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Huxman C. FDA regulatory considerations for innovative orthopedic devices: A review. Injury 2025; 56:112291. [PMID: 40157338 DOI: 10.1016/j.injury.2025.112291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Revised: 03/04/2025] [Accepted: 03/20/2025] [Indexed: 04/01/2025]
Abstract
Novel and innovative orthopedic devices are needed to address clinical challenges in orthopedic practice. Obtaining regulatory authorization for such devices, however, can prove challenging. An inherent dilemma exists between innovation to address unmet needs and imitation to demonstrate substantial equivalence to a predicate device, which is required for the less burdensome 510(k) pathway. This article provides both an overview of highly innovative orthopedic devices over the last 10 years as well as considerations for FDA regulatory pathways and programs available to manufacturers of such devices. A review of 20 innovative orthopedic devices receiving Breakthrough Device Designation and/or a De Novo classification found that devices had diverse features and applications, but did possess shared technological trends including bioresorption, flexible components, and new substance/material use. A review of all new orthopedic devices authorized through the three major regulatory pathways in the last 10 years was also conducted. Spinal devices represented the largest share of recent orthopedic devices (38 % of 510(k) clearances and 25 % of De Novo classifications). Across all three pathways, decision time was on average around 30 % shorter for orthopedic devices with a Breakthrough Device Designation versus those without, though differences were not significant. New orthopedic devices authorized in the last 10 years were found to be highly reliant on the 510(k) pathway, with a 99 % utilization rate. However, the FDA Breakthrough Devices Program and De Novo pathway offer opportunities specific to innovative technologies, such as expedited review and potential market competition protection, as demonstrated through specific case studies in this review. As these FDA initiatives continue to evolve and manufacturers continue to take advantage of these opportunities, orthopedic device development, which has primarily prioritized incremental innovation, may too evolve to produce more breakthrough innovations.
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Affiliation(s)
- Connor Huxman
- Department of Mechanical Engineering, The Pennsylvania State University, 137 Reber Building, University Park, PA, 16802, USA.
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Sherif R, Spence EC, Smith J, McCarthy MJH. Intraoperative imaging adequacy and its impact on unplanned return-to-theatre rates in pedicle screw instrumentation. World J Orthop 2025; 16:103955. [PMID: 40124730 PMCID: PMC11924020 DOI: 10.5312/wjo.v16.i3.103955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 01/13/2025] [Accepted: 02/18/2025] [Indexed: 03/12/2025] Open
Abstract
BACKGROUND Pedicle screw instrumentation is a critical technique in spinal surgery, offering effective stabilization for various spinal conditions. However, the impact of intraoperative imaging quality-specifically the use of both anteroposterior (AP) and lateral views-on surgical outcomes remains insufficiently studied. Evaluating whether the adequacy of these imaging modalities affects the risk of unplanned returns to theatre (URTT) within 90 days due to screw malplacement is essential for refining surgical practices and improving patient care. AIM To evaluate how intraoperative imaging adequacy influences unplanned return-to-theatre rates, focusing on AP and lateral fluoroscopic views. METHODS This retrospective cohort study analyzed 1335 patients who underwent thoracolumbar and sacral pedicle screw instrumentation between January 2013 and December 2022. Data on intraoperative imaging adequacy, screw placement, and URTT events were collected and statistically analyzed using IBM SPSS v23. Imaging adequacy was assessed based on the presence of both AP and lateral views, and outcomes were compared between imaging groups. RESULTS A total of 9016 pedicle screws were inserted, with 82 screws identified as malplaced in 52 patients. Of these, 46 patients required URTT due to screw malplacement, with 37 returning within 90 days (URTT90). Patients with both AP and lateral imaging saved intraoperatively had significantly lower URTT90 rates compared to those with only lateral imaging saved, demonstrating the critical role of imaging adequacy in improving surgical outcomes. CONCLUSION This study underscores that comprehensive intraoperative imaging with both AP and lateral views reduces unplanned returns, improves outcomes, enhances precision, and offers a cost-effective approach for better spinal surgery results.
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Affiliation(s)
- Ramy Sherif
- Department of Spinal Surgery, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Ella Clifford Spence
- Department of Spinal Surgery, Cardiff University, Cardiff CF14 4XW, United Kingdom
| | - Jessica Smith
- Department of Spinal Surgery, Cardiff University, Cardiff CF14 4XW, United Kingdom
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Suggala S, Dyess GA, Darbin O, Menger RP. Delayed neurological deficit due to a medially misplaced thoracic pedicle screw during adolescent idiopathic scoliosis correction: a complication 6 years in the making. Spine Deform 2025; 13:311-324. [PMID: 39230663 PMCID: PMC11729099 DOI: 10.1007/s43390-024-00951-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 08/04/2024] [Indexed: 09/05/2024]
Abstract
PURPOSE Neurological deficits developing years after pedicle screw misplacement is a rare phenomenon. Here, we report level IV evidence of a previously asymptomatic medial thoracic pedicle screw resulting in paraparesis after a motor vehicle accident. METHODS A 21-year-old male presented with acute onset of paraparesis following a motor vehicle collision. Six years prior this incident, the patient underwent a thoracolumbar fusion T4-L4 for AIS performed by an outside orthopedic surgeon. CT scan and CT myelogram illustrated decreased spinal canal diameter and cord compression from a medial T8 pedicle screw. RESULTS Surgical removal of the misplaced pedicle screw resulted in a gradual complete recovery sustained over a period of 2 years. This case is compared to those reported in the literature review between 1981 and 2019 concerning delayed neurological deterioration related to misplaced pedicle screw. CONCLUSION This case reports a delayed neurological deficit implicating a misplaced pedicle screw. This phenomenon remains rare since 5 cases were reported in the literature over the last 4 decades. It calls into focus the need for confirmation of safe instrumentation during the intraoperative period. It also illustrates the potential difficult decision-making in regard to asymptomatic misplaced instrumentation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sudhir Suggala
- Department of Neurosurgery, University of South Alabama, 1601 Center Street, Suite 2D, Mobile, AL, 36604, USA.
| | - Garrett A Dyess
- Department of Neurosurgery, University of South Alabama, 1601 Center Street, Suite 2D, Mobile, AL, 36604, USA
| | - Olivier Darbin
- Department of Neurosurgery, University of South Alabama, 1601 Center Street, Suite 2D, Mobile, AL, 36604, USA
| | - Richard P Menger
- Department of Neurosurgery, University of South Alabama, 1601 Center Street, Suite 2D, Mobile, AL, 36604, USA
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Lei S, Zhou J, Guo L, Guan X, Zhang M, Yue H, Kang X. Debridement and bone graft fusion via the lateral extracavitary approach combined with lateral and posterior screw-rod fixation in the treatment of thoracic spinal tuberculosis: A retrospective study of 38 cases. Heliyon 2024; 10:e39435. [PMID: 39698076 PMCID: PMC11652835 DOI: 10.1016/j.heliyon.2024.e39435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 09/28/2024] [Accepted: 10/14/2024] [Indexed: 12/20/2024] Open
Abstract
Objectives Thoracic spinal tuberculosis (TB) is still common, and surgical treatment can rapidly relieve pain, correct deformity, reduce bone loss and prevent further damage to neurological function. We have practiced an efficient and safe surgical method. Methods From January 2013 to April 2021, 38 patients with thoracic spinal TB were included in our study. Debridement and bone grafting were performed via the lateral extracavitary approach, combined with two different fixation methods. Data from these cases were analyzed retrospectively. Results For all cases, the C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) of all the patients decreased to normal levels at the last follow-up. The average visual analog scale (VAS) score was 7.5 ± 1.6 preoperatively and 0.6 ± 0.8 at the last follow-up, showing a significant reduction. The average angle of kyphosis correction was 6.3 ± 4.7°, and the loss of correction was 1.4 ± 1.6°. Neurological function was significantly improved in all cases according to the American Spinal Injury Association (ASIA) classification. Solid fusion was observed in all cases at the last follow-up. Conclusions Debridement and bone graft fusion via the lateral extracavitary approach combined with two fixation methods can be very effective in the treatment of thoracic spinal TB.
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Affiliation(s)
- Shuanhu Lei
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Jianwei Zhou
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Li Guo
- Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, 730050, China
| | - Xiaoli Guan
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Mingtao Zhang
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Haiyuan Yue
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Xuewen Kang
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
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Zeng W, Hu S, Zhu Z, Wang S, Guo L, Shi B. A 3D-CT Study of the Cortical Bone Trajectory Screw Placement Parameters Based on Lumbar CT. Orthop Surg 2024; 16:2771-2780. [PMID: 39187426 PMCID: PMC11541135 DOI: 10.1111/os.14202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 07/05/2024] [Accepted: 07/24/2024] [Indexed: 08/28/2024] Open
Abstract
OBJECTIVE The cortical bone trajectory (CBT) technology is an effective substitute for traditional pedicle screw (PS) technology. However, there is still controversy about the CBT screw technology placement strategy. The objective of this study was to simulate cortical screw placement with the help of three-dimensional (3D) software, to discuss the differences in screws between genders and vertebral segments, and to explore a safer and more efficient strategy for cortical screw placement. METHODS Mimics Medical software was used to construct a 3D model of the lumbar spine, and the placement of CBT screws was simulated. The volume of each vertebral body from L1 to L5, the pedicle isthmus height (IH), the pedicle isthmus width (IW), and the sagittal vertebral distance (SAVD) were measured. The transverse distance (TD) and the longitudinal distance (LD) between the ideal starting point (SP) and the clinical SP (the intersection Q of the midline of the superior articular process and the horizontal line 1 mm below the transverse process) were measured. The cephalad angle (CA), lateral angle (LA), maximum screw diameter (MSD), maximum screw length (MSL) of each trajectory of the L1 to L5 vertebral bodies, and the percentage of the screw insertion depth (PSID) into the vertebral body were measured. Data were statistically analyzed using Student's t-test, one-way analysis of variance (ANOVA), and Tukey's test. RESULTS Vertebral anatomical parameters and CBT screw parameters differed between males and females. Female patients had lower IH, IW, SAVD, CA, LA, MSD, and MSL than males. IH was greatest in L1 (male, 17.81 mm; female, 16.12 mm) and the smallest in L5 (male, 14.11 mm; female, 13.05 mm). IW was smallest in L1 (male, 8.89 mm; female, 7.37 mm) and greatest in L5 (male, 16.59 mm; female, 15.43 mm). The MSD of males was smallest in L1 (6.05 mm) and greatest in L3 (7.06 mm); the MSD of females was smallest in L1 (5.13 mm) and greatest in L4 (6.64 mm). MSL was greatest at L3 (male, 33.63 mm; female, 32.28 mm) and smallest at L5 (male, 31.25 mm; female, 29.97 mm). CA was smallest in L1 (male, 22.80°; female, 21.92°) and greatest in L3 (male, 25.29°; female, 24.33°). LA was smallest in L1 (male 12.37°, female 11.27°) and greatest in L5 (male 13.56°, female 12.96°). Among the males, TD was smallest at L1 (-0.51 mm) and greatest at L5 (1.37 mm), while LD was greatest at L2 (3.46 mm) and smallest at L5 (2.40 mm). In females, TD was greatest at L1 (0.12 mm) and smallest at L3 (-0.51 mm), while LD was greatest at L1 (3.69 mm) and smallest at L5 (2.08 mm). In the overall sample, the incidence of SAVD and PSID gradually increased from L1 to L5. CONCLUSION The optimal screw placement strategy for CBT screws varies significantly according to sex and vertebral body segments, particularly noting the specificity of screw placement at L5. The optimal screw placement strategy should be selected based on the patient's sex and segment characteristics before surgery to maximize the safety and accuracy of CBT screw placement.
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Affiliation(s)
- Weibo Zeng
- Department of Spinal SurgeryZhujiang Hospital of Southern Medical UniversityGuangzhouChina
| | - Shengxuan Hu
- Department of OrthopedicAffiliated Hospital of Jiujiang UniversityJiujiangChina
| | - Zhemin Zhu
- Department of Spinal SurgeryZhujiang Hospital of Southern Medical UniversityGuangzhouChina
| | - Shuai Wang
- Department of Spinal SurgeryZhujiang Hospital of Southern Medical UniversityGuangzhouChina
| | - Lijun Guo
- Department of Spinal SurgeryZhujiang Hospital of Southern Medical UniversityGuangzhouChina
| | - Benchao Shi
- Department of Spinal SurgeryZhujiang Hospital of Southern Medical UniversityGuangzhouChina
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Guo C, Wang R, Ru N, Liu Q, Zhang F, Liang J, Wu Y, Chen L. Analysis on the related factors of misplacement of freehand pedicle screws via posterior approach in degenerative scoliosis. BMC Musculoskelet Disord 2024; 25:808. [PMID: 39395953 PMCID: PMC11470682 DOI: 10.1186/s12891-024-07919-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 10/03/2024] [Indexed: 10/14/2024] Open
Abstract
BACKGROUND To study the risk factors associated with misplacement of freehand pedicle screws through a posterior approach for degenerative scoliosis. METHODS A total of 204 patients who underwent posterior pedicle screw-rod system surgery for degenerative scoliosis in our hospital from December 2020 to December 2023 were retrospectively analyzed. Patient demographics, radiographic accuracy, and surgery-related information were recorded. RESULTS A total of 204 patients were included. A total of 2496 screws were placed. 2373 (95.07%) were in good position. Misplacement screws were 123 (4.93%). None of the patients had postoperative spinal nerve symptoms due to screw malposition. The misplacement rate of thoracic (T10-T12) pedicle screws was 11.11% (60/540). Misplacement of pedicle screws in the lumbar spine (L1-L5) was 3.22% (63/1956). Age, gender, surgeon, and operation time had no significant effect on misplacement of pedicle screws (P>0.05). Body mass index, Hu value, number of screw segments, Cobb angle, vertebral rotation, and spinal canal morphology had some correlation with pedicle screw misplacement. Among them, BMI, Hu value, number of screw segments, Cobb angle, and vertebral rotation grade were independent risk factors for PS misplacement (P<0.05). The height of the posterior superior iliac spine had a significant effect on pedicle screw misplacement in the lower lumbar spine (L4/5) (P<0.05). CONCLUSION BMI, Hu value, number of screw levels, Cobb angle, and vertebral rotation grade were independent risk factors for pedicle screw misplacement in patients with degenerative scoliosis. Posterior superior iliac spine height has a large impact on PS placement in the lower lumbar spine. Patients with degenerative scoliosis should be preoperatively planned for the size and direction of the placed screws by X-ray and CT three-dimensional, to reduce the misplacement rate of pedicle screws.
