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Advanced Visualization in Minimally Invasive Spine Surgery: The Ergonomics, Economics, and Evolution of Camera-Based Tubes and Retractors. 微创脊柱手术中的先进可视化技术:基于摄像头的管道和牵引器的人体工程学、经济学和演变。
IF 1.7 Q2 SURGERY Pub Date : 2024-08-30 DOI: 10.14444/8643
Advith Sarikonda, Ahilan Sivaganesan, Sheeraz Qureshi

Background: Tubular spine surgery has emerged as a hallmark of minimally invasive spine (MIS) procedures. In recent years, thanks to technological advances, tubular dilators and retractors have been integrated with digital cameras to allow for ergonomic, high-definition visualization of the surgical field.

Objective: To detail the evolution, ergonomics, economics, and outcomes of camera-based tubular spine surgery, spanning the origins of MIS tubular techniques to the current use of operative microscopes and tube-mounted digital cameras (TMDCs).

Methods: This is a narrative review of studies examining the evolution of tubular spine surgery as well as its most recent advances, with a particular emphasis on advances in visualization of the surgical field.

Results: Despite early resistance to tubular techniques due to a steep learning curve, minimally invasive tubular approaches are being increasingly adopted by the mainstream spine surgical community, which has resulted in an expansion of both indications and procedural modalities. This can largely be attributed to the increased quality of visualization, as evidenced by improvements in microscopes as well as emerging technologies like exoscopes and TMDCs. Tubular MIS procedures have also achieved superior efficacy compared with open surgical approaches for the treatment of several spinal pathologies while allowing for improved ergonomics, which may have lasting consequences on surgeon longevity.

Conclusions: Advances in visualization technologies have allowed tubular surgery to become an effective, ergonomic, and muscle-sparing alternative to open spine surgery. Further research is necessary to quantify the true costs and outcomes associated with nascent TMDC technology.

Clinical relevance: This work elucidates developments in visualization for tubular spine surgery.

Level of evidence: 5:

背景:管状脊柱手术已成为微创脊柱(MIS)手术的标志。近年来,由于技术的进步,管状扩张器和牵引器已与数码相机集成,实现了符合人体工程学的手术区域高清可视化:详细介绍基于摄像头的管状脊柱手术的演变、人体工程学、经济学和结果,从 MIS 管状技术的起源到目前手术显微镜和管状数码摄像头(TMDC)的使用:本文是一篇叙述性综述,研究了管状脊柱手术的演变过程及其最新进展,特别强调了手术视野可视化方面的进步:尽管由于学习曲线陡峭,管状技术早期受到抵制,但主流脊柱外科界越来越多地采用微创管状方法,从而扩大了适应症和手术方式。这主要归功于显微镜以及外窥镜和 TMDC 等新兴技术的改进所带来的可视化质量的提高。与开放式手术方法相比,管状 MIS 手术在治疗几种脊柱病理方面也取得了更好的疗效,同时还改善了人体工程学,这可能会延长外科医生的寿命:结论:可视化技术的进步使管状手术成为一种有效、符合人体工学和保护肌肉的脊柱开放手术替代方法。有必要开展进一步研究,以量化与新生 TMDC 技术相关的真实成本和结果:临床相关性:这项研究阐明了管状脊柱手术可视化技术的发展:5:
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引用次数: 0
Predictability in Achieving Target Intervertebral Lordosis Using Personalized Interbody Implants. 使用个性化椎间植入物实现目标椎体后凸的可预测性
IF 1.7 Q2 SURGERY Pub Date : 2024-08-30 DOI: 10.14444/8637
Saeed S Sadrameli, Donald J Blaskiewicz, Jahangir Asghar, Christopher P Ames, Gregory M Mundis, Joseph A Osorio, Justin S Smith, Chun-Po Yen, Sigurd H Berven, Ashvin I Patel, Michele Temple-Wong, Rodrigo J Nicolau, Roland S Kent

Background: Lumbar lordosis distribution has become a pivotal factor in re-establishing the foundational alignment of the lumbar spine. This can directly influence overall sagittal alignment, leading to improved long-term outcomes for patients. Despite the wide availability of hyperlordotic stock cages intended to achieve optimal postoperative alignment, there is a lack of correlation between the lordotic shape of a cage and the resultant intervertebral alignment. Recently, personalized spine surgery has witnessed significant advancements, including 3D-printed personalized interbody implants, which are customized to the surgeon's treatment and alignment goals. This study evaluates the reliability of 3D-printed patient-specific interbody implants to achieve the planned postoperative intervertebral alignment.

Methods: This is a retrospective study of 217 patients with spinal deformity or degenerative conditions. Patients were included if they received 3D-printed personalized interbody implants. The desired intervertebral lordosis (IVL) angle was prescribed into the device design for each personalized interbody (IVL goal). Standing postoperative radiographs were measured, and the IVL offset was calculated as IVL achieved minus IVL goal.

Results: In this patient population, 365 personalized interbodies were implanted, including 145 anterior lumbar interbody fusions (ALIFs), 99 lateral lumbar interbody fusions (LLIFs), and 121 transforaminal lumbar interbody fusions. Among the 365 treated levels, IVL offset was 1.1° ± 4.4° (mean ± SD). IVL was achieved within 5° of the plan in 299 levels (81.9%). IVL offset depended on the approach of the lumbar interbody fusion and was achieved within 5° for 85.9% of LLIF, 82.6% of transforaminal lumbar interbody fusions and 78.6% of ALIFs. Ten levels (2.7%) missed the planned IVL by >10°. ALIF and LLIF levels in which the plan was missed by more than 5° tended to be overcorrected.

Conclusions: This study supports the use of 3D-printed personalized interbody implants to achieve planned sagittal intervertebral alignment.

Clinical relevance: Personalized interbody implants can consistently achieve IVL goals and potentially impact foundational lumbar alignment.

