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Introduction: Lumbar vertebral column is exposed to various kinds of stress during locomotion. In erect posture weight transmitted through posterior part including pedicles. This causes deformities of this region as the age advances in many individuals. Proper correction of deformity is challenging. There have been advances in spinal fusion procedures and interspinous implantation of devices including pedicle screws. Use of unsuitable dimensions of screw may cause problem of destruction of pedicle. Correct metricular data of pedicle is necessary for choice of appropriate screw size. Aims and Objectives: 1) To measure the various dimensions in Indian adult human lumbar vertebral pedicles. 2) To prepare data of lumbar pedicles useful in various surgical procedures. Material and Methods: A Cross-sectional study was done on 45 dry, fully ossified human lumbar vertebral sets. The bones were grouped into typical (L1 to L4) and atypical (L5) lumbar vertebrae. The dimensions measured included pedicle length, height, thickness, axial length, transverse and sagittal angles. ‘Digital Vernier Caliper’ and Protractor were used. The data was analyzed statistically. Results: The mean length, height and thickness of typical vertebral pedicles increases gradually. In atypical (L5), pedicle thickness suddenly increases. The transverse angle of pedicle elevated gradually from L1 to L4 but at L5, it abruptly increased. Conclusions: The study reported significant differences in several dimensions of pedicles of typical as well as atypical lumbar vertebrae. These differences should be considered by neurosurgeons.
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Objective To evaluate the accuracy and safety of pedicle screw placement for spinal deformity under intraoperative CT-as-sisted.Methods The clinical data of 28 patients with spinal deformity,who underwent intraoperative CT-assisted placement of pedicle screws in our hospital from March 2014 to March 2017,were analyzed retrospectively.Intraoperative CT-assisted placement of pedicle screws was to observe the position of pedicle screws and adjust the screw position.The safety of pedicle screw fixation was assessed by the postoperative complications.Results All 28 patients of scoliosis were successfully performed surgery.A total of 402 pedicle screws were placed in the spines and the placements of 64 screws of them were adjusted according to intraoperative CT findings.Of 402 screws,377 were placed in the pedicles,13 by grade 1 pedicle breach,8 by grade 2 pedicle breach and 4 by grade 3 pedicle breach according to Gertzbein-Robbins classifi-cation of pedicle screw placement accuracy.No complication was directly related to the screws placement.No patient required reoperation due to the misplacement of the pedicle screws.Conclusion Intraoperative cone-beam CT scan can help the surgeon improve the accuracy and safety of pedicle screw placement for spinal deformity with less complication.
ABSTRACT
Pedicle screw fixation is widely applied to spinal surgery owing to its advantages of maitaining the stability of spine,promoting the bone graft fusing and so on. Remarkably implantation accu-racy is not only closely related to ultimate fixation,but also can affect the incidence and the severity of complications. Consequently,to improve screw implantation accuracy is one of the goals that spinal sur-geons always pursue. In recent years,newly-developed techniques have been preliminarily used in clinic. An overview on the progresses of these techniques in China and overseas is presented here.
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Since the instability of the spine caused by trauma,tumor,tuberculosis,deformity cor-rection and other reasons requires reconstruction,many scholars have conducted a large number of thorough researches,but the treatment options for unstable cervical spine still plague the clinicians.Considering the factors of stability and safety,more and more clinicians choose cervical pedicle screw placement as the treatment for spinal instability.In this work,the most common methods and the latest technologies of cervi-cal pedicle screw placement at home and abroad are summarized and reviewed.It provides references for clinical practices and presents the significance of high-tech assisted screw placement in the future.
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Objective To study the pedicle of lumbosacral developmental patterns and aging characteristics by means of studying the ado-lescents aging from 12~18 years old,and provide the basis for image and three-dimensional analysis of the treatment of spinal diseases. Meth-ods Select the 30 normal spines of adolescents without any the problems of nervous system,who did thin spiral CT scan of lumbosacral verte-brae. The original data in the form of DICOM were put into three-dimensional software to do the relevant measurement and analyzed according to gender and age. Results There were no significant differences between the pedicle of lumbosacral E/F angle and DSP /DNP and these differ-ences were not influenced by age and gender(P>0. 05). The physical development of human increases gradually with age and has some signifi-cant differences. Conclusion A regular change process and operation in the region value in patients with lumbarsacrum is displayed. But it must be combined with the results of individual imagine and the technology of reverse engineering and the support of rapid prototype manufactur-ing. Only in this way can it meet the satisfaction of individualized treatment.
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Objective To investigate the injury posterior vertebral pedicle nail fixed treatment of thoracolumbar fractures of the clinical efficacy and safety .Methods Forty-eight cases of thoracolumbar fractures were treated by the posterior vertebral pedicle screw fixation ,according to cases decompressive laminectomy ,underwent intertransverse fusion treatment .Postoperative follow-up of 1 year ,preoperative ,postoperative 3 months ,after 1 years of vertebral compression rate ,Cobb Angle were compared .Results Forty-eight patients with postoperative 3 months and 1 year after injury postoperative spinal vertebral body compression rate were significantly decreased compared with preoperative (P<0 .05);After 3 months and 1 year after the Cobb Angle were markedly sig-nificant reduction than preoperative(P<0 .05) .X-ray showed all fractures were obtained good reduction ,internal fixation with no looseness or breakage ,no protruding after spinal deformity ,neural function were all in 1 -3 level recovery .Conclusion Posterior vertebral pedicle injury by nail fixed treatment of thoracolumbar fractures with fixed reliable ,reset effect is good .
