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Pedicle screw piercer with warning device - A technique to increase accuracy of pedicle screw placement

A cadaveric study

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Pedicle screw fixation has achieved significant popularity amongst spinal surgeons for both single and multilevel spinal fusion. Suboptimal placements of pedicle screws may lead to neurological and vascular complications. There have been many advances in techniques available for navigating through the pedicle; however, these techniques are not without drawbacks. The purpose of this study was to investigate the efficacy and feasibility of the pedicle piercer with warning device.

Materials and Methods

Eight normal adult thoracolumbar specimens from cadavers consisting of 80 vertebras (T8–L5) were selected and randomly allocated into four groups. Each group contained 20 vertebra. Group 1 was tested for maximum pressure of the piercer within the vertebrae (F1). Group 2 was tested for maximum pressure of the warning piercer penetrating front cortex of the vertebral body (F2). Group 3 was tested for the maximum pressure of piercer penetrating vertebral body endplate (F3) and pedicle notch (F41, F42). Group 4 was tested for maximum pressure of the piercer penetrating the vertebral lateral cortex (F6), the medial and lateral cortex of pedicle (F51, F52). In the second experiment of this study, 4 normal adult specimens consisting of 40 vertebra and 80 pedicles were used for testing the alarm effects of pedicle piercer. The following indicators were adopted for the tests including true positive/negative, false positive/negative, sensitivity, specificity, availability, Youden index, and diagnostic efficiency. SPSS 16.0 was used for statistical analysis.

Results

There were statistically significant differences between F1, and F2, F3, F41, F42, F51, F52 respectively (P < 0.05). F1 = 8.970 ± 0.2698, F3 = 13.055 ± 0.6718. We found that the threshold value of piercer warning was from 9.6 to 12.3 Kgf. Sensitivity was 92.31%, specificity was 95.12%, usability was 87.45%, Youden index was 87.43% and diagnostic efficiency was 92.5% respectively.

Conclusion

Warning piercer is a safe, simple, sensitive device for detecting pedicle breach during regular pedicle screw placement surgery.

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References

  1. Jalanko T, Helenius I, Remes V, Lamberg T, Tervahartiala P, Yrjönen T, et al. Operative treatment of isthmic spondylolisthesis in children: A longterm, retrospective comparative study with matched cohorts. Eur Spine J 2011;20:766–75.

    Article  Google Scholar 

  2. Crostelli M, Mazza O, Mariani M. Free-hand pedicle screws insertion technique in the treatment of 120 consecutive scoliosis cases operated without use of intraoperative neurophysiological monitoring. Eur Spine J 2012;21 Suppl 1:S43–9.

    Article  Google Scholar 

  3. Fourney DR, Abi-Said D, Lang FF, McCutcheon IE, Gokaslan ZL. Use of pedicle screw fixation in the management of malignant spinal disease: Experience in 100 consecutive procedures. J Neurosurg 2001;94:25–37.

    CAS  PubMed  Google Scholar 

  4. Laine T, Lund T, Ylikoski M, Lohikoski J, Schlenzka D. Accuracy of pedicle screw insertion with and without computer assistance: A randomised controlled clinical study in 100 consecutive patients. Eur Spine J 2000;9:235–40.

    Article  CAS  Google Scholar 

  5. Hicks JM, Singla A, Shen FH, Arlet V. Complications of pedicle screw fixation in scoliosis surgery: A systematic review. Spine (Phila Pa 1976) 2010;35:E465-70.

  6. Merloz P, Tonetti J, Pittet L, Coulomb M, Lavalleé S, Sautot P. Pedicle screw placement using image guided techniques. Clin Orthop Relat Res 1998;354:39–48.

    Article  Google Scholar 

  7. Reichle E, Sellenschloh K, Morlock M, Eggers C. Placement of pedicle screws using different navigation systems. A laboratory trial with 12 spinal preparations. Orthopade 2002;31:368–71.

    Article  CAS  Google Scholar 

  8. Seller K, Urselmann K, Krauspe R. Prospective screw misplacement analysis after conventional and navigation pedicle screw placement. Biomed Technol (Ber l) 2005;9:287–92.

