Disclosures Theologis Safety of reconstruction of complex OREF - - PowerPoint PPT Presentation

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Safety of reconstruction of complex cervical spine pathology using pedicle screws inserted with navigation

Alexander A. Theologis, MD; Shane Burch, MD May 9, 2014

Disclosures

• Theologis

– OREF

• Burch

– Medtronic

Cervical Spine Stabilization

Lateral mass screws Interspinous wiring Facet wiring Interlaminar clamps

Adequate Fixation?

Chin-on-chest deformity Facet fracture/dislocati

• n

Spondylo- arthropathy / Osteoporosis

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Cervicle Pedicle Screws

• 3-column fixation

Cervical pedicle screws vs. lateral mass screws: uniplanar fatigue analysis and residual pullout strengths

Todd L. Johnston, MDa , Eldin E. Karaikovic, MD, PhDb,*, Eugene P . Lautenschlager, PhDb, David Marcu, BSb

a The Spine Journal 6 (2006) 667–672

Challenging Anatomy?

Anatomy Foraminotomy Nav

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O-Arm Purpose

• Determine the safety of cervical pedicle screw

placement with navigation in patients with complex cervicothoracic deformities and revision cervical spine pathology.

Methods

• Retrospective analysis
• Single surgeon
• Cervical pedicle screws inserted using

O-Arm imaging and Stealth Navigation

• 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

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Results

• 22 patients

– Female: 10; Male: 22

• Avge age: 63 years (32-83 yrs)]

– Variable pathology

• 10 primary operations for

cervicothoracic kyphosis

• 12 revision operations
• Radiographic follow-up

15 months (1.4 - 46 mos).

• Accuracy: 96.8%
• No neurovascular complications
• 3 revisions:
• C8 radiculopathy due to iatrogenic foraminal stenosis(reduction of

kyphotic deformity), revision C1-3 PCF to improve chin-brow angle

• No revisions for deformity progression or implant failure or

malposition.

Cervical Level # Screws Percentage of total screws # (%) of misplacement C1 C2 4 3.2 C3 20 16.1 C4 22 17.8 3 (2.4%) C5 23 18.5 1 (0.8%) C6 18 14.5 C7 37 29.8 Total 124 100 4

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

• perations of the cervical spine

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References

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• 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

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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.