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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(11): 1457-1462, 2021 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-34779173

RESUMO

Objective: To investigate the safety and accuracy of robot-assisted pedicle screw implantation in the adolescent idiopathic scoliosis (AIS) surgery. Methods: The clinical data of 46 patients with AIS who were treated with orthopedics, bone graft fusion, and internal fixation via posterior approach between June 2018 and December 2019 were analyzed retrospectively. Among them, 22 cases were treated with robot-assisted pedicle screw implantation (robot group) and 24 cases with manual pedicle screw implantation without robot assistance (control group). There was no significant difference in gender, age, body mass index, Lenke classification, and preoperative Cobb angle of the main curve, pain visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score between the two groups ( P>0.05). The intraoperative blood loss, pedicle screw implantation time, intraoperative pedicle screw adjustment times, and VAS and JOA scores after operation were recorded. The Cobb angle of the main curve was measured on X-ray film and the spinal correction rate was calculated. The screw position and the accuracy of screw implantation were evaluated on CT images. Results: The operation completed successfully in the two groups. The intraoperative blood loss, pedicle screw implantation time, and pedicle screw adjustment times in the robot group were significantly less than those in the control group ( P<0.05). There was 1 case of poor wound healing in the robot group and 2 cases of mild nerve root injury and 2 cases of poor incision healing in the control group, and there was no significant difference in the incidence of complications between the two groups ( P=0.667). All patients in the two groups were followed up 3-9 months (mean, 6.4 months). The VAS and JOA scores at last follow-up in the two groups were superior to those before operation ( P<0.05), but there was no significant difference in the difference of pre- and post-operative scores between the two groups ( P>0.05). The imaging review showed that 343 screws were implanted in the robot group and 374 screws in the control group. There were significant differences in pedicle screw implantation classification and accuracy between the two groups (89.5% vs 79.1%)( Z=-3.964, P=0.000; χ 2=14.361, P=0.000). At last follow-up, the Cobb angles of the main curve in the two groups were significantly lower than those before operation ( P<0.05), and there was significant difference in the difference of pre- and post-operative Cobb angles between the two groups ( t=0.999, P=0.323). The spinal correction rateswere 79.82%±5.33% in the robot group and 79.62%±5.58% in the control group, showing no significant difference ( t=0.120, P=0.905). Conclusion: Compared with manual pedicle screw implantation, robot-assisted pedicle screw implantation in AIS surgery is safer, less invasive, and more accurate.


Assuntos
Parafusos Pediculares , Robótica , Escoliose , Fusão Vertebral , Adolescente , Humanos , Vértebras Lombares , Estudos Retrospectivos , Escoliose/cirurgia , Vértebras Torácicas , Resultado do Tratamento
2.
Zhongguo Gu Shang ; 34(11): 1034-9, 2021 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-34812021

RESUMO

OBJECTIVE: To explore the clinical application of Orthopedic Tianji Robot in the treatment of thoracolumbar fractures with minimally invasive percutaneous pedicle screw internal fixation. METHODS: The clinical data of 46 patients with thoracolumbar fractures treated by minimally invasive percutaneous pedicle screw internal fixation from June 2018 to January 2020 in Gansu Provincial People's Hospital was retrospectively analyzed. According to the different aided equipments, the patients were divided into a C-arm X-ray plus robot assisted nail placement group (observation group) and simple C-arm X-ray assisted nail placement group (control group). Twenty-two patients in observation group, including 12males and 10 females, aged from 24 to 61 years old, with a mean of(40.23±12.19) years, 3 cases were T11 vertebrae fracture, 8 cases were T12, 9 cases were L1, and 2 cases were L2. And there were 24 cases in control group, including 15 males and 9 females, aged from 26 to 58 years old, with a mean of (42.88±10.31) years, 3 cases were T11 vertebrae fracture, 10 cases were T12, 7 cases were L1, and 4 cases were L2. The operation time, the number of intraoperative fluoroscopy, intraoperative blood loss, the days of hospitalization, and postoperative complications were recorded. Preoperative and postoperative VAS at 3 days, 1 week and 3 months were compared between two groups. The sagittal Cobb angle of the injured vertebral body and the percentage of the anterior edge height of the vertebral body were observed before and after operation, and evaluate the accuracy of nail placement according to the Gertzbein-Robbins classification criteria with collected postoperative CT images. RESULTS: All patients were followed up for 5 to 12 months with an average of (7.07±0.83) months. There was no significant differences in intraoperative blood loss, operation time and hospitalization days between two groups (P>0.05). The number of intraoperative fluoroscopy was (5.62±0.51) times in observation group and (12.54±0.52) in control group, the difference between two groups was statistically significant (P<0.05). The VAS, the percentage of the height of the injured vertebra anterior edge and the Cobb angle of the injured vertebral plane at each time point after operation were improved(P<0.05), but the difference between two groups was not statistically significant (P>0.05). One case of postoperative incision infection occurred in the control group, which was cured after active dressing changes. There were no serious complications such as screw loosening and breakage in all patients, and there was no statistically significant difference in the incidence of complications between two groups(P>0.05). The postoperative nail placement accuracy ratesof the observation group and the control group were 98.4% (126/128) and 90.3% (121/134), respectively, and the difference was statistically significant (P<0.05). CONCLUSION: In the surgical treatment of thoracolumbar fractures, compared with simple C-arm fluoroscopy, the pedicle screw placement assisted by Orthopedic Tianji Robot overcomes the shortcomings of surgeon's physiological tremor, fatigue and multiple intraoperative fluoroscopy, improves the accuracy of screw placement, and is a more accurate and safer way of pedicle screw placement for thoracolumbar fractures.