Level of evidence: 4:

背景:腰椎前凸分布已成为重建腰椎基础对齐的关键因素。这可直接影响整体矢状排列,从而改善患者的长期治疗效果。尽管目前市场上有很多旨在实现最佳术后对位的超脊柱侧弯固定架,但固定架的侧弯形状与由此产生的椎间对位之间缺乏相关性。最近,个性化脊柱手术取得了重大进展,包括根据外科医生的治疗和对位目标定制的 3D 打印个性化椎间植入物。本研究评估了三维打印患者特异性椎间植入物实现术后椎间对位计划的可靠性:这是一项回顾性研究,研究对象为 217 名脊柱畸形或退行性病变患者。接受过 3D 打印个性化椎间植入物的患者均被纳入研究范围。每个个性化椎间植入物(IVL 目标)的装置设计中都规定了所需的椎间前凸(IVL)角度。测量术后立位X光片,计算IVL偏移量,即达到的IVL减去IVL目标:结果:在这一患者群体中,共植入了 365 个个性化椎间融合器,包括 145 个前路腰椎椎体间融合器(ALIF)、99 个侧路腰椎椎体间融合器(LLIF)和 121 个经椎间孔腰椎椎体间融合器。在接受治疗的 365 个水平中,IVL 偏移为 1.1° ± 4.4°(平均值 ± SD)。有 299 个椎板水平(81.9%)的 IVL 与计划值相差 5°。IVL偏移量取决于腰椎椎间融合术的方法,85.9%的LLIF、82.6%的经椎间孔腰椎椎间融合术和78.6%的ALIF的IVL偏移量在5°以内。有 10 个水平(2.7%)与计划的 IVL 相差大于 10°。计划偏差超过5°的ALIF和LLIF水平往往矫正过度:这项研究支持使用 3D 打印的个性化椎间植入物来实现计划的矢状椎体间对齐:临床相关性:个性化椎间植入物可持续实现IVL目标,并可能影响腰椎的基础对线:4:
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引用次数: 0
Mismatch Between Pelvic Incidence and Lumbar Lordosis After Personalized Interbody Fusion: The Importance of Preoperative Planning and Alignment in Degenerative Spine Diseases. 个性化椎间融合术后骨盆发生率与腰椎后凸不匹配:脊柱退行性疾病术前规划和对位的重要性。
IF 1.7 Q2 SURGERY Pub Date : 2024-08-30 DOI: 10.14444/8638
Jahangir Asghar, Ashvin I Patel, Joseph A Osorio, Justin S Smith, John Small, Jeffrey P Mullin, Atman Desai, Michele Temple-Wong, Rodrigo J Nicolau

Background: Emerging data have highlighted the significance of planning and aligning total and segmental lumbar lordosis with pelvic morphology when performing short-segment fusion with the goal of reducing the risk of adjacent segment disease while also decreasing spine-related disability. This study evaluates the impact of personalized interbody implants in restoring pelvic incidence-lumbar lordosis (PI-LL) mismatch compared with a similar study using stock interbody implants.

Methods: This multicenter retrospective analysis assessed radiographic pre- and postoperative spinopelvic alignment (PI-LL) in patients who underwent 1- or 2-level lumbar fusions with personalized interbody implants for degenerative (nondeformity) indications. The aim was to assess the incidence of malalignment (PI-LL ≥ 10°) both before and after fusion surgery and to determine the rate of alignment preservation and/or correction in this population.

Results: There were 135 patients included in this study. Of 83 patients who were aligned preoperatively, alignment was preserved in 76 (91.6%) and worsened in 7 (8.4%). Among the 52 preoperatively malaligned patients, alignment was restored in 23 (44.2%), and 29 (55.8%) were not fully corrected. Among patients who were preoperatively aligned, there was no statistically significant difference in either the "preserved" or "worsened" groups between stock devices and personalized interbody devices. In contrast, among patients who were preoperatively malaligned, there was a statistically significant increase in the "restored" group (P = 0.046) and a statistically significant decrease in the "worsened" groups in patients with personalized interbodies compared with historical stock device data (P < 0.05).

Conclusions: Compared with a historical cohort with stock implants, personalized interbody implants in short-segment fusions have shown a statistically significant improvement in restoring patients to normative PI-LL. Using 3-dimensional preoperative planning combined with personalized implants provides an important tool for planning and achieving improvement in spinopelvic parameters.

Level of evidence: 3:

背景:新出现的数据强调了在进行短节段融合术时,根据骨盆形态规划和调整全腰椎和节段腰椎前凸的重要性,目的是降低邻近节段疾病的风险,同时减少脊柱相关残疾。本研究评估了个性化椎体间植入物在恢复骨盆入射角-腰椎前凸(PI-LL)不匹配方面的影响,并与使用库存椎体间植入物的类似研究进行了比较:这项多中心回顾性分析评估了因退行性(非畸形)适应症而使用个性化椎体间植入物进行 1 级或 2 级腰椎融合术的患者术前和术后脊柱骨盆对位(PI-LL)的影像学情况。目的是评估融合手术前后对位不良(PI-LL ≥ 10°)的发生率,并确定该人群的对位保持率和/或矫正率:本研究共纳入 135 名患者。在 83 名术前对位的患者中,76 人(91.6%)的对位得到保留,7 人(8.4%)的对位恶化。在 52 名术前排列不齐的患者中,23 人(44.2%)的排列得到了恢复,29 人(55.8%)的排列未得到完全矫正。在术前对齐的患者中,库存器械和个性化椎间孔镜在 "保持 "或 "恶化 "组别中没有显著的统计学差异。相比之下,在术前错位的患者中,使用个性化椎间孔镜的 "恢复 "组与历史库存器械数据相比有统计学意义的增加(P = 0.046),而 "恶化 "组则有统计学意义的减少(P < 0.05):结论:与使用库存植入物的历史群组相比,短节段融合术中的个性化椎间植入物在使患者恢复正常 PI-LL 方面具有统计学意义上的显著改善。使用三维术前规划结合个性化植入物为规划和改善脊柱骨盆参数提供了重要工具:3:
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引用次数: 0
Editors' Introduction: Rethinking the "One-Size-Fits-All" Approach in Spine Surgery. 编辑导言:反思脊柱手术中的 "一刀切 "方法。
IF 1.7 Q2 SURGERY Pub Date : 2024-08-30 DOI: 10.14444/8635
Paul Park, Philip K Louie
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引用次数: 0
Does Pedicle Morphology Affect the Safety and Accuracy of Pedicle Screw Placement Using 3D-Printed Guides? A 5-Year, Single-Center Experience With 2210 Screws Placed for Adult Spinal Deformity Reconstruction. 椎弓根形态是否影响使用 3D 打印导板植入椎弓根螺钉的安全性和准确性?成人脊柱畸形重建手术中植入 2210 根螺钉的 5 年单中心经验。
IF 1.7 Q2 SURGERY Pub Date : 2024-08-30 DOI: 10.14444/8641
Rakesh Kumar, Jean-Christophe Leveque, Philip K Louie, Rajiv Sethi, Venu M Nemani

