Pedicle screw insertion accuracy in terms of breach and reposition using a new intraoperative cone beam computed tomography imaging technique and evaluation of the factors associated with these parameters of accuracy: a series of 695 screws

Abstract

Use of intraoperative CBCT as 2D-fluoroscopy or coupled with a navigation system for pedicle screw insertion is accurate in terms of breach occurrence and reposition. However, these rates depend on the classification or grading system used. Use of a navigation system does not decrease the risk of breach significantly. And the risk of breach is higher in non-degenerative conditions (trauma, scoliosis, infection, and malignancy disease) than in degenerative diseases.

Computer‐assisted pedicle screw trajectory planning using CT‐inferred bone density: A demonstration against surgical outcomes

“…Posterior vertebral instrumentation, which consists of inserting screws through the selected pedicles into the corresponding vertebral bodies and attaching rods posteriorly on top of the inserted screws, 1 is currently the most widely used stabilization technique in spine surgery. 2,3 It is used in daily surgical practice to treat various pathologies of the spine, such as scoliosis, fractures, tumors, and other degenerations. 2,4,5 Due to the vicinity of the spinal cord, aorta, and viscera, as well as the fact that the pedicles represent the narrowest region of the vertebral anatomy, 6 pedicle screw misplacement can result in a perforation of the pedicle or cortical wall of the vertebral body, which represents a risk for serious neurologic, vascular, or pulmonary complications.…”

“…2,3 It is used in daily surgical practice to treat various pathologies of the spine, such as scoliosis, fractures, tumors, and other degenerations. 2,4,5 Due to the vicinity of the spinal cord, aorta, and viscera, as well as the fact that the pedicles represent the narrowest region of the vertebral anatomy, 6 pedicle screw misplacement can result in a perforation of the pedicle or cortical wall of the vertebral body, which represents a risk for serious neurologic, vascular, or pulmonary complications. 4,7 This includes cerebrospinal fluid leaks, artery injuries, pulmonary pleura injuries, dural sac tears, nerve root injuries, and other neurological deficits, as well pedicle breach or fractures, 8 although the latter may result from the vertebral derotation maneuvers associated with the spinal deformity correction.…”

“…9 Moreover, pedicle screw misplacement can result in a loss of fixation, and therefore, the accuracy of pedicle screw placement is an important aspect of vertebral instrumentation, with two types of techniques established in clinical practice: the free-hand and the image-guided. 2,3,10,11 Both approaches require a steep learning curve for less-experienced spine surgeons, 3,12 nevertheless, image-guided techniques offer additional information because surgical instruments can be intraoperatively tracked and visualized, 13 and therefore assist spine surgeons toward a more accurate screw placement. 4,10 However, if an imageguided insertion technique is used or, for example, in the case of a low bone density that reduces screw fixation, 14,15 pedicle screw placement plans should be determined preoperatively.…”

Intraoperative CT and cone-beam CT imaging for minimally invasive evacuation of spontaneous intracerebral hemorrhage

“…For neurosurgical performance assessment, intraoperative imaging such as MRI [ 7 , 10 , 35 ], angiography [ 13 , 22 ], and computerized tomography (iCT) [ 20 ] or cone-beam CT (CBCT) [ 11 ] have been evidenced to increase patient safety and provide a measure of immediate quality control. For cranial imaging in MIS for ICH, the simple and fast use of iCT and CBCT appears particularly attractive but the benefit of using this technology in that setting has not yet been investigated.…”

Avaliação do uso de guias para posicionamento de parafusos pediculares em cirurgias de correção de escoliose

“…Nos últimos anos, diversos estudos buscaram avaliar os potenciais benefícios do uso de tecnologias auxiliares para o posicionamento de parafusos pediculares em cirurgias de coluna em relação à técnica a mãos livres. Dentre esses ferramentas, encontram-se a fluoroscopia 2D, a navegação auxiliada por fluoroscopia 2D, a navegação auxiliada por fluoroscopia 3D, navegação com tomografia computadorizada intraoperatória ou os guias de inserção de parafusos específicos para cada paciente (14).…”