Document Detail


In vitro study of accuracy of cervical pedicle screw insertion using an electronic conductivity device (ATPS part III).
MedLine Citation:
PMID:  19575244     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Reconstruction of the highly unstable, anteriorly decompressed cervical spine poses biomechanical challenges to current stabilization strategies, including circumferential instrumented fusion, to prevent failure. To avoid secondary posterior surgery, particularly in the elderly population, while increasing primary construct rigidity of anterior-only reconstructions, the authors introduced the concept of anterior transpedicular screw (ATPS) fixation and plating. We demonstrated its morphological feasibility, its superior biomechanical pull-out characteristics compared with vertebral body screws and the accuracy of inserting ATPS using a manual fluoroscopically assisted technique. Although accuracy was high, showing non-critical breaches in the axial and sagittal plane in 78 and 96%, further research was indicated refining technique and increasing accuracy. In light of first clinical case series, the authors analyzed the impact of using an electronic conductivity device (ECD, PediGuard) on the accuracy of ATPS insertion. As there exist only experiences in thoracolumbar surgery the versatility of the ECD was also assessed for posterior cervical pedicle screw fixation (pCPS). 30 ATPS and 30 pCPS were inserted alternately into the C3-T1 vertebra of five fresh-frozen specimen. Fluoroscopic assistance was only used for the entry point selection, pedicle tract preparation was done using the ECD. Preoperative CT scans were assessed for sclerosis at the pedicle entrance or core, and vertebrae with dense pedicles were excluded. Pre- and postoperative reconstructed CT scans were analyzed for pedicle screw positions according to a previously established grading system. Statistical analysis revealed an astonishingly high accuracy for the ATPS group with no critical screw position (0%) in axial or sagittal plane. In the pCPS group, 88.9% of screws inserted showed non-critical screw position, while 11.1% showed critical pedicle perforations. The usage of an ECD for posterior and anterior pedicle screw tract preparation with the exclusion of dense cortical pedicles was shown to be a successful and clinically sound concept with high-accuracy rates for ATPS and pCPS. In concert with fluoroscopic guidance and pedicle axis views, application of an ECD and exclusion of dense cortical pedicles might increase comfort and safety with the clinical use of pCPS. In addition, we presented a reasonable laboratory setting for the clinical introduction of an ATPS-plate system.
Authors:
Heiko Koller; Wolfgang Hitzl; Frank Acosta; Mark Tauber; Juliane Zenner; Herbert Resch; Yasutsugu Yukawa; Oliver Meier; Rene Schmidt; Michael Mayer
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Publication Detail:
Type:  In Vitro; Journal Article     Date:  2009-07-03
Journal Detail:
Title:  European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society     Volume:  18     ISSN:  1432-0932     ISO Abbreviation:  Eur Spine J     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-09-28     Completed Date:  2009-12-15     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  9301980     Medline TA:  Eur Spine J     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1300-13     Citation Subset:  IM    
Affiliation:
Department for Traumatology and Sport Injuries, Paracelsus Medical University Salzburg, Salzburg, Austria. heiko.koller@t-online.de
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MeSH Terms
Descriptor/Qualifier:
Aged
Amplifiers, Electronic / trends*
Bone Screws*
Cadaver
Cervical Vertebrae / anatomy & histology,  radiography,  surgery*
Electric Conductivity / diagnostic use*
Electronics, Medical / instrumentation,  methods
Female
Fluoroscopy / methods
Humans
Internal Fixators
Joint Instability / surgery
Male
Middle Aged
Monitoring, Intraoperative / instrumentation*,  methods
Outcome Assessment (Health Care) / methods
Postoperative Care / methods
Postoperative Complications / etiology,  prevention & control
Predictive Value of Tests
Prosthesis Implantation / instrumentation,  methods
Sensitivity and Specificity
Spinal Diseases / surgery
Spinal Fusion / instrumentation*,  methods*
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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