Radicular symptoms associated with extrapedicular screw placement / Sintomas radiculares associados com a colocação extrapedicular de parafusos / Síntomas radiculares asociados a la colocación de tornillos extrapediculares

ABSTRACT Objective: Transpedicular fixation has rapidly evolved over the last 100 years. A common complication is screw misplacement which can lead to neurological deficits, vascular damage, or organ perforation. We intend to assess the correlation between screw misplacement and radicular symptoms through the Gertzbein scale. Methods: We conducted an observational longitudinal retrospective study on patients who underwent free-hand lumbar instrumentation surgery with fluoroscopy assistance. The patients were evaluated with postoperative CT scans, and screw positions were classified with the Gertzbein scale. Results: The initial sample included 99 patients who underwent surgery. Of the 317 screws placed, 201 did not show cortical damage, 105 screws exhibited variable invasion, and 11 screws displayed severe invasion. 96.5% screws were placed in the safe zone, with 8.6% of patients (n=5.0) exhibiting transitory weakness. 3.47% of screws (n=11) with severe invasion were seen in 7 patients of which two patients suffered from motor deficient and persistent radicular pain. Conclusion: It is of the utmost importance to pay attention to the precise insertion of the screws to minimize the risk of radicular manifestations. We recommend performing control CT scans after the procedure to ensure the correct insertion of the screws, and in case of finding a screw in a no-safe zone or Getsbein 3 position, considering screw repositioning due to high-risk neurologic damage is highly encouraged. Level of Evidence II; Observational Retrospective Study.

Resumo: Objetivo: A fixação transpedicular evoluiu rapidamente nos últimos 100 anos, porém o deslocamento do parafuso é uma complicação comum que pode resultar em déficits neurológicos ou danos vasculares. Pretendemos correlacionar o deslocamento do parafuso com sintomas radiculares usando a escala de Gertzbein. Métodos: Conduzimos um estudo retrospectivo longitudinal observacional em pacientes submetidos à cirurgia de instrumentação lombar à mão livre com assistência de fluoroscopia. Os pacientes foram avaliados com tomografia computadorizada pós-operatória e as posições dos parafusos foram classificadas com a escala de Gertzbein. Resultados: A amostra inicial incluiu 99 pacientes. Dos 317 parafusos colocados, 201 não mostraram danos corticais, 105 exibiram invasão variável e 11 invasão severa. 96,5% dos parafusos foram colocados na zona segura, com 8,6% dos pacientes apresentando fraqueza transitório. 3,47% dos parafusos com invasão severa foram observados em 7 pacientes, dos quais 2 sofreram de deficiência motora e dor radicular persistente. Conclusão: É crucial prestar atenção à inserção precisa dos parafusos para minimizar o risco de manifestações radiculares. Recomendamos tomografias de controle para garantir a correta inserção dos parafusos e, se necessário, reposicionamento devido ao alto risco de dano neurológico. Nível de Evidência II; Estudo Observacional Retrospectivo.

Resumen: Objetivo: La fijación transpedicular ha evolucionado en los últimos 100 años. Una complicación común es el desplazamiento de tornillos, causante de déficits neurológicos o daños vasculares. Buscamos correlacionar el desplazamiento con síntomas radiculares mediante la escala de Gertzbein. Métodos: Se realizó un estudio observacional longitudinal retrospectivo de pacientes sometidos a cirugía de instrumentación lumbar a mano alzada asistida por fluoroscopia. Los pacientes fueron evaluados con tomografía computarizada postoperatoria y las posiciones de los tornillos se clasificaron con la escala de Gertzbein. Resultados: La muestra inicial incluyó 99 pacientes. De los 317 tornillos colocados, 201 no mostraron daño cortical, 105 mostraron invasión variable y 11 mostraron invasión severa. El 96,5% de los tornillos se colocaron en la zona segura, y el 8,6% de los pacientes mostraron debilidad transitoria. Se observó un 3,47% de tornillos con invasión grave en 7 pacientes, 2 de los cuales sufrieron discapacidad motora y dolor radicular persistente. Conclusión: Es crucial prestar atención a la inserción precisa de los tornillos para minimizar el riesgo de manifestaciones radiculares. Recomendamos la realización de tomografias de control para asegurar la correcta inserción de los tornillos y, en caso necesario, su recolocación debido al elevado riesgo de daño neurológico. Nivel de Evidencia II; Estudio Observacional Retrospectivo.

Morphometrics of T11-L5 Vertebrae in Jordanian Population: CT Scan-Based Study / Morfometría de las Vértebras T11-L5 en una Población Jordana: Estudio Basado en Tomografía Computarizada

SUMMARY: The study will provide information on the morphometrics of the vertebrae, which can be used to guide clinicians on the appropriate size of transpedicular screws to use in spine interventions among the Jordanian population and for comparative studies with other races. A retrospective analysis of normal CT scans of the lumbar and thoracolumbar areas was done. Linear and angular measurements of 336 vertebrae were collected for 25 males and 23 females. The results were compared between right and left and between both sexes. The L5 has the longest AVBH and the shortest PVBH in both sexes, it also, had the shortest and widest pedicle in both males and females. ratio of the AVBH to PVBH showed progressive increase in both sexes from T11 to L5. Similarly, the VBW increased progressively from the top to the bottom in both sexes, but it was significantly different between both sexes. The L1 was the most cranially oriented vertebrae in males while the L2 showed the most cranial orientation in females. Both sexes L5 was the most caudally oriented vertebrae. This study provides a database for vertebral morphometrics in the Jordanian population, there are slight differences between the right and left side in the upper studied vertebrae (T11-L2) and some measurement showed significant differences between males and females. These findings need to be taken into consideration when inserting pedicle screws.

Este estudio proporciona información sobre la morfometría de las vértebras, la cual puede ser utilizada por los médicos oara determinar el tamaño adecuado de los tornillos transpediculares a utilizar en intervenciones de columna en la población jordana y para estudios comparativos con otras grupos. Se realizó un análisis retrospectivo de tomografías computarizadas normales de las áreas lumbar y toracolumbar. Se recogieron medidas lineales y angulares de 336 vértebras de 25 hombres y 23 mujeres. Los resultados se compararon entre vértebras derechas e izquierdas y entre ambos sexos. La L5 tiene el AVBH más largo y el PVBH más corto en ambos sexos, también tenía el pedículo más corto y más ancho tanto en hombres como en mujeres. La relación de AVBH a PVBH mostró un aumento progresivo en ambos sexos de T11 a L5. De manera similar, el VBW aumentó progresivamente de arriba hacia abajo en ambos sexos, pero fue significativamente diferente entre ambos sexos. La L1 fue la vértebra más orientada cranealmente en los hombres, mientras que la L2 mostró la orientación más craneal en las mujeres. En ambos sexos L5 fue la vértebra más orientada caudalmente. Este estudio proporciona una base de datos para la morfometría vertebral en la población jordana, donde existen ligeras diferencias entre el lado derecho e izquierdo en las vértebras superiores estudiadas (T11-L2). Algunas mediciones mostraron diferencias significativas entre hombres y mujeres. Estos hallazgos deben tenerse en cuenta al insertar tornillos pediculares.