Background: Adult spinal deformity (ASD) surgery often involves the placement of pedicle screws using various methods, including freehand technique, fluoroscopic guidance, and computer-assisted intraoperative navigation, each with distinct limitations. Particularly challenging is the instrumentation of pedicles with small or absent cancellous channels (Watanabe types C and D pedicles), commonly found at the apex of large curves where precise screw placement is crucial for effective deformity correction. 3D-printed pedicle screw drill guides (3DPSG) may assist in accurately placing pedicle screws while minimally disrupting the standard ASD surgery workflow. This study aims to evaluate the safety and efficacy of 3DPSG in ASD patients with Watanabe types C and D pedicles, where the safe corridor for screw placement is limited.

Methods: 3DPSG were designed using fine cut (≤1.25 mm) computed tomography scans. Preoperative screw trajectory planning and guide manufacturing were conducted using computer-aided design software (Mighty Oak Medical, Englewood, CO). Four ASD surgeons with varying experience levels placed the guides. Data on patient demographics, pedicle morphology, number of levels instrumented, and implant-related complications were collected.

Results: The study included 115 patients (median age 67, range 18-81 years) with 2210 screws placed from T1 to L5. The median number of levels instrumented per case was 11 (range 7-12). Diagnoses included adult degenerative scoliosis (n = 62), adult idiopathic scoliosis (n = 30), Scheuermann's kyphosis (n = 2), and other complex conditions (n = 21). The overall accuracy rate for pedicle screw placement was 99.5%, with a 0% malposition rate in type C and D pedicles. No vascular or neurological complications or reoperations related to screw placement were reported.

Conclusion: 3DPSG facilitates safe and accurate pedicle screw placement regardless of pedicle morphology in ASD surgeries. This includes the challenging Watanabe types C and D pedicles, typically found at curve apices, enabling surgeons to achieve high implant density and optimal spinal fixation in ASD patients.

Level of evidence: 4:

背景:成人脊柱畸形(ASD)手术通常涉及使用各种方法放置椎弓根螺钉,包括徒手技术、透视引导和计算机辅助术中导航,每种方法都有明显的局限性。尤其具有挑战性的是对具有小松质骨通道或无松质骨通道的椎弓根(Watanabe C 和 D 型椎弓根)进行器械植入,这种椎弓根常见于大弯的顶点,精确的螺钉植入对于有效矫正畸形至关重要。三维打印椎弓根螺钉钻导器(3DPSG)可帮助精确放置椎弓根螺钉,同时最大限度地减少对标准 ASD 手术工作流程的干扰。本研究旨在评估3DPSG在渡边C型和D型椎弓根ASD患者中的安全性和有效性,在这些患者中,螺钉置入的安全通道有限。使用计算机辅助设计软件(Mighty Oak Medical, Englewood, CO)进行术前螺钉轨迹规划和导板制造。四名具有不同经验水平的 ASD 外科医生负责放置导板。收集了有关患者人口统计学、椎弓根形态、植入器械的层数以及植入物相关并发症的数据:研究共纳入 115 名患者(中位年龄 67 岁,18-81 岁不等),从 T1 到 L5 共植入 2210 枚螺钉。每个病例植入的螺钉数量中位数为 11 个(7-12 个不等)。诊断包括成人退行性脊柱侧凸(62 例)、成人特发性脊柱侧凸(30 例)、Scheuermann 脊柱侧凸(2 例)和其他复杂情况(21 例)。椎弓根螺钉置入的总体准确率为99.5%,C型和D型椎弓根螺钉置入不良率为0%。结论:在 ASD 手术中,无论椎弓根形态如何,3DPSG 都有助于安全、准确地放置椎弓根螺钉。结论:无论 ASD 手术中的椎弓根形态如何,3DPSG 都有助于安全、准确地放置椎弓根螺钉,包括具有挑战性的渡边 C 型和 D 型椎弓根,它们通常位于曲线顶端,使外科医生能够在 ASD 患者中实现高植入密度和最佳脊柱固定:4:
{"title":"Does Pedicle Morphology Affect the Safety and Accuracy of Pedicle Screw Placement Using 3D-Printed Guides? A 5-Year, Single-Center Experience With 2210 Screws Placed for Adult Spinal Deformity Reconstruction.","authors":"Rakesh Kumar, Jean-Christophe Leveque, Philip K Louie, Rajiv Sethi, Venu M Nemani","doi":"10.14444/8641","DOIUrl":"10.14444/8641","url":null,"abstract":"<p><strong>Background: </strong>Adult spinal deformity (ASD) surgery often involves the placement of pedicle screws using various methods, including freehand technique, fluoroscopic guidance, and computer-assisted intraoperative navigation, each with distinct limitations. Particularly challenging is the instrumentation of pedicles with small or absent cancellous channels (Watanabe types C and D pedicles), commonly found at the apex of large curves where precise screw placement is crucial for effective deformity correction. 3D-printed pedicle screw drill guides (3DPSG) may assist in accurately placing pedicle screws while minimally disrupting the standard ASD surgery workflow. This study aims to evaluate the safety and efficacy of 3DPSG in ASD patients with Watanabe types C and D pedicles, where the safe corridor for screw placement is limited.</p><p><strong>Methods: </strong>3DPSG were designed using fine cut (≤1.25 mm) computed tomography scans. Preoperative screw trajectory planning and guide manufacturing were conducted using computer-aided design software (Mighty Oak Medical, Englewood, CO). Four ASD surgeons with varying experience levels placed the guides. Data on patient demographics, pedicle morphology, number of levels instrumented, and implant-related complications were collected.</p><p><strong>Results: </strong>The study included 115 patients (median age 67, range 18-81 years) with 2210 screws placed from T1 to L5. The median number of levels instrumented per case was 11 (range 7-12). Diagnoses included adult degenerative scoliosis (<i>n</i> = 62), adult idiopathic scoliosis (<i>n</i> = 30), Scheuermann's kyphosis (<i>n</i> = 2), and other complex conditions (<i>n</i> = 21). The overall accuracy rate for pedicle screw placement was 99.5%, with a 0% malposition rate in type C and D pedicles. No vascular or neurological complications or reoperations related to screw placement were reported.</p><p><strong>Conclusion: </strong>3DPSG facilitates safe and accurate pedicle screw placement regardless of pedicle morphology in ASD surgeries. This includes the challenging Watanabe types C and D pedicles, typically found at curve apices, enabling surgeons to achieve high implant density and optimal spinal fixation in ASD patients.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":"18 S1","pages":"S50-S56"},"PeriodicalIF":1.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Changes in Alignment at Untreated Vertebral Levels Following Short-Segment Fusion Using Personalized Interbody Cages: Leveraging Personalized Medicine to Reduce the Risk of Reoperation. 使用个性化椎间融合器进行短节段融合术后未治疗椎体水平的对位变化:利用个性化医学降低再手术风险。
IF 1.7 Q2 SURGERY Pub Date : 2024-08-30 DOI: 10.14444/8639
Jeffrey P Mullin, Jahangir Asghar, Ashvin I Patel, Joseph A Osorio, Justin S Smith, Christopher P Ames, John Small, Atman Desai, Adrien Ponticorvo, Rodrigo J Nicolau

