Dataset Information

Transpedicle osteotomy positioning in pedicle-lengthening laminoplasty.

ABSTRACT: Pedicle-lengthening laminoplasty is a new minimally invasive technique for surgical treatment of lumbar spinal stenosis. The procedure is performed with the assistance of fluoroscopy and involves creating a pedicle passage, transpedicle osteotomy from inside the pedicle passage and lengthening it by using an implant bilaterally to enlarge the spinal canal and neural foramen. A critical component of the procedure is the precise determination of the osteotomy site on the pedicle. The objective of this study was to examine in vitro whether fluoroscopic positioning could be used to guide the osteotomy and to define the cutting site in the pedicle-lengthening laminoplasty in relation to the posterior vertebral line. It was found that the osteotomy site was from 2.0 to 3.5?mm posterior to the posterior vertebral line. The maximum difference between the measured value and that theoretically simulated on 3-dimensional (3D) computed tomography reconstruction was 0.3?mm. The spinal canal cross-sectional area was significantly enlarged after pedicle-lengthening. Accurate placement of the osteotomy is critical in pedicle-lengthening laminoplasty. Guiding the positioning of the osteotomy based on the posterior vertebral line images provides satisfactory accuracy, suggesting a possible clinical application for our technique; however, further verification in vivo is needed.

SUBMITTER: Zhang ZG

PROVIDER: S-EPMC6583406 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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Transpedicle osteotomy positioning in pedicle-lengthening laminoplasty.

Zhang Zhi-gang ZG Mei Xin X Zhang Wen W Liu Peng P Gao Mao-feng MF Yang Hui-lin HL Luo Zong-ping ZP

Orthopaedic surgery 20141101 4

Pedicle-lengthening laminoplasty is a new minimally invasive technique for surgical treatment of lumbar spinal stenosis. The procedure is performed with the assistance of fluoroscopy and involves creating a pedicle passage, transpedicle osteotomy from inside the pedicle passage and lengthening it by using an implant bilaterally to enlarge the spinal canal and neural foramen. A critical component of the procedure is the precise determination of the osteotomy site on the pedicle. The objective of ...[more]

PMID: 25430715

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Project description:Bilateral sagittal split osteotomy (BSSO) is a widely-performed procedure in orthognathic surgery for the correction of dentofacial deformity. Condylar positioning is a critical step during BSSO to maximize functional and morphological results. The unsuitable positioning of condyles represents one of the causative mechanisms that may induce temporomandibular joint noxious effects after BSSO. Repositioning devices can assist surgeons in maintaining the preoperative condylar position; however, empirical repositioning methods based on experience gained are still commonly used. Trainee learning curves are difficult to assess. The aim of this study was to evaluate the relevance of computer-assisted surgery in the acquisition of condylar positioning skills. Forty-eight patients underwent BSSO performed by six maxillofacial trainees (four junior residents and two senior experienced residents). A condyle positioning system (CPS) was used by a senior surgeon to record a condylar position score during the procedure. Firstly, scores were recorded when the trainee manually positioned the condyle without access to the CPS score (phase 1) and then when the trainee positioned the condyle and performed osteosynthesis with visual access to the CPS score (phase 2). Six parameters describing condylar three-dimensional motions were assessed: translational motion from top to bottom (TB), back to front (BF), and left to right (LR), axial rotation (AR), sagittal rotation (SR), frontal rotation (FR), and a total score (TS). There were no significant differences between junior and senior residents in condyle positioning without access to the CPS. Condyles were significantly better positioned during phase 2 with access to the CPS (p<0.001). Over time, use of the CPS (phase 2) produced significantly quicker improvements in scores (p = 0.042). For those teaching surgeries to trainees, computer-assisted devices can potentially result in more rapid learning curves than traditional "observations-imitation" models. Use of a CPS by trainees facilitated condylar repositioning that resulted in an accurate occlusal result and avoidance of adverse effects on the temporomandibular joint.

Dataset Information

Transpedicle osteotomy positioning in pedicle-lengthening laminoplasty.

Publications

Transpedicle osteotomy positioning in pedicle-lengthening laminoplasty.

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