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Affiliation(s)
- ChangJin Guo
- Orthopedics Department, the First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - RuiYang Wang
- Orthopedics Department, the Second People's Hospital of China Three Gorges University, Yichang, China
| | - Neng Ru
- Orthopedics Department, the First College of Clinical Medical Science, China Three Gorges University, Yichang, China.
| | - Qing Liu
- Orthopedics Department, the First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Fan Zhang
- Orthopedics Department, the First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Jie Liang
- Orthopedics Department, the First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - Yu Wu
- Orthopedics Department, the First College of Clinical Medical Science, China Three Gorges University, Yichang, China
| | - LeYuan Chen
- Orthopedics Department, the First College of Clinical Medical Science, China Three Gorges University, Yichang, China
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Nkwerem SP, Ohaegbulam SC, Mezue W, Emejulu JKC, Ndubuisi CA, Nkwerem GI. Lumbar Pedicle Dimensions Using CT Scan in Adults of South-Eastern Nigeria as Related to Transpedicular Fixation. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2024; 14:396-402. [PMID: 39309380 PMCID: PMC11412596 DOI: 10.4103/jwas.jwas_169_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/24/2024] [Indexed: 09/25/2024]
Abstract
Background Transpedicular fixation depends on accuracy of the entry points, angle of insertion and pedicular isthmus width for adequate screw insertion. Preoperative measurements of pedicle dimensions reduce the chances of failure during insertion. These pedicle dimensions (transverse diameter, longitudinal diameter, and maximum length of purchase [MLP]) vary with sex and race. Such data, from a large-scale study, are not available for our population. Objective The study aims to evaluate the dimensions of pedicle that are relevant for pedicle screw fixation in Southeast Nigerian population. Materials and Methods A prospective multi-slice CT based clinical anatomy study done at Memfys Hospital for Neurosurgery, Enugu. This study is on the lumbar pedicle dimensions that are related to transpedicular fixation (transverse and longitudinal diameters of the pedicle, MLP, pedicle transverse and longitudinal angles of inclination). Sample size (273) was calculated with the confidence interval formula based on the number of patients that present for images. Consent and ethical approval were obtained. Results The mean values are as follow: LD1 8.22 mm, LD2 7.73 mm, LD3 7.40 mm, LD4 7.16 mm, LD5 6.87 mm TD1 5.05 mm, TD2 5.31 mm, TD3 6.72 mm, TD4 8.27 mm, TD5 11.31 mm, MLP1 46.60 mm, MLP2 47.97 mm, MLP3 47.14 mm, MLP4 45.54 mm, MLP5 43.47 mm TA1 17.8°, TA2 19.34°, TA3 20.80°, TA4 22.00°, TA5 25.70° LA1 19.42°, LA2 18.61°, LA3 18.00°, LA4 17.09°, LA5 16.40°. Unlike transverse diameter, transverse angle, longitudinal dimension, longitudinal angle (LA), MLP there was significant correlation between age and mean LA. The mean values also correlated significantly with the gender. Conclusion The mean values varied with the different vertebral levels and was good correlations between some of the parameters with age and gender.
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Affiliation(s)
- Sunday Patrick Nkwerem
- Faculty of Medicine, Department of Surgery, Nnamdi Azikiwe University, Nnewi Campus, Awka, Nigeria
| | | | - Wilfred Mezue
- Department of Surgery, University of Nigeria, Enugu Campus, Nigeria
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Hu Y, Chen X, Chu Z, Tian Q, Luo L, Gan Z, Zhong J, Yuan Z, Zhu B, Dong W. Micro-Computed Tomography Analysis and Histological Observation of the Screw-Bone Interface of Novel Porous Scaffold Core Pedicle Screws and Hollow Lateral Hole Pedicle Screws: A Comparative Study in Bama Pigs. World Neurosurg 2024; 190:e315-e322. [PMID: 39059721 DOI: 10.1016/j.wneu.2024.07.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE Screw loosening is a common complication of pedicle screw internal fixation surgery. This study aimed to investigate whether the application of a porous scaffold structure can increase the contact area between screws and bone tissue by comparing the bone ingrowth and screw-bone interface of porous scaffold core pedicle screws (PSCPSs) and hollow lateral hole pedicle screws (HLHPSs) in the lumbar spine of Bama pigs. METHODS Sixteen pedicle screws of both types were implanted into the bilateral pedicles of the L1-4 vertebrae of 2 Bama pigs. All Bama pigs were sacrificed and the lumbar spine was freed into individual vertebrae at 16 weeks postoperatively. After the vertebrae were made into screw-centered specimens, micro-computed tomography analysis and histological observation were performed to assess the screw-bone interface and bone growth around and within the screws. RESULTS We found that the bone condition around PSCPSs and HLHPSs did not show significant differences on micro-computed tomography three-dimensional reconstruction images. CT transverse views showed different bone growth inside the 2 screws. In PSCPSs, bone tissue was seen to fill the internal pores and was evenly distributed around each strut. Inside HLHPSs, bone growth was confined to 1 side of the screw and did not fill the entire cavity. Osteometric analysis showed that bone volume fraction and trabecular number, the parameters representing bone mass, were higher in PSCPSs than in HLHPSs. These differences were not statistically significant (P > 0.05). Histological observations visualized that the osseointegration within PSCPSs was superior to that of HLHPSs, and the tight integration of bone tissue with the porous scaffold resulted in a larger screw-bone integration area in PSCPSs than in HLHPSs. CONCLUSIONS Compared with HLHPSs, PSCPSs possessing a porous scaffold core could promote bone ingrowth and osseointegration, resulting in an effective enhancement of the combined area of the screw-bone interface.
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Affiliation(s)
- Yong Hu
- Department of Spine Surgery, Ningbo No. 6 Hospital of Ningbo University, Ningbo, China.
| | - Xijiong Chen
- Health Science Center, Ningbo University, Ningbo, China
| | - Zhentao Chu
- Health Science Center, Ningbo University, Ningbo, China
| | - Quanliang Tian
- Department of Spine Surgery, Qianxinan Autonomous Prefecture Hospital of TCM, Xingyi, China
| | - Linwei Luo
- Health Science Center, Ningbo University, Ningbo, China
| | - Zhiwei Gan
- Health Science Center, Ningbo University, Ningbo, China
| | - Jianbin Zhong
- Department of Spine Surgery, Ningbo No. 6 Hospital of Ningbo University, Ningbo, China
| | - Zhenshan Yuan
- Department of Spine Surgery, Ningbo No. 6 Hospital of Ningbo University, Ningbo, China
| | - Bingke Zhu
- Department of Spine Surgery, Ningbo No. 6 Hospital of Ningbo University, Ningbo, China
| | - Weixin Dong
- Department of Spine Surgery, Ningbo No. 6 Hospital of Ningbo University, Ningbo, China
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Murata A, Tsutsui S, Yamamoto E, Kozaki T, Nakanishi R, Yamada H. A Bicortical Pedicle Screw in the Cephalad Trajectory Is the Best Option for the Fixation of an Osteoporotic Vertebra: A Finite Element Study. Spine Surg Relat Res 2024; 8:510-517. [PMID: 39399454 PMCID: PMC11464828 DOI: 10.22603/ssrr.2023-0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/22/2024] [Indexed: 10/15/2024] Open
Abstract
Introduction Pedicle screws are commonly used in fixation to treat various spinal disorders. However, screw loosening is a prevalent complication, particularly in patients with osteoporosis. Various biomechanical studies have sought to address this issue, but the optimal depth and trajectory to increase the fixation strength of pedicle screws remain controversial. Therefore, a biomechanical study was conducted using finite element models. Methods Three-dimensional finite element models of the L3 vertebrae were developed from the preoperative computed tomography images of nine patients with osteoporosis and nine patients without who underwent spine surgery. Unicortical and bicortical pedicle screws were inserted into the center and into the anterior wall of the vertebrae, respectively, in different trajectories in the sagittal plane: straightforward, cephalad, and caudal. Subsequently, three different external loads were applied to each pedicle screw at the entry point: axial pullout, craniocaudal, and lateromedial loads. Nonlinear analysis was conducted to examine the fixation strength of the pedicle screws. Results Irrespective of osteoporosis, the bicortical pedicle screws had greater fixation strength than the unicortical pedicle screws in all trajectories and external loads. The fixation strength of the bicortical pedicle screws was not substantially different among the trajectories against any external loads in the nonosteoporotic vertebrae. However, the fixation strength of the bicortical pedicle screws against craniocaudal load in the cephalad trajectory was considerably greater than those in the caudal (P=0.016) and straightforward (P=0.023) trajectories in the osteoporotic vertebrae. However, this trend was not observed in pullout and lateromedial loads. Conclusions Our results indicate that bicortical pedicle screws should be used, regardless of whether the patient has osteoporosis or not. Furthermore, pedicle screws should be inserted in the cephalad trajectory in patients with osteoporosis.
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Affiliation(s)
- Akimasa Murata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Ei Yamamoto
- Department of Biomedical Engineering, Faculty of Biology-Oriented Science and Technology, Kindai University, Kinokawa, Japan
| | - Takuhei Kozaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Ryuichiro Nakanishi
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
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Zhuo C, Liu Y, Zhang Y, Zhang R, Wang L, Yang D, Chen S, Tang H, Cai H, Chen H. Comparison of the short-term efficacy of MIS-TLIF and Endo-LIF for the treatment of two-segment lumbar degenerative disease. BMC Musculoskelet Disord 2024; 25:708. [PMID: 39232720 PMCID: PMC11373331 DOI: 10.1186/s12891-024-07815-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 08/23/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND This study retrospectively compared short-term clinical outcomes and complications of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)and endoscopic lumbar interbody fusion(Endo-LIF))for two-segmental lumbar degenerative disease, aiming to guide spine surgeons in selecting surgical approaches. METHODS From January 2019 to December 2023, 30 patients were enrolled,15 in the MIS-TLIF group and 15 in the Endo-LIF group. All patients were followed up for more than 3 months after surgery and the following information was recorded: (1)surgery time, difference in hemoglobin between preoperative and postoperative, surgical costs, first time out of bed after operation, postoperative hospitalization time, postoperative complication; (2) ODI score (The Oswestry Disability Index), leg and back VAS score (Visual Analogue Scale), and lumbar vertebra JOA score (Japanese Orthopaedic Association Scores); (3) MacNab score at final follow-up to assess clinical outcome, CT to evaluate lumbar fusion. RESULTS There were significant differences between the two groups regarding operation time and cost, with the MIS-TLIF group performing significantly better. Intraoperative bleeding was considerably less in the Endo-LIF group compared to the MIS-TLIF group. However, there were no significant differences in the time of the first postoperative ambulation, postoperative hospitalization time, and postoperative complications. There was no significant difference in preoperative VAS, ODI, and JOA between the two surgical groups There were no significant differences in VAS(leg), ODI, and JOA scores between the two groups before and at 1 day,7 days, 1 month, 3 months and final follow-up. However, at 1 day postoperatively, the VAS( back)score in the Endo-LIF group was lower than that in the MIS-TLIF group, and the difference was statistically significant. At the final follow-up, all patients achieved grade III and above according to the Bridwell criteria, and there was no significant difference between the two surgical groups compared to each other. According to the MacNab score at the final follow-up, the excellent rate was 80.00% in the Endo-LIF group and 73.33% in the MIS-TLIF group, with no significant difference between the two groups. CONCLUSION There was no significant difference in short-term efficacy and safety between Endo-LIF and MIS-TLIF for two-segment degenerative lumbar diseases. MIS-TLIF has a shorter operative time and lower costs, while Endo-LIF causes less tissue damage, blood loss, and early postoperative pain, aiding long-term recovery. Both MIS-TLIF and Endo-LIF are promising for treating two-segment lumbar degenerative disease. The choice of a surgical procedure depends on the patient's financial situation, their ability to tolerate surgery, and the surgeon's expertise.
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Affiliation(s)
- Can Zhuo
- Department of the Spinal Surgery, The First College of Clinical Medical Science (Yichang Central People's Hospital),China Three Gorges University, Yichang, 443000, Hubei, China
| | - Yang Liu
- Department of the Spinal Surgery, The First College of Clinical Medical Science (Yichang Central People's Hospital),China Three Gorges University, Yichang, 443000, Hubei, China
| | - Yuqun Zhang
- Department of the Hematology, The First College of Clinical Medical Science (Yichang Central People's Hospital),China Three Gorges University, Yichang, 443000, Hubei, China
| | - Ruitao Zhang
- Department of Anatomy, Medicine College, China Three Gorges University, Yichang, 443000, Hubei, China
| | - Long Wang
- Department of the Spinal Surgery, The First College of Clinical Medical Science (Yichang Central People's Hospital),China Three Gorges University, Yichang, 443000, Hubei, China
| | - Diao Yang
- Department of the Spinal Surgery, The First College of Clinical Medical Science (Yichang Central People's Hospital),China Three Gorges University, Yichang, 443000, Hubei, China
| | - Shiwen Chen
- Department of the Spinal Surgery, The First College of Clinical Medical Science (Yichang Central People's Hospital),China Three Gorges University, Yichang, 443000, Hubei, China
| | - Heshan Tang
- Orthopedics Department, Jiangling County People's Hospital, Jingzhou, 434100, Hubei, China
| | - Huili Cai
- Department of the Hematology, The First College of Clinical Medical Science (Yichang Central People's Hospital),China Three Gorges University, Yichang, 443000, Hubei, China.
| | - Haidan Chen
- Department of the Spinal Surgery, The First College of Clinical Medical Science (Yichang Central People's Hospital),China Three Gorges University, Yichang, 443000, Hubei, China.