Pedículo Renal: Análisis de sus Variantes / Renal Pedicle: Analysis of their Variants

Testut & Latarjet (1980), Bouchet & Cuilleret (1986), Latarjet & Liard (2005) y Rouvière & Delmas (2005) describen las relaciones intrínsecas del pedículo renal (PR) a partir de dos planos coronales, siendo la PER el elemento que limita entre ambos. Trivedi et al. (2011) demostró relaciones entre los elementos del PR que no coinciden con las descripciones aportadas por dichos autores.Conocer las posibles variantes en las relaciones intrínsecas del PR es de suma importancia en prácticas quirúrgicas como el trasplante renal (García de Jalón Martínez et al., 2003; Batista Hernández et al., 2010). Por lo tanto, el objetivo del presente trabajo fue analizar las variables relaciones entre los elementos que conforman el PR en la región yuxtahiliar del riñón. Se estudiaron 23 PR, formolizados al 10 % y provistos por el Equipo de Disección de la Segunda Cátedra de Anatomía de la Universidad de Buenos Aires. Se clasificaron los PR en dos grupos. En el Grupo I, las afluentes de origen de la vena renal (AOVR) se hallaban en el mismo plano coronal. En el grupo II, las AOVR se encontraban en diferentes planos coronales. Cada grupo fue subdividido en distintos patrones. Los patrones I y II, de mayor incidencia, fueron asociados al grupo I y los patrones III, IV y V al grupo II. En el patrón I, las AOVR eran anteriores a la pelvis renal (PER) y posteriores a la arteria prepiélica (APP). En el patrón II, las AOVR eran anteriores a la PER y a la APP. Los patrones I y II conforman el grupo I y presentaron mayor número de incidencia en nuestra investigación. Existen también variantes que inciden con menor frecuencia que dichos patrones, estas comprenden el grupo II de la clasificación planteada en el presente trabajo.

SUMMARY: Testut & Latarjet (1980), Bouchet & Cuilleret (1986), Latarjet & Liard (2005) y Rouvière & Delmas (2005) describe the intrinsic relationships of the renal pedicle (PR) from two coronal planes, the renal pelvis (PER) being the element that limits between both. Trivedi et al. (2011) showed relationships between the elements of the RP that do not coincide with the descriptions provided by these authors. Knowing the possible variants in the intrinsic relationships of the RP is of the utmost importance in surgical practices such as renal transplantation (García de Jalón Martínez et al., 2003). Therefore, the objective of this study is to analyze the variable relationships between the elements that make up the RP in the juxtahilar region of the kidney. 23 RP were studied, formalized at 10 % and provided by the Dissection Team of the Second Chair of Anatomy of the University of Buenos Aires. PRs were classified into two groups. In Group I, the tributaries of origin of the renal vein (RVOA) were in the same coronal plane. In group II, the AOVRs were in different coronal planes. Each group was subdivided into different patterns. Patterns I and II, with the highest incidence, were associated with group I and patterns III, IV and V with group II. In pattern I, the VROA were anterior to the renal pelvis (PER) and posterior to the prepelvic artery (PPA). In pattern II, AOVRs were prior to PER and APP. Patterns I and II make up group I and presented a higher number of incidence in our investigation. There are also variants that occur less frequently than these patterns, these comprise group II of the classification proposed in this work.

Morphometric study and anatomical variation with its incidence of foramina transversaria on the lower cervical vertebrae / Estudio morfométrico y variación anatómica con la incidencia de forámenes transversos en las vértebras cervicales inferiores

SUMMARY: Anatomical variation of the foramina transversaria (FT) is associated with vertebral neurovascular symptoms and can cause complications after lower spine surgery, especially cervical pedicle screw (CPS) insertion. FT variation has been documented and classified in various populations, as this information can help increase cervical stability in subaxial vertebral surgery. Although the morphometry of the upper cervical spine in Thai populations has been reported, there have yet been no studies examining the features of FT. The FT of dried cervical spines (C3-C7; left and right side; n = 107, male = 53 and female = 54) were examined for morphological variation, and their anteroposterior (AP) and transverse (T) diameters were measured using a digital vernier caliper. Morphometric data and variations were compared by sex and lateral side. It was that the C3-C6 FT in both sexes were round, and the C7 FT was elliptical with an oblique right side. FT diameters did not differ significantly by sex except for the AP diameters of C6-C7 and for T diameters of C4 and C7. The left AP diameters of C3-C6 were significantly longer than the right, as were the T diameters of C4 and C7 FT. Additionally, T diameter was significantly longer than that of the AP, except that of the left C6 in male spines, which did not differ from the AP. Most FT examined were round. These findings should be considered in the provisional diagnosis of vertebral neurovascular symptoms caused by FT variation as well as that of neurovascular damage after cervical pedicle screw placement.

La variación anatómica del foramen transverso (FT) se asocia con síntomas neurovasculares vertebrales y puede causar complicaciones después de la cirugía de columna cervical inferior, especialmente la inserción de tornillos pediculares cervicales (TPC). La variación del FT se ha documentado y clasificado en varias poblaciones, ya que esta información puede ayudar a aumentar la estabilidad cervical en la cirugía vertebral subaxial. Aunque se ha informado sobre la morfometría de la columna cervical superior en poblaciones tailandesas, aún no se han realizado estudios que examinen las características de FT. Se examinó la variación morfológica del FT de vértebras cervicales secas (C3-C7; lado izquierdo y derecho; n = 107, hombres = 53 y mujeres = 54), y se midieron sus diámetros anteroposterior (AP) y transverso (T) usando un pie de metro digital. Se compararon datos morfométricos y variaciones por sexo y lado. Los FT de C3-a C6 en ambos sexos eran redondos, y el FT C7 era elíptico con el lado derecho oblicuo. Los diámetros del FT no difirieron significativamente por sexo excepto para los diámetros AP de C6- C7 y para los diámetros transversos de C4 y C7. Los diámetros AP izquierdos de C3-C6 eran significativamente más largos que los del lado derecho, al igual que los diámetros transversos de C4 y C7. Además, el diámetro transverso fue significativamente mayor que el AP, excepto el C6 izquierdo en las vértebras de hombres, que no difirió del AP. La mayoría de los FT examinados eran redondos. Estos hallazgos deben ser considerados en el diagnóstico provisional de síntomas neurovasculares vertebrales causados por la variación del FT, así como en el de daño neurovascular tras la colocación de tornillos pediculares cervicales.

