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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

Bar diagram showing vertebral level involvement
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Figure 6: Bar diagram showing vertebral level involvement

Mentions: Out of 30 patients included in the study, 22 patients were males and 8 were females. The mean age of patients was 34.53 years (range 17-60 years). Maximum number of patients had a fracture of L1 vertebra (n = 15), followed by L2 (N = 6), T12 (n = 4), L3 (n = 3) and L4 (n = 2) [Graph 1]. 17 patients had no neurological deficit, 12 had paraperesis and one had complete paraplegia. Out of 12 patients with paraparesis, one had Grade 4 power (assessed on MRC grading), six had Grade 3 power and five had Grade 2 power distal to the lesion. No improvement in neurological status was observed postoperatively and at subsequent followups. A total of 118 screws were placed in T11 (n = 8), T12 (n = 28), L1 (n = 20), L2 (n = 36), L3 (n = 16), L4 (n = 6) and L5 (n = 4) [Graph 2]. In one case, only two pedicle screws could be inserted with navigation as position of dynamic reference base was disturbed resulting in loss of contact with computer work station. Remaining two screws were inserted manually, which were excluded from the study.


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)

Bar diagram showing vertebral level involvement
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Bar diagram showing vertebral level involvement
Mentions: Out of 30 patients included in the study, 22 patients were males and 8 were females. The mean age of patients was 34.53 years (range 17-60 years). Maximum number of patients had a fracture of L1 vertebra (n = 15), followed by L2 (N = 6), T12 (n = 4), L3 (n = 3) and L4 (n = 2) [Graph 1]. 17 patients had no neurological deficit, 12 had paraperesis and one had complete paraplegia. Out of 12 patients with paraparesis, one had Grade 4 power (assessed on MRC grading), six had Grade 3 power and five had Grade 2 power distal to the lesion. No improvement in neurological status was observed postoperatively and at subsequent followups. A total of 118 screws were placed in T11 (n = 8), T12 (n = 28), L1 (n = 20), L2 (n = 36), L3 (n = 16), L4 (n = 6) and L5 (n = 4) [Graph 2]. In one case, only two pedicle screws could be inserted with navigation as position of dynamic reference base was disturbed resulting in loss of contact with computer work station. Remaining two screws were inserted manually, which were excluded from the study.

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