• Title/Summary/Keyword: C2 screw

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Can Right-Handed Surgeons Insert Upper Thoracic Pedicle Screws in much Comfortable Position? Right-Handedness Problem on the Left Side

  • Akyoldas, Goktug;Senturk, Salim;Yaman, Onur;Ozdemir, Nail;Acaroglu, Emre
    • Journal of Korean Neurosurgical Society
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    • v.61 no.5
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    • pp.568-573
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    • 2018
  • Objective : Thoracic pedicles have special and specific properties. In particular, upper thoracic pedicles are positioned in craniocaudal plane. Therefore, manipulation of thoracic pedicle screws on the left side is difficult for right-handed surgeons. We recommend a new position to insert thoracic pedicle screw that will be much comfortable for spine surgeons. Methods : We retrospectively reviewed 33 patients who underwent upper thoracic pedicle screw instrumentation. In 15 patients, a total of 110 thoracic pedicle screws were inserted to the upper thoracic spine (T1-6) with classical position (anesthesiologist and monitor were placed near to patient's head. Surgeons were standing classically near to patient's body while patients were lying in prone position). In 18 patients, a total of 88 thoracic pedicle screws were inserted to the upper thoracic spine with the new standing position-surgeons stand by the head of the patient and the anesthesia monitor laterally and under patient's belt level. All the operations performed by the same senior spine surgeons with the help of C-arm. Postoperative computed tomography scans were obtained to assess the screw placement. The screw malposition and pedicle wall violations were divided and evaluated separately. Cortical penetration were measured and graded at either : 1-2 mm penetration, 2-4 mm penetration and >4 mm penetration. Results : Total 198 screws were inserted with two different standing positions. Of 198 screws 110 were in the classical positioning group and 88 were in the new positioning group. Incorrect screw placement was found in 33 screws (16.6%). The difference between total screw malposition by both standing positions were found to be statistically significant (p=0.011). The difference between total pedicle wall violations by both standing positions were found to be statistically significant (p=0.003). Conclusion : Right-handedness is a problem during the upper thoracic pedicle screw placement on the left side. Changing the surgeon's position standing near to patient's head could provide a much comfortable position to orient the craniocaudal plane of the thoracic pedicles.

Unusual Anterior Arch Fracture of C1 - Case Report - (Unusual Anterior Arch Fracture of C1 - 증 례 보 고 -)

  • Kim, Sang Jin;Son, Chan Young;Kim, Tae Hong;Shin, Hyung Sik;Hwang, Young Soon;Park, Sang Keun
    • Journal of Korean Neurosurgical Society
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    • v.30 no.4
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    • pp.537-540
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    • 2001
  • Fractures of C1 are not uncommon, constituting only 10% of all cervical spine injuries. There is a high prevalence of concomitant fractures of the second and first cervical vertebral complex. Surgical treatment is controversal. Mainstay of treatment is various combination of traction and cervical orthosis according to degree of displacement and location of fracture. We experienced unusual type of fracture, anterior arch fracture of C1 who had a history of total laminectomy of C1,2 due to cervical cord tumor(neurilemmoma arising from C2 root). We performed C1,2 lateral mass screw fixation with posterior fusion with good postoperative outcome.

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Surface Finishing of Ballscrew by Abrasive Wheel Brush (연마재함유 휠브러쉬에 의한 볼스크류 연마기술)

  • 이응숙;김재구;황경현
    • Proceedings of the Korean Society of Precision Engineering Conference
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    • 1997.04a
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    • pp.1049-1052
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    • 1997
  • The pupose of this study on the surface finishing is to examine the performance of brushing as a means of reducing the surface roughness of the precision theaded shafts in ball screw assemblies. Ball screws provide superior performance compared to other types of screw feeds in terms of static and dynamic rolling resistance,backlash,and wear characteristics. The Reduction of the surface roughness of the lead shaft in ball screw assembiles is essential for precision movement,high speed/low noise tracel, and for low wear/long life. To reduce machine dependent errors that would influence the surface roughness compared with other lapping or polishing techniques,experiments will be performed using special wire brushes to polish precision ground shafts. The best results were obtained using the Al /sab 2/O /sab3/ brushes, with the Al /sab 2/O /sab3/ #500 grit brush producing a surface finish of approximately 0.7 .mu.m, and the Al /sab 2/O /sab3/ #600 grit producing a surface finish of approximately 0.8 .mu.m. Both of these results were produced at the highest wheel polishing speed of 3520 rpm. The SiC #500 brush produced a surface roughness of approximately 1 .mu.m at 3520 rpm.