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Zheng J, Wu Y, Guo C, Fang X, Ding T. Efficacy and Safety of Cortical Bone Trajectory Screws versus Pedicle Screws in Lumbar Fusion: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 188:e233-e246. [PMID: 38777322 DOI: 10.1016/j.wneu.2024.05.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE A systematic review and meta-analysis was conducted to compare the efficacy and safety of cortical bone trajectory (CBT) screws and traditional pedicle screws in lumbar fusion. METHODS Randomized controlled studies and cohort studies on CBT versus pedicle screws in lumbar fusion were searched in China Biology Medicine, China National Knowledge Infrastructure, Wanfang, VIP Database for Chinese Technical and Science Periodicals, PubMed, Cochrane Library, and Web of Science databases. The search period spanned from the establishment of the databases to December 2023. The Cochrane bias risk assessment tool and Newcastle-Ottawa scale were applied to assess the quality of the literature included. Clinical and imaging data as well as surgical outcomes, recovery, and postoperative complications were extracted from the relevant literature. RESULTS A total of 6 randomized controlled trials and 26 cohort studies were included after screening by inclusion and exclusion criteria with a total of 2478 patients. The meta-analysis demonstrated significant discrepancies between the CBT and TPS groups in Japanese Orthopaedic Association score at 3 and 6 months and final follow-up. Moreover, the TPS group exhibited a higher Oswestry disability index at final follow-up, a greater VAS for low back pain at both 1 week and final follow-up, as well as a higher VAS for leg pain at 1 month. Differences were also noted in surgical and recovery outcomes. However, there was no significant difference between the 2 groups in postoperative complications. CONCLUSIONS CBT and TPS have analogous safety profiles when applied to lumbar fusion, but the clinical efficacy of CBT is superior to that of TPS to some extent, and the procedure is less invasive with faster recovery.
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Affiliation(s)
- Jianqing Zheng
- Department of Orthopaedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Yue Wu
- Department of Orthopaedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Chunliang Guo
- Department of Orthopaedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Xiule Fang
- Department of Orthopaedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Tao Ding
- Department of Orthopaedics, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
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Chen F, Li J, Li T, Xi Y. The application of gradually expanding pedicle technology in the placement of screws in thinner pedicle of patients with idiopathic scoliosis. Front Surg 2024; 11:1388534. [PMID: 39092151 PMCID: PMC11291212 DOI: 10.3389/fsurg.2024.1388534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024] Open
Abstract
Objective To propose a technique of gradual expansion of pedicle diameter to place screws on the thinner pedicle that is difficult to place screws in scoliosis orthopedic surgery, in order to place thicker pedicle screws in the premise of good safety to achieve good stability and orthopaedic effect. Methods The authors reviewed that 36 patients with Adolescent idiopathic scoliosis (AIS) (20 females, 16 males) in our department from June 2020 to March 2024 underwent posterior spinal correction and internal fixation were enrolled in the present study. 194 pedicles had narrower diameter ranging from 0 mm to 4.5 mm. After analysis, 155 pedicles (internal diameter: 2.5 mm-4.5 mm) were treated with gradually expanding pedicles technology. The angle between the inserted screws and the upper endplate of the vertebral body was measured 1 week after operation and 3 months after operation to evaluate the placement of the screws after pedicle expansion. Results All operations were completed without dura mater rupture, nerve root injury, infection and poor incision healing. There was no screw breaking or screw pull-out in DR film at 3 months after operation compared with 1 week after operation. There was no significant difference in the angle between screw and upper endplate measured by the three observers at 3 months and 1 week after operation (Wilcoxon's signed rank test, p > 0.05). In the measurement at 1 week or 3 months after operation, there was no statistically significant difference among the three observers. There is a good consistency between the observers (Cronbach's alpha > 0.80). Conclusion In AIS patients, the thinner pedicle with a diameter range of 2.5 mm to 4.5 mm can be safely inserted with relatively thicker pedicle screws after gradually expanding pedicle technology.
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Affiliation(s)
- Fei Chen
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jianyi Li
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Tao Li
- Department of Spine Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yongming Xi
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Mulhem A, Omran Z, Hammersen S, Kantelhardt SR. Radiologic Outcomes after Operative Management of Traumatic Spine Fractures: Stand-Alone Posterior Stabilization versus Combined Anteroposterior Approach. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38776990 DOI: 10.1055/a-2331-2466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Previous research emphasizes correcting deformities resulting from spine fractures by restoring sagittal alignment and vertebral height. This study aims to compare radiologic outcomes, including sagittal index (SI) and loss of vertebral body height (LVBH), between stand-alone posterior stabilization (group I) and the posteroanterior/combined approach (group II) in the operative management of traumatic thoracic or lumbar spine fractures. METHODS In this retrospective single-center study, all patients with traumatic spine fractures (T1-L5) undergoing surgical stabilization between January 1, 2015, and May 31, 2021, were included. Two spine surgeons independently assessed imaging, recording the SI and LVBH values at baseline, after each surgical intervention, and during follow-up (at least 3 months posttreatment). The mean SI and LVBH values between the assessing surgeons were utilized. Linear mixed-effects regression models, adjusted to baseline values, compared the SI and the LVBH values between the two groups. RESULTS In all, 71 patients (42 men), with the median age of 38 years (interquartile range [IQR]: 28-54) and median follow-up of 4 months (IQR: 3-17), were included. Thirty-two patients were in group I and 39 patients were in group II. Forty fractures included the thoracolumbar junction (T12 or L1), 15 affected the thoracic spine, and 14 the lumbar spine. The regression model revealed superior sagittal alignment in group II, with an adjusted mean difference for SI of -4.24 (95% confidence interval [CI]: -7.13 to -1.36; p = 0.004), and enhanced restoration of vertebral body height with an adjusted mean difference for LVBH of 0.11 in the combined approach (95% CI: 0.02-0.20; p = 0.02). Nine postoperative complications occurred in the entire cohort (4 in group I and 5 in group II). CONCLUSIONS Combined posteroanterior stabilization for spine fractures improves deformities by enhancing sagittal alignment and increasing vertebral body height, with acceptable morbidity compared with the stand-alone posterior approach.
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Affiliation(s)
- Ali Mulhem
- Department for Continuing Education, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Ziad Omran
- Department of Neurosurgery, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Stefanie Hammersen
- Department of Neurosurgery, Vivantes Klinikum im Friedrichshain, Berlin, Germany
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Daher M, Aoun M, El-Sett P, Kreichati G, Kharrat K, Sebaaly A. Unilateral Versus Bilateral Cages in Lumbar Interbody Fusions: A Meta-Analysis of Clinical and Radiographic Outcomes. World Neurosurg 2024; 186:158-164. [PMID: 38561031 DOI: 10.1016/j.wneu.2024.03.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Bilateral cages are often used for interbody fusion. However, this procedure may not be possible in some cases making unilateral cages a reasonable alternative. The literature remains divided on the clinical and radiological distinctions when comparing unilateral to bilateral cages in lumbar interbody fusion. Thus, this meta-analysis will analyze the clinical and radiographic outcomes between these 2 groups. METHODS PubMed, Cochrane, and Google Scholar (page 1-20) were searched till January 2024. The clinical outcomes evaluated were the incidence of adverse events, surgery-related parameters, and patient reported outcomes. RESULTS Lower rates of pseudoarthrosis, subsidence, were reported in the bilateral cages group (P = 0.01, P = 0.001, respectively) whereas shorter operative time (OR time), and lower estimated blood loss were seen in unilateral cage group (P < 0.001, and P = 0.003). There was no statistically significant difference in the remaining analyzed outcomes. CONCLUSIONS Unilateral cages were shown to be superior due to their reduced OR time and estimated blood loss. As for the higher rate of pseudoarthrosis, this outcome may not be related to the cage numbers and it did not affect clinical outcomes. Nevertheless, one must consider other factors such as radiographic sagittal parameters before making a surgical decision.
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Affiliation(s)
- Mohammad Daher
- Faculty of medicine, Saint Joseph University, Beirut, Lebanon; Department of Orthopedic Surgery, Brown University, Providence, Rhode Island, USA
| | - Marven Aoun
- Faculty of medicine, Saint Joseph University, Beirut, Lebanon
| | - Pierre El-Sett
- Faculty of medicine, Saint Joseph University, Beirut, Lebanon
| | - Gaby Kreichati
- Faculty of medicine, Saint Joseph University, Beirut, Lebanon; Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Khalil Kharrat
- Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Amer Sebaaly
- Faculty of medicine, Saint Joseph University, Beirut, Lebanon; Department of Orthopedic Surgery, Hotel Dieu de France Hospital, Beirut, Lebanon.
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Zhai WJ, Wang ZK, Liu HL, Qin SL, Han PF, Xu YF. Comparison between minimally invasive and open transforaminal lumbar interbody fusion for the treatment of multi‑segmental lumbar degenerative disease: A systematic evaluation and meta‑analysis. Exp Ther Med 2024; 27:162. [PMID: 38476911 PMCID: PMC10928985 DOI: 10.3892/etm.2024.12450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/02/2024] [Indexed: 03/14/2024] Open
Abstract
The present study aimed to compare the differences between minimally invasive transforaminal lumbar fusion (MIS-TLIF) and open transforaminal lumbar fusion (TLIF) for multi-segmental lumbar degenerative disease regarding intraoperative indices and postoperative outcomes. PubMed, Web of Science, Embase, CNKI, Wanfang and VIP databases were searched for literature on MIS-TLIF and open TLIF in treating multi-segmental lumbar degenerative diseases. Of the 1,608 articles retrieved, 10 were included for final analysis. The Newcastle-Ottawa Scale and Review Manager 5.4 were used for quality evaluation and data analysis, respectively. The MIS-TLIF group was superior to the open TLIF group regarding intraoperative blood loss [95% confidence interval (CI): -254.33,-157.86; P<0.00001], postoperative in-bed time (95%CI: -3.49,-2.76; P<0.00001), hospitalization time (95%CI: -5.14,-1.78; P<0.0001) and postoperative leg pain Visual Analog Scale score (95%CI: -0.27,-0.13; P<0.00001). The fluoroscopy frequency for MIS-TLIF (95%CI: 2.07,6.12; P<0.0001) was significantly higher than that for open TLIF. The two groups had no significant differences in operation time, postoperative drainage volume, postoperative complications, fusion rate, or Oswestry Disability Index score. In treating multi-segmental lumbar degenerative diseases, MIS-TLIF has the advantages of less blood loss, shorter bedtime and hospitalization time and improved early postoperative efficacy; however, open TLIF has a lower fluoroscopy frequency.
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Affiliation(s)
- Wan-Jing Zhai
- Graduate School, The First Clinical College of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Zhan-Kui Wang
- Graduate School, The First Clinical College of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Hua-Lv Liu
- Graduate School, The First Clinical College of Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Shi-Lei Qin
- Department of Orthopedics, Changzhi Yunfeng Hospital, Changzhi, Shanxi 046000, P.R. China
- Changzhi Institution of Spinal Disease, Changzhi, Shanxi 046000, P.R. China
| | - Peng-Fei Han
- Department of Orthopedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Yun-Feng Xu
- Department of Orthopedics, Changzhi Yunfeng Hospital, Changzhi, Shanxi 046000, P.R. China
- Changzhi Institution of Spinal Disease, Changzhi, Shanxi 046000, P.R. China
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16
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Li Q, Zhao H, Yang J, Song S, Liu X. Optimization of Pedicle Screw Parameters for Enhancing Implant Stability Based on Finite Element Analysis. World Neurosurg 2024; 183:e345-e354. [PMID: 38151174 DOI: 10.1016/j.wneu.2023.12.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE To improve implant stability parameters, including pedicle screw (PS) outer diameter, thread depth, and pitch, by finite element analysis. METHODS Insertion and pullout of the PS were simulated by finite element analysis, and the precision of simulation was evaluated by comparison with mechanical tests. Influences of the parameters on the maximum insertion torque and maximum pullout force were analyzed by computational simulations, including single-factor analysis and orthogonal experiments. RESULTS The simulation results agreed with the mechanical test results. The order of parameters influencing insertion torque and pullout force was outer diameter > pitch > thread depth. When the pilot hole diameter is 0.1 mm larger than the inner diameter of the PS, the calculated Pearson correlation coefficient between the maximum insertion torque and maximum pullout force was r = 0.99. The optimized PS had a maximum insertion torque of 485.16 N·mm and a maximum pullout force of 1726.33 N, 23.9% and 9.1% higher, respectively, than the values of standard screws. CONCLUSIONS The presently used models are feasible for evaluating the implant stability of PSs. The maximum insertion torque and maximum pullout force of PSs are highly correlated and can be improved by increasing the outer diameter and decreasing pitch. Although with the parameters of the PS, pedicle size and bone mineral density are 2 additional factors to consider for better implant stability.