Assuntos
Parafusos Pediculares , Robótica , Adulto , Feminino , Fixação Interna de Fraturas , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
3.
Zhongguo Gu Shang ; 34(11): 1065-71, 2021 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-34812026

RESUMO

OBJECTIVE: To explore the value of multimodal neuroelectrophysiological monitoring technology in the evaluation of spinal cord and nerve root function for the treatment of thoracic tuberculosis with debridement and bone grafting and posterior internal fixation by transcostal transverse process approach. METHODS: The clinical data of 25 patients with thoracic tuberculosis underwent debridement and bone grafting and posterior vertebral arch internal fixation by transcostal transverse process approach from December 2018 to September 2019 was retrospectively analyzed. Among these 25 patients, including 14 males and 11 females;aged from 20 to 83 years old, with a mean of (63.45±9.65) years;there were 3 cases of single vertebral body destruction, 13 cases of 2 vertebral bodies destruction, and 9 cases of 3 or more vertebral bodies destruction. All surgical patients underwent intraoperative detection of somatosensory evoked potential(SEP) and transcranial electric stimulation-motor evoked potential(TES-MEP);and electromyography (EMG) was used to monitor the pedicle screw placement and lesion removal. The erythrocyte sedimentation rate(ESR) was used to evaluate the decline of inflammatory indexes, the visual analogue scale (VAS) was used to evaluate the thoracic spine pain, and the Cobb angle and Oswestry Disability Index(ODI) were used to evaluate the improvement of function. RESULTS: All 25 patients were successfully monitored. Five patients had abnormal SEP waveforms during operation, 3 cases were caused by intraoperative clearing of lesions and spinal cord compression during irrigation, timely replacement of instruments and gestures, and adjustment of irrigation water flow rate returned the waveform to normal; one case was caused by a decrease in systolic blood pressure, and the waveform returned to normal after timely treatment of increased blood pressure;after 1 case of SEP waveform abnormality, the operation was suspended for 10 minutes and recovered spontaneously, and the waveform abnormality did not reappear until the end of the operation. Seven patients had abnormal TES-MEP waveforms, 5 cases occurred when the pedicle screw was inserted, the nail path was adjusted in time, and the waveform recovered after nail repositioning;one case was caused by tilting the operation bed during operation, and the waveform gradually recovered after adjusting the tilt angle of operation bed; one case occurred during the correction of the pedicle screw and rod system, and the waveform gradually returned to normal after the contralateral screw and rod correction were completed during operation. In 5 cases, the EMG burst potential was detected at the same time when the TES-MEP waveform was abnormal. After adjustment, the EMG burst potential disappeared. There was no abnormality in the TES-MEP and SEP waveforms at the same time. Postoperative VAS, ESR, Cobb angle, and ODI were improved compared with preoperatively (P<0.05). CONCLUSION: In patients with thoracic tuberculosis, the use of debridement and bone grafting and posterior internal fixation by transcostal transverse process approach combined with intraoperative SEP, TES-MEP and EMG monitoring can timely reflect the spinal cord and nerve root function, avoid intraoperative injuries while achieving good fixation and lesion removal.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Tuberculose , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tecnologia , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Adulto Jovem
4.
BMC Musculoskelet Disord ; 22(1): 920, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34724945

