國家衛生研究院 NHRI:Item 3990099045/10594

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Title:	Percutaneous pedicle screw placement under single dimensional fluoroscopy with a designed pedicle finder-a technical note and case series
Authors:	Tsuang, FY;Chen, CH;Kuo, YJ;Tseng, WL;Chen, YS;Lin, CJ;Liao, CJ;Lin, FH;Chiang, CJ
Contributors:	Institute of Biomedical Engineering and Nanomedicine
Abstract:	BACKGROUND CONTEXT: Minimally invasive spine surgery has become increasingly popular in clinical practice, and it offers patients the potential benefits of reduced blood loss, wound pain, and infection risk and also diminishes the loss of working time and length of hospital stay. However, surgeons require more intraoperative fluoroscopy and ionizing radiation exposure during minimally invasive spine surgery for localization, especially for guidance in instrumentation placement. In addition, computer navigation is not accessible in some facility-limited institutions. PURPOSE: To demonstrate a method for percutaneous screws placement using only the anterior-posterior trajectory of intraoperative fluoroscopy. STUDY DESIGN: Technical report; a retrospective and prospective case series. PATIENT SAMPLE: Patients who received posterior fixation with percutaneous pedicle screws for thoraco-lumbar degenerative disease or trauma. METHOD: We retrospectively reviewed the charts of consecutive 670 patients who received 4072 pedicle screws between December 2010 and August 2015. Another case series study was conducted prospectively in three additional hospitals, and 88 consecutive patients with 413 pedicle screws were enrolled from February 2014 to July 2016. The fluoroscopy shot number and radiation dose were recorded. In the prospective study, 78 patients with 371 screws received computed tomography at 3 months post-operatively to evaluate the fusion condition and screw positions. RESULTS: In the retrospective series, the placement of a percutaneous screw required 5.1 shots (2-14, SD = 2.366) of anterior-posterior fluoroscopy. One screw was revised due to a medial wall breach of the pedicle. In the prospective series, 5.8 shots (2-16, SD = 2.669) were required for one percutaneous pedicle screw placement. There were two screws with a grade 1 breach (8.6%), both at the lateral wall of the pedicle, out of 23 screws placed at the thoracic spine at T9-12. For the lumbar and sacral area, there were 15 grade 1 breaches (4.3%), 1 grade 2 breach (0.3%), and 1 grade 3 breach (0.3%). No revision surgery was necessary. CONCLUSION: This method avoids lateral shots of fluoroscopy during screw placement and thus decreases the operation time and exposes surgeons to less radiation. At the same time, compared with the computer-navigated procedure, it is less facility-demanding, and provides satisfactory reliability and accuracy.
Date:	2017-09
Relation:	Spine Journal. 2017 Sep;17(9):1373-1380.
Link to:	http://dx.doi.org/10.1016/j.spinee.2017.06.022
JIF/Ranking 2023:	http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=1529-9430&DestApp=IC2JCR
Cited Times(WOS):	https://www.webofscience.com/wos/woscc/full-record/WOS:000410811500018
Cited Times(Scopus):	https://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85025134557
Appears in Collections:	[Feng-Huei Lin] Periodical Articles

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