Matrix spine system degenerative technique guide depuy synthes 7 indications and contraindications the matrix spine system is a posterior pedicle screw and hook. Inaccurate pedicle screw placement is relatively common even when placement is performed under fluoroscopic control. When the applicable dose was applied to the anthropomorphic phantom, radiation doses were centered over l4, which the study found to be the most common location of screw placement. Traditionally, freehand pedicle screw placement in the lumbar spine has had wide acceptance. Freehand technique yongjung j kim, lawrence g lenke one barnesjewish hospital plaza, 10 west pavilion, st. No neurologic or vascular injuries or any other complications were attributable to a pedicle screw in either group. No implant contact to neural structures of the spinal canal.
Late diagnosis of perforation of the aorta by a pedicle screw acta. Radiographic lucency around pedicle screws with cobalt chromium rod constructs in the setting of lumbar fusion volume 2 issue 4 2015 ananth eleswarapu,1 christopher g salib,2 mark m mikhael3 1department of orthopaedic surgery, university of chicago medical center, usa 2meharry medical college, usa. Mean accuracy rate for placement of pedicle screws in the studies was 93. Accuracy of the freehand technique for 3 fixation methods in the c2. Lag screw placement screws placed in lag fashion enable the compression of oblique angled fractured bones, which accelerates osteogenesis. Improper pedicle screw placement rarely results in. Louis, missouri 63110, usa thoracic pedicle screws provide a number of advantages over other methods of spinal fixation in treating a variety of conditions. Lag screw placement eickemeyer veterinary equipment shop. Lumbosacral pedicle screw placement using a fluoroscopic.
Dorsal thoracic and lumbar screw fixation and pedicle. Amin, md, faans, of the loyola university medical center. A glide hole is drilled in the near cortex using a drill bit, which is the same diameter of the outside of the screw thread. Pdf manual and computerassisted pedicle screw placement. Lenke one barnesjewish hospital plaza, 10 west pavilion, st. Pedicle screw and rod constructs have become widely accepted as the ideal option to provide stable spinal fixation 18. An analysis of 2,500 patients by 350 physicians conducted by the north american spine society found that the complication rate with using pedicle screws in spinal fusion. Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Do not use the set screw to drive or otherwise force the rod into the pedicle screw cup. Techniques and accuracy of thoracolumbar pedicle screw placement. Radiographic lucency around pedicle screws with cobalt.
Pedicle breach rates have been reported to be as high as 29% with the traditional, open technique. Average pullout strength in extrapedicular technique was less than two other techniques in dynamic state. Pedicle screw insertions are commonly used for posterior fixation to treat various spine disorders. Pedicle screw placement with oarm and stealth navigation article pdf available in orthopedics 351. Mar 20, 2014 technique transpedincular screw placement 1. Review article freehand technique for thoracolumbar. Power rod gripper 33801 alternative to rod holding forceps for secure placement and positioning of the implant rod. A minimally invasive approach for posterior spinal surgery. Instrumentation of the lumbosacral spine increasingly involves screw fixation to the sacrum. Yoo ju, ghanayem a, petersilge c, lewin j 1997 accuracy of using computed tomography to identify pedicle screw placement in cadaveric human lumbar spine.
Ipsilateral pedicle screw placement with contralateral percutaneous facet screws placement on the contralateral side. This was the classification used by the vast majority of eligible studies. Accuracy of c2 pedicle screw placement using the anatomic. Posterior thoracic segmental pedicle screw instrumentation.
Therefore, the purpose of this study was to investigate the use of a freehand technique for placement of pars, pedicle, and intralaminar screws in. Screw installation sp20001 tool and slide both into the guide. Cadaver training module for teaching thoracic pedicle screw. Backs out an implanted screw to adjust dorsal height or for revision removal. Plan for proper pockethole placement kreg tool company. Other literatures have described typical analysis methods adopted to evaluate materials and failures on pedicle screw. The accuracy of thoracic pedicle screws placement was reported in all the studies.