RESUMO

OBJECTIVE: This paper was a anatomical radiographic study of distance between lumbar bi-cortical pedicle screws (BPSs) and anterior large vessels (ALVs) in patients with lumbar spondylolisthesis, and to provide clinical basis for evaluating the safety of bi-cortical pedicle screw implantation during lumbar spondylolisthesis. METHODS: Complete Computed tomography (CT) data of 104 patients with grade I lumbar spondylolisthesis (L4 52 and L5 52) and 107 non-spondylolisthesis patients (control group) were collected in this study. The distances between lumbar 4,5(L4,5) and sacrum 1(S1) BPSs and ALVs (abdominal aorta, inferior vena cava, left and right common iliac artery, internal and external iliac artery) were respectively measured at different transverse screw angles (TSAs) (L4:5°,10°; L5:10°,15°; S1:0°,5°,10°) and analyzed by SPSS (v25.0). There were three types of distances from the anterior vertebral cortex (AVC) to the ALVs (DAVC-ALV): DAVC-ALV N, DAVC-ALV ≥ 0.50 cm, and DAVC-ALV < 0.50 cm; these different distances represented non-contact, distant and close ALV respectively. RESULTS: We calculated the incidences of screw tip contacting large vessels at different TSAs and provided the appropriate angle of screw implantation. In non-spondylolisthesis group, in L4, the appropriate left TSA was 5°, and the incidence of the close ALV was 4.62%. In S1, the appropriate left TSA was 0° and the incidence of the close ALV was 22.4%, while the appropriate right TSA was 10° and the incidence of the close ALV was 17.8%. In L4 spondylolisthesis group, in L4, the appropriate left TSA was 5°, and the incidence of the close ALV was 3.8%. In L5 spondylolisthesis group, in S1, the appropriate left TSA was 0° and the incidence of the close ALV was 19.2%, while the appropriate right TSA was 10° and the incidence of the close ALV was 21.2%. The use of BPS was not appropriate on the right side of L4 or on the either side of L5 both in spondylolisthesis and control group. In patients with lumbar 4 spondylolisthesis, the incidences of screw tip contacting large vessels were less than the control group in both L4 and 5. In patients with lumbar 5 spondylolisthesis, the incidences of screw tip contacting large vessels were less than the control group in L5, while there were no significant difference in S1. CONCLUSION: It is very important that considering the anatomical relationship between the AVC and the ALVs while planning BPSs. The use of BPS does not apply to every lumbar vertebra. In patients with lumbar spondylolisthesis and non-spondylolisthesis patients, the incidences of screw tip contacting large vessels are different.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Espondilolistese , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Região Lombossacral , Fusão Vertebral/efeitos adversos , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia
5.
BMC Musculoskelet Disord ; 22(1): 938, 2021 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-34758793

RESUMO

BACKGROUND: Compression-extension injury with unilateral facet joint fracture is one of the most devastating injuries of subaxial cervical spine. However, it is not yet clear which fixation technique represents the optimal choice in surgical management. This study aims to assess the construct stability at the operative level (C4/C5 cervical spine) following anterior cervical discectomy and fusion (ACDF) alone and combined fixation techniques (posterior-anterior fixations). METHODS: A previously validated three-dimensional C2-T1 finite element model were modified to simulate surgical procedures via the anterior-only approach (ACDF) and combined cervical approach [(transarticular screw, lateral mass screw, unilateral pedicle screw, bilateral pedicle screw) + ACDF, respectively] for treating compression-extension injury with unilateral facet joint fracture at C4/C5 level. Construct stability (range of rotation, axial compression displacement and anterior shear displacement) at the operative level was comparatively analyzed. RESULTS: In comparison with combined fixation techniques, a wider range of motion and a higher maximum von Mises stress was found in single ACDF. There was no obvious difference in range of motion among transarticular screw and other posterior fixations in the presence of anterior fixation. In addition, the screws inserted by transarticular screw technique had high stress concentration at the middle part of the screw but much less than 500 MPa under different conditions. Furthermore, the variability of von Mises stress in the transarticular screw fixation device was significantly lower than ACDF but no obvious difference compared with other posterior fixations. CONCLUSIONS: Of the five fixation techniques, ACDF has proven poor stability and high structural stress. Compared with lateral and pedicle screw, transarticular screw technique was not worse biomechanically and less technically demanding to acquire in clinical practice. Therefore, our study suggested that combined fixation technique (transarticular screw + ACDF) would be a reasonable treatment option to acquire an immediate stabilization in the management of compression-extension injury with unilateral facet joint fracture. However, clinical aspects must also be regarded when choosing a reconstruction method for a specific patient.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Articulação Zigapofisária , Fenômenos Biomecânicos , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Discotomia , Análise de Elementos Finitos , Humanos , Amplitude de Movimento Articular , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/cirurgia
6.
BMC Musculoskelet Disord ; 22(1): 850, 2021 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-34615516

