Early expertise of inserting image-guided minimally invasive pedicle screws with out Ok-wires or bone-anchored trackers.
J Neurosurg Backbone. 2018 Jan 26;:1-7
Authors: Malham GM, Parker RM
OBJECTIVE Picture steering for backbone surgical procedure has been reported to enhance the accuracy of pedicle screw placement and scale back revision charges and radiation publicity. Present navigation and robot-assisted methods for percutaneous screws depend on bone-anchored trackers and Kirchner wires (Ok-wires). There’s a paucity of revealed knowledge concerning the position of image-guided percutaneous screws with out Ok-wires. A brand new skin-adhesive stereotactic affected person tracker (SpineMask) eliminates each an invasive bone-anchored tracker and Ok-wires for pedicle screw placement. This research experiences the authors’ early expertise with using SpineMask for “Ok-wireless” placement of minimally invasive pedicle screws and makes suggestions for its potential purposes in lumbar fusion. METHODS Forty-five consecutive sufferers (involving 204 screws inserted) underwent Ok-wireless lumbar pedicle screw fixation with SpineMask and intraoperative neuromonitoring. Screws had been inserted by percutaneous stab or Wiltse incisions. If required, decompression with or with out interbody fusion was carried out utilizing mini-open midline incisions. Multimodality intraoperative neuromonitoring assessing motor and sensory responses with triggered electromyography (tEMG) was carried out. Computed tomography scans had been obtained 2 days postoperatively to evaluate screw placement and any cortical breaches. A breach was outlined as any violation of a pedicle screw involving the cortical bone of the pedicle. RESULTS Fourteen screws (7%) required intraoperative revision. Screws had been eliminated and repositioned resulting from a tEMG response < 13 mA, tactile suggestions, and 3D fluoroscopic evaluation. All screws had been revised utilizing the SpineMask with the identical screw placement approach. The very best proportion of revisions occurred with Wiltse incisions (four/12, 33%) as this induced the best diploma of SpineMask deformation, adopted by a mini midline incision (three/26, 12%). Percutaneous screws by way of a single stab incision resulted within the fewest revisions (7/166, four%). Postoperative CT demonstrated 7 pedicle screw breaches (three%; 5 lateral, 1 medial, 1 superior), all with percutaneous stab incisions (7/166, four%). The radiological accuracy of the SpineMask tracker was 97% (197/204 screws). No sufferers suffered neural harm or required postoperative screw revision. CONCLUSIONS The noninvasive cutaneous SpineMask tracker with 3D picture steering and tEMG monitoring offered excessive accuracy (97%) for percutaneous pedicle screw placement by way of stab incisions with out Ok-wires.
PMID: 29372857 [PubMed – as supplied by publisher]