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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

Postoperative computed tomographic scan showing Laine's Grade 5 screw placement
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Figure 8: Postoperative computed tomographic scan showing Laine's Grade 5 screw placement

Mentions: There were concerns regarding the extra time that would be required for matching and registration, however as we shall see that this time is within manageable limits. The average time taken for matching was 7.8 min (range 5-12 min) whereas time taken for insertion of a single screw from marking the entry with an awl to complete insertion of the screw was 4.19 min (range 2-8 min). The average total time is taken for screw insertion was 34.23 min (range 24-45 min) after exposure for a four screw construct, which includes time for matching and actual screw insertion. Only one screw out of a total of 118 screws perforated the lateral wall of the right pedicle of L2 vertebra [Figure 6] with a Laine's Grade 5 showing a screw misplacement rate of 0.847% only. All other screws were inside the pedicles with Grade 1 placements. No improvement in neurological status was observed postoperatively and at subsequent followups.


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)

Postoperative computed tomographic scan showing Laine's Grade 5 screw placement
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 8: Postoperative computed tomographic scan showing Laine's Grade 5 screw placement
Mentions: There were concerns regarding the extra time that would be required for matching and registration, however as we shall see that this time is within manageable limits. The average time taken for matching was 7.8 min (range 5-12 min) whereas time taken for insertion of a single screw from marking the entry with an awl to complete insertion of the screw was 4.19 min (range 2-8 min). The average total time is taken for screw insertion was 34.23 min (range 24-45 min) after exposure for a four screw construct, which includes time for matching and actual screw insertion. Only one screw out of a total of 118 screws perforated the lateral wall of the right pedicle of L2 vertebra [Figure 6] with a Laine's Grade 5 showing a screw misplacement rate of 0.847% only. All other screws were inside the pedicles with Grade 1 placements. No improvement in neurological status was observed postoperatively and at subsequent followups.

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