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What are the Differences in Outcome among Various Fusion Methods of the Lumbar Spine?

  • Kang, Suk-Hyung;Kim, Young-Baeg;Park, Seung-Won;Hong, Hyun-Jong;Min, Byung-Kook
    • Journal of Korean Neurosurgical Society
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    • v.37 no.1
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    • pp.39-43
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    • 2005
  • Objective: For Posterior lumbar interbody fusion(PLIF) various cages or iliac bone dowels are used with or without pedicle screw fixation(PSF). To evaluate and compare the clinical and radiological results of different fusion methods, we intend to verify the effect of added PSF on PLIF, the effect of bone cages and several factors which are thought to be related with the postoperative prognosis. Methods: One hundred and ninety seven patients with lumbar spinal stenosis and instability or spondylolisthesis underwent various fusion operations from May 1993 to May 2003. The patients were divided into five groups, group A (PLIF with autologous bone dowels, N=24), group B (PLIF with bone cages, N=13), group C (PLIF with bone dowels and PSF, N=37), group D (PLIF with bone cages and PSF, N=30) and group E (PSF with intertransverse bone graft, N=93) for comparison and analyzed for the outcome and fusion rate. Results: Outcome was not significantly different among the five groups. In intervertebral height (IVH) changes between pre- and post-operation, Group B ($2.42{\pm}2.20mm$) was better than Group A ($-1.33{\pm}2.05mm$). But in the Group C, D and E, the IVH changes were not different statistically. Fusion rate of group C, D was higher than that of Group A and B. But the intervertebral height(IVH) increased significantly in group B($2.42{\pm}2.20mm$). Fusion rate of group C and D were higher than that of group A and D. Conclusion: Intervertebral cages are superior to autologous iliac bone dowels for maintaining intervertebral height in PLIF. The additional pedicle screw fixation seems to stabilize the graft and improve fusion rates.

Product Characteristics as Factors of Process Parameters in Starch Phosphates Preparation by Twin-screw Extruder (이축압출성형기로 인산전분 제조시 Process Parameters에 따른 제품의 특성)

  • Kim, Chong-Tai;Kim, Dong-Chul;Kim, Chul-Jin;Kim, Hae-Sung
    • Korean Journal of Food Science and Technology
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    • v.23 no.2
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    • pp.235-240
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    • 1991
  • Starch phosphates were prepared from the corn starch mixed with 2% sodium tripolyphosphate by twin-screw extruder with a feed rate of 20 kg/hr and an extrusion temperature of $130^{\circ}C$, and the effects of extrusion variables on the physicochemical properties (target parameters) of starch phosphates were investigated. Interrelations of system parameters (specific mechanical energy and extrudate moisture) and rheological properities of starch was analyzed by using the response surface analysis. Degree of substitution (DS) was increased with increasing the feed moisture, and showed the maximum value at the screw of near 250 rpm, Degree of gelatinization was proportionally increased with increasing the screw speed and decreasing the feed moisture. Apparent viscosity of the paste was increased with increasing the feed moisture, but it was not significantly affected by the screw speed. It was found by scanning electron microscopy that the starch microgranules were much more degradaded, and as consequent result, the intrinsic viscosity was decreased, whereas, water solubility index was increased. The rate of retrogradation of the gels was retarded with increasing DS and decreasing viscosity.

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The Effect of Repetitive Insertion and Pullout of Spinal Screws on Pullout Resistance : A Biomechanical Study (척추 수술에 사용되는 나사못의 반복 삽입과 인출이 인장항력에 미치는 영향 : 생체 역학적 연구)