RESUMO

BACKGROUND: Few reports to date have evaluated the effects of different pedicle screw insertion depths on sagittal balance and prognosis after posterior lumbar interbody and fusion (PLIF) in patients with lumbar degenerative spondylolisthesis (LDS). METHODS: A total of 88 patients with single-level PLIF for LDS from January 2018 to December 2019 were enrolled. Long screw group (Group L): 52 patients underwent long pedicle screw fixation (the leading edge of the screw exceeded 80% of the anteroposterior diameter of vertebral body). Short screw group (Group S): 36 patients underwent short pedicle screw fixation (the leading edge of the screw was less than 60% of the anteroposterior diameter of vertebral body). Local deformity parameters of spondylolisthesis including slip degree (SD) and segment lordosis (SL), spino-pelvic sagittal plane parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and lumbar lordosis (LL), Oswestry Disability Index (ODI), and Visual Analog Scale (VAS) for back pain of both groups were compared. Postoperative complications, including vertebral fusion rate and screw loosening rate, were recorded. RESULTS: Except that PI in Group S at the final follow-up was not statistically different from the preoperative value (P > 0.05), other parameters were significantly improved compared with preoperative values one month after surgery and at the final follow-up (P < 0.05). There was no significant difference in parameters between Group L and Group S before and one month after surgery (P > 0.05). At the final follow-up, SD, SL, LL, PT and PI-LL differed significantly between the two groups (P < 0.05). Compared with the preoperative results, ODI and VAS in both groups decreased significantly one month after surgery and at the final follow-up (P < 0.05). Significant differences of ODI and VAS were found between the two groups at the final follow-up (P < 0.05). Postoperative complications were not statistically significant between the two groups (P > 0.05). CONCLUSIONS: PLIF can significantly improve the prognosis of patients with LDS. In terms of outcomes with an average follow-up time of 2 years, the deeper the screw depth is within the safe range, the better the spino-pelvic sagittal balance may be restored and the better the quality of life may be.


Assuntos
Parafusos Pediculares , Espondilolistese , Humanos , Qualidade de Vida , Estudos Retrospectivos , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(10): 1311-1317, 2021 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-34651486

RESUMO

Objective: To investigate the short-term effectiveness of percutaneous pedicle fixation combined with intravertebral allograft by different methods for thoracolumbar fractures. Methods: The clinical data of 94 patients with single segment thoracolumbar fracture who underwent percutaneous pedicle fixation combined with intravertebral allograft by different methods between October 2018 and October 2019 were retrospectively analyzed. According to the different methods of intravertebral allograft, they were divided into group A (bone grafting by Jack dilator, 40 cases) and group B (bone grafting by funnel, 54 cases). There was no significant difference between the two groups ( P>0.05) in the gender, age, body mass index, cause of injury, injured segment, Wolter index, time from injury to operation, and preoperative visual analogue scale (VAS) score, injured vertebral height ratio, and Cobb angle. The operation time, fluoroscopy frequency, allograft volume, and complications were recorded and compared between the two groups. VAS score of low back pain was used to evaluate the remission of clinical symptoms before operation, at 3 days, 3 months, 12 months after operation, and at last follow-up. The injured vertebral height ratio and Cobb angle were measured before operation, at 3 days, 3 months, and 12 months after operation. Results: The operation time, fluoroscopy frequency, and allograft volume in group A were significantly higher than those in group B ( P<0.05). No complication occurred after operation, such as loosening or fracture of internal fixation. And bone grafting in the injured vertebrae healed at last follow-up. The VAS score, injured vertebral height ratio, and Cobb angle at each postoperative time point significantly improved when compared with preoperative ones ( P<0.05); compared with 3 days postoperatively, the VAS score improved further after 3 months, but the injured vertebral height ratio decreased and the Cobb angle increased, and the differences were significant ( P<0.05). There was no significant difference in the VAS scores of low back pain between the two groups at each time point after operation ( P>0.05); the injured vertebrae height ratio in group A was significantly higher than that in group B, and the Cobb angle was significantly lower than that in group B, all showing significant differences ( P<0.05). Conclusion: The intravertebral allograft via Jack dilator can restore the height and decrease the Cobb angle of the injured vertebrae, but accompanied with higher fluoroscopy frequency and longer operation time when compared with funnel bone grafting. For patients with single level thoracolumbar fractures, intravertebral allograft via Jack dilator is recommended.


Assuntos
Parafusos Pediculares , Fraturas da Coluna Vertebral , Aloenxertos , Fixação Interna de Fraturas , Humanos , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento
8.
Spine (Phila Pa 1976) ; 46(21): 1485-1494, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34618709

RESUMO

STUDY DESIGN: A prospective single center observational study. OBJECTIVES: The aim of this study was to examine the potential role of sonication in the diagnosis of low-grade infections and its association with pedicle screw (PS) loosening, and to describe risk factors and radiological findings associated with spinal implant infection. SUMMARY OF BACKGROUND DATA: Although PS loosening has mainly been attributed to mechanical overload, implant colonization and biofilm formation have recently been suggested. Culturing of sonication fluid implants is promising in the field of spine instrumentation infection, but little data are available. METHODS: We prospectively included all patients who were subjected to implant removal. PS loosening was assessed with computed tomography (CT) scan. Different clinical and radiological parameters which could serve as indicators of implant infection were studied. RESULTS: Thirty-eight patients were included in the study and 11 of them (29%) had a positive sonication result. Patients with spinal implant infection were associated with screw loosening (P = 0.005). Particularly, those screws with a positive microbiological culture showed signs of screw loosening in the preoperative CT scan (P < 0.001). Our results also showed that radiological screw loosening at L1-L3 level, and loosened larger constructs were associated with screw microbial colonization. The most common isolated microorganisms were coagulase-negative staphylococci and Cutibacterium acnes. An implant-based multivariate analysis indicated that screw loosening, the absence of prophylactic cefazolin, ICU hospitalization, screw breakage, and L1-L3 spine level were independent risk factors for implant-associated infection. Our model exhibited a high predictive power with an area under the curve of 0.937. CONCLUSION: As clinical presentation of deep implant chronic infection is unspecific, consideration of these factors enables preoperative prediction and risk stratification of implant colonization, thus helping patient's management.Level of Evidence: 3.


