European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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This study aimed at studying the accuracy and safety of extra-pedicular screw insertion for dysplastic pedicles in AIS comparing cannulated screw system versus conventional screw system. ⋯ Usage of cannulated screw system significantly increases the accuracy of pedicle screw insertion in dysplastic pedicles in AIS.
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Pedicle screw (PS) insertion has been criticized for its risk of serious injury to neurovascular structures. Although computed tomography (CT)-based navigation has been developed to avoid such complications, perforation remains an issue, even with the aid of additional guidance. We clarify screw perforation rate and direction in 359 consecutive patients treated using CT-based PS insertion and present important considerations for more accurate screw placement. ⋯ Even with CT-based navigation, careful insertion of PS is needed in the middle cervical spine because of a significantly higher perforation rate as compared with the lumbar region.
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The goal of this study was to compare the accuracy of a novel intraoperative cone beam computed tomography (CBCT) imaging technique with that of conventional computed tomography (CT) scans for assessment of pedicle screw placement and breach detection. ⋯ Intraoperative CBCT provides accurate assessment of pedicle screw placement and enables intraoperative repositioning of misplaced screws. This technique may make postoperative CT imaging unnecessary.
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The goals of this paper are to assess the ionizing radiation exposure to the patients during thoracic and lumbar spinal fusion using a new intraoperative 3D imaging system and to evaluate the factors that could explain the variability in the observed doses. ⋯ Patient exposure was highly variable. Four parameters were found to explain about 68% of its variance when using a multi-axis robotic C-arm system. MIS technique (with navigation or not) as well as the acquisition protocol dramatically increases the radiation dose for patients. These results show the necessity to develop specific strategies adapted to patients and surgical procedures.