  • Bak, Koang Hum;Ferrara, Lisa;Kim, Kwang Jin;Kim, Jae Min;Kim, Choong Hyun;Benzel, Edward C.
    • Journal of Korean Neurosurgical Society
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    • v.30 no.2
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    • pp.131-136
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    • 2001
  • Object : The clinical uses of screws are increasing with broader applications in spinal disorders. When screws are inserted repeatedly to achieve optimal position, tips of screw pitch may become damaged during insertion even though there are significant differences in the moduli of elasticity between bone and titanium. The effect of repeated screw insertion on pullout resistance was investigated. Methods : Three different titanium screws(cortical lateral mass screw, cancellous lateral mass screw and cervical vertebral body screw) were inserted into the synthetic cancellous material and then extracted axially at a rate of 2.4mm/min using Instron(Model TT-D, Canton, MA). Each set of screws was inserted and pulled out three times. There were six screws in each group. The insertional torque was measured with a torque wrench during insertion. Pullout strength was recorded with a digital oscilloscope. Results : The mean pullout force measurements for the cortical lateral mass screws($185.66N{\pm}42.60$, $167.10N{\pm}27.01$ and $162.52 N{\pm}23.83$ for first, second and third pullout respectively : p=0.03) and the cervical vertebral body screws($386.0N{\pm}24.1$, $360.2N{\pm}17.5$ and $330.9N{\pm}16.7$ : p=0.0024) showed consecutive decrease in pullout resistance after each pullout, whereas the cancellous lateral mass screws did not($194.00N{\pm}36.47$, $219.24N{\pm}26.58$ and 199.49N(36.63 : p=0.24). The SEM after insertion and pullout three times showed a blunting in the tip of the screw pitch and a smearing of the screw surface. Conclusions : Repetitive screw insertion and pullout resulted in the decrease of pullout resistance in certain screws possibly caused by blunting the screw tip. This means screw tips suffer deformations during either repeated insertion or pullout. Thus, the screws that have been inserted should not be used for the final construct.

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Accuracy and Safety in Pedicle Screw Placement in the Thoracic and Lumbar Spines : Comparison Study between Conventional C-Arm Fluoroscopy and Navigation Coupled with O-Arm$^{(R)}$ Guided Methods

  • Shin, Myung-Hoon;Ryu, Kyeong-Sik;Park, Chun-Kun
    • Journal of Korean Neurosurgical Society
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    • v.52 no.3
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    • pp.204-209
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    • 2012
  • Objective : The authors performed a retrospective study to assess the accuracy and clinical benefits of a navigation coupled with O-arm$^{(R)}$ system guided method in the thoracic and lumbar spines by comparing with a C-arm fluoroscopy-guided method. Methods : Under the navigation guidance, 106 pedicle screws inserted from T7 to S1 in 24 patients, and using the fluoroscopy guidance, 204 pedicle screws from T5 to S1 in 45 patients. The position of screws within the pedicle was classified into four groups, from grade 0 (no violation cortex) to 3 (more than 4 mm violation). The location of violated pedicle cortex was also assessed. Intra-operative parameters including time required for preparation of screwing procedure, times for screwing and the number of X-ray shot were assessed in each group. Results : Grade 0 was observed in 186 (91.2%) screws of the fluoroscopy-guided group, and 99 (93.4%) of the navigation-guided group. Mean time required for inserting a screw was 3.8 minutes in the fluoroscopy-guided group, and 4.5 minutes in the navigation-guided group. Mean time required for preparation of screw placement was 4 minutes in the fluoroscopy-guided group, and 19 minutes in the navigation-guided group. The fluoroscopy-guided group required mean 8.9 times of X-ray shot for each screw placement. Conclusion : The screw placement under the navigation-guidance coupled with O-arm$^{(R)}$ system appears to be more accurate and safer than that under the fluoroscopy guidance, although the preparation and screwing time for the navigation-guided surgery is longer than that for the fluoroscopy-guided surgery.

A THREE DIMENSIONAL FINITE ELEMENT STRESS ANALYSIS OF SINGLE IMPLANT PROSTHESES ACCORDING TO THE HEX-LOCK TYPE (단일 임플랜트 보철물의 Hex-lock 형태에 따른 3차원 유한요소법적 응력분석)

  • Hwang, Young-Pil;Kay, Kee-Sung;Cho, Kyu-Zong
    • The Journal of Korean Academy of Prosthodontics
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    • v.34 no.2
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    • pp.385-402
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    • 1996
  • The purpose of this study was to analyze how the stability of the implant prostheses and the loosening of the fastening screw was affected when the various types of Hex structure provided for the effect of anti-rotation of the single prostheses were given. Three dimensional finite element model was designed with which the implants with the external hex type of 0.75mm, 1.5mm and the implant with the internal hex type of 0.75mm, 1.5mm and the implant with the external hex type of $15^{\circ}$ tapered shape of 0.75mm were supposed to completely osseointegrate to the mandible. After fininshing the finite element model, the preload of 10N at the fastening screw was applied and then the vertical and $30^{\circ}$ lateral load of 200N was applied respectively at the cusp tips of the prostheses. The following results were obtained : 1. In case of displacement, the amount of displacement was increased at the internal hex type(model C, D) than at the external hex type(model A, B, E) when the vertical and lateral load was applied. 2. Less equivalent stress was represented at the model B with increased external hex height than at the model A when the vertical and lateral load was applied. 3. Much stress was represented at the model E with increased hex angle than at the model A in case of the stress happened to the implant body and the fastening screw when the vertical and lateral load was applied. 4. Much equivalent stress was represented at the model D with deepened internal hex height than at the model C when vertical and lateral load was applied. 5. The least stress was taken at the model B and the most stress was taken at the model D in case of the stress happened to the implant when the vertical and lateral load was applied. 6. The least stress was taken at the model C at the vertical load. And the least stress was taken at the model B at lateral load in case of the stress happened to the fastening screw. As a results of this study, the good lateral stability of prostheses and less stress of the component of implant was taken when the external hex height was increased, and the risk of neck fracture of implant and fastening screw was increased when the internal hex height was deepned because of long screw neck portion and thin implant neck portion.