Assuntos
Parafusos Pediculares , Sonicação , Falha de Equipamento , Humanos , Vértebras Lombares , Estudos Prospectivos
9.
J Orthop Surg (Hong Kong) ; 29(3): 23094990211042237, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34592859

RESUMO

Purpose: To assess whether the magnitude of lengthening in magnetically controlled growing rod (MCGR) surgeries has an immediate or delayed effect on spinal off-loading. Methods: 9 whole porcine spines were instrumented using two standard MCGRs from T9 to L5. Static compression testing using a mechanical testing system (MTS) was performed at three MCGR lengthening stages (0 mm, 2 mm, and 6 mm) in each spine. At each stage, five cycles of compression at 175N with 25 min of relaxation was carried out. Off-loading was derived by comparing the load sustained by the spine with force applied by the MTS to the spine. Micro-CT imaging was subsequently performed. Results: The mean load sustained by the vertebral body before lengthening was 39.69N, and immediately after lengthening was 25.12N and 19.91N at 2 mm and 6 mm lengthening, respectively; decreasing to 10.07N, 8.31N, and 8.17N after 25 minutes of relaxation, at 0 mm, 2 mm, and 6 mm lengthening stages, respectively. There was no significant difference in off-loading between 2 mm and 6 mm lengthening stages, either instantaneously (p = 0.395) or after viscoelastic relaxation (p = 0.958). CT images showed fractures/separations at the level of pedicle screws in six spines and in the vertebral body's growth zone in five spines after 6 mm MCGR lengthening. Conclusion: This study demonstrated MCGRs cause significant off-loading of the spine leading to stress shielding. 6 mm of lengthening caused tissue damage and microfractures in some spines. There was no significant difference in spine off-loading between 2 mm and 6 mm MCGR lengthening, either immediately after lengthening or after viscoelastic relaxation.


Assuntos
Procedimentos Ortopédicos , Parafusos Pediculares , Escoliose , Animais , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Coluna Vertebral/cirurgia , Suínos
10.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 38(5): 877-884, 2021 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-34713655

RESUMO

The human spine injury and various lumbar spine diseases caused by vibration have attracted extensive attention at home and abroad. To explore the biomechanical characteristics of different approaches for lumbar interbody fusion surgery combined with an interspinous internal fixator, device for intervertebral assisted motion (DIAM), finite element models of anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are created by simulating clinical operation based on a three-dimensional finite element model of normal human whole lumbar spine. The fusion level is at L4-L5, and the DIAM is implanted between spinous process of L4 and L5. Transient dynamic analysis is conducted on the ALIF, TLIF and LLIF models, respectively, to compute and compare their stress responses to an axial cyclic load. The results show that compared with those in ALIF and TILF models, contact forces between endplate and cage are higher in LLIF model, where the von-Mises stress in endplate and DIAM is lower. This implies that the LLIF have a better biomechanical performance under vibration. After bony fusion between vertebrae, the endplate and DIAM stresses for all the three surgical models are decreased. It is expected that this study can provide references for selection of surgical approaches in the fusion surgery and vibration protection for the postsurgical lumbar spine.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Fenômenos Biomecânicos , Análise de Elementos Finitos , Humanos , Vértebras Lombares/cirurgia , Amplitude de Movimento Articular , Vibração
11.
J Orthop Surg (Hong Kong) ; 29(1_suppl): 23094990211012865, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34711079

RESUMO

INTRODUCTION: Computer-assisted navigation (CAN) is a well-established tool in spinal instrumentation surgery. Different techniques - each with specific advantages and disadvantages - are used in the cervical spine. METHODS: A structured summary of different spinal navigation techniques and a review of the literature were done to discuss the advantages and disadvantages of specific navigation tools in the cervical spine. RESULTS: In cervical spine surgery, CAN increases the accuracy of pedicle screw placement, reduces screw mispositioning and leads to fewer revision surgeries. Due to the mobility of the cervical spine, preoperative CT followed by region matching or intraoperative CT are recommended. CONCLUSIONS: CAN increases pedicle screw placement accuracy and should be used in spinal instrumentation for the cervical spine whenever possible.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Cirurgia Assistida por Computador , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Reoperação , Coluna Vertebral
12.
J Clin Neurosci ; 93: 75-81, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34656265