Background: An abnormal postoperative lordosis distribution index (LDI), which quantifies the ratio between the lordosis at L4 to S1 and the lordosis at L1 to S1, contributes to the development of adjacent segment disease and increased revision rates in patients undergoing short-segment lumbar intervertebral fusions. Incorporating preoperative spinopelvic parameters and LDI into the surgical plan for short-segment fusion is important for guiding alignment restoration and preserving normal preoperative alignment in unfused segments. This study examined changes in LDI, segmental lordosis, and lordosis of the unfused levels in patients treated with personalized interbody cage (PIC) implants.

Methods: This retrospective study evaluated radiographic measurements from 111 consecutively treated patients diagnosed with degenerative spinal conditions and treated with a short-segment fusion of L4 to L5, L5 to S1, or L4 to S1 using PIC implant(s) within 6 months of the fusion procedure. Comparisons of intervertebral lordosis for treated and untreated levels as well as LDI pre- and postoperatively were performed.

Results: In patients with a preoperative hypolordotic distribution (LDI < 50%), statistically significant increases were found in LDI postoperatively, approaching the normal LDI range (LDI 50%-80%). Likewise, patients with hyperlordotic distribution preoperatively (LDI > 80%) experienced a decrease in LDI postoperatively, trending toward the normal range, although the changes were not statistically significant. Intervertebral lordosis for the L5 to S1 level increased significantly following the placement of a PIC in the normal and hypolordotic LDI groups. Changes in intervertebral lordosis for L5 to S1 were not significant for patients with preoperative hyperlordotic LDI. Reciprocal changes in intervertebral lordosis at L1 to L4 were not observed in any groups.

Conclusions: PIC implants may provide a benefit for patients, particularly those with hypolordotic distributions preoperatively. They have the potential to further improve patient outcomes by helping surgeons to achieve patient-specific lordosis goals, which may help to reduce the risk of adjacent segment disease and revisions in patients undergoing short-segment lumbar intervertebral fusions.

Clinical relevance: Personalized implants can help surgeons achieve patient-specific alignment goals, potentially prevent adjacent segment disease, and reduce long-term reinterventions.

Level of evidence: 4:

背景:异常的术后前凸分布指数(LDI)可量化 L4 至 S1 处的前凸与 L1 至 S1 处的前凸之间的比率,它是导致接受短节段腰椎间融合术的患者发生邻近节段疾病和增加翻修率的原因。将术前脊柱骨盆参数和 LDI 纳入短节段融合术的手术计划对于指导对位恢复和保留未融合节段的正常术前对位非常重要。本研究探讨了使用个性化椎间笼植入物治疗患者的 LDI、节段前凸和未融合水平前凸的变化:这项回顾性研究评估了111名连续接受治疗的脊柱退行性疾病患者的影像学测量结果,这些患者在融合术后6个月内接受了L4至L5、L5至S1或L4至S1的短节段融合术,并使用了PIC植入物。对治疗过和未治疗过的椎体前凸以及术前和术后的 LDI 进行了比较:结果:对于术前椎体后凸分布过低(LDI < 50%)的患者,术后 LDI 有显著的统计学增长,接近正常 LDI 范围(LDI 50%-80%)。同样,术前脊柱前凸分布过度(LDI > 80%)的患者术后 LDI 有所下降,趋向于正常范围,但变化无统计学意义。在LDI正常组和LDI过低组植入PIC后,L5至S1水平的椎间前凸明显增加。术前 LDI 过度的患者 L5 至 S1 椎间前凸的变化不明显。在任何组别中均未观察到 L1 至 L4 椎间前凸的相互变化:结论:PIC 植入物可为患者带来益处,尤其是那些术前脊柱分布过低的患者。结论:PIC 植入物可为患者带来益处,尤其是那些术前椎体分布过低的患者,它们有可能帮助外科医生实现患者特定的前凸目标,从而进一步改善患者的预后,这可能有助于降低接受短节段腰椎间融合术的患者发生邻近节段疾病和翻修的风险:个性化植入物可帮助外科医生实现患者特定的对位目标,预防邻近节段疾病,减少长期再干预:4:
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引用次数: 0
Tomographic Assessment of Fusion Rate, Implant-Endplate Contact Area, Subsidence, and Alignment With Lumbar Personalized Interbody Implants at 1-Year Follow-Up. 对腰椎个性化椎间植入物一年随访期间的融合率、植入物与终板接触面积、下沉和对齐情况进行断层扫描评估。
IF 1.7 Q2 SURGERY Pub Date : 2024-08-30 DOI: 10.14444/8640
Christopher P Ames, Justin S Smith, Rodrigo J Nicolau

Background: Incongruity between irregularly shaped vertebral endplates and the uniform surfaces of stock interbody fusion cages has been identified as contributing to cage subsidence, pseudarthrosis, and unpredictable alignment. Advances in manufacturing techniques have driven the development of personalized interbody cages (PICs) that can match individual endplate morphology and provide the exact shape and size needed to fill the disc space and achieve the planned correction. This study used computed tomography (CT) imaging to evaluate the implant-endplate contact area, fusion, subsidence, and achievement of planned alignment correction in patients receiving PIC devices.

Methods: This retrospective study included patients treated for adult spinal deformity at a single site and implanted with PIC devices at L4 to L5 or L5 to S1 for segmental stabilization and alignment correction, who received 1-year postoperative CT images as part of their standard of care. An evaluation using 3-dimensional thin-section scans was conducted. Implant-endplate contact and signs of fusion were assessed in each CT slice across both endplates. The degree of subsidence as well as measures of segmental and global lumbar alignment were also assessed.

Results: Fifteen patients were included in the study, with a mean age of 68.2 years. Follow-up ranged between 9 and 14 months. Twenty-six total lumbar levels were implanted; 20 with PIC devices via the anterior lumbar interbody fusion approach, 2 with stock cages via the anterior lumbar interbody fusion approach, and 4 with PIC devices via the transforaminal lumbar interbody fusion approach. CT analysis of PIC-implanted levels found an overall implant-endplate contact area ratio of 93.9%, a subsidence rate of 4.5%, a fusion rate of 100%, and satisfactory segmental and global lumbar correction compared with the preoperative plan.

Conclusions: PIC implants can provide nearly complete contact with endplate surfaces regardless of the individual endplate morphology. Subsidence, fusion, and alignment assessments in this tomographic study illustrated results consistent with the benefits of a personalized interbody implant.

Level of evidence: 4:

背景:不规则形状的椎体终板与椎体间融合笼的统一表面之间的不协调已被确认为导致椎体间融合笼下沉、假关节和不可预测的对位的原因。制造技术的进步推动了个性化椎体间融合保持架(PIC)的发展,这种保持架可以与个体终板形态相匹配,并提供填充椎间盘间隙和实现计划矫正所需的精确形状和尺寸。本研究使用计算机断层扫描(CT)成像评估植入物与椎间盘终板的接触面积、融合、下沉以及接受PIC装置的患者实现计划对位矫正的情况:这项回顾性研究纳入了在单一部位接受成人脊柱畸形治疗并在 L4 至 L5 或 L5 至 S1 植入 PIC 装置以进行节段稳定和对位矫正的患者。我们使用三维薄层扫描进行了评估。在每张 CT 片上评估植入物与终板的接触情况以及两个终板的融合迹象。此外,还评估了下沉程度以及节段和整体腰椎排列的测量结果:研究共纳入 15 名患者,平均年龄为 68.2 岁。随访时间为 9 至 14 个月。共植入了 26 个腰椎水平,其中 20 个通过前路腰椎椎间融合器植入了 PIC 装置,2 个通过前路腰椎椎间融合器植入了库存保持架,4 个通过经椎间孔腰椎椎间融合器植入了 PIC 装置。对PIC植入水平的CT分析发现,植入体与终板的总体接触面积比为93.9%,下沉率为4.5%,融合率为100%,与术前计划相比,节段和整体腰椎矫正效果令人满意:结论:无论椎板形态如何,PIC 植入物都能与椎板内表面实现近乎完全的接触。这项断层扫描研究中的下沉、融合和对位评估结果表明,个性化椎间植入物的优势是一致的:4:
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引用次数: 0
Radiographic Alignment in Deformity Patients Treated With Personalized Interbody Devices: Early Experience From the COMPASS Registry. 使用个性化椎间孔镜治疗的畸形患者的放射学对齐情况:COMPASS 登记的早期经验。
IF 1.7 Q2 SURGERY Pub Date : 2024-08-30 DOI: 10.14444/8636
Roland S Kent, Christopher P Ames, Jahangir Asghar, Donald J Blaskiewicz, Joseph A Osorio, Chun-Po Yen, Jeffrey Mullin, Justin S Smith, John M Small, Michele Temple-Wong, Jeffrey D Schwardt

Background: Literature supports the need for improved techniques to achieve spinopelvic alignment and reduce complication rates in patients with adult spinal deformity (ASD). Personalized interbody devices were developed to address this need and are under evaluation in the multicenter Clinical Outcome Measures in Personalized aprevo (circle R superscript) Spine Surgery (COMPASS (TM suprascript) registry. This report presents interim COMPASS pre- and postoperative sagittal alignment results and complication rates for a subcohort of COMPASS patients diagnosed and surgically treated for spinal deformity.

