5/9/2014 Disclosures • Theologis Safety of reconstruction of complex – OREF cervical spine pathology using pedicle screws inserted with navigation • Burch – Medtronic Alexander A. Theologis, MD; Shane Burch, MD May 9, 2014 Cervical Spine Stabilization Adequate Fixation? Interlaminar clamps Interspinous wiring Chin-on-chest deformity Facet Spondylo- fracture/dislocati arthropathy / on Osteoporosis Facet wiring Lateral mass screws 1
5/9/2014 Challenging Anatomy? Cervicle Pedicle Screws • 3-column fixation Cervical pedicle screws vs. lateral mass screws: uniplanar fatigue analysis and residual pullout strengths Todd L. Johnston, MD a , Eldin E. Karaikovic, MD, PhD b, *, . Lautenschlager, PhD b , David Marcu, BS b Eugene P The Spine Journal 6 (2006) 667–672 a Anatomy Foraminotomy Nav 2
5/9/2014 O-Arm Methods Purpose - Retrospective analysis • Determine the safety of cervical pedicle screw - Single surgeon placement with navigation in patients with - Cervical pedicle screws inserted using complex cervicothoracic deformities and O-Arm imaging and Stealth Navigation revision cervical spine pathology. - 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
5/9/2014 Percentage of # (%) of Results Cervical Level # Screws total screws misplacement C1 0 0 0 4 C2 3.2 0 20 • 22 patients C3 16.1 0 22 C4 17.8 3 (2.4%) 23 – Female: 10; Male: 22 C5 18.5 1 (0.8%) 18 C6 14.5 0 • Avge age: 63 years (32-83 yrs)] C7 37 29.8 0 – Variable pathology Total 124 100 4 • 10 primary operations for • Accuracy: 96.8% cervicothoracic kyphosis • No neurovascular complications • 12 revision operations • 3 revisions: • C8 radiculopathy due to iatrogenic foraminal stenosis(reduction of • Radiographic follow-up kyphotic deformity), revision C1-3 PCF to improve chin-brow angle • No revisions for deformity progression or implant failure or 15 months (1.4 - 46 mos). 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
5/9/2014 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):2899-905. Abumi K, Ito M, Sudo H. Reconstruction of the subaxial cervical spine using pedicle screw instrumentation. Spine (Phila Pa 1976). 2012;37(5):E349-56. 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):19-28. Abumi K, Kaneda K. Pedicle screw fixation for nontraumatic lesions of the cervical spine. Spine (Phila Pa 1976). 1997;22(16):1853-63. 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):19-26. 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):667-72. 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):327-34. 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):488-93. Yoshimoto H, Sato S, Hyakumachi T, Yanagibashi Y, Masuda T. Spinal reconstruction using a cervical pedicle screw system. Clin Orthop Relat Res. 2005(431):111-9. 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):2675-81. 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):962-9. Epub 2000/04/18. 5
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