    Article  Google Scholar 

  9. Jutte PC, Castelein RM. Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations. Eur Spine J 2002;11:594–8.

    Article  CAS  Google Scholar 

  10. Katonis P, Christoforakis J, Kontakis G, Aligizakis AC, Papadopoulos C, Sapkas G, et al. Complications and problems related to pedicle screw fixation of the spine. Clin Orthop Relat Res 2003;411:86–94.

    Article  Google Scholar 

  11. Matsuzaki H, Tokuhashi Y, Matsumoto F, Hoshino M, Kiuchi T, Toriyama S. Problems and solutions of pedicle screw plate fixation of lumbar spine. Spine (Phila Pa 1976) 1990;15:1159–65.

    Article  CAS  Google Scholar 

  12. Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976) 2007;32:E111–20.

    Article  Google Scholar 

  13. Ebraheim NA1, Xu R, Ahmad M, Yeasting RA. Projection of the thoracic pedicle and its morphometric analysis. Spine 1997;22:233–38.

    Article  CAS  Google Scholar 

  14. Magerl FP. Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop Relat Res. 1984;10:125–141.

    Google Scholar 

  15. Schizas C, Michel J, Kosmopoulos V, Theumann N. Computer tomography assessment of pedicle screw insertion in percutaneous posterior transpedicular stabilization. Eur Spine J 2007;16:613–7.

    Article  Google Scholar 

  16. Assaker R, Reyns N, Vinchon M, Demondion X, Louis E. Transpedicular screw placement: Image-guided versus lateral-view fluoroscopy: in vitro simulation. Spine (Phila Pa 1976) 2001;26:2160–4.

    Article  CAS  Google Scholar 

  17. Austin MS, Vaccaro AR, Brislin B, Nachwalter R, Hilibrand AS, Albert TJ. Image-guided spine surgery: A cadaver study comparing conventional open laminoforaminotomy and two image-guided techniques for pedicle screw placement in posterolateral fusion and nonfusion models. Spine (Phila Pa 1976) 2002;27:2503–8.

    Article  Google Scholar 

  18. Papadopoulos EC, Girardi FP, Sama A, Sandhu HS, Cammisa FP Jr. Accuracy of single-time, multilevel registration in image-guided spinal surgery. Spine J 2005;5:263–7.

    Article  Google Scholar 

  19. Schwarzenbach O, Berlemann U, Jost B, Visarius H, Arm E, Langlotz F, et al. Accuracy of computer-assisted pedicle screw placement. An in vivo computed tomography analysis. Spine (Phila Pa 1976) 1997;22:452–8.

    Article  CAS  Google Scholar 

  20. Hart RA, Hansen BL, Shea M, Hsu F, Anderson GJ. Pedicle screw placement in the thoracic spine: A comparison of image-guided and manual techniques in cadavers. Spine (Phila Pa 1976) 2005;30:E326–31.

    Article  Google Scholar 

  21. Bolger C, Kelleher MO, McEvoy L, Brayda-Bruno M, Kaelin A, Lazennec JY, et al. Electrical conductivity measurement: A new technique to detect iatrogenic initial pedicle perforation. Eur Spine J 2007;16:1919–24.

    Article  Google Scholar 

  22. Kantelhardt SR, Bock CH, Larsen J, Bockermann V, Schillinger W, Rohde V, et al. Intraosseous ultrasound in the placement of pedicle screws in the lumbar spine. Spine (Phila Pa 1976) 2009;15;34:400–7.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, The 175th Hospital of PLA, Traumatic Orthopaedics Center of PLA, Southeast Hospital of Xiamen University, Zhangzhou, Fujian Province, PR China

    Lin Bin, He Yong, Xu Yang, Zhang Bi, Sha Mo & Guo Zhi-Min

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  1. Lin Bin
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  2. He Yong
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  3. Xu Yang
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  4. Zhang Bi
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  5. Sha Mo
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  6. Guo Zhi-Min
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Correspondence to Lin Bin.

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Bin, L., Yong, H., Yang, X. et al. Pedicle screw piercer with warning device - A technique to increase accuracy of pedicle screw placement. IJOO 48, 545–549 (2014). https://doi.org/10.4103/0019-5413.144205

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  • DOI: https://doi.org/10.4103/0019-5413.144205

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