Fluoroscopy-guided pedicle screw accuracy with a mini-open approach: a tomographic evaluation of 470 screws in 125 patients

Soriano-Sánchez, José Antonio; Ortega-Porcayo, Luis Alberto; Gutiérrez-Partida, Carlos Francisco; Ramírez-Barrios, Luis Rodolfo; Ortiz-Leyva, Ramses Uriel; Rodríguez-García, Manuel; Sánchez-Escandón, Óscar

doi:10.14444/2054

Cited by 12 publications

(2 citation statements)

References 38 publications

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“…Fourteen suitable articles were found and included. 3,6,18,[20][21][22][33][34][35]37,38,41,43,44 Data from Ryang et al, 34 Kantelhardt et al, 20 and Bydon et al 6 were identified as outliers. Table 5 summarizes the meta-analysis of screw revision rates from the included studies.…”

Section: Figmentioning

confidence: 99%

Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis

Schröder

Staartjes

2017

Neurosurgical Focus

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OBJECTIVEThe accuracy of robot-guided pedicle screw placement has been proven to be high, but little is known about the impact of such guidance on clinical outcomes such as the rate of revision surgeries for screw malposition. In addition, there are very few data about the impact of robot-guided fusion on patient-reported outcomes (PROs). Thus, the clinical benefit for the patient is unclear. In this study, the authors analyzed revision rates for screw malposition and changes in PROs following minimally invasive robot-guided pedicle screw fixation.METHODSA retrospective cohort study of patients who had undergone minimally invasive posterior lumbar interbody fusion (MI-PLIF) or minimally invasive transforaminal lumbar interbody fusion was performed. Patients were followed up clinically at 6 weeks, 12 months, and 24 months after treatment and by mailed questionnaire in March 2016 as a final follow-up. Visual analog scale (VAS) scores for back and leg pain severity, Oswestry Disability Index (ODI), screw revisions, and socio-demographic factors were analyzed. A literature review was performed, comparing the incidence of intraoperative screw revisions and revision surgery for screw malposition in robot-guided, navigated, and freehand fusion procedures.RESULTSSeventy-two patients fit the study inclusion criteria and had a mean follow up of 32 ± 17 months. No screws had to be revised intraoperatively, and no revision surgery for screw malposition was needed. In the literature review, the authors found a higher rate of intraoperative screw revisions in the navigated pool than in the robot-guided pool (p < 0.001, OR 9.7). Additionally, a higher incidence of revision surgery for screw malposition was observed for freehand procedures than for the robot-guided procedures (p < 0.001, OR 8.1). The VAS score for back pain improved significantly from 66.9 ± 25.0 preoperatively to 30.1 ± 26.8 at the final follow-up, as did the VAS score for leg pain (from 70.6 ± 22.8 to 24.3 ± 28.3) and ODI (from 43.4 ± 18.3 to 16.2 ± 16.7; all p < 0.001). Undergoing PLIF, a high body mass index, smoking status, and a preoperative ability to work were identified as predictors of a reduction in back pain. Length of hospital stay was 2.4 ± 1.1 days and operating time was 161 ± 50 minutes. Ability to work increased from 38.9% to 78.2% of patients (p < 0.001) at the final follow-up, and 89.1% of patients indicated they would choose to undergo the same treatment again.CONCLUSIONSIn adults with low-grade spondylolisthesis, the data demonstrated a benefit in using robotic guidance to reduce the rate of revision surgery for screw malposition as compared with other techniques of pedicle screw insertion described in peer-reviewed publications. Larger comparative studies are required to assess differences in PROs following a minimally invasive approach in spinal fusion surgeries compared with other techniques.

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Section: Figmentioning

confidence: 99%

Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis

Schröder

Staartjes

2017

Neurosurgical Focus

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“…22 Other modifications in the pedicle insertion technique such as the assistance of fluoroscopic view of the pedicle axis have been attempted and reported to improve the accuracy of the screw placement and reduce the risk of complications. [23][24][25][26] With the advent of technology, computer simulation software have been developed, which can also be used for training and practice. 27…”

Section: Discussionmentioning

confidence: 99%

New classification of S1 pedicle morphometry impacting pedicle screw insertion technique

Tiwari¹,

Sonone²,

Jaiswal³

2022

Int J Res Orthop

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Background: The conventional entry point for the S1 pedicle screw insertion has been described as ‘at the base of and lateral to the superior S1 superior facet’. However, many orthopaedic surgeons complain that this technique is extremely demanding and is faced with many challenges in execution. Therefore, alternative entry points and modifications of existing techniques are explored for a greater convenience.Methods: We conducted a survey amongst 136 spine surgeons on the technical difficulties faced during insertion of the S1 pedicle screw. We also classified the S1 pedicles based by measuring their geometric parameters on 100 random computed tomography (CT) images.Results: The S1 pedicle entry technique was considered to be the most difficult and challenging by the orthopaedic surgeons in our survey due to an inadequate medial angulation due to paraspinal muscle mass tension and an overhanging iliac crest. This could be explained by the hourglass shaped pedicle (type 3) with a desired medial angle more 50 degrees (type III) observed as the most common S1 pedicle in the study population. To overcome this limitation, most of them preferred a tri-corticate approach.Conclusions: A more lateral entry point and a longer screw might be considered as solutions for a better and safer S1 pedicle entry. Also, the use of pre-operative CT can be considered to visualize the type of S1 pedicle and hence, decide on the most appropriate technique of screw insertion.

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Allied Devices and Their Influence on Spinal Implants

Alvarado

2021

Handbook of Orthopaedic Trauma Implantology

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Fluoroscopy-guided pedicle screw accuracy with a mini-open approach: a tomographic evaluation of 470 screws in 125 patients

Abstract: Our study demonstrated a high accuracy (90.2%) for 2-D fluoroscopy-guided pedicle screw using electromonitoring. Only 0.71% of the 470 screws had a major breach. Knowing the radiological spine pedicle anatomy and the correct interpretation of EMG are the key factors for this technique.

Cited by 12 publications

References 38 publications

Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis

Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis

New classification of S1 pedicle morphometry impacting pedicle screw insertion technique

Allied Devices and Their Influence on Spinal Implants

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