Objective To investigate short-term effectiveness of spinal navigation with the intra-operative three-dimensional (3D)-imaging modality in pedicle screw fixation for congenital scoliosis (CS). Methods Between July 2010 and December 2011, 26 patients with CS were treated. Of 26 patients, 13 patients underwent pedicle screw fixation using the spinal navigation with the intra-operative 3D-imaging modality (navigation group), while 13 patients underwent the conventional technique with C-arm X-ray machine (control group). There was no significant difference in gender, age, hemivertebra number and location, major curve Cobb angle, and Risser grade between 2 groups (P gt; 0.05). Operation time, operative blood loss, frequency of the screw re-insertion, and postoperative complication were observed. The pedicle screw position was assessed by CT postoperatively with the Richter’s standard and the correction of Cobb angle was assessed by X-ray films. Results All patients underwent the surgery successfully without major neurovascular complication. There was no significant difference in operation time, operative blood loss, and pedicle screw location between 2 groups (P gt; 0.05). A total of 58 screws were inserted in navigation group, and 3 screws (5.2%) were re-inserted. A total of 60 screws were inserted in control group, and 10 screws (16.7%) were re-inserted. There was significant difference in the rate of pedicle screw re-insertion between 2 groups (χ2=3.975, P=0.046). Patients of navigation group were followed up 6-24 months, and 6-23 months in control group. According to Richter’s standard, the results were excellent in 52 screws and good in 6 screws in navigation group; the results were excellent in 51 screws, good in 5 screws, and poor in 4 screws in control group. Significant difference was found in the pedicle screw position between 2 groups (Z= — 1.992, P=0.046). The major curve Cobb angle of 2 groups at 1 week and last follow-up were significantly improved when compared with preoperative value (P lt; 0.05), but there was no significant difference between 1 week and last follow-up (P gt; 0.05). No significant difference in correction rate of the major curve Cobb angle was found between 2 groups at last follow-up (t=0.055, P=0.957). Conclusion Spinal navigation with the intra-operative 3D-imaging modality can improve the accuracy of pedicle screw implantation in patients with CS, and effectually reduce the rate of screw re-insertion, and the short-term effectiveness is satisfactory.
Objective To employ spinal virtual surgery system (SVSS) for preoperative planning of thoracolumbar pedicle screw fixation, and to establ ish the measurement method for pedicle screw-related parameters. Methods Eight thoracicand lumbar spine specimens (T11-L3) were selected. First of all, SVSS was used for the preoperative planning of pedicle screw and the parameters of both sides of pedicle were measured in every vertebral segment, including angle of axial view (Aa), angle of sagittal view (As), x-direction entrance (XE), total pedicle length of axial view (TLa), total pedicle length of sagittal view (TLs), pedicle height (PH), pedicle width (PW), and pedicle spongy width (PSW). Then the corresponding parameters of the right and left pedicle screws of the specimens were measured actually. Finally, its accuracy was verified by comparing the data by virtual measurement and actual measurement. Results There was no significant difference in the parameters of virtual measurement (Aa, As, TLa, TLs, XE, PW, PSW, and PH) and actual measurement (Aa, As, TLa, XE, PW, PSW, and PH) between the right and left sides (P gt; 0.05). Except XE of the L3 vertebral segment and PSW of T11 and T12 vertebral segments (P lt; 0.05), the differences in other parameters of other segments were not significant (P gt; 0.05). Conclusion After statistical analysis and comparison, the feasibil ity of preoperative planning of thoracolumbar pedicle screw fixation and the accuracy of the measurement of the SVSS is verified.
ObjectiveTo investigate the short-term effectiveness of balloon vertebroplasty combined with short-segment pedicle screw instrumentation for the treatment of thoracolumbar burst fractures. MethodsBetween June 2011 and December 2013, 22 patients with thoracolumbar burst fractures were included. There were 14 males and 8 females, aged 20-60 years (mean, 42.5 years). The fracture segments included T11 in 1 case, T12 in 4 cases, L1 in 10 cases, L2 in 6 cases, and L3 in 1 case. According to AO classification system, there were 13 cases of type A and 9 cases of type B. Spinal cord injury was classified as grade C in 2 cases, grade D in 3 cases, and grade E in 17 cases according to Frankel scale. The time from injury to operation was 3-10 days (mean, 5.5 days). All patients underwent posterior reduction and fixation via the injured vertebra, transpedicular balloon reduction of the endplate and calcium sulfate cement (CSC) injection. The ratio of anterior vertebral height, the ratio of central vertebral height, the sagittal Cobb angle, the restoration of nervous function, and internal fixation failure were analyzed. ResultsPrimary healing of incision was obtained in the others except 2 cases of poor healing, which was cured after dressing change or debridement. All the patients were followed up 9-40 months (mean, 15 months). CSC leakage occurred in 2 cases. Absorption of CSC was observed at 8 weeks after operation with complete absorption time of 12-16 weeks (mean, 13.2 weeks). The mean fracture healing time was 18.5 weeks (range, 16-20 weeks). The ratio of anterior vertebral height, ratio of central vertebral height, and sagittal Cobb angle were significantly improved at 1 week and 3 months after operation and last follow-up when compared with preoperative values (P<0.01), but no significant difference was found among 3 time points after operation (P>0.01). There was no internal fixation failure or Cobb angle loss more than 10°. Frankel scale was improved with no deterioration of neurologic function injury. ConclusionBalloon vertebroplasty combined with short-segment pedicle screw instrumentation is simple and safe for the treatment of thoracolumbar burst fractures, and it can improve the quality of reduction, restore vertebral mechanical performance effectively, and prevent the loss of correction and internal fixation failure.