Methods: COMPASS is a postmarket observational registry of patients enrolled either before or after index surgery and then followed prospectively for 24 months. Sagittal alignment was assessed with SRS-Schwab modifiers for pelvic incidence minus lumbar lordosis, pelvic tilt, and T1 pelvic angle. Summed SRS-Schwab modifiers were utilized to assign overall deformity status as mild, moderate, or severe. Complications were extracted from patient medical records.

Results: The study included 67 patients from 9 centers. Preoperative severe deformity was observed in 66% of patients. Index surgeries included implantation of a median of 2 personalized interbody devices by anterior, lateral, or transforaminal approaches and with a median of 8 posteriorly instrumented levels. Overall postoperative sagittal alignment improved with a significant decrease in the mean sum of SRS-Schwab modifiers that correlated strongly to improvements in pelvic incidence minus lumbar lordosis. Among 44 patients with preoperative severe overall deformity, 16 improved to moderate and 9 to mild deformity. Complications occurred for 13 patients (19.4%), including 1 mechanical complication requiring revision 9 months after surgery and none related to personalized interbody devices.

Conclusions: This study demonstrates that ASD patients whose treatment included personalized interbody devices can obtain favorable postoperative alignment status comparable to published results and with no complications related to the personalized interbody devices.

Clinical relevance: This study contributes to growing evidence that personalized interbody devices contribute to improved sagittal alignment in ASD patients by directly adjusting the orientation of adjacent vertebra.

Level of evidence: 3:

背景:文献支持需要改进技术来实现脊柱骨盆对齐,并降低成人脊柱畸形(ASD)患者的并发症发生率。为满足这一需求,我们开发了个性化椎间孔镜设备,并在多中心个性化椎间孔镜(COMPASS)脊柱手术(COMPASS(TM suprascript))临床结果测量登记中进行评估。本报告介绍了COMPASS术前和术后矢状对位的中期结果,以及诊断为脊柱畸形并接受手术治疗的COMPASS亚群患者的并发症发生率:COMPASS 是一项市场后观察登记,患者在指数手术之前或之后登记,然后进行 24 个月的前瞻性随访。用SRS-Schwab修正器评估骨盆内陷减去腰椎前凸、骨盆倾斜和T1骨盆角的矢状对齐情况。利用 SRS-Schwab 改良因子的总和将整体畸形状态分为轻度、中度或重度。并发症摘自患者病历:研究包括来自 9 个中心的 67 名患者。66%的患者术前出现严重畸形。指标手术包括通过前路、侧路或经椎孔路植入中位数为2的个性化椎间器械,以及中位数为8的后路器械水平。术后整体矢状排列得到改善,SRS-Schwab修正因子的平均总和显著下降,这与骨盆内陷减去腰椎前凸的改善密切相关。在44名术前整体严重畸形的患者中,16人的畸形改善为中度,9人的畸形改善为轻度。13名患者(19.4%)出现了并发症,其中1例为机械性并发症,需要在术后9个月进行翻修,无一例与个性化椎间孔镜装置有关:本研究表明,使用个性化椎间孔镜进行治疗的 ASD 患者术后对位状况良好,与已发表的结果相当,且没有出现与个性化椎间孔镜相关的并发症:这项研究为越来越多的证据做出了贡献,即个性化椎间孔镜通过直接调整相邻椎体的方向,有助于改善ASD患者的矢状对位:3:
{"title":"Radiographic Alignment in Deformity Patients Treated With Personalized Interbody Devices: Early Experience From the COMPASS Registry.","authors":"Roland S Kent, Christopher P Ames, Jahangir Asghar, Donald J Blaskiewicz, Joseph A Osorio, Chun-Po Yen, Jeffrey Mullin, Justin S Smith, John M Small, Michele Temple-Wong, Jeffrey D Schwardt","doi":"10.14444/8636","DOIUrl":"10.14444/8636","url":null,"abstract":"<p><strong>Background: </strong>Literature supports the need for improved techniques to achieve spinopelvic alignment and reduce complication rates in patients with adult spinal deformity (ASD). Personalized interbody devices were developed to address this need and are under evaluation in the multicenter Clinical Outcome Measures in Personalized aprevo (circle R superscript) Spine Surgery (COMPASS (TM suprascript) registry. This report presents interim COMPASS pre- and postoperative sagittal alignment results and complication rates for a subcohort of COMPASS patients diagnosed and surgically treated for spinal deformity.</p><p><strong>Methods: </strong>COMPASS is a postmarket observational registry of patients enrolled either before or after index surgery and then followed prospectively for 24 months. Sagittal alignment was assessed with SRS-Schwab modifiers for pelvic incidence minus lumbar lordosis, pelvic tilt, and T1 pelvic angle. Summed SRS-Schwab modifiers were utilized to assign overall deformity status as mild, moderate, or severe. Complications were extracted from patient medical records.</p><p><strong>Results: </strong>The study included 67 patients from 9 centers. Preoperative severe deformity was observed in 66% of patients. Index surgeries included implantation of a median of 2 personalized interbody devices by anterior, lateral, or transforaminal approaches and with a median of 8 posteriorly instrumented levels. Overall postoperative sagittal alignment improved with a significant decrease in the mean sum of SRS-Schwab modifiers that correlated strongly to improvements in pelvic incidence minus lumbar lordosis. Among 44 patients with preoperative severe overall deformity, 16 improved to moderate and 9 to mild deformity. Complications occurred for 13 patients (19.4%), including 1 mechanical complication requiring revision 9 months after surgery and none related to personalized interbody devices.</p><p><strong>Conclusions: </strong>This study demonstrates that ASD patients whose treatment included personalized interbody devices can obtain favorable postoperative alignment status comparable to published results and with no complications related to the personalized interbody devices.</p><p><strong>Clinical relevance: </strong>This study contributes to growing evidence that personalized interbody devices contribute to improved sagittal alignment in ASD patients by directly adjusting the orientation of adjacent vertebra.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S6-S15"},"PeriodicalIF":1.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Patient-Specific Rods in Adolescent and Adult Spinal Deformity Surgery: A Narrative Review. 青少年和成人脊柱畸形手术中的患者专用杆:叙述性综述。
IF 1.7 Q2 SURGERY Pub Date : 2024-08-30 DOI: 10.14444/8642
Anson G Bautista, Justin L Reyes, Nathan J Lee, Michael W Fields, Zeeshan M Sardar, Lawrence G Lenke, Joseph M Lombardi, Ronald A Lehman