RESUMO

There are no reports comparing fluoroscopy and intraoperative computed tomography (CT) navigation in lateral single-position surgery (SPS) in terms of surgical outcomes or implant-related complications. Therefore, the purpose of this study was to use radiological evaluation to compare the incidence of instrument-related complications in SPS of lateral lumbar interbody fusion (LLIF) using fluoroscopy with that using CT navigation techniques. We evaluated 99 patients who underwent lateral SPS. Twenty-six patients had a percutaneous pedicle screw (PPS) inserted under fluoroscopy (SPS-C group), and 73 patients had a PPS inserted under intraoperative CT navigation (SPS-O group). Average operation time was shorter in the SPS-C group than in the SPS-O group (88.4 ± 24.4 min versus 111.9 ± 35.3 min, respectively, P = 0.003). However, there was no significant difference between the two groups in postoperative thigh symptoms or reoperation rate. The screw insertion angle of the SPS-C group was smaller than that of the SPS-O group, but there was no significant difference in the rate of screw misplacement (4.6% versus 3.4%, respectively, P = 0.556). By contrast, facet joint violation (FJV) was significantly lower in the SPS-O group than in the SPS-C group (8.4% versus 21.3%, respectively, P < 0.001). While fluoroscopy was superior to intraoperative CT navigation in terms of mean surgery time, there was no significant difference in the accuracy of PPS insertion between fluoroscopy and intraoperative CT navigation. The advantage of intraoperative CT navigation over fluoroscopy is that it significantly decreases the occurrence of FJV in SPS.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Cirurgia Assistida por Computador , Fluoroscopia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Tomografia Computadorizada por Raios X
13.
Neurol India ; 69(4): 925-930, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507414

RESUMO

Background: Screw diameters are currently available based on the literature available for the Western population. No data are available in such a large number of patients for the Indian population. Objective: The aim of this study was to define the average pedicle size available and to determine the angulation for placement of screws for C2 pedicle in the Indian population. We also try to determine the pedicle screw diameter which can be used universally in most Indian patients, considering the pedicle dimensions. Material and Methods: Retrospective morphometric analysis of CT scans of 247 patients (152 M, 95 F) was done to calculate the C2 pedicle width (PW), pedicle height (PH), pedicle length (PL), pedicle transverse angle (PTA) and the craniocaudal angulation (CCA) of the C2 pedicle. Results: Mean PW in females was 5.3 mm and in males it was 5.9 mm. This difference was statistically significant. The mean PH in the study population was 8.9 mm, while the mean PL was 29.7 mm. The mean PTA was 40.0 degrees and the CCA was 28.4 degrees. Conclusion: This is a morphometric analysis of the C2 pedicle which provides information for the surgeons to determine the safe site of entry and trajectory for the screw implantation. We conclude that a screw diameter of 2.7 mm can be safely implanted in a vast majority of the patient population.


Assuntos
Parafusos Pediculares , Vértebras Cervicais , Feminino , Humanos , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
14.
Spine (Phila Pa 1976) ; 46(19): E1049-E1057, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34517402

RESUMO

STUDY DESIGN: Retrospective Cohort. OBJECTIVE: To evaluate the effect of computer-assisted navigation (NAV) on rates of complications and reoperations after spinal fusion (SF) for adolescent idiopathic scoliosis (AIS) using a nationally representative claims database. SUMMARY OF BACKGROUND DATA: Significant controversy surrounds the reported benefits of NAV in SF for AIS. Previous studies have demonstrated decreased rates of pedicle screw breaches with NAV compared to free-hand methods but no impact on complication rates. Thus, the clinical utility of NAV remains uncertain. METHODS: Analyses were performed using the IBM MarketScan databases. Patients aged 10 to 18 undergoing SF for AIS were grouped by use of NAV. Patients with nonidiopathic scoliosis were excluded. Univariate and risk-adjusted multivariate analyses were performed. Primary outcomes were neurological complications, any medical complications, and reoperations. Secondary outcomes included adjusted total reimbursements and length of stay. RESULTS: A total of 12,046 patients undergoing SF for AIS were identified, and 8640 had 90-day follow-up. NAV was used in 467 patients (5.4%), increasing from 2007 to 2015. After risk adjustment, the odds for any complication within 90 days were lower with NAV (OR = 0.61, P = 0.025), but neurological complications were unrelated to NAV (P = 0.742). NAV was not associated with reoperation within 90 days (P = 0.757) or 2 years (P = 0.095). We observed a $25,038 increase in adjusted total reimbursements (P < 0.001) and a 0.32-day decrease in length of stay (P = 0.022) with use of NAV. CONCLUSION: In this national sample, NAV was associated with a lower rate of total complications but no change in rates of neurological complications or reoperations. In addition, NAV was associated with a large increase in total payments, despite a modest decrease in hospital stay. Considering the increasing popularity of NAV, this study provides important context regarding the utility of NAV for AIS.Level of Evidence: 3.