Objective To ascertain whether augmentation pedicle screw fixation with polymethylmethacrylate (PMMA) can enhance the stability of unstable thoracolumbar burst fractures of osteoporotic spine. Methods Six fresh frozen female osteoporotic spines (T10-L5) were harvested and an anterior and posterior columnunstable model of L1 was made. Each specimen was fixated with plate and the stability test were performed by flexion, extension, axial rotation and lateral bending. The test of fatigue was done with MTS 858.The tests were repeated after screws were augmented with PMMA. To compare the biomechanical stability of 6 different conditions:○anormal specimens(control), ○bdefectmodel fixed with plate, not augmented and not fatigued, ○cafter fatigued, not augmented, ○dscrews augmented with PMMA, not fatigued, ○e after augmented and fatigued. ResultsIn ○b,○d and ○e conditions, the ranges of motion(ROM) were 6.23±1.56，4.49±1.00，4.46±1.83 inflexion and 6.60±1.80，4.41±0.82，4.46±1.83 in extension. There was no significant difference (Pgt;0.05), they were significantly smaller than those in ○a and ○c conditions (8.75±1.88，1.47±2.25 and 8.92±2.97，12.24±3.08) (Plt;0.01).Conclusion The results demonstrated that augmentation pedicle screws fixation with PMMA can increase the stability of osteoporotic spine.
ObjectiveTo explore the feasibility of the clinical application of individualized simulated S1 pedicle screw.MethodsThe data of patients with lumbar disease diagnosed and treated in the Fourth People’s Hospital of Zigong from May 2017 to April 2019 were retrospectively analyzed. According to the preoperative individualized design of the S1 pedicle screw placement path, the patients were divided into individualized screw placement group and traditional screw placement group. The distance D between the screw tip and the endplate of the S1, the angle α of the screw in the plane of the dysplasia and the lumbar pedicle of the L5, the angle of oblique angle β, the number of screws of 35 and 40 mm in length, and the screw loosening rate (followed-up within 1 year) in the two groups were analyzed.ResultsA total of 59 patients were enrolled in this study, 31 in the individualized screw placement group and 28 in the traditional screw placement group. The differences in the distance D between the screw tip and the endplate of the S1 [(2.61±0.82) vs.(4.13±1.51) mm; t=-5.718, P<0.001], the angle α of the screw in the plane of the dysplasia and the lumbar pedicle of the L5 [(9.31±3.52) vs. (13.53±4.78)°; t=-5.646, P<0.001], the angle of oblique angle β [(15.73±6.04) vs. (10.65±5.09)°; t=3.022, P=0.004], the proportion of using screw models [40 mm in length: 56 vs. 8; 35 mm in length: 6 vs. 48; χ2=68.539, P<0.001], and the screw loosening rate followed-up within 1 year [3.22% vs. 16.07%; χ2=5.774, P<0.001] were statistically significant between the individualized screw placement group and the traditional screw placement group.ConclusionsPreoperative individualized design of the pedicle screw of the S1 pedicle screw can be used in clinical practice. The biomechanical stability of the S1 pedicle screw can be improved and the sagittal balance can be achieved.
ObjectiveTo re-evaluate the systematic review and meta-analysis (SR/MAs) of the efficacy of robot-assisted pedicle screw placement. MethodsThe CNKI, VIP, WanFang Data, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science databases were electronically searched to collect SR/MAs of robot-assisted pedicle screw placement from inception to April 28, 2023. Two reviewers independently screened literature, extracted data and then assessed the quality of reports, methodological quality, risk of bias, and the strength of evidence quality by using PRISMA, AMSTAR-Ⅱ, ROBIS, and GRADE tool. ResultsA total of 20 SR/MAs were included. The results of the included studies showed that robot-assisted pedicle screw placement was more accurate and had a lower number of complications compared with freehand pedicle screw placement. The quality of reports, methodology, and evidence for pedicle screw placement efficiency in all SR/MAs were low or extremely low, with a high risk of bias. The main reasons included high heterogeneity of included studies, unclear research methods and selection criteria, and missing key reporting processes. ConclusionRobot-assisted pedicle screw placement may have better clinical efficiency than traditional freehand pedicle screw placement. But the quality of relational SR/MAs is low.