Analysis of the clinical effect of percutaneous pedicle screw fixation combined with transpedicular bone grafting in the treatment of thoracolumbar fracture / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy of percutaneous screw fixation combined with minimally invasive transpedicular bone grafting and non-bone grafting in the treatment of thoracolumbar fractures.@*METHODS@#From Janury 2021 to June 2022, 40 patients with thoracolumbar fracture were divided into the experimental group and the control group. There were 26 patients in the experimental group, including 21 males and 5 females with an aberage age of (47.3±12.3) years old, who underwent percutaneous pedicle screw fixation combined with transpedicular autogenous bone grafting. In the control group, 14 patients received percutaneous pedicle screw fixation only. including 7 makes and 7 females with an average age of (50.2±11.2) years old. The operative time, intraoperative blood loss, anterior height ratio of injured vertebrae, Cobb angle, visual analogue score (VAS), MacNab scores, loosening or broken of the implants. were compared and analyzed.@*RESULTS@#There was no significant difference in operation time, intraoperative blood loss, VAS and anterior height ratio of injured vertebrae between the two groups. Compared with the preoperative results, VAS and anterior height ratio of injured vertebrae were improved statistically(P<0.05). For Cobb angle of injured vertebra, there was no significant difference between the two groups before surgery (P=0.766). While at 1 week, 3 months and 12 months after surgery, there were statistically differences between the two groups (P values were 0.042, 0.007 and 0.039, respectively). The Cobb angle of injured vertebrae one year after operation was statistically decreased in both groups compared with that before surgery (P<0.001). One year after surgery, the excellent and good rate of Macnab scores was 96.15% in the experimental group and 92.86% in the control group, and there was no statistical differences between the two groups (P=0.648). There was one patient in the control group suffering superficial wound infection on the third day, which was cured by dressing change and anti-infection treatment. There were no postoperative screw loosening and broken in both groups.@*CONCLUSION@#The two surgical methods have the advantages of less trauma, less pain and quicker recovery, which can restore the height of the injured vertebra, reconstruct the spinal sequence and reduce the fracture of the vertebral body. Transpedicular autogenous bone grafting can increase the stability of the fractured vertebra and maintain the height of the vertebra better after surgery, thus reducing the possibility of complications such as kyphosis, screw loosening and broken.

Clinical application of percutaneous pedicle screw placement guided by ultrasound volume navigation combined with X-ray fluoroscopy: a prospective randomized controlled study / 中国修复重建外科杂志

OBJECTIVE@#To explore the feasibility and accuracy of ultrasound volume navigation (UVN) combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation through a prospective randomized controlled study.@*METHODS@#Patients with thoracic and lumbar vertebral fractures scheduled for percutaneous pedicle screw fixation between January 2022 and January 2023 were enrolled. Among them, 60 patients met the selection criteria and were included in the study. There were 28 males and 32 females, with an average age of 49.5 years (range, 29-60 years). The cause of injury included 20 cases of traffic accidents, 21 cases of falls, 17 cases of slips, and 2 cases of heavy object impact. The interval from injury to hospital admission ranged from 1 to 5 days (mean, 1.57 days). The fracture located at T 12 in 15 cases, L 1 in 20 cases, L 2 in 19 cases, and L 3 in 6 cases. The study used each patient as their own control, randomly guiding pedicle screw implantation using UVN combined with X-ray fluoroscopy on one side of the vertebral body and the adjacent segment (trial group), while the other side was implanted under X-ray fluoroscopy (control group). A total of 4 screws and 2 rods were implanted in each patient. The implantation time and fluoroscopy frequency during implantation of each screw, angle deviation and distance deviation between actual and preoperative planned trajectory by imaging examination, and the occurrence of zygapophysial joint invasion were recorded.@*RESULTS@#In terms of screw implantation time, fluoroscopy frequency, angle deviation, distance deviation, and incidence of zygapophysial joint invasion, the trial group showed superior results compared to the control group, and the differences were significant ( P<0.05).@*CONCLUSION@#UVN combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation can yreduce screw implantation time, adjust dynamically, reduce operational difficulty, and reduce radiation damage.

Percutaneous pedicle screw fixation combined expandable tubular retractor in the treatment of spinal metastases / 北京大学学报(医学版)

OBJECTIVE@#To investigate the effectiveness of percutaneous pedicle screw fixation combined expandable tubular retractor in the treatment of patients with spinal metastases.@*METHODS@#In the study, 12 patients of spinal metastases treated with percutaneous pedicle screw fixation combined expandable tubular retractor in our hospital were retrospectively reviewed between June 2017 and October 2019. Among the 12 patients, 9 were males and 3 were females; the median age was 62.5 years [(65.1±2.9) years]. The decompression segment of 7 patients was located at the lower thoracic spine (including 1 patient with incomplete paraplegia) and the decompression segment of 5 patients was located at the lumbar spine; Tomita score was 6.0±0.6. Perioperative data of the patients were reviewed. Visual analog scale (VAS score), Karnofsky score, and Eastern Cooperative Oncology Group (ECOG) score were compared before and after surgery. The patient's survival, adjuvant treatment, and internal fixation failure were observed in the follow-up period.@*RESULTS@#All the 12 patients had a successful operation with percuta-neous pedicle screw fixation combined expandable tubular retractor. The average operative time, blood loss, and blood transfused of the patients were (247.0±14.6) min, (804.2±222.3) mL and (500.0±100.0) mL, respectively. The average amount of drainage was (240.8±79.3) mL. Drainage tubes were pulled out early postoperative [(3.2±0.3) d], allowing early mobilization. The patients discharged (7.8±0.8) d postoperative. All the patients were followed up for 6-30 months, and the average overall survival time was (13.6±2.4) months. During the follow-up period, 2 patients experienced screw displacement, the internal fixation was stable after conservative treatment and no revision surgery was performed. The VAS of the patients was 7.1±0.2 before surgery, which decreased to 2.3±0.1 and 2.8±0.4 at 3 and 6 months after surgery (P < 0.05). The Karnofsky score of the patients was 59.2±1.9 before surgery, which increased to 75.0±1.9 and 74.2±3.1 at 3 and 6 months after surgery (P < 0.05). The ECOG of the patients was 2.3±0.2 before surgery, which decreased to 1.7±0.1 and 1.7±0.2 at 3 and 6 months after surgery (P < 0.05).@*CONCLUSION@#For selected patients with spinal metastases, minimally invasive surgical treatment of spinal metastases (percutaneous pedicle screw internal fixation combined with expandable tubular retractor) can effectively relieve the clinical symptoms and improve the quality of life, with satisfactory clinical outcome.

