Intraoperative radiation exposure to patients in idiopathic scoliosis surgery with freehand insertion technique of pedicle screws and comparison to navigation techniques

Berlin, Clara; Quante, Markus; Thomsen, B.; Koeszegvary, Mark; Platz, Uwe; Ivanits, David; Halm, H.

doi:10.1007/s00586-020-06465-w

Cited by 10 publications

(8 citation statements)

References 24 publications

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“…Pedicle screws have been widely used in posterior spinal surgeries 1 , 2 , 3 , 4 , 5 . They are useful in achieving and maintaining the desired correction in the corrective surgery for spinal deformity including the ankylosing spondylitis (AS)‐ related thoracolumbar kyphosis owing to the strong pullout strength and superior biomechanical stability 6 , 7 , 8 , 9 .…”

Section: Introductionmentioning

confidence: 99%

Pedicle Morphology of Lower Thoracic and Lumbar Spine in Ankylosing Spondylitis Patients with Thoracolumbar Kyphosis: A Comparison with Fracture Patients

Huang

Xuan

Qian

et al. 2022

Orthopaedic Surgery

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Objective The pedicle morphology of ankylosing spondylitis (AS)‐related thoracolumbar kyphosis patients may be different from that of individuals with normal spine due to the ectopic ossification and kyphotic deformity. However, there was no literature analyzing the pedicle morphology of AS patients with thoracolumbar kyphosis. Therefore, the present study aimed to investigate the pedicle morphology of lower thoracic and lumbar spine (T9‐L5) in ankylosing spondylitis (AS)‐related thoracolumbar kyphosis patients. Methods A retrospective review of AS patients with thoracolumbar kyphosis (AS group) and the patients with spinal or rib fracture (fracture group) who underwent CT scans of the lower thoracic and lumbar spine between February 2017 and September 2018 was performed. Patients with spinal tumor, spinal tuberculosis, severe degenerative spinal diseases including degenerative scoliosis, degenerative spondylolisthesis, degenerative spinal stenosis or history of previous spine surgery, or AS patients with pseudarthrosis which influenced the measurement of pedicle parameters were excluded. The measured parameters on CT images included transverse pedicle angle (TPA), transverse pedicle width (TPW), chord length (CL), pedicle length (PL), and sagittal pedicle angle (SPA). The intraclass correlation coefficient (ICC) was used to evaluate the agreement of radiographic parameters between observers. The independent sample t test was applied for the comparison of pedicle parameters between the two groups. The gender distribution between the two groups were compared using the Fisher's exact test. Results A total of 1444 pedicles of 53 AS‐related thoracolumbar kyphosis patients and 30 patients with fracture were analyzed. TPA was significantly smaller in AS group (p < 0.05). Significantly larger TPW was found in AS group in the lumbar spine (p < 0.05). TPW ≥ 7.5 mm was observed in 95.3%–98.1% of the pedicles at the levels of L3‐L5 in AS group. The CL and PL were significantly larger in AS group at the levels of T9‐L5 (p < 0.05). The CL ≥ 50 mm was found in 84.0%–96.2% of the pedicles in mid‐to‐lower lumbar spine in AS group. Significantly smaller SPA was found in AS group at the levels from L3 to L5 (p < 0.05). Conclusions Pedicle screws with relatively large diameter of 7.5 mm and length of 50 mm could be used in mid‐to‐lower lumbar spine in the majority of AS‐related thoracolumbar kyphosis patients. Also, the insertion angle of pedicle screws in both the transverse and sagittal plane should be appropriately reduced in these patients. This study may help surgeons select the pedicle screws of appropriate size in AS patients.

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Section: Introductionmentioning

confidence: 99%

Pedicle Morphology of Lower Thoracic and Lumbar Spine in Ankylosing Spondylitis Patients with Thoracolumbar Kyphosis: A Comparison with Fracture Patients

Huang

Xuan

Qian

et al. 2022

Orthopaedic Surgery

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“…25) Furthermore, 3D navigation involves radiation exposure. Surgeries performed by an experienced surgeon using a fluoroscopy-guided free-hand technique were reportedly safe, with a significant decrease in patient radiation exposure, compared with the use of a 3D navigation technique, among patients with idiopathic scoliosis 26) .…”

Section: Discussionmentioning

confidence: 96%

Usefulness of Preoperative Planning by Three-Dimensional Planning Software for Pedicle Screw Placement in Thoracolumbar Surgeries: <i>Misplacement Rate and Associated Risk Factors</i>