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Affiliation(s)
- Qiang Li
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China; Shanghai Engineering Research Center of High-Performance Medical Device Materials, Shanghai, People's Republic of China.
| | - Hu Zhao
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Jinshuai Yang
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Shihong Song
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
| | - Xuyan Liu
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, People's Republic of China
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Mamdouhi T, Wang V, Echevarria AC, Katz A, Morris M, Zavurov G, Verma R. A Comprehensive Review of the Historical Description of Spine Surgery and Its Evolution. Cureus 2024; 16:e54461. [PMID: 38510905 PMCID: PMC10953613 DOI: 10.7759/cureus.54461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Major strides in the advancement of spine surgery came about in the 21st century. However, the extensive history of spine surgery can be traced back to long before this time. A clear description of the journey from a primitive yet accurate understanding of the human musculoskeletal system to today's modern aspects of spinal techniques is lacking. A narrative literature review was conducted to elucidate where spine surgery began and the techniques used that evolved over time. This review was conducted using PubMed and Google Scholar. Search terms used included "history of spine surgery," "evolution of spine surgery," "origins of spine surgery," "history of laminectomy," "history of spinal fusion," "history of lumbar interbody fusion," "minimally invasive spine surgery," and "navigation in spine surgery." We highlight the evolution of the basic understanding of anatomy and non-surgical and surgical techniques, including bracing, laminectomy, discectomy, and spinal fusion. The current evolution and integration of minimally invasive techniques, lumbar interbody fusion techniques, robotics, navigation, and motion preservation are discussed, as these are the major areas of focus for technological advancement. This review presents an overarching synopsis of the events that chronicle the progress made in spine surgery since its conception. The review uniquely contributes to the growing body of literature on the expansion of spine surgery and highlights major events in its history.
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Affiliation(s)
- Tania Mamdouhi
- Orthopedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
- Orthopedic Surgery, University of Michigan, Ann Arbor, USA
| | - Victoria Wang
- Orthopedic Surgery, University of Connecticut, Storrs, USA
| | | | - Austen Katz
- Orthopedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
- Orthopedic Surgery, North Shore University Hospital, Manhasset, USA
| | - Matthew Morris
- Orthopedic Surgery, North Shore University Hospital, Manhasset, USA
- Orthopedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - Gabriel Zavurov
- Orthopedic Surgery, North Shore University Hospital, Manhasset, USA
- Orthopedic Surgery, Spine Surgery, North Shore University Hospital, Manhasset, USA
| | - Rohit Verma
- Orthopedic Surgery, Northwell Health, Manhassett, USA
- Orthopedic Surgery, Spine Surgery, North Shore University Hospital, Manhasset, USA
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Zhu Z, Hu S, Zeng W, Cen S, Liu Y, Zhang W, Shi B. Effect of L5 spinal canal type on pedicle screw placement based on CT imaging: a retrospective clinical study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:298-306. [PMID: 37659047 DOI: 10.1007/s00586-023-07904-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/03/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The objective of this study was to investigate the optimal entry point and pedicle camber angle for L5 pedicle screws of different canal types. METHODS CT imaging data were processed by Mimics for simulated pedicle screw placement, and PD (Pedicle diameter), PCA (Pedicle camber angle), LD (Longitudinal distance), TD (Transverse distance), and PBG (Pedicle screw breach grade) were measured. Then they were divided into the Round group and Trefoil group according to the type of spinal canal. When comparing PD, PCA, LD, TD, and PBG, the two sides of the pedicle were compared separately, so they were first divided into the round-type pedicle group and the trefoil-type pedicle group. RESULTS In the round-type pedicle group (n = 134) and the trefoil-type pedicle group (n = 264), there was no significant difference in PD and LD, but there was a significant difference in PCA between the two groups (t = - 4.072, P < 0.05). A statistically significant difference in the distance of the Magerl point relative to the optimal entry point (t = - 3.792, P < 0.05), and the distance of the Magerl point relative to the optimal entry point was greater in the trefoil-type pedicle group than in the round-type pedicle group. CONCLUSION The optimal entry point for L5 is more outward than the Magerl point, and the Trefoil spinal canal L5 is more outwardly oriented than the Round spinal canal L5, with a greater angle of abduction during pedicle screw placement.
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Affiliation(s)
- Zhemin Zhu
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Shengxuan Hu
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Weibo Zeng
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Shuizhong Cen
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Yubin Liu
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China
| | - Wei Zhang
- Department of Bone and Joint, Panyu Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China.
| | - Benchao Shi
- Department of Spinal Surgery, Zhujiang Hospital of Southern Medical University, 253# industry road, Guangzhou, 510280, Guangdong, China.
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Wang Y, Kahaer A, Maimaiti A, Guo H, Rexiti P. Complication, fusion, and revision rate in the lumbar cortical bone trajectory and pedicle screw fixation techniques: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:382. [PMID: 37226223 DOI: 10.1186/s13018-023-03820-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/02/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND To obtain the complication rate, fusion rate, and revision rate of the lumbar cortical bone trajectory technique and pedicle screw fixation technique in lumbar interbody fusion surgery by single-arm meta-analysis and lay a basis for orthopedic surgeons to select the fixation techniques and perioperative management. METHODS PubMed, Ovid Medline, Web of Science, CNKI, and Wanfang databases were searched comprehensively. Data extraction, content analysis, and quality assessment of the literature were performed by two independent reviewers according to the Cochrane Collaboration guidelines using R and STATA software for single-arm meta-analysis. RESULTS The total complication rate of the lumbar cortical bone trajectory technique was 6%, including a hardware complication rate of 2%, ASD (adjacent segment degeneration) rate of 1%, wound infection rate of 1%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 1%. Lumbar pedicle screw fixation techniques had a total complication rate of 9%, with a hardware complication rate of 2%, ASD rate of 3%, wound infection rate of 2%, dural damage rate of 1%, hematoma rate tending to 0%, fusion rate of 94%, and revision rate of 5%. This study was registered with PROSPERO, CRD42022354550. CONCLUSION Lumbar cortical bone trajectory was associated with a lower total complication rate, ASD rate, wound infection rate, and revision rate than pedicle screw fixation. The cortical bone trajectory technique reduces the incidence of intraoperative and postoperative complications and can be an alternative in lumbar interbody fusion surgery.
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Affiliation(s)
- Yixi Wang
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Alafate Kahaer
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
- Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University), China Ministry of Education, Urumqi, China.
- Xinjiang Clinical Research Center for Orthopedics, Xinjiang Medical University, Urumqi, China.
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20
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Yuan YF, Ren ZX, Zhang C, Li GJ, Liu BZ, Li XD, Miao J, Li JF. Multitrack and multianchor point screw technique combined with the Wiltse approach for lesion debridement for lumbar tuberculosis. World J Clin Cases 2023; 11:3167-3175. [PMID: 37274032 PMCID: PMC10237128 DOI: 10.12998/wjcc.v11.i14.3167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/01/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND The incidence of lumbar tuberculosis is high worldwide, and effective treatment is a continuing problem. AIM To study the safety and efficacy of the multitrack and multianchor point screw technique combined with the contralateral Wiltse approach for lesion debridement to treat lumbar tuberculosis. METHODS The C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) score, oswestry disability index (ODI) and American Spinal Injury Association (ASIA) grade were recorded and analysed pre- and postoperatively. RESULTS The CRP level and ESR returned to normal, and the VAS score and ODI were decreased at 3 mo postoperatively, with significant differences compared with the preoperative values (P < 0.01). Neurological dysfunction was relieved, and the ASIA grade increased, with no adverse events. CONCLUSION The multitrack, multianchor point screw fixation technique combined with the contralateral Wiltse approach for debridement is an effective and safe method for the treatment of lumbar tuberculosis.
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Affiliation(s)
- Yu-Fei Yuan
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Zhi-Xin Ren
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Cun Zhang
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Guan-Jun Li
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Bing-Zhi Liu
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Xiao-Dong Li
- Department of Orthopadics, Handan Center Hospital, Handan 056001, Hebei Provence, China
| | - Jie Miao
- Department of Orthopedic Surgery, Handan Central Hospital, Handan 056001, Hebei Province, China
| | - Jian-Fei Li
- Department of CT, Handan Central Hospital, Handan 056001, Hebei Province, China
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21
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Yang S, Sun T, Zhang L, Cong M, Guo A, Liu D, Song M. Stress Distribution of Different Pedicle Screw Insertion Techniques Following Single-Segment TLIF: A Finite Element Analysis Study. Orthop Surg 2023; 15:1153-1164. [PMID: 36855914 PMCID: PMC10102325 DOI: 10.1111/os.13671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVES At present, a variety of posterior lumbar internal fixation implantation methods have been developed, which makes it difficult for spine surgeons to choose. The stress distribution of the internal fixation system is one of the important indexes to evaluate these technologies. Common insertion technologies include Roy Camille, Magerl, Krag, AO, and Weinstein insertion techniques. This study aimed to compare the distribution of von Mises stresses in different screw fixation systems established by these insertion technologies. METHODS Here, the three-dimensional finite element (FE) method was selected to evaluate the postoperative stress distribution of internal fixation. Following different pedicle screw insertion techniques, five single-segment transforaminal lumbar interbody fusion (TLIF) models were established after modeling and validation of the L1-S1 vertebrae FE model. RESULTS By analyzing the data, we found that stress concentration phenomenon was in all the models. Additionally, Roy-Camille, Krag, AO, and Weinstein insertion techniques led to the great stress on lumbar vertebra, intervertebral disc, and screw-rod fixation systems. Therefore, we hope that the results can provide ideas for clinical work and development of pedicle screws in the future. It is worth noting that flexion, unaffected side lateral bending, and affected side axial rotation should be limited for the patients with cages implanted. CONCLUSIONS Overall, our method obtained the results that Magerl insertion technique was the relatively safe approach for pedicle screw implantation due to its relatively dispersive stress in TLIF models.
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Affiliation(s)
- Simengge Yang
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, China.,Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tianze Sun
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Liwen Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Menglin Cong
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Anyun Guo
- Department of Joint Trauma, General Hospital of Shenzhen University, Shenzhen, China
| | - Dakai Liu
- Department of Orthopaedics, The Second People's Hospital of Dalian, Dalian, China
| | - Mingzhi Song
- Department of Orthopaedics, The First Affiliated Hospital of Dalian Medical University, Dalian, China.,Department of Orthopaedics, The Third Affiliated Hospital of Dalian Medical University, Dalian, China
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22
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Lopez IB, Benzakour A, Mavrogenis A, Benzakour T, Ahmad A, Lemée JM. Robotics in spine surgery: systematic review of literature. INTERNATIONAL ORTHOPAEDICS 2023; 47:447-456. [PMID: 35849162 DOI: 10.1007/s00264-022-05508-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Over 4.83 million spine surgery procedures are performed annually around the world. With the considerable caseload and the precision needed to achieve optimal spinal instrumentation, technical progress has helped to improve the technique's safety and accuracy with the development of peri-operative assistance tools. Contrary to other surgical applications already part of the standard of care, the development of robotics in spine surgery is still a novelty and is not widely available nor used. Robotics, especially when coupled with other guidance modalities such as navigation, seems to be a promising tool in our quest for accuracy, improving patient outcomes and reducing surgical complications. Robotics in spine surgery may also be for the surgeon a way to progress in terms of ergonomics, but also to respond to a growing concern among surgical teams to reduce radiation exposure. METHOD We present in this recent systematic review of the literature realized according to the PRISMA guidelines the place of robotics in spine surgery, reviewing the comparison to standard techniques, the current and future indications, the learning curve, the impact on radiation exposure, and the cost-effectiveness. RESULTS Seventy-six relevant original studies were identified and analyzed for the review. CONCLUSION Robotics has proved to be a safe help for spine surgery, both for the patient with a decrease of operating time and increase in pedicular screw accuracy, and for the surgical team with a decrease of radiation exposure. Medico-economic studies demonstrated that despite a high buying cost, the purchase of a robot dedicated for spine surgery is cost-effective resulting in lesser revision, lower infection, reduced length of stay, and shorter surgical procedure.
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Affiliation(s)
- Ignacio Barrio Lopez
- Department of Neurosurgery, University Hospital of Angers, 4, rue Larrey, 49933, Angers Cedex 09, France
| | - Ahmed Benzakour
- Centre Orléanais du Dos, Pôle Santé Oréliance, Saran, France
| | - Andreas Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Jean-Michel Lemée
- Department of Neurosurgery, University Hospital of Angers, 4, rue Larrey, 49933, Angers Cedex 09, France. .,INSERM CRCI2NA Team 5, GLIAD, Angers, France.
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23
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Losch MS, Kardux F, Dankelman J, Hendriks BHW. Diffuse reflectance spectroscopy of the spine: improved breach detection with angulated fibers. BIOMEDICAL OPTICS EXPRESS 2023; 14:739-750. [PMID: 36874502 PMCID: PMC9979673 DOI: 10.1364/boe.471725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 06/18/2023]
Abstract
Accuracy in spinal fusion varies greatly depending on the experience of the physician. Real-time tissue feedback with diffuse reflectance spectroscopy has been shown to provide cortical breach detection using a conventional probe with two parallel fibers. In this study, Monte Carlo simulations and optical phantom experiments were conducted to investigate how angulation of the emitting fiber affects the probed volume to allow for the detection of acute breaches. Difference in intensity magnitude between cancellous and cortical spectra increased with the fiber angle, suggesting that outward angulated fibers are beneficial in acute breach scenarios. Proximity to the cortical bone could be detected best with fibers angulated at θ f = 45 ∘ for impending breaches between θ p = 0 ∘ and θ p = 45 ∘ . An orthopedic surgical device comprising a third fiber perpendicular to the device axis could thus cover the full impending breach range from θ p = 0 ∘ to θ p = 90 ∘ .