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Effect of thread design on the marginal bone stresses around dental implant (임플란트 나사산 디자인이 변연골 응력에 미치는 영향)

  • Lee, Sang-Hyun;Jo, Kwang-Heon;Lee, Kyu-Bok
    • The Journal of Korean Academy of Prosthodontics
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    • v.49 no.4
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    • pp.316-323
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    • 2011
  • Purpose: The purpose of this study was to investigate the effect of different thread designs on the marginal bone stresses around dental implant. Materials and methods: Standard ITI implant(ITI Dental Implant System; Straumann AG, Waldenburg, Switzerland), 4.1 mm in diameter and 10 mm in length, was selected as control. Test implants of four different thread patterns were created based on control implant, i.e. maintaining all geometrical design of control implant except thread pattern. Four thread designs used in test implants include (1) small V-shape screw (model A), (2) large V-shape screw (model B), (3) buttress screw (model C), and (4) trapezoid screw (model D). Surface area for unit length of implant was 14.4 $mm^2$ (control), 21.7 (small V-shape screw), 20.6 (large V-shape screw), 17.0 (buttress screw) and 28.7 $mm^2$ (trapezoid screw). Finite element models of implant/bone complex were created using an axisymmetric scheme with the use of NISA II/DISPLAY III (Engineering Mechanics Research Corporation, Troy, MI, USA). A load of 100 N applied to the central node on the crown top either in parallel direction or at 30 degree to the implant axis (in order to apply non-axial load to the implant NKTP type 34 element was employed). Quantification and comparison of the peak stress in the marginal bone of each implant model was made using a series of regression analyses based on the stress data calculated at the 5 reference points which were set at 0.2, 0.4, 0.6, 0.8 and 1.0 mm from implant wall on the marginal bone surface. Results: Results showed that although severe stress concentration on the marginal bone cannot be avoided a substantial reduction in the peak stress is achievable using different thread design. The peak marginal bone stresses under vertical loading condition were 7.84, 6.45, 5.96, 6.85, 5.39 MPa for control and model A, B, C and D, respectively. And 29.18, 26.45, 25.12, 27.37, 23.58 MPa when subject to inclined loading. Conclusion: It was concluded that the thread design is an important influential factor to the marginal bone stresses.

Stabilization using Screws, Wire, and PMMA for Traumatic Cervical Fracture in a Maltese Dog (말티즈 견에서 Screw, Wire와 PMMA를 사용한 외상성 경추 골절의 안정화)

  • Kim, KeunYung;Kim, Minkyung;Park, Ji-Hun;Shin, Jeong-In;Kim, Junsu;Jang, Yun-Seol;Lee, Jae-Hoon
    • Journal of Veterinary Clinics
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    • v.31 no.6
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    • pp.519-522
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    • 2014
  • A 2-year-old, 2 kg Maltese dog was evaluated for progressive tetraparesis and neck pain. The dog had been treated with steroids for the preceding 2 weeks after unknown trauma but was deteriorating progressively and had become tetraparetic. The dog was presented with a non-ambulatory tetraparesis. Radiographic and computed tomographic examinations revealed a transverse C2 fracture with subluxation of the atlantoaxial joint and C2-C3. In addition, hydrocephalus was observed on magnetic resonance imaging. Stabilization of C1-C3 using screws, wires, and polymethyl methacrylate (PMMA) was performed. Application of ventral screws, wires, and PMMA resulted in improvement of the clinical signs after 4 weeks, and the dog could walk as before the tetraparesis 6 weeks after the operation. This stabilization method is an effective surgical treatment for management of cervical instability.