• Journal of Korean Neurosurgical Society
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• 제52권3호
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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.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1998년도 추계학술대회
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• pp.155-156
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• 1998

Screw loosening and subsequent pullout can be attributed to the reduction in bone mineral density in the vertebrae manifested by osteoporosis in which the decrease in fixation strength between the cancellous bone and screw threads are accelerated by repeated loads exerted by patients own weight and activities following the surgery. In this study, the change in pullout strength of the pedicle screws was investigated before and after repeated loads were imparted. For this purpose. Diapason pedicle screws $(6.7\times40mm)$ were inserted onto fresh porcine spine specimens (T1-L5) after bone mineral density was measured using a DEXA. With an MTS, an axial load was applied at a loading rate of 0.33mm/sec until failure to measure the maximum pullout strength. Flexion moment of 7.5N-m was then imparted at 0.5Hz for 2000 cycles. It was found that the maximum pullout strength was exponentially related to BMD regardless of load types ($107.71\;\times\;\exp^{(1.43{\times}BMD)}r^2=0.93$, P<0.0001 without repeated load; ($107.71\;\times\;\exp^{(2.19{\times}BMD)}r^2=0.78$, P<0.0001 with repeated load). The results suggest that the reduction in pullout strength for pedicle screws is far more prominent in osteoporotic spine than in normal spine especially as number of repeated load was increased. More importantly, it was demonstrated that the level of bone mineral density and the activity level of the patient should be evaluated in more detail for successful implementation of pedicle screw systems in spinal surgery.

• Journal of Korean Neurosurgical Society
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• 제39권5호
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• pp.360-365
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• 2006

Objective : This is a cadaver study to assess the accuracy of three cervical screw insertion techniques; the blind technique [Group I], the laminotomy technique [Group II], and the funnel technique [Group III]. Methods : Ten human cadavers embalmed with formaldehyde were prepared. After exposing the spinous processes, the laminas and the lateral masses, titanium alloy transpedicular screws were inserted from C3 to C7. A total of 100 pedicles were ramdomly assigned to one of three techniques [the blind technique : 31 screws, the laminotomy technique : 51 screws, the funnel technique: 18 screws]. Axial computed tomography with 1-mm slices, and sagittal and coronal reformation were performed to identify the accuracy of the screw insertion and the anatomic relationships. Results : In Group I, 9 screws [29%] were either contained within or penetrated less than 1mm, which were rated as successful. In Group II, 24 screws [47%] were successful. In Group III, 16 screws [89%] were successful. In the multiple comparison, there was a statistically significant difference between Groups I and III and between Groups II and III [$X^2$ test and Bonfenoni test]. Conclusion : The funnel technique can help a surgeon's understanding about the cervical pedicle more precisely than the other two techniques. The funnel technique is less dependent on lateral soft tissue retraction state.

• 대한의용생체공학회:의공학회지
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• 제38권1호
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• pp.9-15
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• 2017

Recently, flexible cages have been introduced in an attempt to absorb and reduce the abnormal load transfer along the anterior parts of the spine. They are designed to be used with the pedicle screw systems to allow some mobility at the index level while containing ROM at the adjacent level. In this study, a finite element (FE) study was performed to assess biomechanical efficacies of the flexible cage when combined with pedicle screws with flexible rods. The post-operated models were constructed by modifying the L4-5 of a previously-validated 3-D FE model of the intact lumbar spine (L2-S1): (1) Type 1, flexible cage only; (2) Type 2, pedicle screws with flexible rods; (3) Type 3, interbody fusion cage plus pedicle screws with rigid rods; (4) Type 4, interbody fusion cage plus Type 2; (5) Type 5, Type 1 plus Type 2. Flexion/extension of 10 Nm with a compressive follower load of 400N was applied. As compared to the Type 3 (62~65%) and Type 4 (59~62%), Type 5 (53~55%) was able to limit the motion at the operated level effectively, despite moderate reduction at the adjacent level. It was also able to shift the load back to the anterior portions of the spine thus relieving excessively high posterior load transfer and to reduce stress on the endplate by absorbing the load with its flexible shape design features. The likelihood of component failure of flexble cage remained less than 30% regardless of loading conditions when combined with pedicle screws with flexible rods. Our study demonstrated that flexible cages when combined with posterior dynamic system may help reduce subsidence of cage and degeneration process at the adjacent levels while effectively providing stability at the operated level.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1998년도 추계학술대회
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• pp.279-280
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• 1998