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Objective To discuss the surgical treatment of spinal injury, and provide insights on key points and related issues for operations. Methods Two hundred and five cases of spinal fracture were treated through posterior surgical treatment. Under C-arm X-ray monitoring, surgeries had been operated on pedicle screws insertion, vertebral canal decompression, over-extending reduction position, and placed the connecting rod, knocked in the bone graft and finally transplanted the paraspinal bone. Results After operations , the height and morphology of vertebral bodies and spinal physiological curvature were basically recovered analyzed by X ray examination. The follow-up results (in the average of 14 to 36 months) indicated that there were 4 cases of delayed infection, 7 cases of loosen screw, 6 cases of broken screw (14 screws)and 1 case of broken stick, with no secondary nerve injury or other syndromes. Conclusion The vertebral pedicle screw internal fixation manipulated easily, which could sufficiently enlarge vertebral canal in order to decompression. In addition, during the operation, together with over-extending reduction position is beneficial to regain the height of fractured vertebral bodies.
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When the patients with senile or secondary osteoporosis are treated with screw fixation, the screws are likely to get loose or pulled out. Polymethylmethacrylate (PMMA) can enhance screw fixation strength to some extent in clinic, but PMMA has such disadvantages as irresorbability, polymeric heating effect and toxic reaction so that its clinical application is limited. Calcium phosphate cement, however, has drawn much attention because it gets rid of the shortcomings of PMMA. This article introduces recent progress made in research on fixation with calcium phosphate cement enhancing screw.
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Objective To evaluate the clinical efficacy of vertebroplasty using vertebral pedicle screw technique combined with calcium sulfate cement injection in the treatment of thoracolumbar vertebrae fractures.Methods Twenty-eight patients with thoracolumbar vertebrae fractures admitted in our department in recent 2 years were enrolled in this study,including 21 cases of type A,3 cases of type B,and 4 cases of type C.All patients were fixed with vertebral pedicle screw,and then verteplasty was performed using calcium sulfate cement injection.Results All patients were followed up for an average time of 16 months.Within the follow-up,there was no complication noted,such as loosening or breakage of internal fixation,chronical lumbar back pain,and loss of effected vertebral height.Artificial bones injected into vertebrae were absorbed in about 3 months.Conclusion Vertebroplasty using vertebral pedicle screw technique combined with calcium sulfate cement injection is an effective and safe procedure for thoracolumbar vertebrae fractures,which renders it possible to bear weight early and to maintain corrected vertebral height postoperatively.
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Objective To study the clinical effect of pedicle screw fixation in treatment of unstable upper and middle thoracic vertebrae fractures. Methods A retrospective study was performed on 17 cases of unstable upper and middle thoracic vertebrae fractures treated with vertebral pedicle screw system (GSS 全称in 11 cases and USS 全称in six) fixation, posterolateral bone grafting and fusion from March 2001 on. There were one case of T_3, two T_4, two T_5, four T_6, six T_7 and two T_8. Of all, nine cases were with compression fractures, five with fracture-dislocation and three with burst fractures. Results All cases were followed up for 10-38 months (average 21.1 months). During the follow up, the anterior vertebral body height was restored from preoperative 40% to postoperative 91%. Except for four screw malpositions, there was no postoperative neurologic deterioration, screw loose or breakage of the internal fixation, or loss of the normal spine curve and the spinal height of the injured vertebra. Conclusions Pedicle screw fixation is an effective way for treating unstable upper and middle thoracic vertebrae fractures. Correct placement depend on a comprehensive familiarity of pedicle anatomy, appropriate pedicle diameter and entry point and depth can avoid potential risks in placing pedicle screws into the upper and middle thorax.
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Objective To explore the efficacy of computer-assisted fluoroscopic navigation to guide the treatment of thoracolumbar burst fractures. Methods 18 patients with thoracolumbar unstable fractures were treated with short-segment vertebral pedicle screw fixation guided by computer-assisted fluoroscopic navigation, and fractures were reinforced with CPC cement vertebroplasty. Postimplantatively, the implants' images-error between virtual image of fluoroscopy and X-ray image was measured. Results The implant's location was excellent. All patients were allowed sitting-up or bearing body weight one week after operation. The vertebral height restored 40% postoperatively. 12 months after operation the vertebral height only changed 0.15%. Dynamic X-ray films showed no abnormal segment instability and no instrument breaking. Conclusion Using computer-assisted fluoroscopic navigation to guide the treatment of thoracolumbar burst fractures with CPC vertebroplasty and short-segment pedicle srew fixation could determine the internal fixation approach and let implants to the precise position by one time of X-ray image. It increases the security of pedicle screw fixation and vertebroplasty.