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Affiliation(s)
- Merle S. Losch
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Famke Kardux
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Jenny Dankelman
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Benno H. W. Hendriks
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
- Image Guided Therapy and Ultrasound Devices
and System Department, Philips Research,
Royal Philips NV, Eindhoven, The
Netherlands
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24
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Liu D, Kahaer A, Wang Y, Zhang R, Maiaiti A, Maimaiti X, Zhou Z, Shi W, Cui Z, Zhang T, Li L, Rexiti P. Comparison of CT values in traditional trajectory, traditional cortical bone trajectory, and modified cortical bone trajectory. BMC Surg 2022; 22:441. [PMID: 36575417 PMCID: PMC9795663 DOI: 10.1186/s12893-022-01893-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To compare the CT values and length of the screw tracks of traditional trajectory (TT), cortical bone trajectory (CBT), and modified cortical bone trajectory (MCBT) screws and investigate the effects on the biomechanics of lumbar fixation. METHODS CT scan data of 60 L4 and L5 lumbar spine were retrieved and divided into 4 groups (10 male and 10 female cases in the 20-30 years old group and 20 male and 20 female cases in the 30-40 years old group). 3-dimentional (3D) model were established using Mimics 19.0 for each group and the placement of three techniques was simulated on the L4 and L5, and the part of the bone occupied by the screw track was set as the region of interest (ROI). The mean CT value and the actual length of the screw track were measured by Mimics 19.0. RESULTS The CT values of ROI for the three techniques were significantly different between the same gander in each age group (P < 0.05). The difference of screw track lengths for CBT and MCBT in the male and female is significant (P < 0.05). CONCLUSIONS According to the CT values of the three screw tracks: MCBT > CBT > TT, the MCBT screw track has greater bone-screw surface strength and longer screw tracks than CBT, which is easier to reach the anterior column of the vertebral body contributing to superior biomechanical properties.
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Affiliation(s)
- Dongshan Liu
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
| | - Alafate Kahaer
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
| | - Yixi Wang
- grid.13394.3c0000 0004 1799 3993Xinjiang Medical University, Urumqi, China
| | - Rui Zhang
- grid.13394.3c0000 0004 1799 3993Xinjiang Medical University, Urumqi, China
| | - Abulikemu Maiaiti
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
| | - Xieraili Maimaiti
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
| | - Zhihao Zhou
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
| | - Wenjie Shi
- grid.13394.3c0000 0004 1799 3993Xinjiang Medical University, Urumqi, China
| | - Zihao Cui
- grid.13394.3c0000 0004 1799 3993Digital Orthopaedic Center, Xinjiang Medical University, Urumqi, China
| | - Tao Zhang
- grid.13394.3c0000 0004 1799 3993Digital Orthopaedic Center, Xinjiang Medical University, Urumqi, China
| | - Longfei Li
- grid.13394.3c0000 0004 1799 3993Digital Orthopaedic Center, Xinjiang Medical University, Urumqi, China
| | - Paerhati Rexiti
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang Uygur Autonomous Region China
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Lang Z, Ge T, Wu J, Yuan Q, Sun Y. Comparison of transfacet and pedicle screws in oblique lateral interbody fusion for single-level degenerative lumbar spine diseases: a retrospective propensity score-matched analysis. BMC Surg 2022; 22:429. [PMID: 36522754 PMCID: PMC9753392 DOI: 10.1186/s12893-022-01880-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To perform a comparative assessment of percutaneous transfacet screws (TFS) and percutaneous bilateral pedicle screws (BPS) in oblique lateral interbody fusion (OLIF) for the treatment of single-level degenerative lumbar spine diseases in terms of radiological examinations and clinical outcomes. METHODS Sixty-six patients who received single-level OLIF with percutaneous supplementary fixation assisted by the robot for the treatment of degenerative lumbar spine diseases were selected. There were 16 cases of OLIF with TFS and 50 cases of OLIF with BPS. The propensity score matching method selected 11 patients in each group with matched characteristics to perform a clinical comparison. RESULTS The estimated blood loss was 68.2 ± 25.2 ml in the OLIF with TFS group compared to 113.6 ± 39.3 ml in the OLIF with BPS group (P < 0.05). The intervertebral disc height raised from 8.6 to 12.9 mm in the TFS group and from 8.9 to 13.9 mm in the BPS group in the immediate postoperative period, and dropped to 10.8 and 12.9 mm at the twelfth month, respectively (P < 0.05). The fusion rates were 91% and 100% for TFS and BPS groups (P > 0.05). Quantitative assessments of back/leg pain of the two groups reached a healthy level in the late period of the follow-up. CONCLUSION Both TFS and BPS techniques for the OLIF surgery relieve back pain caused by degenerative lumbar spine diseases. The TFS technique exhibits less blood loss compared with the BPS. A moderate cage subsidence is present in TFS but no complication is reported.
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Affiliation(s)
- Zhao Lang
- Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, People's Republic of China
| | - Tenghui Ge
- Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, People's Republic of China
| | - Jingye Wu
- Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, People's Republic of China
| | - Qiang Yuan
- Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, People's Republic of China
| | - Yuqing Sun
- Department of Spine Surgery, Peking University 4th Clinical Medical College, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, People's Republic of China.
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26
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Hu Y, Chu Z, Shen S, Zhong J, Zhu B, Wu J, Yuan Z, Dong W. Biomechanical Properties of Novel Lateral Hole Pedicle Screws and Solid Pedicle Screws: A Comparative Study in the Beagle Dogs. Orthop Surg 2022; 15:328-336. [PMID: 36411506 PMCID: PMC9837263 DOI: 10.1111/os.13596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Although pedicle screws are widely used to reconstruct the stability of the spine, screw loosening is a common complication after spine surgery. The main objective of this study was to investigate whether the application of the hollow lateral hole structure had the potential to improve the stability of the pedicle screw by comparing the biomechanical properties of the novel lateral hole pedicle screws (LHPSs) with those of the solid pedicle screws (SPSs) in beagle dogs. METHODS The cancellous bone of the distal femur, proximal femur, distal tibia, and proximal tibia were chosen as implantation sites in beagle dogs. In each of 12 dogs, four LHPSs, and four SPSs were implanted into both lower limbs. At 1, 2, and 3 months after surgery, four dogs were randomly sampled and sacrificed. The LHPS group and SPS group were subdivided into four subgroups according to the length of their duration of implantation (0, 1, 2, 3 months). The biomechanical properties of both pedicle screws were evaluated by pull-out and the cyclic bending tests. RESULTS The results of the study showed that no significant difference was found between LHPSs (276.62 ± 50.11 N) and SPSs (282.47 ± 42.98 N) in pull-out tests at time 0 (P > 0.05). At the same time point after implantations, LHPSs exhibited significantly higher maximal pullout strength than SPSs (month 1: 360.51 ± 25.63 vs 325.87 ± 28.11 N; month 2: 416.59 ± 23.78 vs 362.12 ± 29.27 N; month 3: 447.05 ± 38.26 vs 376.63 ± 32.36 N) (P < 0.05). Moreover, compared with SPSs, LHPSs withstood more loading cycles (month 2: 592 ± 21 vs 534 ± 48 times; month 3: 596 ± 10 vs 543 ± 59 times), and exhibiting less displacement before loosening at month 2 (1.70 ± 0.17 vs 1.96 ± 0.10 mm) and 3 (1.69 ± 0.19 vs 1.92 ± 0.14 mm) (P < 0.05), but no significant difference in time 0 and month 1 (P > 0.05). CONCLUSIONS The pedicle screw with the hollow lateral hole structure could allow bone to grow into the inner architecture, which improved biomechanical properties by extending the contact area between screw and bone tissue after implantation into the cancellous bone. It indicated that LHPS could reduce loosening of the pedicle screws in long term after surgery.
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Affiliation(s)
- Yong Hu
- Department of Spine SurgeryThe Ningbo No. 6 HospitalNingboChina
| | | | | | - Jian‐bin Zhong
- Department of Spine SurgeryThe Ningbo No. 6 HospitalNingboChina
| | - Bing‐ke Zhu
- Department of Spine SurgeryThe Ningbo No. 6 HospitalNingboChina
| | - Jia‐da Wu
- School of MedicineNingbo UniversityNingboChina
| | - Zhen‐shan Yuan
- Department of Spine SurgeryThe Ningbo No. 6 HospitalNingboChina
| | - Wei‐xin Dong
- Department of Spine SurgeryThe Ningbo No. 6 HospitalNingboChina
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27
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Unilateral pedicle screw fixation of lumber spine: A safe internal fixation method. Heliyon 2022; 8:e11621. [DOI: 10.1016/j.heliyon.2022.e11621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/29/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022] Open
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Muacevic A, Adler JR, Jha AA. Analysis of a Hybrid Spine Fixation Approach for the Treatment of Unstable Thoracolumbar Fractures. Cureus 2022; 14:e31953. [PMID: 36600826 PMCID: PMC9798929 DOI: 10.7759/cureus.31953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction The treatment of unstable thoracolumbar burst fractures and fracture dislocations of the thoracolumbar spine remains ever evolving. Anterior or posterior approaches both have equal efficacy, but the posterior approach has been preferred in our study due to its ease of application, less extensile nature, and reduced intra-operative bleeding. Posterior approaches can employ short-segment fixation or long-segment fixation techniques. Long segment fixation may need implant removal later to increase mobility in nonfusion surgeries. The thoracolumbar segment is a transition zone where the thoracic spine is a less flexible zone, and the lumbar spine is a more flexible zone. Lumbar motion is important to preserve. Hence, we proposed to study spinal fixation two levels above and one level below the fracture for stabilization. This may provide increased stability along with preservation of the motion segment at the lumbar level. Methods We retro-prospectively reviewed the results of unstable thoracolumbar junction fractures with incomplete or intact neurology in 34 consecutive cases operated with alternate two above and one below fixation approach between June 2018 and June 2019 at our institute. Five cases were excluded due to incomplete follow up and the remaining 29 patients were included in the study. Regular follow-up in the postoperative period at three, six, and 12 months was conducted. Data analysis was done by SPSS software version 22 (IBM Corp., Armonk, NY). Results Twenty-nine patients were included in the study out of which 16 were males and 13 were females. The average age was 36.31±1.46 years (range, 14-60 years). The average follow-up duration was 14.31 months. The average injury to surgery interval was 7.17±7.31 days (range, 1-30 days). On analysis via paired t-test, pre-operative kyphotic angle (mean=20.06±8.34º) improved to immediate post-operative (mean=8.44±5.76º, p=0.0001). The postoperative kyphotic angle at 12 months follow-up showed significant stability (Mean=14.13±5.27º, p=0.0001). A median average pre-operative neurological compromise was ASIA score C and Frankel Grade C and the median average disability was an ODI score of 61%-80%. At the end of 12 months of follow-up the median average neurological compromise improved to ASIA Score D and Frankel Grade D and the median average disability improved to an ODI score of 21%-40%. Conclusion Two levels above and one level below hybrid pedicle screw fixation with decompression for the treatment of unstable thoracolumbar fractures with partial and intact neurology was successful within the limited time frame we had for follow-up in preserving progressive post-operative kyphosis, preserving one-motion segment, improving the neurological outcome and disability of the patients without any major complications.
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Musso S, Buscemi F, Bonossi L, Silven MP, Torregrossa F, Iacopino DG, Grasso G. Lumbar facet joint stabilization for symptomatic spinal degenerative disease: A systematic review of the literature. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:401-409. [PMID: 36777906 PMCID: PMC9910129 DOI: 10.4103/jcvjs.jcvjs_112_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/30/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Lumbar spinal degenerative disease (LSDD), unresponsive to conservative therapy, is commonly treated by surgical decompression and interbody fusion. Since facet joint incompetence has been suggested as responsible for the entire phenomenon of spinal degeneration, facet stabilization can be considered as an alternative technique to treat symptomatic spinal degenerative disease. The purpose of this study was to systematically review the literature for studies utilizing lumbar facet joint fixation techniques for LSDD to assess their safety and efficacy. Methods A systematic literature review was performed following the preferred reporting items for systematic reviews and meta-analyses statement, with no limits in terms of date of publication. Demographic data, inclusion criteria, clinical and radiological outcome, frequency of adverse events (AEs), and follow-up time were evaluated. Results A total of 19 studies were included with a total of 1577 patients. The techniques used for facet arthrodesis were Goel intra-articular spacers in 21 patients (5.3%), Facet Wedge in 198 patients (15.8%), facet screws fixation techniques in 1062 patients (52.6%), and facet joints arthroplasty in 296 patients (26.3%). Clinical outcomes were assessed through the evaluation of pain relief and improvement in functional outcome. Radiological outcomes were assessed by the evaluation of proper positioning of instrumentation, solid bony fusion rate, and preservation of disk height. AE's mainly observed were pseudoarthrosis, reoperation, instrumentation displacement/malpositioning/migration, neurological impairment, deep vein thrombosis, and infections. The mean follow-up time ranged from 6 months to 11.7 years. Conclusion Our data demonstrate that facet joint arthrodesis appears to be effective in managing LSDD. These findings, however, are limited by the small sample size of patients. Accordingly, larger series are needed before formal recommendations can be made.
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Affiliation(s)
- Sofia Musso
- Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Felice Buscemi
- Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Lapo Bonossi
- Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Manikon Poulley Silven
- Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Fabio Torregrossa
- Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Domenico Gerardo Iacopino
- Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Giovanni Grasso
- Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
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Lai YP, Lin YH, Wu YC, Shih CM, Chen KH, Lee CH, Pan CC. Robot-Assisted Pedicle Screw Placement Led to Lower Screw Loosening Rate than Fluoroscopy-Guided Technique in Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Disease: A Single-Center Retrospective Study. J Clin Med 2022; 11:jcm11174989. [PMID: 36078918 PMCID: PMC9456711 DOI: 10.3390/jcm11174989] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Robot-assisted pedicle screw placement for spine surgery has become popular in recent years. This study compares clinical, radiographic outcomes and the screw loosening rate between robot-assisted and fluoroscopy-guided pedicle screw placement in patients who underwent transforaminal lumbar interbody fusion (TLIF). We retrospectively examined 108 patients with the degenerative lumbar disease who underwent TLIF. According to whether the robotic system was used, patients were assigned to either the robot-assisted (Ro TLIF, n = 29) or fluoroscopy-guided TLIF (FG TLIF, n = 79) group. Radiographic parameters and patient-reported outcomes, including leg and back pain visual analog scale (VAS) and Oswestry Disability Index (ODI), were assessed. Loosening signs were noted in 48 out of 552 pedicle screws. The screw loosening rate was higher in the FG TLIF (10.2%) than Ro TLIF group (4.3%). A significant correlation was found between screw loosening and age, the number of level(s) fused, and the ratio of the average distance from the pedicle screw to the upper endplate to vertebral body height. VAS-leg, VAS-back, and ODI showed significant improvements in both groups postoperatively (all p < 0.05). These results indicated that robot-assisted pedicle screw placement in TLIF had a lower screw loosening rate and similar patient-reported outcomes compared with the fluoroscopy-guided technique.