Treatment of spinal burst fractures with pedicle screw fixation at high altitude area / 中国骨伤

OBJECTIVE@#According to the characteristics of spinal burst fractures in high-altitude areas and the local medical conditions, to explore the clinical efficacy of short-segment fixation with pedicle screws combined with screw placement in injured vertebrae in the treatment of thoracolumbar burst fractures.@*METHODS@#From August 2018 to December 2021, 12 patients with single-vertebral thoracolumbar burst fractures without neurological symptoms were treated with injured vertebral screw placement technique, including 7 males and 5 females;aged 29 to 54 years old, with an average of(42.50±7.95) years old;6 cases of traffic accident injury, 4 cases of high fall injury, 2 cases of heavy object injury;2 cases of T11, 4 cases of T12, 3 cases of L1, 2 cases of L2, and 1 case of L3. In the operation, screws were first placed in the upper and lower vertebrae of the fracture, pedicle screws were placed in the injured vertebra, and connecting rods were installed, and the fractured vertebral body was reset by positioning and distraction. Visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) scoring were used to evaluate the changes in pain and quality of life of patients, and the kyphotic correction rate and correction loss rate of the injured segment were measured by X-ray.@*RESULTS@#All operations were successful without significant intraoperative complications. All 12 patients were followed up, the duration ranged from 9 to 27 months, with an mean of (17.75±5.79) months. VAS at 3 days after operation was significantly higher than that at admission (t=6.701, P=0.000). There was significant difference in JOA score between 9 months after operation and at admission (t=5.085, P=0.000). Three days after operation, Cobb angle was (4.42±1.16)°, and the correction rate was (82±5)% compared with (25.67±5.71)° at admission. Cobb angle was (5.08±1.24) °at 9 months after operation, with a corrected loss rate of (16±13)%. No loosening or breakage of internal fixation was found.@*CONCLUSION@#Under the high-altitude hypobaric and hypoxic environment, the effect of the operation should be ensured while reducing the trauma. The application of the technique of placing screws on the injured vertebra can effectively restore and maintain the height of the injured vertebra, with less bleeding and shorter fixed segments, which is an effective method.

Lumbar arthrodesis in lateral single position: concepts, rational and clinical-functional results of 100 consecutive cases / Artrodese lombar em decúbito lateral único: conceitos, justificativas e resultados clínico-funcionais de 100 casos consecutivos / Artrodesis lumbar en posición lateral única: conceptos, justificaciones y resultados clínico-funcionales de 100 casos consecutivos

ABSTRACT Objective: Arthrodesis techniques such as anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) aim to reestablish physiological lordosis and minimize tissue damage to the paravertebral musculature. Supplementation with percutaneous pedicle screws is indicated in most cases, therefore, intraoperative changes in decubitus are necessary, generating costs and risks for the patient. This study aims to present concepts and results of a series of 100 cases of patients undergoing 360° fusion in lateral single position surgery (LSPS). Methods: retrospective analysis of databases collected between 2016 and 2021. Patients who underwent 360° fusion of the lumbar spine in single lateral decubitus to treat degenerative and infectious diseases were included. Cases with arthrodesis greater than 3 levels were excluded. Data collected include demographics, body mass index (BMI) and scores such as visual analog scale (VAS), EuroQOL 5D (EQ5D) and Oswestry disability index (ODI). Results: 100 patients were included in the study, submitted to LLIF and/or ALIF associated with percutaneous pedicle fixation. The lumbar VAS improved from 6.75 to 2.1 after 12 months, while the sciatica VAS started from 4.55 and reached 0.81 after one year. The EQ5D improved from 66.1 to 81.6 after the first year, while the ODI ranged from 28.54 to 14.18 in the same period. Conclusions: the clinical-functional results of the LSPS procedures are favorable and place the LSPS as an option to be studied, developed and practiced by spine surgery teams. Level of evidence: IV. Case series.

Resumo: Objetivo: Técnicas de artrodese como anterior lumbar interbody fusion (ALIF) e lateral lumbar interbody fusion (LLIF) tem como objetivos o reestabelecimento da lordose fisiológica e a mínima lesão tecidual da musculatura paravertebral. A suplementação com parafusos pediculares por via percutânea é indicada na maioria dos casos, sendo, portanto, necessárias mudanças de decúbito intraoperatórias, gerando custos e riscos para o paciente. Este estudo tem como objetivo apresentar conceitos e resultados de uma série de 100 casos de pacientes submetidos a fusão 360° em lateral single position surgery (LSPS). Métodos: análise retrospectiva de banco de dados coletados entre 2016 e 2021. Foram incluídos pacientes submetidos a fusão 360° da coluna lombar em decúbito lateral único para tratamento doenças degenerativas e infecciosas. Foram excluídos casos com artrodeses maiores que 3 níveis. Os dados coletados incluem demografia, índice de massa corpórea (IMC) e scores como visual analog scale (VAS), EuroQOL 5D (EQ5D) e Oswestry disability index (ODI). Resultados: 100 pacientes foram incluídos no estudo, submetidos a LLIF e/ ou ALIF associados a fixação pedicular percutânea. O VAS lombar apresentou melhora de 6,75 para 2,1 após 12 meses, já o VAS ciatalgia partiu de 4,55 e atingiu 0,81 após um ano. O EQ5D apresentou melhora de 66,1 para 81,6 após o primeiro ano, enquanto o ODI variou de 28,54 para 14,18 no mesmo período. Conclusões: os resultados clínico-funcionais dos procedimentos em LSPS se mostram favoráveis e a colocam o LSPS como uma opção a ser estudada, desenvolvida e praticada pelas equipes de cirurgia de coluna. Nível de evidência: IV. Série de casos.

Resumen: Objetivo: Las técnicas de artrodesis como la fusión intersomática lumbar anterior (ALIF) y la fusión intersomática lumbar lateral (LLIF) tienen como objetivo restablecer la lordosis fisiológica. La suplementación con tornillos pediculares percutáneos está indicada en la mayoría de los casos, por lo que son necesarios cambios en decúbito intraoperatorios, generando costos y riesgos para el paciente. Este estudio tiene como objetivo presentar conceptos y resultados de una serie de 100 casos de pacientes sometidos a fusión de 360° en cirugía de posición única lateral (LSPS). Métodos: análisis retrospectivo de bases de datos recolectadas entre 2016 y 2021. Se incluyeron pacientes que se sometieron a fusión de columna lumbar 360° en decúbito lateral y se excluyeron los casos con artrodesis mayores de 3 niveles. Los datos recopilados incluyen datos demográficos, índice de masa corporal (IMC) y puntajes como la escala analógica visual (VAS), EuroQOL 5D (EQ5D) y el índice de discapacidad de Oswestry (ODI). Resultados: 100 pacientes fueron incluidos en el estudio, sometidos a LLIF y/o ALIF asociados a fijación pedicular percutánea. La EVA lumbar mejoró de 6,75 a 2,1 a los 12 meses, mientras que la EVA de ciática partió de 4,55 y llegó a 0,81 al año. El EQ5D mejoró 66,1 a 81,6 después del primer año, mientras que el ODI varió 28,54 a 14,18 en el mismo período. Conclusiones: los resultados clínico-funcionales de los procedimientos de LSPS son favorables y a sitúan como una opción a ser estudiada, desarrollada y practicada por los equipos de cirugía de columna. Nivel de evidencia: IV. Series de casos.