Assuntos
Cifose , Parafusos Pediculares , Escoliose , Fusão Vertebral , Adolescente , Humanos , Estudos Retrospectivos , Escoliose/epidemiologia , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
15.
J Pediatr Orthop ; 41(10): 591-596, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34516471

RESUMO

BACKGROUND: Accurate pedicle screw placement is critical to surgically correct pediatric high-grade spondylolisthesis (HGS). The recent advent of robotics coupled with computer-assisted navigation (RAN) may represent a novel option to improve surgical outcomes of HGS, secondary to enhanced pedicle screw placement safety. This series presents the HGS-RAN technique adopted by our site, describing its surgical outcomes and feasibility. METHODS: Consecutive patients with a diagnosis of HGS (Meyerding grade III to V), operated on using RAN from 2019 to 2020 at a single-center were reviewed. Demographics, screw accuracy, sagittal L5-S1 parameters, complications, and perioperative outcomes were described. All patients were treated with instrumentation, decompression, posterior lumbar interbody fusion, and reduction. Robotic time included anatomic registration to end of screw placement. Screw accuracy-defined as a screw placed safely within the planned intrapedicular trajectory-was characterized by the Gertzbein-Robbins system for patients with additional 3-dimensional imaging. RESULTS: Ten HGS patients, with an average age of 13.7 years old, were included in the series. All 62 screws were placed without neurological deficit or complication. Seven patients had additional 3-dimensional imaging to assess screw accuracy (42 of 62 screws). One hundred percent of screws were placed safely with no pedicle breaches (Gertzbein-Robbins-grade A). Thirty screws (48%) were placed through separate incisions that were percutaneous/transmuscular and 32 screws (52%) were inserted through the main incision. There were statistically significant improvements in L5 slippage (P=0.002) and lumbosacral angle (P=0.002), reflecting successful HGS correction. The total median operative time was 324 minutes with the robotic usage time consuming a median of 72 minutes. Median estimated blood loss was 150 mL, and length-of-stay was a median 3 days. CONCLUSIONS: This case-series demonstrates that RAN represents a viable option for HGS repair, indicated by high screw placement accuracy, safety, and L5-S1 slippage correction. Surgeons looking to adopt an emerging technique to enhance safety and correction of pediatric HGS should consider the RAN platform. LEVEL OF EVIDENCE: Level IV-therapeutic study.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Espondilolistese , Adolescente , Criança , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Região Lombossacral , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia
16.
Medicine (Baltimore) ; 100(38): e27282, 2021 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-34559135

RESUMO

OBJECTIVE: The purpose of this systematic review and meta-analysis is to explore the screw positioning accuracy, complications related to pedicle screw implantation, revision rate and radiation exposure between robot screw placement and traditional fluoroscopic screw placement. METHODS: We searched several databases, including CNKI, Wanfang database, cqvip datebase, PubMed, Cochrane library and EMBASE, to identify articles that might meet the criteria. Meta-analysis was performed using Revman 5.3 software. RESULTS: A total of 13 randomized controlled trial were included. The results showed that the pedicle screw accuracy of the robot assisted group was significantly better than that of the conventional freehand (FH) group (OR = 3.5, 95% confidence interval [CI] [2.75,4.45], P < .0001). There was no significant difference in the complications caused by pedicle screw implantation between the robot-assisted group and the conventional FH group [OR = 0.39, 95%CI (0.10,1.48), P = .17]. The rate of facet joint invasion in the robot-assisted group was significantly lower than that in the conventional FH group (OR = 0.06, 95%CI [0.01,0.29], P = .0006). The revision rate in the robot-assisted group was significantly lower than that in the conventional FH group (OR = 0.19, 95%CI [0.05,0.71], P = 0.0.01). There was no significant difference in the average radiation of pedicle screws implantation between the robot-assisted group and the conventional FH (mean difference = -7.94, 95%CI [-20.18,4.30], P = .20). CONCLUSION: The robot-assisted group was significantly better than the conventional FH in the accuracy of pedicle screw placement and facet joint invasion rate and revision rate. There was no significant difference in the complication and fluoroscopy time between the two groups.


Assuntos
Vértebras Lombares/cirurgia , Parafusos Pediculares , Procedimentos Cirúrgicos Robóticos , Vértebras Torácicas/cirurgia , Fluoroscopia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação
17.
J Clin Neurosci ; 92: 183-188, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34509249

RESUMO

BACKGROUND: A method to evaluate pedicle screw loosening on digital tomosynthesis images is yet to be established owing to lack of methods for selecting slices of the same cross-sectional view. We aimed to develop an objective method for selecting slices of the same cross-sectional view on digital tomosynthesis images. METHODS: First, an objective method of pixel selection was developed by measuring the size of glass disk and titanium alloy screw on digital tomosynthesis images followed by comparison with the actual sizes. Second, a method for selecting slices of the same cross-sectional view was explored on a bone model with posterior spinal instrumentation using the screw centerline and rod curvature as indicators of the same cross section. The angle between the screw centerline and rod was calculated to verify the accuracy in obtaining the same cross-sectional view. Third, the method for selecting slices of the same cross-sectional view was applied to six patients after posterior lumbar spinal instrumentation. RESULTS: The pixel selection method enabled objective determination of a pixel on the peripheral lines of objects with an error as low as 200 µm in distance measurements on titanium alloy and glass. The mean differences of rod-screw angles between two slices were less than 1° and were not statistically significant in the bone model and patient images. CONCLUSION: A method for selecting slices of the same cross-sectional view on digital tomosynthesis images was successfully developed. This method can enable objective and quantitative evaluations of pedicle screw loosening.