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Affiliation(s)
- Yen-Po Lai
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Yu-Hsien Lin
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Yun-Che Wu
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Cheng-Min Shih
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Physical Therapy, Hungkuang University, Taichung 43304, Taiwan
| | - Kun-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Computer Science & Information Engineering, College of Computing and Informatics, Providence University, Taichung 43301, Taiwan
- Department of Biomedical Engineering, College of Intelligent Technology, Hungkuang University, Taichung 43304, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Food Science and Technology, Hungkuang University, Taichung 43304, Taiwan
| | - Chien-Chou Pan
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli 35664, Taiwan
- Correspondence: ; Tel.: +886-4-23592525 (ext. 5101)
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Mandelka E, Gierse J, Gruetzner PA, Franke J, Vetter SY. First Clinical Experience with a Novel 3D C-Arm-Based System for Navigated Percutaneous Thoracolumbar Pedicle Screw Placement. Medicina (B Aires) 2022; 58:medicina58081111. [PMID: 36013578 PMCID: PMC9414596 DOI: 10.3390/medicina58081111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: Navigated pedicle screw placement is becoming increasingly popular, as it has been shown to reduce the rate of screw misplacement. We present our intraoperative workflow and initial experience in terms of safety, efficiency, and clinical feasibility with a novel system for a 3D C-arm cone beam computed-tomography-based navigation of thoracolumbar pedicle screws. Materials and Methods: The first 20 consecutive cases of C-arm cone beam computed-tomography-based percutaneous pedicle screw placement using a novel navigation system were included in this study. Procedural data including screw placement time and patient radiation dose were prospectively collected. Final pedicle screw accuracy was assessed using the Gertzbein–Robbins grading system. Results: In total, 156 screws were placed. The screw accuracy was 94.9%. All the pedicle breaches occurred on the lateral pedicle wall, and none caused clinical complications. On average, a time of 2:42 min was required to place a screw. The mean intraoperative patient radiation exposure was 7.46 mSv. Conclusions: In summary, the investigated combination of C-arm CBCT-based navigation proved to be easy to implement and highly reliable. It facilitates the accurate and efficient percutaneous placement of pedicle screws in the thoracolumbar spine. The careful use of intraoperative imaging maintains the intraoperative radiation exposure to the patient at a moderate level.
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Lin W, Xie F, Zhao S, Lin S, He C, Wang Z. Novel Pedicle Navigator Based on Micro Inertial Navigation System (MINS) and Bioelectric Impedance Analysis (BIA) to Facilitate Pedicle Screw Placement in Spine Surgery: Study in a Porcine Model. Spine (Phila Pa 1976) 2022; 47:1172-1178. [PMID: 35238856 PMCID: PMC9348817 DOI: 10.1097/brs.0000000000004348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A porcine model. OBJECTIVE The study aims to design a novel pedicle navigator based on micro-inertial navigation system (MINS) and bioelectrical impedance analysis (BIA) to assist place pedicle screw placement and validate the utility of the system in enhancing pedicle screw placement. SUMMARY OF BACKGROUND DATA The incidence of pedicle screw malpositioning in complicated spinal surgery is still high.Procedures such as computed tomography image-guided navigation, and robot-assisted surgery have been used to improve the precision of pedicle screw placement, but it remains an unmet clinical need. METHODS The miniaturized integrated framework containing MINS was mounted inside the hollow handle of the pedicle finder. The inner core was complemented by a high-intensity electrode for measuring bioelectric impedance. Twelve healthy male Wuzhishan minipigs of similar age and weight were used in this experiment and randomized to the MINS-BIA or freehand (FH) group. Pedicle screw placement was determined according to the modified Gertzbein-Robbins grading system on computed tomography images. An impedance detected by probe equal to the baseline value for soft tissue was defined as cortical bone perforation. RESULTS A total of 216 screws were placed in 12 minipigs. There were 15 pedicle breaches in the navigator group and 31 in the FH group; the detection rates of these breaches were 14 of 15 (93.3%) and 25 of 31 (80.6%), respectively, with a statistically significant difference between groups. The mean offsets between the planned and postoperatively measured tilt angles of the screw trajectory were 4.5° ± 5.5° in the axial plane and 4.8° ± 3.3° in the sagittal plane with the navigator system and 7.0° ± 5.1° and 7.7° ± 4.7°, respectively, with the FH technique; the differences were statistically significant. CONCLUSION A novel and portable navigator based on MINS and BIA could be beneficial for improving or maintaining accuracy while reducing overall radiation exposure.
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Affiliation(s)
- Wentao Lin
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde Foshan), Foshan, Guangdong, china
| | - Faqin Xie
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde Foshan), Foshan, Guangdong, china
| | - Shuofeng Zhao
- School of Ophthalmology and Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, Zhejiang China
| | - Songhui Lin
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde Foshan), Foshan, Guangdong, china
| | - Chaoqin He
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde Foshan), Foshan, Guangdong, china
| | - Zhiyun Wang
- Department of Spine Surgery, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde Foshan), Foshan, Guangdong, china
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Biomechanical Comparison of Salvage Pedicle Screw Augmentations Using Different Biomaterials. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Allograft bone particles, hydroxyapatite/β-hydroxyapatite-tricalcium phosphate (HA/β-TCP), calcium sulfate (CS), and polymethylmethacrylate (PMMA) bone cement are biomaterials clinically used to fill defective pedicles for pedicle screw augmentation. Few studies have systematically investigated the effects of various biomaterials utilized for salvage screw stabilization. The aim of this study was to evaluate the biomechanical properties of screws augmented with these four different materials and the effect of different pilot hole sizes and bone densities on screw fixation strength. Commercially available synthetic bones with three different densities (7.5 pcf, 15pcf, 30 pcf) simulating different degrees of bone density were utilized as substitutes for human bone. Two different pilot hole sizes (3.2 mm and 7.0 mm in diameter) were prepared on test blocks to simulate primary and revision pedicle screw fixation, respectively. Following separate specimen preparation with these four different filling biomaterials, a screw pullout test was conducted using a material test machine, and the average maximal screw pullout strength was compared among groups. The average maximal pullout strength of the materials, presented in descending order, was as follows: bone cement, calcium sulfate, HA/β-TCP, allograft bone chips and the control. In samples in both the 3.2 mm pilot-hole and 7.0 mm pilot-hole groups, the average maximal pullout strength of these four materials increased with increasing bone density. The average maximal pullout strength of the bone cement augmented salvage screw (7.0 mm) was apparently elevated in the 7.5 pcf test block. Salvage pedicle screw augmentation with allograft bone chips, HA/β-TCP, calcium sulfate, and bone cement are all feasible methods and can offer better pullout strength than materials in the non-augmentation group. Bone cement provides the most significantly augmented effect in each pilot hole size and bone density setting and could be considered preferentially to achieve larger initial stability during revision surgery, especially for bones with osteoporotic quality.
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Holistic Approach to the Diagnosis and Treatment of Patients with Tumor Metastases to the Spine. Cancers (Basel) 2022; 14:cancers14143480. [PMID: 35884541 PMCID: PMC9317366 DOI: 10.3390/cancers14143480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/10/2022] [Accepted: 07/15/2022] [Indexed: 01/04/2023] Open
Abstract
The treatment of neoplastic spine metastases requires multi-faceted assessment and an interdisciplinary approach to patients. The metastases do not show specific symptoms but are often the first confirmation of the presence of a primary tumor in a patient. The diagnostic process includes imaging and invasive procedures, e.g., biopsy. It is essential to qualify the patient for an appropriate treatment using dedicated scales. Decompression of the spinal cord is a critical issue to save or restore neurological function in a patient with spine metastases. Surgical treatment ought to meet three criteria: release spinal cord and nerve roots, restore the spine’s anatomical relations, and ensure the internal stabilization of the spine. A good result from surgical treatment enables the continuation of radiotherapy, chemotherapy, hormone therapy, and targeted molecular therapy. Stereotactic radiosurgery and stereotactic body radiotherapy are more effective ways of treating spine metastases than conventional external beam radiotherapy. They allow higher doses of radiation, concentrated precisely at the tumor site. Our review summarizes the established and emerging concepts in the treatment of spine metastases. A holistic approach to the patient enables the selection of the appropriate therapy.
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Ma ML, Dong H, Yu H, Ruan BJ, Xu XH, Tao YP, Wang YX, Gu JX. Comparison of different segments in the fixation of thoracolumbar fractures: a Bayesian network meta-analysis. Injury 2022; 53:2579-2587. [PMID: 35613967 DOI: 10.1016/j.injury.2022.05.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/02/2022] [Accepted: 05/08/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Posterior internal fixation (PIF) is commonly used in the treatment of thoracolumbar fracture (TLF), but there is still no standard for the number of fixed segments. The objective of this meta-analysis was to evaluate the efficacy and safety of short segment (SS), intermediate segment (IS) and long segment (LS) in the fixation of TLF. METHODS Two authors independently searched through PubMed, Embase, Cochrane Library and Web of Science for studies of thoracolumbar fracture treated by posterior internal fixation, which were published until the end of April 2021. The Aggregate Data Drug Information System (ADDIS) software was used for data evaluation according to the Markov chain Monte Carlo (MCMC) method based on the Bayesian theorem. RESULTS Nineteen trials evaluating a total of 970 patients were enrolled in these studies, of which 340 in the SS group, 429 in the IS group and 201 in the LS group. For anterior vertebral height ratio (AVHR), IS had the highest AVHR, LS had the second highest AVHR. IS also ranked first in reducing visual analogue scale (VAS), SS ranked second. For sagittal Cobb's angle (SCA), LS had the lowest SCA and IS had the second lowest SCA. In terms of adverse events, IS had the lowest implant failure rate and LS had the second lowest implant failure rate. CONCLUSIONS IS may be the most desirable treatment option for TLF in reducing SCA, implant failure rate, VAS, and improving AVHR. However, more randomized controlled trials are needed to verify these results.
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Affiliation(s)
- Ming-Ling Ma
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou; Department of Graduate School, Dalian Medical University, Dalian, China
| | - Hui Dong
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou; Department of Graduate School, Dalian Medical University, Dalian, China
| | - Hang Yu
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou
| | - Bin-Jia Ruan
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou; Department of Graduate School, Dalian Medical University, Dalian, China
| | - Xiao-Hang Xu
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou
| | - Yu-Ping Tao
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou
| | - Yong-Xiang Wang
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou.
| | - Jia-Xiang Gu
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou.
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Augmented Reality Spine Surgery Navigation: Increasing Pedicle Screw Insertion Accuracy for Both Open and Minimally Invasive Spine Surgeries. Spine (Phila Pa 1976) 2022; 47:865-872. [PMID: 35132049 DOI: 10.1097/brs.0000000000004338] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Collectively, seven cadavers were instrumented with 124 thoracolumbar pedicle screws using VisAR augmented reality/guidance. Sixty-five screws were inserted into four donors using open dissection spine surgery. Fifty-nine screws were positioned in three donors with a minimally invasive spine surgery (MISS) procedure. For both open and MISS, VisAR was used exclusively for pedicle screw navigation. OBJECTIVE The objective of this study was to determine the accuracy of pedicle screw placement using VisAR for open spine and MISS procedures. SUMMARY OF BACKGROUND DATA Pedicle screw placement can be challenging depending on anatomical location and a surgeon's experience. AR may minimize fluoroscopy use and speed screw insertion. METHODS Prior to computed tomography (CT) a series of four image visible April Tag optical fiducials were attached to the backs' of the donors. Resulting images were used preoperatively for planned virtual pedicle screw pathways including entry point, trajectory, and depth. The study link was encrypted on a quick response (QR) code, printed, and viewed in the operating room (OR) by the surgeon using VisAR (HoloLens 2 headset). Viewing the code wirelessly uploads and launches the study, converting the DICOM data to holographic images which register to the fiducials on the donor's back. The annotated pathways for each pedicle were called up by voice command and the surgeon positioned each screw by aligning with the virtual guidance hologram. RESULTS Overall, 124 pedicle screws were inserted with VisAR navigation with 96% accuracy (Gertzbein-Robbins grades A and B). The combined angle of error was 2.4° and the distance error was 1.9 mm. CONCLUSION Augmented reality is a highly accurate, emerging technology for navigating both open and minimally invasive spine surgery techniques with off-the-shelf headset hardware. LEVEL OF EVIDENCE N/A.
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Singhatanadgige W, Songthong K, Pholprajug P, Yingsakmongkol W, Kotheeranurak V, Limthongkul W. Trajectory of Lumbar Translaminar Facet Screw Under Navigation: A Cadaveric Study. Global Spine J 2022; 12:765-771. [PMID: 35109705 PMCID: PMC9344519 DOI: 10.1177/2192568220962444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Anatomic cadaver study. OBJECTIVE Translaminar facet screw fixation supplements unilateral pedicle screw-rod fixation in minimally invasive transforaminal lumbar interbody fusion (TLIF). Various screw diameters, lengths, trajectories, and insertion points are used; however, they do not represent true screw trajectory. We aimed to evaluate lumbar laminar anatomy and suggest a safe and effective insertion point and trajectory during lumbar-translaminar facet screw fixation in an anatomic cadaver study. METHODS O-arm navigation simulating the true translaminar facet screw trajectory was used to evaluate L1-S1 in cadaveric spines. The inner and outer diameters, length, and trajectory of the screw pathway were measured along the trajectory from the spinous process base through the contralateral lamina, crossing the facet joint to the transverse process base using 2 starting points: cephalad one-third (1/3SL) and one-half (1/2SL) of the spinolaminar junction. RESULTS Using the 1/2SL starting point, the outer and inner lamina diameters did not differ significantly from L1-L5 (7.47 ± 1.38 to 6.7 ± 1.84 mm and 4.73 ± 1.04 to 3.86 ± 1.46 mm, respectively). Screw length (36.16 ± 4.02 to 49.29 ± 10.07 mm) and lateral angle increased (50.28° ± 8.78° to 60.77° ± 8.88°), but caudal angle decreased (16.19° ± 9.01° to 1.13° ± 11.31°). Lamina diameter and screw length did not differ with different starting points. L2-L3 caudal angles were lower in the 1/2SL starting point. CONCLUSION A 36- to 50-mm translaminar facet screw-with 5.0-mm diameter for L1-L2 and 4.5-mm diameter for L3-L5-can be inserted at the middle of the spinolamina, especially during minimally invasive TLIF, with a 50° to 60° lateral angle relative to the spinous process, and a caudal angle of 16° to 1° relative to the spinolamina from L1-L5.
