Improved Accuracy and Safety of Pedicle Screw Placement by Using a Probe with an Electrical Conductivity-Measuring Device during Severe Syndromic and Neuromuscular Scoliosis Spine Surgery

Abstract

An electrical conductivity-measuring device (ECD) has recently been developed to support pedicle screw placement. However, no evidence exists regarding its efficacy for syndromic/neuromuscular scoliosis with extremely difficult screwing. We retrospectively reviewed 2010–2016 medical records of 21 consecutive syndromic/neuromuscular scoliosis patients undergoing free-hand segmental fixation surgery at our institution and compared the pedicle screw insertion accuracy and safety between 10 with a conventional non-ECD probe (2010–2013) and 11 with an ECD probe (2014–2016). We analyzed preoperative pedicle shape and postoperative screw placement in computed tomography. There were no significant differences between ECD and non-ECD groups in demographic, clinical, and treatment characteristics including scoliosis severity and pedicle diameter. The abandonment rate due to liquorrhea or perforation was lower in ECD (12.3%) than in non-ECD (26.7%) (p < 0.01). Acceptable insertion without perforation or <2-mm lateral/cranial position was more frequent in ECD (67.1%) than in non-ECD (56.9%) (p = 0.02). Critical ≥5-mm medial/caudal malposition was not seen in ECD (0.0%) but in non-ECD (2.4%) (p = 0.02). The perforation distance was shorter in ECD (2.2 ± 1.1 mm) than in non-ECD (2.6 ± 1.7 mm) (p = 0.01). Results involve small sample size, selection, performance, and learning curve biases; nevertheless, ECD could be useful for more accurate and safer pedicle screw placement in severe syndromic/neuromuscular scoliosis.

Accuracy of pin placement in the canine thoracolumbar spine using a free‐hand probing technique versus 3D‐printed patient‐specific drill guides: An ex‐vivo study

“…31,36,37 In recent years, probes with an electrical impedance conductivitymeasuring device have been developed to improve accuracy of pedicle screw placement in people. 37,38 By monitoring electrical conductivity in surrounding tissues, these probes can alert the surgeon to an impending breach. 37,38 The 3DPG technique was associated with a very high degree of accuracy in our study, with 54/56 pins assigned grade I.…”

“…In people, straight and curved pedicle probes/awls are commercially available but are generally larger than would be appropriate for canines because of the relatively larger size of the pedicle in people 31,36,37 . In recent years, probes with an electrical impedance conductivity‐measuring device have been developed to improve accuracy of pedicle screw placement in people 37,38 . By monitoring electrical conductivity in surrounding tissues, these probes can alert the surgeon to an impending breach 37,38 …”

“…37,38 By monitoring electrical conductivity in surrounding tissues, these probes can alert the surgeon to an impending breach. 37,38 The 3DPG technique was associated with a very high degree of accuracy in our study, with 54/56 pins assigned grade I. Importantly, no pin tracts were graded grade IIb (full penetration of medial pedicle wall) with either technique.…”

Spine Surgery with Electronic Conductivity Device: A Prospectively Multicenter Randomized Clinical Trial and Literature Review

“…Ovadia et al 30 reported a significant decrease in neuro-monitoring alarms during scoliosis surgeries of a magnitude of three-fold. In retrospective studies, Allaoui et al, 31 Yurube et al, 32 and Kudo et al, 33 showed the accuracy between 87.7% and 93.6%. Kageyama et al 16 showed a 98% accuracy in retrospective lumbar surgeries with ECD and multi-axis angiography unit.…”

Advances in robotics and pediatric spine surgery

“…However, to date most pediatric spinal deformity surgery has been performed utilizing open techniques, and most demanding screws in pediatric spinal deformity surgery are typically the proximal to mid-thoracic spine [2,18 ▪▪ ]. In the setting of pediatric scoliosis and syndromic scoliosis (i.e., neurofibromatosis), there is often extreme rotational deformity of the thoracic vertebrae and dysplastic pedicles that necessitate extra-pedicular screw trajectories (“in-out-in” screws) [18 ▪▪ ,19 ▪ ]. The local anatomic structures in the upper thoracic spine, including the great vessels, esophagus, trachea and pleura, increase the risk associated with misplaced screws and place specific demands on the surgeon regardless of the surgical technique chosen for screw placement [18 ▪▪ ].…”