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A novel system for accurate lumbar spine pedicle screw placement based on three-dimensional computed tomography reconstruction.

ABSTRACT: ObjectivesThe accuracy of pedicle screw placement strongly affects the outcome of spinal surgery and has mainly relied on the surgeons’ experience. There is no simple, low-cost, and effective pedicle screw placement system to assist new spinal surgeons with less experience.MethodsWe designed a localization system with six parameters (starting point height [SP-H], starting point length [SP-L], transverse section angle, sagittal section angle [SSA], pedicle width [W] and height [H]) based on preoperative computed tomography reconstruction and combined it with the Roussouly classification to guide lumbar spine pedicle screw placement and analysed the change patterns of the six parameters in 50 participants.ResultsBased on the system, we confirmed that combining SP-H and SP-L can localize the entrance of the pedicle screw. Furthermore, we considered that SP-L and transverse section angle would be a new standard for determination of the transverse orientation of the pedicle screw. More importantly, the linear regression equations between H and W and SP-H and H were concealed. In addition, H and W can guide the appropriate selection of pedicle screw. Moreover, change patterns of SSA combined with the Roussouly classification indicate that SSA of L3 can be used as a benchmark to guide the establishment of sagittal alignment of the lumbar spine.ConclusionsUnderstanding and applying the six-parameter localization system are essential for achieving accuracy in lumbar spine pedicle screw placement, and the system is a useful guide in the establishment of sagittal alignment.The translational potential of this articleThis study provides a new pedicle-screw placement system for accurate lumbar spine pedicle screw placement based on three-dimensional CT reconstruction, requiring six parameters to guide the system.

SUBMITTER: Ding B

PROVIDER: S-EPMC7322241 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Project description:BackgroundPedicle screw invasion of the proximal articular process will cause local articular process degeneration and acceleration, which is an important factor affecting adjacent segment degeneration. Although lumbar spondylolisthesis is a risk factor for screw invasion of the proximal joint, there is no clear conclusion regarding the two different types of spondylolisthesis. Therefore, the purpose of this study was to explore the influence of pedicle screw placement on proximal facet invasion in the treatment of degenerative spondylolisthesis and isthmic spondylolisthesis.MethodsIn total, 468 cases of lumbar spondylolisthesis treated by decompression and fusion in our hospital from January 2017 to January 2020 were included in this retrospective study. Among them, 238 cases were degenerative spondylolisthesis (group A), and 230 cases were isthmic spondylolisthesis (group B). Sex, age, body mass index, bone mineral density, preoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, postoperative VAS and ODI scores at 1 month and 3 months, and angle of the proximal facet joint at the last follow-up were recorded and compared between the two groups. The degree of pedicle screw invasion of the proximal facet joint was graded and compared by the SEO grading method.ResultsThere were no significant differences in sex, age, body mass index, bone mineral density, preoperative VAS and ODI scores, or proximal facet joint angle between the two groups (P > 0.05). There was no significant difference in VAS and ODI scores between the two groups at 1 month and 3 months after the operation (P > 0.05). The VAS score of group A at the last follow-up was 1 (1,2). The VAS score of group B at the last follow-up was 3 (1,3). The ODI score of group A at the last follow-up was 6(4,26). The ODI score of group B at the last follow-up was 15(8,36). The VAS and ODI scores of the two groups at the last follow-up were significantly different (P < 0.05). According to the SEO grading method, the invasion of the proximal articular process by pedicle screw placement in group A involved 320 cases in grade 0, 128 cases in grade I and 28 cases in grade II. In group B, there were 116 cases in grade 0, 248 cases in grade I and 96 cases in grade II, with a significant difference (P < 0.01).ConclusionIn summary, a certain number of cases involving screws invading the proximal facet joint occurred in the two different types of lumbar spondylolisthesis, but the number in the isthmic spondylolisthesis group was significantly higher than that in the degenerative spondylolisthesis group, which caused more trauma to the proximal facet joint and significantly affected the patient prognosis.

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A novel system for accurate lumbar spine pedicle screw placement based on three-dimensional computed tomography reconstruction.

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