Spinal deformity surgery often requires complex surgical interventions that can have a drastic effect on both patient quality of life and functional capacity. Modern-day corrective solutions for these deformities include spinal osteotomies, pedicle screw instrumentation, and dual/multirod constructs. These solutions are efficacious and are currently considered standard practice for spinal surgeons, but they lack individualization. Patient-specific rods (PSRs) are a novel technology that attempts to offer a personalized approach to spinal deformity correction based on preoperative computerized tomography scans. Moreover, PSRs may offer several advantages to conventional rods, which include achievement of desired rod contour angles according to surgical planning alignment goals, reduced operative time, and reduced blood loss. In adolescent idiopathic scoliosis, those instrumented with PSR have observed coronal Cobb reductions up to 74%. In adult spinal deformity, PSRs have offered superior correction in radiographic parameters such as sagittal vertical axis and pelvic incidence minus lumbar lordosis. However, there still remains a paucity of research in this area, mainly in health care expenditure, cost-effectiveness, and longitudinal clinical outcomes. The purpose of this article is to survey the current body of knowledge of PSR instrumentation in both adolescent and adult spinal deformity populations. The current strength, limitations, and future directions of PSRs are highlighted throughout this article.

脊柱畸形手术通常需要复杂的手术干预,这会对患者的生活质量和功能能力产生巨大影响。针对这些畸形的现代矫正方案包括脊柱截骨术、椎弓根螺钉器械植入术和双/多螺柱结构。这些方案都很有效,目前被认为是脊柱外科医生的标准做法,但它们缺乏个性化。患者特异性矫正杆(PSR)是一种新型技术,它试图根据术前计算机断层扫描提供个性化的脊柱畸形矫正方法。此外,与传统矫形棒相比,PSRs 还具有一些优势,包括根据手术规划对齐目标实现所需的矫形棒轮廓角度、缩短手术时间和减少失血量。在青少年特发性脊柱侧凸中,使用 PSR 的患者的冠状面 Cobb 降低率高达 74%。在成人脊柱畸形中,PSR 在矢状垂直轴和骨盆内陷减去腰椎前凸等影像学参数方面具有卓越的矫正效果。然而,这方面的研究仍然很少,主要是在医疗支出、成本效益和纵向临床结果方面。本文旨在对青少年和成人脊柱畸形人群中 PSR 器械的现有知识体系进行调查。本文重点介绍了 PSR 目前的优势、局限性和未来发展方向。
{"title":"Patient-Specific Rods in Adolescent and Adult Spinal Deformity Surgery: A Narrative Review.","authors":"Anson G Bautista, Justin L Reyes, Nathan J Lee, Michael W Fields, Zeeshan M Sardar, Lawrence G Lenke, Joseph M Lombardi, Ronald A Lehman","doi":"10.14444/8642","DOIUrl":"10.14444/8642","url":null,"abstract":"<p><p>Spinal deformity surgery often requires complex surgical interventions that can have a drastic effect on both patient quality of life and functional capacity. Modern-day corrective solutions for these deformities include spinal osteotomies, pedicle screw instrumentation, and dual/multirod constructs. These solutions are efficacious and are currently considered standard practice for spinal surgeons, but they lack individualization. Patient-specific rods (PSRs) are a novel technology that attempts to offer a personalized approach to spinal deformity correction based on preoperative computerized tomography scans. Moreover, PSRs may offer several advantages to conventional rods, which include achievement of desired rod contour angles according to surgical planning alignment goals, reduced operative time, and reduced blood loss. In adolescent idiopathic scoliosis, those instrumented with PSR have observed coronal Cobb reductions up to 74%. In adult spinal deformity, PSRs have offered superior correction in radiographic parameters such as sagittal vertical axis and pelvic incidence minus lumbar lordosis. However, there still remains a paucity of research in this area, mainly in health care expenditure, cost-effectiveness, and longitudinal clinical outcomes. The purpose of this article is to survey the current body of knowledge of PSR instrumentation in both adolescent and adult spinal deformity populations. The current strength, limitations, and future directions of PSRs are highlighted throughout this article.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":"18 S1","pages":"S57-S63"},"PeriodicalIF":1.7,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Elective Spinal Transpedicular Ablation of the Basivertebral Nerve of the Vertebral Segment in Adult Spinal Deformity Patients. 成人脊柱畸形患者选择性脊柱椎节基底椎体神经消融术。
IF 1.7 Q2 SURGERY Pub Date : 2024-08-24 DOI: 10.14444/8632
Guy Fogel, Jake Dickinson, Sunny Vuong