Treatment of thoracolumbar fractures by closed reduction via a percutaneous solid pedicle screw / Tratamento de fraturas toracolombares por redução fechada com parafuso de pedículo percutâneo

ABSTRACT Objectives: Investigate the effect of closed reduction and per- cutaneous pedicle screw fixation in treating thoracolumbar fractures. Methods: This retrospective study analyzed 12 cases of single-segment thoracolumbar spine fractures without spinal cord and nerve injury at our department from March 2016 to September 2017. Patients were treated with closed reduction, percutaneous reduction, and internal fixation with solid pedicle screws. The operation time, intraoperative blood loss, anterior vertebral body height ratio (AVHR), Cobb angle (CA) of sagittal kyphosis, and VAS of back pain were determined and statistically compared. Results: The average operation time was 147.2 ± 45.6 min, and the average intraoperative bleeding was 67.8 ± 34.2 mL. All fractured vertebrae were completely reduced, their height was restored, and kyphosis was corrected. The average follow-up period was 10.6 ± 2.7 months, with significant improvements seen in the AVHR, CA of sagittal kyphosis, and VAS score (P < 0.01). One case had a broken rod after three months, and another had a postoperative infection. All the patients achieved bony healing. Conclusion: The treatment of thoracolumbar fractures by closed reduction and internal fixation with a percutaneous solid pedicle screw is simple, effective, and economical. Level of Evidence VI; Therapeutic Study, Case Series.

RESUMO Objetivo: Investigar o efeito da redução incruenta e da fixação com parafuso de pedículo percutâneo no tratamento das fraturas toraco- lombares. Métodos: Este estudo retrospectivo analisou 12 casos de fraturas toracolombares com segmento único sem lesão medular ou neural, encontrados no departamento dentro do período de março de 2016 a setembro de 2017. Os pacientes foram tratados com redução fechada e fixação interna com parafusos de pedículo percutâneo. O tempo de operação, a perda sanguínea intra-operatória, a relação da altura do corpo vertebral anterior (AVHR), o ângulo de Cobb (CA) da cifose sagital e a EVA relativa à dor nas costas foram determinados e comparados estatisticamente. Resultados: O tempo médio da operação foi de 147,2±45,6 min, com sangramento intraoperatório médio de 67,8±34,2 mL. Todas as vértebras fraturadas foram com- pletamente reduzidas, suas alturas foram restauradas e a cifose foi corrigida. O período médio de acompanhamento foi de 10,6±2,7 meses, apresentando melhorias significativas observadas no AVHR, CA da cifose sagital e pontuação VAS (P <0,01). Um caso teve uma haste quebrada após 3 meses, e outro paciente apresentou uma infecção pós-operatória. Todos os pacientes alcançaram a recuperação óssea. Conclusão: O tratamento das fraturas toracolombares por redução fechada com fixação interna pelo parafuso de pedículo percutâneo é simples, eficaz e econômico. Nível de Evidência IV; Estudos Terapêuticos, Série de Casos

Kite subcutaneous pedicle flap design in postoperative defect repair of nasal skin cancer based on partition and blood supply / 中华医学美学美容杂志

Objective:To investigate the clinical effect of repairing postoperative nasal skin cancer defect with subcutaneous pedicle flap based on partition and blood supply.Methods:From March 2018 to September 2020, 39 patients with skin cancer (basal cell carcinoma, Bowen′s disease, squamous cell carcinoma and malignant melanoma in situ) were repaired with kites subcutaneous pedicle flap after extensive resection.Results:Thirty-nine patients were treated with parafasal kite flaps, including 44 cases. The donor sites of the flap were nasal tip in 4 cases, bilateral alar in 7 cases, bilateral nasolabial sulcus in 19 cases, bilateral parasinal in 12 cases and interglabellar in 2 cases. There were no serious complications such as necrosis, hematoma or infection. During the follow-up period of 6 to 24 months, 2 patients complained of occasional tingling in the surgical area, 1 complained of occasional pruritus, and 1 patient had local recurrence of squamous cell carcinoma and underwent surgery again. The scar was evaluated 6 months after surgery, and the scores of Vancouver scar scale and visual analogue scale were 2.42±1.04 and 7.83±1.21, respectively. The skin color of the operation area was similar to that of the surrounding skin without obvious local strain deformation.Conclusions:The subcutaneous pedicle flap designed by considering the nasal division and blood supply has a high survival rate, fewer complications and small local appearance deformation, which is worthy of popularization and application.

Replantation of severed midfoot with pedicled perforator flap around ankle for repair traumatic defect: Report of 4 cases / 中华显微外科杂志

Objective:To discuss the pedicled perforator flap around ankle in complicated replantation of severed traumatic midfoot.Methods:From May 2017 to December 2020, a total of 4 patients with severed midfoot combined with severely traumatic soft tissue defects were treated in the Department of Micro-orthopaedics, The Second Affiliated Hospital of Luohe Medical Collage. The patients were all males and aged from 22 to 53 (mean, 44) years old. Two patients had left foot injured and 2 in right foot. Causes of injuries: One patient was injured by strangulation of a corn harvester belt, and 3 were crushed by a heavy steel bar. Three patients had the severed sites at the level of intertarsal joint and 1 at the base of metatarsus. The time from injury to admission was 2.0-5.0(mean, 3.5) hours. The severed feet were replanted by anterograde method. Pedicled perforator flaps around ankle were used to repair the soft tissue defects of feet in emergency surgery or post first-stage surgery. The sizes of the flaps were 7.5 cm×8.0 cm-9.0 cm×19.0 cm. Scheduled follow-ups were arranged at outpatient clinic or by online reviews. Appearance, texture, colour, blood supply and sensory-motor function of the replanted feet and flaps were observed. The function of the foot and ankle was evaluated according to the American Orthopaedic Foot Ankle Association (AOFAS).Results:All 4 patients engaged follow-ups lasted for 13-36(mean, 19.5) months. Three replantations survived after surgery. In the other case, a chronic necrosis of the broken foot was caused by skin necrosis, wound infection, and vascular embolism. And then the necrotic forefoot was released, and the wound was later repaired with a flap based medial supramalleolar branches. A total of 5 flaps in 4 patients survived. All flaps were in good appearance with good texture and colour. All flaps healed primarily, and all skin grafts survived. All of the 4 patients could walked without assistance. Sensation restored to S 3. The patient with a failed replantation had left with a mild claudication. According to AOFAS, 2 patients were in excellent, 1 in good and 1 in fair at the last follow-up. Conclusion:Replantation of severed midfoot with an early application of pedicled perforator flap around ankle for reconstruction of severely traumatic defect is an effective and feasible treatment strategy.