A new algorithm is developed that can reduce the metal artifact on CT caused by pedicle screws. Metal artifact has been recognized as a major problem in precise reading of CT images. In particular, spine surgeons have been bothered with the artifact appearing on CT taken after pedicle screw insertion. To reduce the artifact, our new algorithm first finds the center line from CT images, and then overlays an exact size screw image on the CT. The exact screw is obtained from an actual design specifications of screw, and the CT images are processed to maximize bone margins while minimizing screw images through adjusting the window width and level. 실험 결과 단순한 Window W/L 조절로는 해결되지 않는군요. This algorithm provides spine surgeons with more accurate CT images and thus better interpretation of CT to ascertain the success or failure of pedicle screw insertion.

• Journal of Trauma and Injury
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• 제35권1호
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• pp.12-18
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• 2022

Purpose: Pedicle screw fixation provides 3-column stabilization, multidimensional control, and a higher rate of interbody fusion. Although computed tomography (CT) is recommended for the postoperative assessment of pedicle screw fixation, its use is limited due to the radiation exposure dose. The purpose of this preliminary retrospective study was to assess the clinical usefulness of low-dose mobile cone-beam CT (CBCT) for the postoperative evaluation of pedicle screw fixation. Methods: The author retrospectively reviewed postoperative mobile CBCT images of 15 patients who underwent posterior pedicle screw fixation for spinal disease from November 2019 to April 2020. Pedicle screw placement was assessed for breaches of the bony structures. The breaches were graded based on the Heary classification. Results: The patients included 11 men and four women, and their mean age was 66±12 years. Of the 122 pedicle screws, 34 (27.9%) were inserted in the thoracic segment (from T7 to T12), 82 (67.2%) in the lumbar segment (from L1 to L5), and six (4.9%) in the first sacral segment. Although there were metal-related artifacts, the image of the screw position (according to Heary classification) after surgery could be assessed using mobile CBCT at all levels (T7-S1). Conclusions: Mobile CBCT was accurate in determining the location and integrity of the pedicle screw and identifying the surrounding bony structures. In the postoperative setting, mobile CBCT can be used as a primary modality for assessing the accuracy of pedicle screw fixation and detecting postoperative complications.

• Journal of Korean Neurosurgical Society
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• 제50권4호
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• pp.341-347
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• 2011

Objective : The purpose of this retrospective study was to evaluate the efficacy and safety of atlantoaxial stabilization using a new entry point for C2 pedicle screw fixation. Methods : Data were collected from 44 patients undergoing posterior C1 lateral mass screw and C2 screw fixation. The 20 cases were approached by the Harms entry point, 21 by the inferolateral point, and three by pars screw. The new inferolateral entry point of the C2 pedicle was located about 3-5 mm medial to the lateral border of the C2 lateral mass and 5-7 mm superior to the inferior border of the C2-3 facet joint. The screw was inserted at an angle $30^{\circ}$ to $45^{\circ}$ toward the midline in the transverse plane and $40^{\circ}$ to $50^{\circ}$ cephalad in the sagittal plane. Patients received followed-up with clinical examinations, radiographs and/or CT scans. Results : There were 28 males and 16 females. No neurological deterioration or vertebral artery injuries were observed. Five cases showed malpositioned screws (2.84%), with four of the screws showing cortical breaches of the transverse foramen. There were no clinical consequences for these five patients. One screw in the C1 lateral mass had a medial cortical breach. None of the screws were malpositioned in patients treated using the new entry point. There was a significant relationship between two group (p=0.036). Conclusion : Posterior C1-2 screw fixation can be performed safely using the new inferolateral entry point for C2 pedicle screw fixation for the treatment of high cervical lesions.