<p><strong>Background: </strong>Ablation of the basivertebral nerve (BVNA) innervating the vertebral endplate has become a standard treatment of vertebrogenic chronic low back pain (CLBP) arising from vertebral endplate damage. BVNA treatment of CLBP in clinical trials was successful and durable for pain relief and return to daily activities. This case review adds new information about older patients with adult degenerative spinal deformity (ASD) and associated comorbidities not previously described in clinical trials.</p><p><strong>Methods: </strong>One hundred and eighteen ASD patients with vertebrogenic CLBP in a community practice setting underwent 503 levels of BVNA (average 4.3 levels). Forty-one patients with minimal comorbidities (Group A) were compared to 77 patients with significant comorbidities (Group B). Visual analog scale (VAS 10 cm) and Oswestry Disability Index (ODI 100-point scale) were obtained before BVNA and at a last follow-up (LFU).</p><p><strong>Results: </strong>Group A VAS at LFU was an average of 2 cm, a 7 cm improvement. Group B VAS at LFU was 3 cm, a 6 cm improvement. At LFU, Group A ODI mean was 14 points or minimal disability, with a 39-point improvement, and Group B improved 28 points to 29 but remained moderately disabled. At LFU, the lumbar stenosis with laminectomy and BVNA subgroup of 26 had mean VAS 2 cm and ODI 28-point improvement but remained on average 21 points with a final low moderate disability. Eleven laminectomy and BVNA patients had continued posterior column pain related to radiculopathy, and or peripheral neuropathy, and sacroiliac joint pain in 30%. Mobile spondylolisthesis in 21 patients in Group B at LFU had a 6 cm improvement of VAS and 25-point improvement of ODI but remained moderately disabled on ODI. At LFU in group B, there was a 20% incidence of continued stenosis and radiculopathy symptoms. At LFU, Lumbar fusion was recommended in 9. Vertebral compression fracture (VCF) occurred in 9 after BVNA (10%) of Group B. These patients were older (mean 78 years), and all had significant osteoporosis. Eight fractures were within the area of the BVNA, and 1 was an S2 sacral fracture. These VCF patients were treated with vertebroplasty or kyphoplasty and continued preventive care with added teriparatide. At LFU, the VCF subgroup had a modest 6 cm improvement in VAS to 4 cm and continued to have significant severe to moderate disability (Oswestry Disability Index average of 38 points).</p><p><strong>Conclusion: </strong>Clinical trials of BVNA treatment of CLBP found success and durability for pain relief and daily activities. Patients with ASD without comorbidities showed durable pain relief of vertebrogenic CLBP and return of daily activities similar to clinical trials. In those with comorbidities, the result was an improvement in pain and disability that could be diminished by the complications related to the comorbidities. This is new information about BVNA for older patients with spinal deformi
背景:消融支配椎体终板的椎基底神经(BVNA)已成为治疗椎体终板损伤引起的椎源性慢性腰背痛(CLBP)的标准疗法。在临床试验中,BVNA 对 CLBP 的治疗是成功和持久的,可以缓解疼痛并恢复日常活动。本病例回顾为临床试验中未提及的患有成人退行性脊柱畸形(ASD)和相关合并症的老年患者增添了新的信息:方法:118 名患有椎体源性 CLBP 的 ASD 患者在社区诊所接受了 503 个级别的 BVNA(平均 4.3 个级别)。41名合并症较少的患者(A组)与77名合并症较多的患者(B组)进行了比较。在进行 BVNA 前和最后一次随访(LFU)时,分别测量了视觉模拟量表(VAS 10 厘米)和 Oswestry 失能指数(ODI 100 分制):结果:A 组在 LFU 时的 VAS 平均为 2 厘米,改善了 7 厘米。B 组在 LFU 时的 VAS 为 3 厘米,改善了 6 厘米。在 LFU 时,A 组的 ODI 平均值为 14 点或轻度残疾,改善了 39 点;B 组改善了 28 点,达到 29 点,但仍为中度残疾。在 LFU,腰椎椎板切除术和 BVNA 治疗的 26 例腰椎管狭窄亚组的 VAS 平均值为 2 厘米,ODI 改善了 28 分,但平均仍为 21 分,最终为低度中度残疾。11例椎板切除术和BVNA患者的后柱疼痛仍与根性神经病、或周围神经病变有关,30%的患者有骶髂关节疼痛。B 组的 21 名活动性脊椎滑脱患者在接受 LFU 治疗后,VAS 改善了 6 厘米,ODI 改善了 25 分,但 ODI 仍为中度残疾。B 组患者在接受腰椎间盘置换术后,继续出现狭窄和根性病变症状的发生率为 20%。LFU 建议对 9 名患者进行腰椎融合术。这些患者年龄较大(平均 78 岁),均有严重的骨质疏松症。其中 8 例骨折发生在 BVNA 区域内,1 例为 S2 骶骨骨折。这些 VCF 患者接受了椎体成形术或椎体后凸成形术治疗,并在添加特立帕肽后继续接受预防性护理。在LFU时,VCF亚组的VAS略有改善,从6厘米降至4厘米,但仍有严重至中度残疾(Oswestry残疾指数平均为38分):结论:BVNA治疗CLBP的临床试验发现,该疗法在缓解疼痛和日常活动方面具有成功性和持久性。无合并症的 ASD 患者的椎体源性 CLBP 疼痛得到了持久缓解,并恢复了日常活动,这与临床试验结果相似。对于有合并症的患者,疼痛和残疾的改善可能会因合并症相关并发症而减弱。这是为患有脊柱畸形和其他合并症的老年患者提供的有关 BVNA 的新信息。这项研究可能会对研究实践和政策产生影响,从而将 BVNA 的适应症扩大到成年脊柱畸形患者:临床相关性:本系列病例是关于成人脊柱畸形患者接受 BVNA 治疗的唯一文献。结果是可预测和可重复的。许多患者感到满意,愿意再次接受治疗,并向亲朋好友推荐 BVNA。这一发现应能鼓励ASD患者接受BVNA治疗,事实上,BVNA可能应在任何融合术前进行,以限制和选择融合术的水平:4:
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引用次数: 0
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International Journal of Spine Surgery
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