A case report of bilateral chylous hemothorax presenting after laparoscopic renal pedicle lymphatic disconnection / 中华泌尿外科杂志

Laparoscopic renal pedicle lymphatic disconnection is the most effective method for treating chyluria that has failed to respond to conservative management. Chylous hemothorax is a rare clinical occurrence resulting from the anatomic abnormality. This paper reported a case, who was admitted with painless gross hematuria for 1 month and was diagnosed with left chylous hematuria. Laparoscopic left renal pedicle lymphatic disconnection was performed, and bilateral chylous hemothorax occurred after the operation. After conservative treatment such as bilateral closed thoracic drainage and blood transfusion support, the patient recovered well. After 2 months of follow-up, there was no obvious effusion in the bilateral thoracic cavity, and the chylous test of urine fluid was negative.

Axial instrument strategy for atlantoaxial dislocation with complex artery variation / 中华骨科杂志

Objective:To evaluate the axial instrument strategy for atlantoaxial dislocation with complex vertebral artery variation.Methods:A total of 55 patients with atlantoaxial dislocation who underwent surgical treatment from January 2019 to December 2021 were retrospectively analyzed, including 14 males and 41 females, aged 54.0±12.8 years (range, 22-78 years). Among these patients, 10 patients with unilateral vertebral artery high ride with contralateral vertebral artery occlusion, 30 patients with bilateral vertebral artery high ride with single dominant vertebral artery, 15 patients with bilateral vertebral artery high ride. All patients underwent posterior reduction and internal fixation. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score were used to evaluate the postoperative efficacy.Results:All patients completed the surgery successfully with a follow-up time of 14.6±5.5 months (range, 6-24 months). C 2 pedicle screw fixation was performed on the non-dominant side of unilateral vertebral artery high ride and the non-dominant side of bilateral vertebral artery high ride with one dominant vertebral artery (40 vertebraes). The dominant side of unilateral high vertebral artery and bilateral high vertebral artery with one dominant vertebral artery was fixed with C 2 medial "in-out-in" screw (10 vertebraes), C 2 isthmus screw (21 vertebraes), C 2 without screw (9 vertebraes) only extended the fixed segment. For bilateral vertebral artery high ride patients, one side was used C 2 "in-out-in" pedicle screws (right 10 vertebraes, left 5 vertebraes), and the other side was fixed with C 2 medial "in-out-in" screw (8 vertebraes), C 2 isthmus screw (5 vertebraes), C 2 without screw only extended the fixed segment (2 vertebraes). The JOA scores were 8.5±1.8, 13.9±1.3, and 14.4±1.1 preoperatively, 6 months postoperatively, and at the final follow-up, respectively, with statistically significant differences ( F=279.40, P<0.001). JOA at 6 months postoperatively and at the final follow-up was greater than preoperatively, and the differences were statistically significant ( P<0.05), whereas the differences in JOA scores at 6 months postoperatively and at the final follow-up was not statistically significant ( P>0.05). Preoperative, 6 months postoperatively and final follow-up cervical VAS scores were 3.7±1.9, 2.1±0.9 and 1.6±1.0, respectively, with statistically significant differences ( F=39.53, P<0.001). The cervical VAS at 6 months postoperatively and at the last follow-up was less than that before surgery, and the differences were statistically significant ( P<0.05). Cervical VAS scores at 6 months postoperatively were greater than at the last follow-up, with a statistically significant difference ( P<0.05). Conclusion:For patients with atlantoaxial dislocation with complex vertebral artery variation, C 2 lateral "in-out-in" screw, C 2 medial "in-out-in" screw, isthmus screw fixation or C 2 without screw only extended the fixed segment can obtain good clinical efficacy.

A brief discussion of Glisson pedic-first approach in laparoscopic anatomical hepatectomy / 中华肝胆外科杂志

With the continuous in-depth understanding of liver anatomy and the progress of surgical techniques, laparoscopic hepatectomy has been developed rapidly, especially the laparoscopic anatomic hepatectomy has become the most commonly surgical method. The dissection and treatment of liver Glisson pedicle is the core techniques of laparoscopic anatomic hepatectomy. The Glisson hepatic pedicle approach has been widely used in open and laparoscopic anatomical hepatectomy, especially in laparoscopic hepatectomy. The possible advantages over the traditional approach are still under debate, and there is no standard surgical approach for pedicle dissection to date. This article introduces Glisson pedicle approach and the advantages and clinical application of laparoscopic anatomical hepatectomy with Glisson pedicle approach.

A clinical study of a novel manual screw placement based on anatomical study of the 7th cervical vertebra / 中华创伤骨科杂志

Objective:To evaluate the feasibility, accuracy, effectiveness and safety of a novel manual placement of cervical 7 pedicle screws via the posterior approach of cervicothoracic junction.Methods:A retrospective case series study was conducted to analyze the 35 patients with injury to the lower cervical spine or cervicothoracic junction who had been treated by a novel manual placement of cervical 7 pedicle screws at Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University from March 2015 to July 2021. There were 16 males and 19 females, with an age of (52.7±13.2) years. The core of this placement was to determine the entry point of cervical 7 pedicle screws. After the intersection of the upper edge of the cervical 7 lamina and the medial edge of the superior articular process was recorded as point A while the intersection of the lateral edge of the inferior articular process and the lower edge of the transverse process as point B, the intersection of the outer and middle 1/3 of the AB line was taken as the screw entry point, with the screw placement angle perpendicular to the lamina line or slightly inclined from 30° to 40° to the head side and outward. The length, diameter and placement angle of the cervical 7 pedicle screws were recorded and compared postoperatively between the left and right sides to explore the feasibility of this novel manual placement. According to the Rampersaud method, the screw positions were graded 1 week and 6 months after operation to evaluate the accuracy of this manual placement. The visual analogue scale (VAS) and the Japanese Orthopaedic Association (JOA) score were compared between preoperation, 1 week and 6 months after operation to evaluate the effectiveness of this placement. The postoperative complications were counted to evaluate the safety of this method. Loosening, displacement and breakage of the screws were observed by CT scanning at 6 months after operation.Results:This case series was followed up for (9.8±1.7) months. There was no significant difference in the length, diameter or placement angle of the screws between the left and right sides ( P>0.05). A total of 66 cervical 7 pedicle screws were placed. There was no change in the screw position grading at 1 week or 6 months after surgery. Grade A was achieved in 64 screws, Grade B in 2 screws, and Grade C or D in none. The VAS scores before operation, 1 week and 6 months after operation were respectively 4.4±1.7, 3.8±1.0 and 1.1±1.1, and the JOA scores respectively 6.7±2.2, 13.2±1.5 and 15.3±1.2. The VAS and JOA scores at 1 week and 6 months after operation were significantly improved compared with the preoperative values ( P<0.05). The improvement rates in JOA at 1 week and 6 months after operation were 62.7%±13.3 % and 83.9%±11.6%, respectively. There were no complications related to the placement of cervical 7 pedicle screws; there was no wound hematoma or infection. No loosening, displacement or breakage of the screws was observed by the 6-month follow-up. Conclusion:The novel manual placement of cervical 7 pedicle screws via the posterior approach of cervicothoracic junction is feasible, accurate, effective and safe.

