Disclosures. Cervical Spine Stabilization. Adequate Fixation?

Size: px

Start display at page:

Download "Disclosures. Cervical Spine Stabilization. Adequate Fixation?"

Gladys Wilcox
5 years ago
Views:

1 Disclosures Safety of reconstruction of complex cervical spine pathology using pedicle screws inserted with navigation Alexander A. Theologis, MD; Shane Burch, MD Theologis OREF Burch Medtronic May 9, 2014 Cervical Spine Stabilization Adequate Fixation? Interlaminar clamps Interspinous wiring Facet wiring Lateral mass screws Chin-on-chest deformity Facet fracture/dislocati on Spondyloarthropathy / Osteoporosis 1

2 Cervicle Pedicle Screws 3-column fixation Challenging Anatomy? Cervical pedicle screws vs. lateral mass screws: uniplanar fatigue analysis and residual pullout strengths a Todd L. Johnston, MD a, Eldin E. Karaikovic, MD, PhD b, *, Eugene P. Lautenschlager, PhD b, David Marcu, BS b The Spine Journal 6 (2006) Anatomy Foraminotomy Nav 2

O-Arm Purpose Determine the safety of cervical pedicle screw placement with navigation in

- Retrospective analysis - Single surgeon Methods - Cervical pedicle screws inserted using

screws) - Data 1) Operative data (indications for surgery, concomitant surgeries, length,

3 O-Arm Purpose Determine the safety of cervical pedicle screw placement with navigation in patients with complex cervicothoracic deformities and revision cervical spine pathology. - Retrospective analysis - Single surgeon Methods - Cervical pedicle screws inserted using O-Arm imaging and Stealth Navigation - Accuracy: (# intra-op screw revision) / (total # screws) - Data 1) Operative data (indications for surgery, concomitant surgeries, length, EBL) 2) # cervicle pedicle screws 3) Neurovascular complications 4) Need for revision cervical surgery 3

22 patients Results Female: 10; Male: 22 Avge age: 63 years (32-83 yrs)] Variable pathology 10 primary operations for cervicothoracic kyphosis 12 revision operations Radiographic follow-up 15 months

4 22 patients Results Female: 10; Male: 22 Avge age: 63 years (32-83 yrs)] Variable pathology 10 primary operations for cervicothoracic kyphosis 12 revision operations Radiographic follow-up 15 months ( mos). Cervical Level # Screws Percentage of # (%) of total screws misplacement C C C C (2.4%) C (0.8%) C C Total Accuracy: 96.8% No neurovascular complications 3 revisions: C8 radiculopathy due to iatrogenic foraminal stenosis(reduction of kyphotic deformity), revision C1-3 PCF to improve chin-brow angle No revisions for deformity progression or implant failure or malposition. Conclusions In this study, placement of cervical pedicle screws using O-Arm imaging and Stealth Navigation is safe, accurate, and effective method for posterior stabilization in cervicothoracic deformity and revision operations of the cervical spine 4

References Xu R, Ebraheim NA, Skie M. Pedicle screw fixation in the cervical spine. Am J Orthop (Belle Mead NJ). 2008;37(8):403-8; discussion 8. Abumi K, Ito M, Kaneda K.

5 References Xu R, Ebraheim NA, Skie M. Pedicle screw fixation in the cervical spine. Am J Orthop (Belle Mead NJ). 2008;37(8):403-8; discussion 8. Abumi K, Ito M, Kaneda K. Surgical treatment of cervical destructive spondyloarthropathy (DSA). Spine (Phila Pa 1976). 2000;25(22): Abumi K, Ito M, Sudo H. Reconstruction of the subaxial cervical spine using pedicle screw instrumentation. Spine (Phila Pa 1976). 2012;37(5):E Abumi K, Itoh H, Taneichi H, Kaneda K. Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. J Spinal Disord. 1994;7(1): Abumi K, Kaneda K. Pedicle screw fixation for nontraumatic lesions of the cervical spine. Spine (Phila Pa 1976). 1997;22(16): Abumi K, Kaneda K, Shono Y, Fujiya M. One-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems. J Neurosurg. 1999;90(1 Suppl): Johnston TL, Karaikovic EE, Lautenschlager EP, Marcu D. Cervical pedicle screws vs. lateral mass screws: uniplanar fatigue analysis and residual pullout strengths. Spine J. 2006;6(6): Epub 2006/11/08. Kast E, Mohr K, Richter HP, Borm W. Complications of transpedicular screw fixation in the cervical spine. Eur Spine J. 2006;15(3): Yukawa Y, Kato F, Yoshihara H, Yanase M, Ito K. Cervical pedicle screw fixation in 100 cases of unstable cervical injuries: pedicle axis views obtained using fluoroscopy. J Neurosurg Spine. 2006;5(6): Yoshimoto H, Sato S, Hyakumachi T, Yanagibashi Y, Masuda T. Spinal reconstruction using a cervical pedicle screw system. Clin Orthop Relat Res. 2005(431): Ludwig SC, Kowalski JM, Edwards CC, 2nd, Heller JG. Cervical pedicle screws: comparative accuracy of two insertion techniques. Spine (Phila Pa 1976). 2000;25(20): Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K. Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine (Phila Pa 1976). 2000;25(8): Epub 2000/04/18. 5

The use of internal fixation in the subaxial cervical

The use of internal fixation in the subaxial cervical J Neurosurg Spine 19:614 623, 2013 AANS, 2013 -related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws A systematic review Hiroyuki Yoshihara, M.D.,