Limits...
Navigated pedicle screw placement using computed tomographic data in dorsolumbar fractures.

Kapoor S, Sharma R, Garg S, Jindal R, Gupta R, Goe A - Indian J Orthop (2014)

Bottom Line: No neurovascular complications were seen in any of the patients postoperatively and in subsequent followup of 1-year duration.CT-based navigation is effective in improving accuracy of pedicle screw placement in traumatic injuries of dorsolumbar spine (T9-L5), however additional cost of procuring CT scan to the patient and cost of equipment is of significant concern in developing countries.Reduced radiation exposure and lowered ergonomic constraints around the operation table are its additional benefits.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Government Medical College and Hospital, Chandigarh, India.

ABSTRACT

Background: Computed tomographic (CT) based navigation is a technique to improve the accuracy of pedicle screw placement. It is believed to enhance accuracy of pedicle screw placement, potentially avoiding complications arising due to pedicle wall breach. This study aims to assess the results of dorsolumbar fractures operated by this technique.

Materials and methods: Thirty consecutive skeletally mature patients of fractures of dorsolumbar spine (T9-L5) were subjected to an optoelectronic navigation system. All patients were thoroughly examined for neurological deficit. The criterion for instability were either a tricolumnar injury or presence of neurological deficit or both. Patients with multilevel fractures and distorted spine were excluded from study. Time taken for insertion of each pedicle screw was recorded and placement assessed with a postoperative CT scan using Laine's grading system.

Results: Only one screw out of a total of 118 screws was misplaced with a Laine's Grade 5 placement, showing a misplacement rate of 0.847%. Average time for matching was 7.8 min (range 5-12 min). Average time taken for insertion of a single screw was 4.19 min (range 2-8 min) and total time for all screws after exposure was 34.23 min (range 24-45 min) for a four screw construct. No neurovascular complications were seen in any of the patients postoperatively and in subsequent followup of 1-year duration.

Conclusion: CT-based navigation is effective in improving accuracy of pedicle screw placement in traumatic injuries of dorsolumbar spine (T9-L5), however additional cost of procuring CT scan to the patient and cost of equipment is of significant concern in developing countries. Reduced radiation exposure and lowered ergonomic constraints around the operation table are its additional benefits.

No MeSH data available.


Related in: MedlinePlus

Preoperative planning of screw diameter and trajectory
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4232823&req=5

Figure 1: Preoperative planning of screw diameter and trajectory

Mentions: 30 adult patients of unstable fracture of lower dorsal and lumbar spine (T9-L5) requiring pedicle screw fixation operated between June 2008 and June 2010 were included in the study. Patients with multilevel fractures and those with preexisting distorted spine anatomy were excluded from the study. The criteria for instability were either a tricolumnar injury or presence of neurological deficit, or both together. History and clinical examination was recorded in all patients. Besides the routine blood investigations and plain radiographs of involved spine, a CT scan was done with specialized protocol. A written and informed consent was taken from all patients explaining them the procedure as well as CT scan protocol and its hazards. The CT scan included the region of two vertebrae above and below the fractured vertebrae having 1 mm consecutive cuts with 150° field of view, nonoverlapping and contiguous with a recorded computer disc (CD). Such protocol did not expose patients to any extra radiation as CT scanning is now considered essential for assessment of vertebral fractures.22 This CD was then fed to the navigation computer which provided preoperative complete projections of the spine in different planes and three dimensional reconstruction. The pedicle morphology including diameter, inclination and configuration was studied as part of preoperative planning. The points of entry of the pedicle screws, screw size and their trajectory were identified in different projections of the spine [Figure 1].


Navigated pedicle screw placement using computed tomographic data in dorsolumbar fractures.

Kapoor S, Sharma R, Garg S, Jindal R, Gupta R, Goe A - Indian J Orthop (2014)

Preoperative planning of screw diameter and trajectory
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232823&req=5

Figure 1: Preoperative planning of screw diameter and trajectory
Mentions: 30 adult patients of unstable fracture of lower dorsal and lumbar spine (T9-L5) requiring pedicle screw fixation operated between June 2008 and June 2010 were included in the study. Patients with multilevel fractures and those with preexisting distorted spine anatomy were excluded from the study. The criteria for instability were either a tricolumnar injury or presence of neurological deficit, or both together. History and clinical examination was recorded in all patients. Besides the routine blood investigations and plain radiographs of involved spine, a CT scan was done with specialized protocol. A written and informed consent was taken from all patients explaining them the procedure as well as CT scan protocol and its hazards. The CT scan included the region of two vertebrae above and below the fractured vertebrae having 1 mm consecutive cuts with 150° field of view, nonoverlapping and contiguous with a recorded computer disc (CD). Such protocol did not expose patients to any extra radiation as CT scanning is now considered essential for assessment of vertebral fractures.22 This CD was then fed to the navigation computer which provided preoperative complete projections of the spine in different planes and three dimensional reconstruction. The pedicle morphology including diameter, inclination and configuration was studied as part of preoperative planning. The points of entry of the pedicle screws, screw size and their trajectory were identified in different projections of the spine [Figure 1].

Bottom Line: No neurovascular complications were seen in any of the patients postoperatively and in subsequent followup of 1-year duration.CT-based navigation is effective in improving accuracy of pedicle screw placement in traumatic injuries of dorsolumbar spine (T9-L5), however additional cost of procuring CT scan to the patient and cost of equipment is of significant concern in developing countries.Reduced radiation exposure and lowered ergonomic constraints around the operation table are its additional benefits.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Government Medical College and Hospital, Chandigarh, India.

ABSTRACT

Background: Computed tomographic (CT) based navigation is a technique to improve the accuracy of pedicle screw placement. It is believed to enhance accuracy of pedicle screw placement, potentially avoiding complications arising due to pedicle wall breach. This study aims to assess the results of dorsolumbar fractures operated by this technique.

Materials and methods: Thirty consecutive skeletally mature patients of fractures of dorsolumbar spine (T9-L5) were subjected to an optoelectronic navigation system. All patients were thoroughly examined for neurological deficit. The criterion for instability were either a tricolumnar injury or presence of neurological deficit or both. Patients with multilevel fractures and distorted spine were excluded from study. Time taken for insertion of each pedicle screw was recorded and placement assessed with a postoperative CT scan using Laine's grading system.

Results: Only one screw out of a total of 118 screws was misplaced with a Laine's Grade 5 placement, showing a misplacement rate of 0.847%. Average time for matching was 7.8 min (range 5-12 min). Average time taken for insertion of a single screw was 4.19 min (range 2-8 min) and total time for all screws after exposure was 34.23 min (range 24-45 min) for a four screw construct. No neurovascular complications were seen in any of the patients postoperatively and in subsequent followup of 1-year duration.

Conclusion: CT-based navigation is effective in improving accuracy of pedicle screw placement in traumatic injuries of dorsolumbar spine (T9-L5), however additional cost of procuring CT scan to the patient and cost of equipment is of significant concern in developing countries. Reduced radiation exposure and lowered ergonomic constraints around the operation table are its additional benefits.

No MeSH data available.


Related in: MedlinePlus