Analysis of spinal stress analysis application in determining method for the pedicle screw placement under the guidance of X-Ray

Abstract

OBJECTIVE:

To evaluate the accuracy of a novel guidance method of pedicle screw implantation determined by spinal stress.

METHODS:

We retrospectively analyzed patients underwent pedicle screw internal fixation between January 2015 and August 2018 in our hospital. Patients were divided into two groups according to the methods of pedicle screw implantation namely, the conventional nail placement and novel guidance method of pedicle screw implantation determined by spinal stress. Accuracy of spinal pedicle screw placements was evaluated using intraoperative and postoperative X-ray computed tomography (CT) examination and intraoperative touch of nerve root dissection pedicle bone. The success rate of intraoperative one-time screw placement was calculated according to Heary classification I.

RESULTS:

A total of 785 patients underwent pedicle screw internal fixation were retrospectively analyzed. Among them 384 patients were treated using conventional nail placement (Group A) and 401 patients were treated using the technique according to analysis of spinal stress (Group B). There was no significant difference in terms of the characteristics between two groups. There were significant differences in terms of the success rate of total of screw placement (88.7% vs. 96.2%, P < 0.001) including thoracic screw placement (87.8% vs. 94.5%, P = 0.003) and lumbar screw placement (88.8% vs. 96.5%, P = 0.001) for Group A and Group B, respectively.

CONCLUSIONS:

Using the novel guidance method of pedicle screw implantation determined by spinal stress might improve the accuracy of pedicle screw implantation.

Keywords

Pedicle screw implantation,free-hand,stress conduction,thoracolumbar spine

Get full access to this article

View all access options for this article.

References

Boos and

J.K.

Webb , Pedicle screw fixation in spinal disorders: A European view, Eur Spine J 6(1997), 2–18.

Sarwahi ,

S.F.

Wendolowski and

R.C.

Gecelter , et al., Are we underestimating the significance of pedicle screw misplacement? Spine (Phila Pa 1976) 41 (2016), E548–55.

Shimizu ,

Takahashi and

Ikegami , et al., Are pedicle screw perforation rates influenced by registered or unregistered vertebrae in multilevel registration using a CT-based navigation system in the setting of scoliosis? Eur Spine J 23 (2014), 2211–2217.

J.D.

van Dijk ,

R.P.

van den Ende and

Stramigioli , et al., Clinical pedicle screw accuracy and deviation from planning in robot-guided spine surgery: Robot-guided pedicle screw accuracy, Spine (Phila Pa 1976) 40 (2015), E986–991.

Pu ,

Yin and

Ma , et al., Design and application of a novel patient-specific three-dimensional printed drill navigational guiding in atlantoaxial pedicle screw placement, World Neurosurg 114 (2018), e1–e10.

J.N.

Weinstein ,

K.F.

Spratt and

Spengler , et al., Spinal pedicle fixation: reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement, Spine (Phila Pa 1976) 13 (1988), 1012–1018.

M.H.

Krag ,

B.D.

Beynnon and

M.H.

Pope , et al., An internal fixator for posterior application to short segments of the thoracic, lumbar, or lumbosacral spine. Design and testing, Clin Orthop Relat Res 1986, 75–98.

Roy-Camille ,

Saillant and

Mazel , Internal fixation of the lumbar spine with pedicle screw plating, Clin Orthop Relat Res 1986, 7–17.

I.D.

Gelalis ,

N.K.

Paschos ,

E.E.

Pakos ,

A.N.

Politis ,

C.M.

Arnaoutoglou ,

A.C.

Karageorgos ,

Ploumis and

T.A.

Xenakis , Accuracy of pedicle screw placement: A systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques, Eur Spine J 21 (2012), 247–255.

10.

Allam ,

Silbermann ,

Riese and

Greiner-Perth , Computer tomography assessment of pedicle screw placement in thoracic spine: Comparison between free hand and a generic 3D-based navigation techniques, Eur Spine J 22 (2013), 648–653.

11.

S.C.

Cowin , Wolff’s law of trabecular architecture at remodeling equilibrium, Journal of Biomechanical Engineering 108 (1986), 83–88.

12.

Tsubota ,

Suzuki and

Yamada , et al., Computer simulation of trabecular remodeling in human proximal femur using large-scale voxel FE models: Approach to understanding Wolff’s law, J Biomech 42 (2009), 1088–1094.

13.

Halm ,

Niemeyer ,

Link and

Liljenqvist , Segmental pedicle screw instrumentation in idiopathic thoracolumbar and lumbar scoliosis, Eur Spine J 9 (2000), 191–197.

14.

Y.J.

Kim ,

L.G.

Lenke and

K.H.

Bridwell , et al., Free hand pedicle screw placement in the thoracic spine: is it safe? Spine (Phila Pa 1976) 29 (2004), 333–342.

15.

Zhang ,

Xie and

Wang , et al., Thoracic pedicle classification determined by inner cortical width of pedicles on computed tomography images: its clinical significance for posterior vertebral column resection to treat rigid and severe spinal deformities-a retrospective review of cases, BMC Musculoskelet Disord 15 (2014), 278.

16.

M.F.

Ivicsics ,

N.E.

Bishop ,

Puschel , et al., Increase in facet joint loading after nucleotomy in the human lumbar spine, J Biomech 47 (2014), 1712–1717.

17.

B.S.

Brown ,

T.E.

McIff and

R.C.

Glattes , et al., The effect of starting point placement technique on thoracic transverse process strength: an ex vivo biomechanical study, Scoliosis 5 (2010), 14.

18.

R.F.

Heary ,

C.M.

Bono and

Black , Thoracic pedicle screws: Postoperative computerized tomography scanning assessment, J Neurosurg 100 (2004), 325–331.

19.

S.J.

Hyun ,

Y.J.

Kim and

Cheh , et al., Free hand pedicle screw placement in the thoracic spine without any radiographic guidance: Technical note, a cadaveric study, Journal of Korean Neurosurgical Society 51(2012), 66.

20.

Isik ,

K.C.

Kose and

M.E.

Inanmaz , et al., The mechanisms of medial pedicle wall violation: insertion method is as important as correct cannulation of the pedicle, Adv Orthop 2014 (2014), 283783.

21.

C.S.

Gerard and

R.G.

Fessler , Accurate pedicle screw placement – a perspective statement, World Neurosurg 83 (2015), 747–749.