Assuntos
Parafusos Pediculares , Fusão Vertebral , Estudos Transversais , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Radiografia
18.
Expert Rev Med Devices ; 18(10): 995-1022, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503387

RESUMO

INTRODUCTION: Pedicle screws are commonly used for spinal procedures for fusion stability, which is particularly important in osteoporotic patients, who are at an increased risk of requiring revision procedures. AREAS COVERED: A systematic review and meta-analysis were conducted to compare clinical effectiveness of conventional pedicle screws (CPS) vs fenestrated pedicle screws (FPS) in patients undergoing spinal surgery. Primary outcomes included screw loosening, revision surgeries (involving an implant) and reoperations (not involving intervention on an implant) in patients treated with CPS vs FPS, sub-stratified by with and without osteoporosis. Secondary outcomes included changes in pain scores. Forty-eight studies with 8,302 patients were included, with 1,565 (19.18%) treated with FPS and 6,710 (80.82%) treated with CPS. FPS was associated with a lower risk of screw loosening (p = 0.001) vs CPS. In the general population, there was a non-significant trend of lower revision rate, but no difference in reoperation rate, between patients treated with FPS vs CPS. In osteoporotic patients, revision rates were significantly lower for FPS vs CPS (p = 0.009). EXPERT OPINION: This review suggests that FPS are effective for surgical fixation and reduce rates of screw loosening, and in osteoporotic patients, revision surgeries, compared to CPS.


Assuntos
Osteoporose , Parafusos Pediculares , Fusão Vertebral , Cimentos Ósseos , Humanos , Vértebras Lombares , Osteoporose/cirurgia , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
19.
Neurol Med Chir (Tokyo) ; 61(11): 667-673, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34483199

RESUMO

A lateral mass screw (LMS) is one of the standard anchor screws in posterior cervical fixation. Although the advantage of cervical LMS is that it is easier and safer to place than pedicle screw, it is sometimes difficult for surgeons to confirm the exact point for screw entry and accurate angle in cases of revision surgery. When LMS fixation is performed as revision surgery after cervical laminoplasty or laminectomy, it might be complicated to secure safe placement of the LMSs. We present a simple but practical technique involving a caliper and angle device for revision surgery after cervical laminoplasty for ossification of the posterior longitudinal ligament. In this technique, the distance between the bilateral entry points is ascertained using preoperative CT. Insertion of the screw is guided using the angle device set to 25 degrees. The technique presented here is easy and allows accurate placement of the LMSs in the posterior cervical spine, and is practical even for revision surgery.


Assuntos
Laminoplastia , Parafusos Pediculares , Fusão Vertebral , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Humanos , Ligamentos Longitudinais , Osteogênese , Reoperação
20.
Injury ; 52(11): 3253-3260, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34521540

RESUMO

PURPOSE: To establish the finite element model of T12 and L2 (T12-L2) pedicle screw fixation for severe L1 burst fracture, and quantitatively simulate and analyze the screw stress and vertebral displacement in different degrees of L1 posterior upper wall fracture (PUWF), and evaluate whether PUWF degree is a risk factor for fixation failure. METHODS: The data of 6 healthy volunteers were used to establish a finite element model of T12-L2 pedicle screw fixation for type A severe burst fractures. The stress and displacement of the conventional and Schanz pedicle screws for the different degrees of PUWF (including the anterior upper wall of the vertebral canal and the bipedicle) were evaluated. RESULTS: The maximum stress and L1 displacement of conventional and Schanz pedicle screws were positively correlated with the severity of the PUWF (P<0.05). During anterior flexion, the maximum stress of conventional pedicle screws for 70% type I were 538.3±59.75MPa and the maximum stress of Schanz pedicle screws for 90% type Ⅱ, 90% type Ⅲ and 70% type IV fractures were close to the fatigue threshold. The maximum stress during anterior flexion were significantly higher than those during posterior extension, bending and rotation (P<0.05). CONCLUSION: The posterior upper wall fracture of vertebral body (VB) of type A burst fracture is not an independent risk factor for the failure of short-segment pedicle screw fixation (SSPSF). Anterior flexion of type A fractures combined with severe PUWF of VB was a risk factor for the failure of SSPSF.


Assuntos
Parafusos Pediculares , Fraturas da Coluna Vertebral , Análise de Elementos Finitos , Fixação Interna de Fraturas , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Fatores de Risco , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/lesões
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