Thoracic Pedicle Morphometry of Dry Vertebral Columns in Relation to Trans-Pedicular Fixation: A Cross-Sectional Study From Central India

Verma, V. K.; Santoshi, John Ashutosh; Jain, Vaibhav; Patel, Manmohan; Dwivedi, Manish; Nagar, Mukesh; Selvanayagam, Rajkumar; Pal, Dharm

doi:10.7759/cureus.8148

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…The malposition rate of 2 mm to 6 mm was present in 30 of 192 screws (15.6%) with 23 of these occurring in the thoracic spine, where pedicle widths are significantly less than the lumbar region. 103 125 Devito et al 93 reported on the technical accuracy placement of 646 pedicle screws inserted in 139 patients using postoperative CT scans. 577 were centered in the pedicle, 58 were less than 2 mm off center, 9 breached 2 mm to 4 mm off center and 2 screws deviated greater than 4 mm from the pedicle wall.…”

Section: Resultsmentioning

confidence: 99%

“… 127 , 128 In the thoracic region, pedicle width progressively decreases from T1 to T5 (mean 3.65 ± 0.40 mm) and increases from T6 though the T12 levels (mean 7.89 ± 0.70 mm). 103 , 125 The lumbar vertebrae allow greater cross sectional areas for “ideal” pedicle screw placement, however, the proximity of adjacent exiting nerve roots ranges from 2.9 mm to 6.2 mm proximally and 0.8 mm to 2.8 mm distally. Moreover, the distance between the medial borders of pedicle to thecal sac ranges from 0.9 mm to 2.1 mm.…”

Section: Resultsmentioning

confidence: 99%

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Comparative Analysis of Optoelectronic Accuracy in the Laboratory Setting Versus Clinical Operative Environment: A Systematic Review

Cunningham

Brooks

2022

Global Spine Journal

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Study Design: Systematic review. Objectives: The optoelectronic camera source and data interpolation process serve as the foundation for navigational integrity in robotic-assisted surgical platforms. The current systematic review serves to provide a basis for the numerical disparity observed when comparing the intrinsic accuracy of optoelectronic cameras versus accuracy in the laboratory setting and clinical operative environments. Methods: Review of the PubMed and Cochrane Library research databases was performed. The exhaustive literature compilation obtained was then vetted to reduce redundancies and categorized into topics of intrinsic accuracy, registration accuracy, musculoskeletal kinematic platforms, and clinical operative platforms. Results: A total of 465 references were vetted and 137 comprise the basis for the current analysis. Regardless of application, the common denominators affecting overall optoelectronic accuracy are intrinsic accuracy, registration accuracy, and application accuracy. Intrinsic accuracy equaled or was less than 0.1 mm translation and 0.1 degrees rotation per fiducial. Controlled laboratory platforms reported 0.1 to 0.5 mm translation and 0.1 to 1.0 degrees rotation per array. Accuracy in robotic-assisted spinal surgery reported 1.5 to 6.0 mm translation and 1.5 to 5.0 degrees rotation when comparing planned to final implant position. Conclusions: Navigational integrity and maintenance of fidelity of optoelectronic data is the cornerstone of robotic-assisted spinal surgery. Transitioning from controlled laboratory to clinical operative environments requires an increased number of steps in the optoelectronic kinematic chain and error potential. Diligence in planning, fiducial positioning, system registration and intra-operative workflow have the potential to improve accuracy and decrease disparity between planned and final implant position.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Comparative Analysis of Optoelectronic Accuracy in the Laboratory Setting Versus Clinical Operative Environment: A Systematic Review

Cunningham

Brooks

2022

Global Spine Journal

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“…Several techniques/methods may be used to minimize the risk of cortical breach during pedicle screw insertion like the use of "in-out-in" technique, medial margin targeting technique, and pedicle or transverse process hooks [15][16]. Use of navigation assisted spinal instrumentation may also minimize the risk of pedicle wall breakage [16].…”