Objective To investigate the effectiveness of posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting for lumbar spondylolysis. Methods Between January 2005 and October 2009, 22 patients with lumbar spondylolysis underwent posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting. There were 19 males and 3 females with an average age of 18.4 years (range, 12-26 years). The main symptom was low back pain with an average disease duration of 16 months (range, 8-56 months). The visual analogue scale (VAS) was 6.0 ± 1.2 and Oswestry disability index (ODI) was 72.0% ± 10.0% preoperatively. The X-ray films showed bilateral spondylolysis at L4 in 9 cases and at L5 in 13 cases. The range of motion (ROM) at upper and lower intervertebral spaces was (11.8 ± 2.8)°and (14.1 ± 1.9)°, respectively. ResultsAll incisions healed by first intention. All patients were followed up 12-45 months (mean, 25 months). Low back pain was significantly alleviated after operation. The VAS score (0.3 ± 0.5) and ODI (17.6% ± 3.4%) were significantly decreased at last follow-up when compared with preoperative scores (P lt; 0.05). CT showed bone graft fusion in the area of isthmus defects, with no loosening or breaking of internal fixator. At last follow-up, the lateral flexion-extension X-ray films of the lumbar spine showed that the ROM at upper and lower intervertebral spaces was (12.3 ± 2.1)°and (13.5 ± 1.7)°, respectively; showing significant differences when compared with preoperative values (P lt; 0.05). Pain at donor site of iliac bone occurred in 1 case, and was cured after pain release treatment. ConclusionThe posterior intrasegmental fixation with pedicle screw-lamina hook system and bone grafting is a reliable treatment for lumbar spondylolysis, having a high fusion rate, low complication rate, and maximum retention of lumbar ROM.
ObjectiveTo explore the application value of thin CT angiography (CTA) of pedicle sagittal plane of axis for preoperative evaluation planning pedicle screw placement.MethodsBetween February 2016 and August 2017, 34 patients (68 pedicles) who underwent thin CTA scan before posterior axial surgery were retrospectively analyzed. The vertebral artery development was statistically analyzed. The continuous layers of transverse process hole pedicle height more than or equal to 4 mm (f) were measured and read. The axial fixation methods, clinical manifestations of vertebral artery and spinal cord injury and the bone union of fractures or implants were recorded. Postoperative results of pedicle screws were evaluated by CT scan.ResultsThe right sides of 8 cases and the left sides of 18 cases were dominant vertebral arteries, and equilibrium was reached in 8 cases; f>9 layers were found in 16 pedicles,f=9 layers in 27 pedicles, f=8 layers in 17 pedicles, and f<8 layers in 8 pedicles. The 43 pedicles off≥9 layers used pedicle screw fixation; in the 17 pedicles of f=8 layers, 16 used pedicle screw fixation, and the other one used laminar screw fixation; in the 8 pedicles of f<8 layers, 4 used pedicle screw fixation, and the other 4 used laminar screw fixation. A self-defined pedicle screw grading system was used to evaluate the excellence, and the result showed that,f>9 layers: 14 pedicles were class A, 2 were class B, none was class C;f=9 layers: 16 pedicles were class A, 7 were class B, 4 were class C; f=8 layers: 3 pedicles were class A, 5 were class B, 8 were class C; f<8 layers: none was pedicles class A or class B, 4 were class C. The other 4 lamina screws fixation didn’'t invade the spinal canal. One case of pedicle class C showed clinical manifestations of mild dizziness and drowsiness. The patients were followed up for 6-11 months with an average of (8±3) months, and the fracture or bone graft fusion were observed after 6 months of following-up.ConclusionBased on preoperative CTA thin layer scanning, through measuring and reading continuous layers of transverse process hole pedicle height more than or equal to 4 mm, can effectively judge the security of axial pedicle screws in order to subsequently choose the reasonable operation methods so as to improve success rate and decrease surgical risk.
OBJECTIVE: To introduce a method to treat kyphosis with universal spine system (USS) and to evaluate its clinical effect. METHODS: From January 2000 to September 2002, 31 patients with kyphosis were treated with "one-stage total vertebral wedge-shaped osteotomy" and internal fixation of USS. The average follow-up time was 12 months (6-31 months). We observed the clinical effect with the spinal column Cobb before operation and after operation, and the osteotomy confluence rate. RESULTS: In 31 patients, the average angle (Cobb) was 89 degrees before operation and 74 degrees after operation; the average rate of correction was 83.15% and the average rate of osteotomy confluence was 96.77%. No screw and rod broke and loosened. CONCLUSION: The USS is the reliable internal fixation instrument for the treatment of kyphosis, can increase the osteotomy confluence rate and improve correcting rate.
Objective To elucidate the new development and effects of three-dimensional correction techniques of idiopathic scol iosis (IS). Methods The related home and abroad l iterature concerning three-dimensional correction techniques of IS was extensively reviewed. Results With more and more attention to three-dimensional correction of IS, all kinds of surgery and developed techniques of correction are applied to the correction of IS. The effects of three-dimensional correction of IS are satisfied. Conclusion With more knowledge about IS and more developed theory of correction, more safe and effective techniques of correction is therefore the hot spot for future study.