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Affiliation(s)
- Weerasak Singhatanadgige
- Department of Orthopaedics, Faculty
of Medicine, Chulalongkorn University and King
Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kittisak Songthong
- Department of Orthopaedics, Faculty
of Medicine, Chulalongkorn University and King
Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Phattareeya Pholprajug
- Department of Orthopaedics, Faculty
of Medicine, Chulalongkorn University and King
Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Wicharn Yingsakmongkol
- Department of Orthopaedics, Faculty
of Medicine, Chulalongkorn University and King
Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Worawat Limthongkul
- Department of Orthopaedics, Faculty
of Medicine, Chulalongkorn University and King
Chulalongkorn Memorial Hospital, Bangkok, Thailand,Worawat Limthongkul, Department of
Orthopaedics, Faculty of Medicine, Chulalongkorn University and King
Chulalongkorn Memorial Hospital, Bangkok, Thailand.
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Beyond the pedicle screw-a patent review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1553-1565. [PMID: 35380271 DOI: 10.1007/s00586-022-07193-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This review provides an overview of the patent literature on posteriorly placed intrapedicular bone anchors. Conventional pedicle screws are the gold standard to create a fixation in the vertebra for spinal fusion surgery but may lack fixation strength, especially in osteoporotic bone. The ageing population demands new bone anchors that have an increased fixation strength, that can be placed safely, and, if necessary, can be removed without damaging the surrounding tissue. METHODS The patent search was conducted using a classification search in the Espacenet patent database. Only patents with a Cooperative Patent Classification of A61B17/70 or A61B17/7001 concerning spinal positioners and stabilizers were eligible for inclusion. The search query resulted in the identification of 731 patents. Based on preset inclusion criteria, a total of 56 unique patents on different anchoring methods were included, reviewed and categorized in this study. RESULTS Five unique fixation methods were identified; (1) anchors that use threading, (2) anchors that utilize a curved path through the vertebra, (3) anchors that (partly) expand, (4) anchors that use cement and (5) anchors that are designed to initiate bone ingrowth. Of the anchor designs included in this study, eight had a corresponding commercial product, six of which were evaluated in clinical trials. CONCLUSION This review provides insights into worldwide patented intrapedicular bone anchors that aim to increase the fixation strength compared to the conventional pedicle screw. The identified anchoring methods and their working principles can be used for clinical decision-making and as a source of inspiration when designing novel bone anchors.
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Hampel GA, Yilmaz E, Massrey C, Clifton W, Iwanaga J, Loukas M, Tubbs RS. History of Bone Grafts in Spine Surgery. Cureus 2022; 14:e24655. [PMID: 35663670 PMCID: PMC9156791 DOI: 10.7759/cureus.24655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2022] [Indexed: 11/19/2022] Open
Abstract
Bone grafting replaces damaged or missing bone with new bone and is used for surgical arthrodesis. Patients benefit from a huge variety of bone graft techniques and options for spinal fusions. This article reviews the rich history of bone grafts in surgery with particular emphasis on spinal fusion. During the early years of bone grafting in spine surgery, bone grafts were used on tuberculosis patients, and the structural support of the graft was most the important consideration. Between 1960 and 2000, many advances were made, specifically in the use of bone graft substitutes. The field of bone grafts in spine surgery has evolved rapidly since first described.
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Ye B, Ye Z, Yan M, Huang P, Tu Z, Wang Z, Luo Z, Hu X. Effection of monoplanar pedicle screw on facet joint degeneration in thoracolumbar vertebral fractures. BMC Musculoskelet Disord 2022; 23:407. [PMID: 35490240 PMCID: PMC9055697 DOI: 10.1186/s12891-022-05360-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background This study aimed to compare the clinical outcomes and effect on instrument-related facet joints between fixed-axis pedicle screw (FAPS) and monoplanar pedicle screw (MPPS). Methods 816 pedicle screws of 204 patients with thoracolumbar vertebral fractures (TLVF) who underwent internal fixation surgery were analyzed in this retrospective study. All patients were divided into two groups (FAPS and MPPS). Preoperative, immediate postoperative, and 12–18-months postoperative CT and X-ray, and clinical data, including demographics, preoperative and immediate postoperative Visual Analogue Scale (VAS), blood loss (BL), operation time (OT) and hospital stay time (HST), were collected. Facet joint violation and degeneration grade were evaluated by CT according to Babu’s criteria and Weishaupt’s criteria respectively, and preoperative, immediate postoperative and 12–18-months postoperative anterior body compression index (ABCI) were measured by X-ray. Results Postoperative VAS of two groups was lower than preoperative VAS (p < 0.05). BL, OT, and HST were less in MPPS than FAPS, and the difference was statistically significant in BL and HST (p < 0.05) but no in OT (p > 0.05). Immediate postoperative and 12–18-months postoperative ABCI were significantly higher than preoperative (p < 0.05), and the difference of ABCI between immediate postoperative and 12–18-months postoperative were not significant in two groups (p > 0.05). Total violation rate (VR) was about 1.35% (11/816) and FAPS had a lower VR than MPPS, but no significant (p > 0.05). Weishaupt’s criteria revealed that average class (AC) was 0.69 in FAPS and 0.67 in MPPS, and the distribution of degenerated facet joints in two groups did not differ preoperatively (p > 0.05). In 12–18 months postoperatively, AC was significantly higher in FAPS than in MPPS, and the distribution of degenerated facet joints in two groups was significantly different (p < 0.05). The comparison of cranial to caudal joints in two groups revealed that cranial joints had more severe degeneration than caudal joints. Conclusions The findings suggested that both MPPS and FAPS were effective for patients with TLVF, but MPPS by percutaneous may be a better choice to avoid adjacent segment degeneration, especially the surgery-involved facet joints degeneration.
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Affiliation(s)
- Bin Ye
- Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, No. 169 West Changle Road, Shaanxi Province, 710032, Xi'an, China
| | - Zhengxu Ye
- Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, No. 169 West Changle Road, Shaanxi Province, 710032, Xi'an, China
| | - Ming Yan
- Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, No. 169 West Changle Road, Shaanxi Province, 710032, Xi'an, China
| | - Peipei Huang
- Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, No. 169 West Changle Road, Shaanxi Province, 710032, Xi'an, China
| | - Zhipeng Tu
- Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, No. 169 West Changle Road, Shaanxi Province, 710032, Xi'an, China
| | - Zhe Wang
- Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, No. 169 West Changle Road, Shaanxi Province, 710032, Xi'an, China
| | - Zhuojing Luo
- Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, No. 169 West Changle Road, Shaanxi Province, 710032, Xi'an, China.
| | - Xueyu Hu
- Department of Orthopedics, Xijing Hospital, Air Force Medical University of PLA, No. 169 West Changle Road, Shaanxi Province, 710032, Xi'an, China.
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Is the Use of Intraoperative 3D Navigation for Thoracolumbar Spine Surgery a Risk Factor for Post-Operative Infection? J Clin Med 2022; 11:jcm11082108. [PMID: 35456201 PMCID: PMC9025334 DOI: 10.3390/jcm11082108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022] Open
Abstract
Pedicle screw fixation is a technique used to provide rigid fixation in thoracolumbar spine surgery. Safe intraosseous placement of pedicle screws is necessary to provide optimal fixation as well as to avoid damage to adjacent anatomic structures. Despite the wide variety of techniques available, none thus far has been able to fully eliminate the risk of malpositioned screws. Intraoperative 3-dimensional navigation (I3DN) was developed to improve accuracy in the placement of pedicle screws. To our knowledge, no previous studies have investigated whether infection rates are higher with I3DN. A single-institution, retrospective study of patients age > 18 undergoing thoracolumbar fusion and instrumentation was carried out and use of I3DN was recorded. The I3DN group had a significantly greater rate of return to the operating room for culture-positive incision and drainage (17 (4.1%) vs. 1 (0.6%), p = 0.025). In multivariate analysis, the use of I3DM did not reach significance with an OR of 6.49 (0.84−50.02, p = 0.073). Post-operative infections are multifactorial and potential infection risks associated with I3DN need to be weighed against the safety benefits of improved accuracy of pedicle screw positioning.
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Ronzani LD, Bang H, Kock KS, Menegaz PDS, Martins RO, Back Netto M. THORACOLUMBAR FUSION IN THE UNIFIED HEALTH SYSTEM: PRE-COVID-19 TEMPORAL. COLUNA/COLUMNA 2022; 21. [DOI: 10.1590/s1808-185120222102257395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To evaluate the temporal trends of thoracolumbar fusion procedures performed by the United Health System in Brazil from 2009 to 2019. Methods: This was an observational ecological study based on data collected from the information systems under the aegis of DATASUS, especially the Hospital Information System, which manages the Hospital Admission Authorizations (Autorizações de Internação Hospitalar - AIHs). All patients who had undergone the procedures of interest, that is, elective and emergency short and long thoracolumbar arthrodeses, were included. The temporal trends of the procedures performed in Brazil and in its five regions were calculated using polynomial regression. Results: The temporal trend of elective thoracolumbar arthrodesis decreased, while that of emergency arthrodesis increased, with the peak in 2015, followed by a marked decline. Short fusions were more frequent in both elective and emergency modalities, and the South and Central-West Regions had the highest indices of procedures per million inhabitants during the entire 2009 to 2019 period. Conclusions: The temporal trends of thoracolumbar fusions performed by SUS have decreased over the last decade, a phenomenon which may be explained by the growing criticism of indications of the procedure in the current literature. Level of evidence III; Retrospective Comparative Study.
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Affiliation(s)
| | - Hannah Bang
- Universidade do Sul de Santa Catarina, Brazil
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Marshall SL, Jacobsen TD, Emsbo E, Murali A, Anton K, Liu JZ, Lu HH, Chahine NO. Three-Dimensional-Printed Flexible Scaffolds Have Tunable Biomimetic Mechanical Properties for Intervertebral Disc Tissue Engineering. ACS Biomater Sci Eng 2021; 7:5836-5849. [PMID: 34843224 DOI: 10.1021/acsbiomaterials.1c01326] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The intervertebral disc (IVD) exhibits complex structure and biomechanical function, which supports the weight of the body and permits motion. Surgical treatments for IVD degeneration (e.g., lumbar fusion, disc replacement) often disrupt the mechanical environment of the spine which lead to adjacent segment disease. Alternatively, disc tissue engineering strategies, where cell-seeded hydrogels or fibrous biomaterials are cultured in vitro to promote matrix deposition, do not recapitulate the complex IVD mechanical properties. In this study, we use 3D printing of flexible polylactic acid (FPLA) to fabricate a viscoelastic scaffold with tunable biomimetic mechanics for whole spine motion segment applications. We optimized the mechanical properties of the scaffolds for equilibrium and dynamic moduli in compression and tension by varying fiber spacing or porosity, generating scaffolds with de novo mechanical properties within the physiological range of spine motion segments. The biodegradation analysis of the 3D printed scaffolds showed that FPLA exhibits lower degradation rate and thus has longer mechanical stability than standard PLA. FPLA scaffolds were biocompatible, supporting viability of nucleus pulposus (NP) cells in 2D and in FPLA+hydrogel composites. Composite scaffolds cultured with NP cells maintained baseline physiological mechanical properties and promoted matrix deposition up to 8 weeks in culture. Mesenchymal stromal cells (MSCs) cultured on FPLA adhered to the scaffold and exhibited fibrocartilaginous differentiation. These results demonstrate for the first time that 3D printed FPLA scaffolds have de novo viscoelastic mechanical properties that match the native IVD motion segment in both tension and compression and have the potential to be used as a mechanically stable and biocompatible biomaterial for engineered disc replacement.
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Affiliation(s)
- Samantha L Marshall
- Department of Orthopedic Surgery, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States
| | - Timothy D Jacobsen
- Department of Orthopedic Surgery, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States.,Department of Biomedical Engineering, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States
| | - Erik Emsbo
- Department of Biomedical Engineering, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States
| | - Archana Murali
- Department of Biomedical Engineering, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States
| | - Kevin Anton
- Department of Biomedical Engineering, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States
| | - Jessica Z Liu
- Department of Biomedical Engineering, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States
| | - Helen H Lu
- Department of Biomedical Engineering, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States
| | - Nadeen O Chahine
- Department of Orthopedic Surgery, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States.,Department of Biomedical Engineering, Columbia University, 650 West 168th Street, 1410, New York, New York 10031, United States
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Fenton-White HA. Trailblazing: the historical development of the posterior lumbar interbody fusion (PLIF). Spine J 2021; 21:1528-1541. [PMID: 33757870 DOI: 10.1016/j.spinee.2021.03.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 02/23/2021] [Accepted: 03/16/2021] [Indexed: 02/03/2023]
Abstract
Today, the posterior lumbar interbody fusion (PLIF), and related methods of fusion, represent the gold standard in spinal arthrodesis. However, despite the PLIF being first performed in the 1940s, its reputation was marked by animosity for the next fifty years. Only due to the extraordinary talent and perseverance from a small group of pioneers, was the operation eventually appreciated to be an ideal fusion technique. This process of popularization has assisted the surgical community to better recognize the complexities of spinal biomechanics and has encouraged the momentum of success in modern spinal surgery. Neither the complete origins of the technique, nor the remarkable story of its propagation, have previously been reported.