Ozaki

Yamada

Nakamura

2022

Spine Surg Relat Res

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Introduction A number of imaging technologies have been developed to reduce the risk of pedicle screw (PS) misplacement. For example, preoperative three-dimensional (3D) planning can reportedly enhance implant placement accuracy in some orthopedic surgeries. However, no study has investigated the effect of preoperative 3D planning on PS placement without intraoperative 3D navigation. Thus, in this study, we aim to examine the accuracy of PS placement and identify the risk factors for PS misplacement in thoracolumbar surgeries performed using preoperative 3D planning software with intraoperative fluoroscopic guidance in a retrospective study. Methods In total, 25 consecutive patients (197 PSs) underwent thoracic or lumbar spinal fusion surgeries using preoperative 3D planning with intraoperative fluoroscopic guidance. PS misplacement was graded based on the degree of perforation (Grade 0, no perforation; Grade 1, <2 mm; Grade 2, 2-4 mm; Grade 3, >4 mm) observed in postoperative computed tomography (CT). Deviations between planned and actual PSs were evaluated by matching preoperative and postoperative CT volume images for each vertebra. Results The overall PS misplacement rate was 6.6% (Grade 1: 4.0%, Grade 2: 1.5%, Grade 3: 1.0%). The median linear deviations of PS entry points between planned and actual locations were determined to be 3.3 mm and 3.3 mm for the horizontal and vertical axes, respectively. The median angular deviations of the PS axis were 6.2° and 4.5° for the transverse and sagittal planes, respectively. Multivariate analysis revealed that horizontal deviation of the PS entry point was the sole factor associated with Grade ≥1 PS misplacement (odds ratio=2.47, p<0.001). Conclusions Preoperative 3D planning software without intraoperative 3D navigation was able to achieve a relatively low PS misplacement ratio among the reported ratio of conventional techniques without navigation. Surgeons should carefully ensure that the entry point is consistent with preoperative planning, especially in the mediolateral direction to avoid misplacement in this method.

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“…Operative time and inpatient stay are longer, and patient exposure to radiation greater, with CAN and RA surgery compared to freehand techniques [ 132 , 137 , 138 ]. Freehand positioning of pedicle screws is safe and effective for correction of paediatric spinal deformity and associated with a significantly reduced radiation exposure to patients [ 139 ]. Further research and innovation will help to determine the optimal role of CAN and RA techniques in improving outcomes in the surgical correction of paediatric spinal deformity.…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Paediatric Spinal Deformity Surgery: Complications and Their Management

Roberts

2022

Healthcare

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Surgical correction of paediatric spinal deformity is associated with risks, adverse events, and complications that must be preoperatively discussed with patients and their families to inform treatment decisions, expectations, and long-term outcomes. The incidence of complications varies in relation to the underlying aetiology of spinal deformity and surgical procedure. Intraoperative complications include bleeding, neurological injury, and those related to positioning. Postoperative complications include persistent pain, surgical site infection, venous thromboembolism, pulmonary complications, superior mesenteric artery syndrome, and also pseudarthrosis and implant failure, proximal junctional kyphosis, crankshaft phenomenon, and adding-on deformity, which may necessitate revision surgery. Interventions included in enhanced recovery after surgery protocols may reduce the incidence of complications. Complications must be diagnosed, investigated and managed expeditiously to prevent further deterioration and to ensure optimal outcomes. This review summarises the complications associated with paediatric spinal deformity surgery and their management.

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Intraoperative radiation exposure to patients in idiopathic scoliosis surgery with freehand insertion technique of pedicle screws and comparison to navigation techniques

Cited by 10 publications

References 24 publications

Pedicle Morphology of Lower Thoracic and Lumbar Spine in Ankylosing Spondylitis Patients with Thoracolumbar Kyphosis: A Comparison with Fracture Patients

Pedicle Morphology of Lower Thoracic and Lumbar Spine in Ankylosing Spondylitis Patients with Thoracolumbar Kyphosis: A Comparison with Fracture Patients

Usefulness of Preoperative Planning by Three-Dimensional Planning Software for Pedicle Screw Placement in Thoracolumbar Surgeries: <i>Misplacement Rate and Associated Risk Factors</i>

Paediatric Spinal Deformity Surgery: Complications and Their Management

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