review and Meta-Analysis

Power-assisted pedicle screws placement: Is it as safe and as effective as manual technique? Narrative review of the literature and our technique

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