Section: Discussionmentioning

confidence: 99%

Computed Tomographic Measurement of Thoracic Pedicle in Filipino Patients

Hung¹,

Castro²

2022

IJN

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Knowledge of the morphometric measurements of Filipino thoracic spine pedicles would help the surgeons in determining the proper size and increase accuracy of pedicle screws placement during surgery to avoid complications. This study aims to measure the outer diameter, chord length and transverse angulation of the thoracic spine pedicles (T1-T12). A retrospective analysis of patients ages 18-85 years who underwent CT scan of the thoracic spine from January to December 2019. A total of 65 patients were included in the study. Pedicle morphology was measured with the following: transverse outer pedicle diameter, pedicle chord length, and transverse pedicle angle. TOPD was narrowest at the level of T4 (4.2 ± 1.0mm) followed by T5 (4.6 ± 1.0mm) and the largest TOPD at the level of T12 (8.7 ± 2.1mm). The largest PCL was at the level T12 (47.7 ± 4.6mm) and the shortest was at T2 (35.6 ± 3.7mm). The mean TPA largest at the level of T1 (35.8 ± 6.1mm) and progressively decreasing and slight increase at the level of T12 (6.3 ± 3.5mm). Men have larger pedicles as compared with women. It is recommended to use 4.5mm pedicle screw however it should be used with extra caution especially at mid thoracic level and among female patients.

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“…Trans-pedicular screw fixation is one of the main modalities of spinal instrumentation today and patients are stabilized with pedicle screws and rods [15].…”

Section: Discussionmentioning

confidence: 99%

Adapting Policy Guidelines for Spine Surgeries During COVID-19 Pandemic in View of Evolving Evidences: An Early Experience From a Tertiary Care Teaching Hospital

Verma¹,

Nagar²,

Jain³

et al. 2020

Cureus

Self Cite

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Eight patients (61.5%) presented with spinal cord injury (SCI) due to vertebral fracture with fall from height (87.5%) as the most common etiology. Among the traumatic SCI patients, six (75%) were managed surgically with posterior decompression and instrumented fusion with pedicle screws while two patients (25%) were managed conservatively. There were four patients (30.8%) of tuberculosis of the spine of whom two (50%) were managed with posterior decompression, debridement, and stabilization with pedicle screws, samples for culture, biopsy, and cartridge-based nucleic acid amplification test (CBNAAT) were collected during the procedure; for the remaining two patients (50%), a trans-pedicular biopsy was performed to confirm the diagnosis for initiation of anti-tubercular therapy. Prolapsed intervertebral disc causing cauda equina syndrome was the reason for emergency surgery in one patient (7.7%). COVID-19 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription-polymerase chain reaction (RT-PCR) test was performed in four patients (30.8%), in whom the most common symptom was fever (two patients (50%)). These patients were residents of high prevalence area for COVID-19 infection. Sore throat (25%), fatigue (25%), and low oxygen saturation (25%) were present in one patient which prompted us to get the COVID-19 test. All patients were reported negative for COVID-19. Conclusion The structural organization and the management protocol we describe allowed us to reduce infection risk and ultimately hospital stay, thereby maximizing the already stretched available medical resources. These precautions helped us to reduce transmission and exposure to COVID-19 in health care workers (HCW) and patients in our institute. The aim of this article is that our early experience can be of value to the medical communities that will soon be in a similar situation.

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Thoracic Pedicle Morphometry of Dry Vertebral Columns in Relation to Trans-Pedicular Fixation: A Cross-Sectional Study From Central India

Cited by 8 publications

References 29 publications

Comparative Analysis of Optoelectronic Accuracy in the Laboratory Setting Versus Clinical Operative Environment: A Systematic Review

Comparative Analysis of Optoelectronic Accuracy in the Laboratory Setting Versus Clinical Operative Environment: A Systematic Review

Computed Tomographic Measurement of Thoracic Pedicle in Filipino Patients

Adapting Policy Guidelines for Spine Surgeries During COVID-19 Pandemic in View of Evolving Evidences: An Early Experience From a Tertiary Care Teaching Hospital

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