ABSTRACT
Background: Pedicle screw instrumentation of the cervical spine, although technically challenging due to the potential risk of serious neurovascular injuries, is biomechanically favorable for stabilization purposes. Patient-specific templates are increasingly used in the thoracolumbar spine with excellent accuracy. The aim of this study was to evaluate the accuracy of cervical pedicle screw placement with patient-specific templates in a clinical setting and to report the European experience so far. Methods: Multicentric, retrospectively obtained data of twelve patients who underwent dorsal instrumentation of the cervical spine with 3D-printed patient-specific templates were analyzed. Postoperative computed tomography (CT) scans were used to evaluate pedicle perforation and screw deviations between the planned and actual screw position. Furthermore, surgical time, radiation exposure, blood loss and immediate postoperative complications were analyzed. Results: A total of 86 screws were inserted, of which 82 (95.3%) were fully contained inside the pedicle. All perforations (four screws, 4.7%) were within the safe zone of 2 mm and did not result in any neurovascular complications. Overall, median deviation from planned entry point (Euclidean distance) was 1.2 mm (0.1 - 11 mm), median deviation from the planned trajectory (Euler angle) was 4.4° (0.2-71.5°), median axial and sagittal trajectory deviation from the planned trajectory were 2.5° (0 - 57.5°) and 3.3° (0 - 54.9°), respectively. Median operative time was 168 minutes (111 - 564 minutes), median blood loss was 300 ml (150 - 1300 ml) and median intraoperative fluoroscopic dose was 321.2 mGycm2 (102.4 - 825.0 mGycm2). Overall complications were one adjacent segment kyphosis, one transient C5 palsy and one wound healing disorder. Conclusion: Patient-specific 3D-printed templates provide a highly accurate option for placing cervical pedicle screws for dorsal instrumentation of the cervical spine.
ABSTRACT
BACKGROUND: Kyphoplasty represents an established minimal-invasive method for correction and augmentation of osteoporotic vertebral fractures. Reliable data on perioperative and postoperative complications are lacking in the literature. The present study was designed to evaluate the incidence and patterns of perioperative complications in order to determine the safety of this procedure for patients undergoing kyphoplasty. PATIENTS AND METHODS: We prospectively enrolled 102 consecutive patients (82 women and 20 men; mean age 69) with 135 operatively treated fractured vertebrae who underwent a kyphoplasty between January 2004 to June 2006. Clinical and radiological follow-up was performed for up 6 months after surgery. RESULTS: Preoperative pain levels, as determined by the visual analogous scale (VAS) were 7.5 +/- 1.3. Postoperative pain levels were significantly reduced at day 1 after surgery (VAS 2.3 +/- 2.2) and at 6-month follow-up (VAS 1.4 +/- 0.9). Fresh vertebral fractures at adjacent levels were detected radiographically in 8 patients within 6 months. Two patients had a loss of reduction with subsequent sintering of the operated vertebrae and secondary spinal stenosis. Accidental cement extravasation was detected in 7 patients in the intraoperative radiographs. One patient developed a postoperative infected spondylitis at the operated level, which was treated by anterior corporectomy and 360 degrees fusion. Another patient developed a superficial wound infection which required surgical revision. Postoperative bleeding resulting in a subcutaneous haematoma evacuation was seen in one patient. CONCLUSION: The data from the present study imply that percutaneous kyphoplasty can be associated with severe intra- and postoperative complications. This minimal-invasive surgical procedure should therefore be performed exclusively by spine surgeons who have the capability of managing perioperative complications.