Percutaneous kyphoplasty through transverse pedicle approach for osteoporotic vertebral compression fractures / 中华创伤骨科杂志

Objective:To investigate the clinical efficacy of percutaneous kyphoplasty (PKP) through the transverse process-pedicle approach (TPPA) by comparing with PKP through the conventional transpedicle approach (CTA).Methods:A retrospective study was conducted to analyze the data of 101 patients with single-segment osteoporotic vertebral compression fracture (OVCF) who had been treated at Department of Spine Surgery, The Fourth Hospital of Wuhan from August 2020 to August 2021. There were 31 males and 70 females, with an age of (70.3±7.6) years. Their T values of bone mineral density averaged (-3.0±0.3). They were divided into a TPPA group of 52 cases in which PKP was performed through the TPPA and a CTA group of 49 cases in which PKP was performed through the CTA. The clinical efficacy was evaluated by comparing the 2 groups in terms of operation time, frequency of intraoperative fluoroscopy, excellent to good rate of bone cement distribution, rate of bone cement leakage, refractures, and visual analogue scale (VAS), Oswestry disability index (ODI) and Beck index at preoperation, 24 hours, 3 months and 6 months postoperation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P>0.05). All the patients were followed up for (9.8±1.5) months. Operations were completed successfully in all patients with no complications like nerve injury or pedicle fracture. There were no significant differences in operation time, frequency of intraoperative fluoroscopy or rate of bone cement leakage between the 2 groups ( P>0.05). In the TPPA group, the excellent to good rate of bone cement distribution [92.3% (48/52)] was significantly higher than that in the CTA group [61.2% (30/49)], the VAS score [3.0 (2.0, 4.0)] and ODI (57.2±4.6) at 24 hours postoperation were significantly lower than those in the CTA group [4.0 (3.0, 4.0) and 59.2±5.3] ( P<0.05). There were no significant differences in VAS or ODI between the 2 groups at preoperation, 3 months or 6 months postoperation ( P>0.05). The VAS and ODI improved steadily within each group, showing significant differences between every 2 time points ( P<0.05). The Beck indexes [0.81 (0.69, 0.86) and 0.76 (0.67, 0.81)] at 24 hours and 6 months postoperation in the TPPA group were significantly higher than those in the CTA group [0.75 (0.71, 0.79) and 0.72 (0.68, 0.77)] ( P<0.05). The Beck indexes at 24 hours and 6 months postoperation improved significantly in all patients compared with the preoperative values ( P<0.05). Conclusions:In the treatment of OVCF with PKP, the TPPA shows the same surgical safety as CTA does, but leads to better cement distribution, better pain relief at immediate postoperation and an advantage in restoring and maintaining the height of the injured vertebral body.

Percutaneous vertebroplasty by percutaneous bi-level bilateral puncture for treatment of type ⅡA acute symptomatic osteoporotic thoracolumbar fractures with dense bone bands / 中华创伤骨科杂志

Objective:To evaluate the efficacy of percutaneous vertebroplasty (PVP) by percutaneous bi-level bilateral puncture in the treatment of type ⅡA acute symptomatic osteoporotic thoracolumbar fracture (ASOTLF) with dense bone bands.Methods:From March 2017 to March 2018, 65 patients (65 vertebrae) with type ⅡA ASOTLF with dense bone bands were treated at Department of Orthopaedic Trauma, Qingdao Central Hospital. They were 25 males and 40 females, with an age of (71.6±8.4) years. The time from injury to operation was (3.5±0.7) d. They were divided into 2 groups according to different treatments. In the observation group of 31 cases (31 vertebrae), PVP was conducted by percutaneous bi-level bilateral puncture; in the control group of 34 cases (34 vertebrae), PVP was conducted by percutaneous single-level bilateral puncture. The 2 groups were compared in terms of operation time, volume of polymethyl methacrylate injected, incidence of bone cement leakage, incidence of vertebral refracture, diffusive distribution of bone cement in the vertebral body, and visual analogue scale (VAS) and Oswestry dysfunction index (ODI) at postoperative 1 day and 6 months.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). Operations were completed uneventfully in all the 65 patients. All the 65 patients were followed up for (8.2±1.2) months. There was no significant difference between the 2 groups in operation time, incidence of bone cement leakage or incidence of vertebral refracture for each vertebral body injured ( P>0.05). The volume of polymethyl methacrylate injected [(6.64±0.93) mL] and the excellent and good rate of diffusive distribution of bone cement in the vertebral body [87.1% (27/31)] in the observation group were significantly larger than those in the control group [(4.36±0.79) mL and 64.7% (22/34)] ( P<0.05). The VAS scores at postoperative 1 day and 6 months [2 (1, 2) and 1 (1, 2)] and ODIs at postoperative 1 day and 6 months (23.7%±1.6% and 18.8%±1.4%) in the observation group were significantly lower than those in the control group [2 (2, 3) and 2 (2, 2); 26.9%±4.2% and 22.1%±3.3%] ( P<0.05). The VAS scores and ODIs at postoperative 1 day and 6 months in all patients were significantly lower than those before operation ( P<0.05). Compression symptoms of the spinal cord and nerve root were observed in none of the patients. Conclusion:In the treatment of type ⅡA ASOTLF with dense bone bands, PVP by percutaneous bi-level bilateral puncture is more effective than the traditional PVP by percutaneous single-level bilateral puncture, and will not increase bone cement leakage or vertebral refracture.