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Gennari A, Langlais T, Litrico S, Persohn S, Allain J, Skalli W. Biomechanical specimen assessment by low dose biplanar X-ray study of fusion constructions using a posterior lumbar cage with integrated anchors and posterior adjunctive fixators. Comput Methods Biomech Biomed Engin 2021; 25:536-542. [PMID: 34392764 DOI: 10.1080/10255842.2021.1966625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The objective was to compare L4/5 range of motions of fusion constructs using anchored cages. Twelve human cadaveric spine were tested in intact condition, and divided into TLIF and PLIF groups. Testing consisted in applying pure moments in flexion-extension, lateral bending and axial rotation. The computation of intersegmental motion was assessed using 3 D biplanar radiographs. In TLIF group, the addition of contralateral transfacet decreased flexion-extension motion (39%; p = 0.036) but without difference with the ipsilateral pedicle screw construction (53%; p = 0.2). In PLIF group, the addition of interspinous anchor reduced flexion-extension motion (12%; p = 0.036) but without difference with the bilateral pedicle screw construction (17%; p = 0.8).
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Affiliation(s)
- A Gennari
- Arts et Metiers ParisTech, Institut de Biomecanique Humaine Georges Charpak, Paris, France.,Neurosurgery, Spine Unit, CHU, Nice, France
| | - T Langlais
- Arts et Metiers ParisTech, Institut de Biomecanique Humaine Georges Charpak, Paris, France.,Département Othopédie Pédiatrique, Hôpital des Enfants, Purpan, Toulouse Université, France
| | - S Litrico
- Neurosurgery, Spine Unit, CHU, Nice, France
| | - S Persohn
- Arts et Metiers ParisTech, Institut de Biomecanique Humaine Georges Charpak, Paris, France
| | - J Allain
- Orthopedic Surgery, Spine Unit, Clinique Geoffroy Saint-Hilaire, Paris, France
| | - W Skalli
- Arts et Metiers ParisTech, Institut de Biomecanique Humaine Georges Charpak, Paris, France
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Rosinski AA, Mittal A, Odeh K, Ungurean V, Leasure J, Telles C, Kondrashov D. Alternatives to Traditional Pedicle Screws for Posterior Fixation of the Degenerative Lumbar Spine. JBJS Rev 2021; 9:01874474-202107000-00016. [PMID: 34319968 DOI: 10.2106/jbjs.rvw.20.00177] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Traditional pedicle screws are currently the gold standard to achieve stable 3-column fixation of the degenerative lumbar spine. However, there are cases in which pedicle screw fixation may not be ideal. Due to their starting point lateral to the pars interarticularis, pedicle screws require a relatively wide dissection along with a medialized trajectory directed toward the centrally located neural elements and prevertebral vasculature. In addition, low bone mineral density remains a major risk factor for pedicle screw loosening, pullout, and pseudarthrosis. The purpose of this article is to review the indications, advantages, disadvantages, and complications associated with posterior fixation techniques of the degenerative lumbar spine beyond the traditional pedicle screws. METHODS Comprehensive literature searches of the PubMed, Scopus, and Web of Science databases were performed for 5 methods of posterior spinal fixation, including (1) cortical bone trajectory (CBT) screws, (2) transfacet screws, (3) translaminar screws, (4) spinous process plates, and (5) fusion mass screws and hooks. Articles that had been published between January 1, 1990, and January 1, 2020, were considered. Non-English-language articles and studies involving fixation of the cervical or thoracic spine were excluded from our review. RESULTS After reviewing over 1,700 articles pertaining to CBT and non-pedicular fixation techniques, a total of 284 articles met our inclusion criteria. CBT and transfacet screws require less-extensive exposure and paraspinal muscle dissection compared with traditional pedicle screws and may therefore reduce blood loss, postoperative pain, and length of hospital stay. In addition, several methods of non-pedicular fixation such as translaminar and fusion mass screws have trajectories that are directed away from or posterior to the spinal canal, potentially decreasing the risk of neurologic injury. CBT, transfacet, and fusion mass screws can also be used as salvage techniques when traditional pedicle screw constructs fail. CONCLUSIONS CBT and non-pedicular fixation may be preferred in certain lumbar degenerative cases, particularly among patients with osteoporosis. Limitations of non-pedicular techniques include their reliance on intact posterior elements and the lack of 3-column fixation of the spine. As a result, transfacet and translaminar screws are infrequently used as the primary method of fixation. CBT, transfacet, and translaminar screws are effective in augmenting interbody fixation and have been shown to significantly improve fusion rates and clinical outcomes compared with stand-alone anterior lumbar interbody fusion. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alexander A Rosinski
- San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California
| | - Ashish Mittal
- San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California
| | - Khalid Odeh
- San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California
| | | | | | | | - Dimitriy Kondrashov
- San Francisco Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, California
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Abstract
BACKGROUND/INTRODUCTION Pedicle screws have long been part of the continued advancements in spine surgery. Despite the many techniques that have been devised for their safe placement, malposition of screws continues to occur. Studies have evaluated the possible safe limits of screw malposition, and have given some insight on anatomic variation in spinal deformity. Review of the literature reveals several cases of deleterious long-term sequelae of malpositioned screws. DISCUSSION With the current experience, proposed recommendations are provided to detect and avoid the potential long-term sequelae. Though the literature has helped to define possible concerning screws, there are no good studies predicting long-term risk. CONCLUSION Improvements in technology and techniques, advancements in intraoperative confirmation and postoperative surveillance, studies that assist risk stratification, and expert consensus evaluations will help guide surgeons in their decision for addressing misplaced screws.
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Bochicchio M, Aicale R, Romeo R, Nardi PV, Maffulli N. Mini-invasive bilateral transfacet screw fixation with reconstruction of the neural arch for lumbar stenosis: A two centre case series. Surgeon 2021; 20:e122-e128. [PMID: 34187737 DOI: 10.1016/j.surge.2021.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/17/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Lumbar stenosis and instability frequently coexist. Spinal canal decompression is often combined with fixation of the relevant vertebral segment and can be performed using different techniques and devices, including pedicle screws and interspinous devices and facet screws. The present study evaluates the clinical outcome of laminectomy and single-level fusion using a minimally invasive technique for rigid posterior spinal column fixation with two cross-linked lag screws. METHODS The records of patients operated from 2012 to 2016 were retrieved from the computerised medical record database system. Data on age, sex, surgical level, type of deficit and disease were collected. The Oswestry Disability Index (ODI) and Short Form-36 (SF-36) questionnaires were administered pre-operatively and at 1, 6, 12 and 24 months after surgery. MAIN FINDINGS A total of 46 consecutive patients were operated between January 2012 to October 2016. One intraoperative complication was reported, and 4 patients experienced radiographic pseudarthrosis postoperatively. Five patients underwent additional surgery. The lumbar and lower limb VAS score, ODI and SF-36 scores showed statistically significant improvement for each score at the first and last follow-up (p < 0.01). CONCLUSION Percutaneous lumbar transfacet screw placement with the Facet-Link ® system is feasible and safe but with a relatively high rate of poor articular fusion. This technique can reduce the morbidity of single-level lumbar spinal stenosis and mild instability and improve patient outcome scores. Comparative studies, including randomised controlled trials, are needed to confirm these findings.
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Affiliation(s)
- Michele Bochicchio
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, 74121 Taranto, Italy.
| | - Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, San Giovanni di Dio e Ruggi D'Aragona Hospital, 84131 Salerno, Italy.
| | - Rocco Romeo
- Department of Orthopaedic and Trauma Surgery, Ospedale San Carlo, Via Potito Petrone, 85100 Potenza, PZ, Italy.
| | - Pier Vittorio Nardi
- Ospedale Cristo Re, U.O.C. Neurochirurgia, Via delle Calasanziane, 25, 00167, Rome, Italy.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy; Clinica Ortopedica, San Giovanni di Dio e Ruggi D'Aragona Hospital, 84131 Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England.
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Chiang CW, Chen CH, Manga YB, Huang SC, Chao KM, Jheng PR, Wong PC, Nyambat B, Satapathy MK, Chuang EY. Facilitated and Controlled Strontium Ranelate Delivery Using GCS-HA Nanocarriers Embedded into PEGDA Coupled with Decortication Driven Spinal Regeneration. Int J Nanomedicine 2021; 16:4209-4224. [PMID: 34188470 PMCID: PMC8235953 DOI: 10.2147/ijn.s274461] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/03/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Strontium ranelate (SrR) is an oral pharmaceutical agent for osteoporosis. In recent years, numerous unwanted side effects of oral SrR have been revealed. Therefore, its clinical administration and applications are limited. Hereby, this study aims to develop, formulate, and characterize an effective SrR carrier system for spinal bone regeneration. METHODS Herein, glycol chitosan with hyaluronic acid (HA)-based nanoformulation was used to encapsulate SrR nanoparticles (SrRNPs) through electrostatic interaction. Afterward, the poly(ethylene glycol) diacrylate (PEGDA)-based hydrogels were used to encapsulate pre-synthesized SrRNPs (SrRNPs-H). The scanning electron microscope (SEM), TEM, rheometer, Fourier-transform infrared spectroscopy (FTIR), and dynamic light scattering (DLS) were used to characterize prepared formulations. The rabbit osteoblast and a rat spinal decortication models were used to evaluate and assess the developed formulation biocompatibility and therapeutic efficacy. RESULTS In vitro and in vivo studies for cytotoxicity and bone regeneration were conducted. The cell viability test showed that SrRNPs exerted no cytotoxic effects in osteoblast in vitro. Furthermore, in vivo analysis for new bone regeneration mechanism was carried out on rat decortication models. Radiographical and histological analysis suggested a higher level of bone regeneration in the SrRNPs-H-implanted groups than in the other experimental groups. CONCLUSION Local administration of the newly developed formulated SrR could be a promising alternative therapy to enhance bone regeneration in bone-defect sites in future clinical applications.
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Affiliation(s)
- Chih-Wei Chiang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, 10617, Taiwan
- Department of Orthopedics, Taipei Medical University Hospital, Taipei, 11031, Taiwan
| | - Chih-Hwa Chen
- Department of Orthopedics, Taipei Medical University–Shuang Ho Hospital, New Taipei City, 23561, Taiwan
- Graduate Institute of Biomedical Materials and Tissue Engineering, International PhD Program in Biomedical Engineering, School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan
- Research Center of Biomedical Device, Taipei Medical University, Taipei, 11031, Taiwan
| | - Yankuba B Manga
- Graduate Institute of Biomedical Materials and Tissue Engineering, International PhD Program in Biomedical Engineering, School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan
| | - Shao-Chan Huang
- Graduate Institute of Biomedical Materials and Tissue Engineering, International PhD Program in Biomedical Engineering, School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan
| | - Kun-Mao Chao
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, 10617, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, 10617, Taiwan
| | - Pei-Ru Jheng
- Graduate Institute of Biomedical Materials and Tissue Engineering, International PhD Program in Biomedical Engineering, School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan
| | - Pei-Chun Wong
- Graduate Institute of Biomedical Materials and Tissue Engineering, International PhD Program in Biomedical Engineering, School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan
| | - Batzaya Nyambat
- Graduate Institute of Biomedical Materials and Tissue Engineering, International PhD Program in Biomedical Engineering, School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan
| | - Mantosh Kumar Satapathy
- Graduate Institute of Biomedical Materials and Tissue Engineering, International PhD Program in Biomedical Engineering, School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan
| | - Er-Yuan Chuang
- Graduate Institute of Biomedical Materials and Tissue Engineering, International PhD Program in Biomedical Engineering, School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, 11031, Taiwan
- Cell Physiology and Molecular Image Research Center, Taipei Medical University–Wan Fang Hospital, Taipei, 116, Taiwan
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Stress distribution of different lumbar posterior pedicle screw insertion techniques: a combination study of finite element analysis and biomechanical test. Sci Rep 2021; 11:12968. [PMID: 34155224 PMCID: PMC8217271 DOI: 10.1038/s41598-021-90686-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/10/2021] [Indexed: 12/23/2022] Open
Abstract
At present, the pedicle screw is the most commonly used internal fixation device. However, there are many kinds of common posterior pedicle screw insertion techniques performed to reconstruct the lumbar stability. Therefore, spinal surgeons often face a difficult choice. The stress distribution of internal fixation system is an important index for evaluating safety. Unfortunately, little had been known about the difference of stress distribution of screw-rod systems that established by Roy-Camille, Magerl and Krag insertion techniques. Here, combination of finite element analysis and model measurement research was adopted to evaluate the difference of stress. Following different pedicle screw insertion techniques, three lumbar posterior surgery models were established after modeling and validation of the L1–S1 vertebrae finite element model. By analyzing the data, we found that stress concentration phenomenon was in all the postoperative models. Roy-Camille and Magerl insertion techniques led to the great stress on screw-rod systems. Then, fresh frozen calf spines were selected as a model for subsequent measurements. Fitted with a specially designed test pedicle screw, L5–L6 vertebrae were selected to repeat and verify the results of the finite element analysis. With the aid of universal testing machine and digital torque wrench, models simulated flexion, extension, lateral bending and rotation. Finally, the strain value was captured by the strain gauge and was then calculated as the stress value. Krag and Magerl were found to be the safer choice for pedicle screw insertion. Overall, our combination method obtained the reliable result that Krag insertion technique was the safer approach for pedicle screw implantation due to its relatively dispersive stress. Therefore, without the consideration of screw size, pedicle fill, bone density, and bone structures, we recommend the Krag insertion technique as the first choice to reconstruction of lumbar stability. Additionally, the combination method of finite element analysis and strain gauge measurement can provide a feasible way to study the stress distribution of spinal internal fixation.
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