A prospective multicenter registry on the accuracy of pedicle screw. Postoperative ct scans were performed using 2mm cuts with 1mm overlap to assess the accuracy of screw placement in all patients. Pdf a surgical drill guide for pedicle screw placement. Accuracy of c2 pedicle screw placement using the anatomic freehand technique. With the use of computerassisted 2dimensional fluoroscopy, breach rates have been reported between 5% and 23%. Accuracy of cps placement using a preoperative 3d ctbased navigation system was 93. A variety of pedicle screw systems have been described and new systems are being developed everyday. Aug 01, 2010 postoperative ct scans were performed using 2mm cuts with 1mm overlap to assess the accuracy of screw placement in all patients. Morphometry of the thoracic and lumbar spine related to transpedicular screw placement for surgical spinal fixations spine. We considered all prospective in vivo clinical studies in the english literature that assessed the results of different pedicle screw placement techniques freehand technique, fluoroscopy guided, computed tomography ctbased navigation, fluorobased navigation. Rod holding forceps 33691 securely hold rod for placement and positioning in. Sep 07, 2011 therefore, the importance of accuracy in screw placement meaning that the screw is fully included in the pedicle and there is no cortex violation has been recognized early. Medial screw misplacement can lead to severe neurologic deficits. Use of pedicle screw systems for spinal stabilization has become increasingly common in spine surgery.
While there was a rod and screw breakage rate of approximately 10% in the 1980s, with modern pedicle screws the breakage rate has now been reduced to about one in 1,000. In general, pedicle screw accuracy was defined as having the entire screw contained within the cortices of each respective pedicle 3. Freehand technique article pdf available in neurology india 534. Computed tomographybased navigation and fluoroscopicbased navigation with its two and threedimensional options are the most popular spine navigation systems. However, the misplacement of pedicle screws can lead to disastrous complications. In order to improve the accuracy of the screw placement, we applied a technique using guide wires. A surgical drill guide for pedicle screw placement.
Incidence of lumbar spine pedicle breach after percutaneous. Ipsilateral pedicle screw placement with contralateral. Pdf pedicle screw placement with oarm and stealth navigation. Lawrence g lenke cochief adultpediatric spinal surgery one barnesjewish hospital plaza 10 west pavilion st. First rotate the set screw installation tool counter clockwise a half turn and then start rotating clockwise to ensure proper thread alignment of the set screw. Each resident instrumented alternating sides of 5 con secutive cadavers t1t12. When comparing the automatically obtained and manually defined plans for pedicle screw placement, a relatively high agreement was observed, with madsd of 0. There was statistically significant difference between three techniques. The incidence of injury associated with pedicle screw placement was 0. A prospective, randomized clinical study was performed by to determine whether unilateral pedicle screw fixation was comparable with bilateral fixation in 1 or 2segment lumbar interbody fusion. Pedicle screws have been used successfully for posterior spinal fixation for over. To evaluate the accuracy of freehand pedicle screws placement at the seventh cervical vertebra.
Up to 75% of maximum insertional torque can be achieved with engagement of the neurocentral junction. Determine the length of the pedicle screw using the depth gauge for screws 3 319. This allows for practice placement of the c2 pedicle screw by the trainee based on the landmarks and trajectory described above, as shown in figure 3. An extrapedicular approach to the placement of screws in. Of the screws demonstrating perforations, 92% were medial, potentially injuring the spinal cord or a nerve root. The grade of pedicle screw violation was classified into four groups. This occurred in 21% of the screws placed where direct visualization was the definitive endpoint.
Thoracic pedicle screws provide a number of advantages over other methods of spinal fixation in treating a variety of conditions including. Despite the clinical successes reported with thoracic pedicle screw rod constructs, controversy exists about the safety of this technique in pedicles that are anatomically too small for transpedicular fixation. Since its introduction in spine surgery, pedicle screw insertion remains a challenge for every spine surgeon. Three dimensional imageguided surgery igs can result in better screw accuracy. Head adjuster 33661 aligns polyaxial screw heads for rod placement. Lumbar 5 vertebra sacrum 5 vertebra coccyx 34 vertebra 2. A single screw provides stability in five planes of motion.
Pedicle breach rates vary substantially in the literature. Recommended locations and techniques for screw placement vary, particularly when bicortical purchase of the sacrum is performed. A total of 341 c2 pedicle screws in 181 patients, with average screw length of 22. The radiographs and ct scans were analyzed with respect to the. The strongest technique for screw placement was intratransverse process technique. The nature of the pedicle screwbone junction is much more secure than the wire or hookbone junction. Anatomic techniques for cervical pedicle screw placement. The technique and principle of screw placement as well as anatomical landmarks of screw placement, however, are common to all systems.
258 799 1356 840 1688 1615 1074 446 533 986 1059 292 720 1315 966 111 412 150 338 1596 1252 1541 605 1515 913 1098 945 1156 1003 455 485 650