Efficacy of O-arm combined with CT three-dimensional navigation system assisted versus manual screw placement in the treatment of lower cervical fracture and dislocation / 中华创伤杂志

Objective:To compare the clinical efficacies of O-arm combined with CT three-dimensional navigation system assisted screw placement versus manual screw placement in treating lower cervical fracture and dislocation.Methods:A retrospective cohort study was used to analyze the clinical data of 41 patients with lower cervical fracture and dislocation, who were treated in Honghui Hospital, Xi′an Jiaotong University from May 2021 to February 2022. The patients included 26 males and 15 females, aged 31.5-48.6 years [(41.5±15.0)years]. The injured segments were C 3 in 3 patients, C 4 in 12, C 5 in 13, C 6 in 10 and C 7 in 3. Nineteen patients were treated with cervical pedicle screws by O-shaped arm combined with CT three-dimensional navigation system (navigation group, 76 screws) and 22 by bare hands (traditional group, 88 screws). The total operation time, effective operation time, single nail placement time, single screw correction times, screw distance from anterior cortex, intraoperative blood loss, intraoperative fluoroscopic radiation dose, incision length and length of hospital stay were compared between the two groups, and the height of intervertebral space, Cobb angle, interbody slip distance and American Spinal injury Association (ASIA) grade were compared before operation and at 3 days after operation. Visual analogue score (VAS), Japanese Orthopedic Association (JOA) score, and neck dysfunction index (NDI) were evaluated before operation, at 3 days, 3 months after operation and at the last follow-up. Accuracy of screw placement and incidence of complications (adjacent facet joint invasion, infection, screw loosening) were detected as well. Results:All the patients were followed up for 11.1-13.9 months [(12.5±1.4)months]. The total operation time, intraoperative blood loss, intraoperative fluoroscopic radiation dose and incision length in the navigation group were more or longer than those in the traditional group (all P<0.05). The effective operation time, single nail placement time, single nail correction times and screw distance from anterior cortex in the navigation group were markedly less or smaller than those in the traditional group (all P<0.05). There was no significant difference in the length of hospital stay between the two groups ( P>0.05). There were significant improvements in the height of intervertebral space, Cobb angle and interbody slip distance between the two groups at 3 days after operation (all P<0.05). There was no significant difference in the height of intervertebral space, Cobb angle, interbody slip distance or ASIA grade between the two groups before operation or at 3 days after operation (all P>0.05). Compared with pre-operation, the VAS, JOA score and NDI were significantly improved in both groups at 3 days, 3 months after operation and at the last follow-up (all P<0.05), with further improvement with time. There was no significant difference in VAS between the two groups before operation or at 3 months after operation (all P>0.05), but it was markedly lower in the navigation group compared with the traditional group at 3 days after operation and at the last follow-up (all P<0.05). There were no significant differences in JOA score or NDI between the two groups before operation or at 3 days and 3 months after operation (all P>0.05), but both were lower in the navigation group compared with the traditional group at the last follow-up (all P<0.05). The accuracies of placement of grade 0 and grade 0+1 screws were 92.0% (70/76) and 96.6% (73/76) in the navigation group, respectively, which were markedly higher than 88.7% (78/88) and 93.5% (82/88) in the traditional group (all P<0.05). The rates of adjacent facet joint invasion of A, B, and C degrees were 71.2% (54/76), 28.8% (22/76) and 0% (0/76) in the navigation group, respectively, while the invasion rates were 60.5% (53/88), 32.3% (28/88) and 7.3% (7/88) in the traditional group ( P<0.05). No screw loosening was noted in the navigation group, but the screw loosening rate was 9.1% (8/88) in the traditional group ( P<0.01). Conclusion:Compared with manual screw placement, O-arm combined with CT three-dimensional navigation system assisted screw placement for lower cervical fracture and dislocation has the advantages of shorter effective operation time, quicker screw placement, stronger screw holding force, better cervical stability, slighter postoperative pain, higher screw placement accuracy, and lower facet joint invasion and screw loosening rates.

Anatomical analysis of C 7 pedicle screw implantation based on three-dimensional CT reconstruction model / 中华创伤杂志

Objective:To analyze the ideal entry parameters and entry points for C 7 pedicle screws based on three-dimensional CT reconstruction model. Methods:A retrospective case series study was used to analyze the cervical spine CT image data of 50 adult volunteers collected from April 2021 to March 2022 at Taizhou People′s Hospital Affiliated to Nanjing Medical University, including 25 males and 25 females; aged 20-67 years [(43.8±13.5)years]. No significant structural abnormalities were seen in the cervicothorax of all volunteers. First, the 50 CT images were imported into the medical engineering software Mimics 17.0 to reconstruct the three-dimensional C 7 model, and the C 7 pedicle screw diameter (PSD), pedicle screw length (PSL), sagittal angle (SA) and lateral angle (LA) were measured. Then, the anatomical markers, namely the lateral notch and the midpoint of the inferior edge of the C 6 articular process, were used to measure the horizontal distance between the midpoint of the inferior edge of the C 6 articular process and the ideal entry point (line segment A), and the horizontal and vertical distances between the lateral notch and the ideal entry point (line segments B and C). Finally, the lateral notch and the midpoint of the inferior edge of the C 6 articular process were used as markers to observe the distribution of entry points. The values of the above measured parameters were recorded and compared with each other to analyze the differences between different sides and genders. Intra-group correlation coefficients (ICC) were also used to assess intra- and inter-observer agreement. Results:All 100 pedicles from 50 C 7 models were accessed, with the PSD being (6.5±0.7)mm, PSL being (31.8±4.5)mm, SA being (89.8±8.8)°, LA being (31.0±6.7)°, line segment A being 0.9(-0.4, 2.1) mm, line segment B being (5.8±1.7)mm, and line segment C being (3.6±1.5)mm. All ideal entry points were located medial above the lateral notch; moreover, with the midpoint of the inferior edge of the C 6 articular process as a reference, 71 (71%) of the entry points were located laterally and 29 (29%) were located medially. The 12 mm area around the midpoint of the inferior edge of the C 6 articular process was divided into 6 sections, with 47% of the entry points being located within 2 mm lateral to the midpoint, 25% within 2 mm medial to the midpoint, 19% within 2-4 mm lateral to the midpoint, and only 9% within 50% lateral to the midpoint. The measured parameters were not significantly different between the left and right sides (all P>0.05). The PSD, SA, and line segment B in males were (6.8±0.7)mm, (92.0±8.2)°, and (6.3±1.6)mm, which were significantly greater than those in females [(6.2±0.6)mm, (87.5±8.0)°, and (5.3±1.6)mm] (all P<0.01). The remaining parameters were similar between two genders (all P>0.05). All measured parameters had high intra- and inter-observer agreement (ICC: 0.84-0.91), except for line segment A that had moderate intra- and inter-observer agreement (ICC: 0.46-0.63). Conclusions:For C 7 pedicle screw implantation, when the surface of the lateral mass is used as the reference plane, SA is approximately 90°; with reference to the lateral notch, all the ideal entry points are located medially above it; with reference to the midpoint of the inferior edge of the C 6 articular process, approximately 70% of the entry points are located laterally. There are no significant differences in the parameters between the different sides of screw implantation on pedicles. The measured parameters show high intra- and inter-observer agreement, except for line segment A.