• Journal of Korean Neurosurgical Society
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• 제64권2호
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• pp.247-254
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• 2021

Objective : The subaxial cervical pedicle screwing technique shows powerful biomechanical properties for posterior cervical fusion. When applying a pedicle screw using the freehand technique, it is essential to analyse cervical computed tomography and plan the surgery accordingly. Normal cervical computed tomography is usually performed in the supine position, whereas during surgery, the patient lies in a prone position. This fact leads us to suppose that radiological evaluations may yield misleading results. Our study aimed to investigate whether there is any superiority between preoperative preparation on computed tomography performed in the prone position and that performed in the supine position. Methods : This study included 17 patients (132 pedicle screws) who were recently operated on with cervical vertebral computed tomography in the prone position and 17 patients (136 pedicle screws) who were operated on by conventional cervical vertebral computed tomography as the control group. The patients in both groups were compared in terms of age, gender, pathological diagnosis, screw malposition and complications. A screw malposition evaluation was made according to the Gertzbein-Robbins scale. Results : No statistically significant difference was observed between the two groups regarding age, gender and pathological diagnosis. The screw malposition rate (from 11.1% to 6.9%, p<0.05), mean malposition distance (from 2.18 mm to 1.86 mm, p <0.05), and complications statistically significantly decreased in the prone position computed tomography group. Conclusion : Preoperative surgical planning by performing cervical vertebral computed tomography in the prone position reduces screw malposition and complications. Our surgical success increased with a simple modification that can be applied by all clinicians without creating additional radiation exposure or additional costs.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1998년도 추계학술대회
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• pp.167-168
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• 1998

The purpose of this study is to verify the biomechanical characteristics of the custom-made(our) pedicle screws which are designed the different types of shape, pitch, and profile. The results of experiments for our pedicle screw were summarized. 1) The screw of larger outer diameter showed greater holding strength. 2) The holding strength of cylindrical shaped screw was superior to that of conical shaped screw. 3) The holding strength of buttress shape of thread profile showed superior to that of V-shape. 4) The pull out and holding strength of our pedicle screws was superior to that of commercialized screw (Diapason and CD) which is widely used.

• Journal of Korean Neurosurgical Society
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• 제56권4호
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• pp.330-333
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• 2014

Objective : To identify the accuracy and efficiency of the computed tomographic (CT)-based navigation system on upper cervical instrumentation, particularly C1 lateral mass and C2 pedicle screw fixation compared to previous reports. Methods : Between May 2005 and March 2014, 25 patients underwent upper cervical instrumentation via a CT-based navigation system. Seven patients were excluded, while 18 patients were involved. There were 13 males and five females; resulting in four degenerative cervical diseases and 14 trauma cases. A CT-based navigation system and lateral fluoroscopy were used during the screw instrumentation procedure. Among the 58 screws inserted as C1-2 screws fixation, their precise positions were evaluated by postoperative CT scans and classified into three categories : in-pedicle, non-critical breach, and critical breach. Results : Postoperatively, the precise positions of the C1-2 screws fixation were 81.1% (47/58), and 8.6% (5/58) were of non-critical breach, while 10.3% (6/58) were of critical breach. Most (5/6, 83.3%) of the critical breaches and all of non-critical breaches were observed in the C2 pedicle screws and there was only one case of a critical breach among the C1 lateral mass screws. There were three complications (two vertebral artery occlusions and a deep wound infection), but no postoperative instrument-related neurological deteriorations were seen, even in the critical breach cases. Conclusion : Although CT-based navigation systems can result in a more precise procedure, there are still some problems at the upper cervical spine levels, where the anatomy is highly variable. Even though there were no catastrophic complications, more experience are needed for safer procedure.