Objective The purpose of this study is to highlight our technique for freehand placement of juxtapedicular screws along with intraoperative computed tomography (CT) and radiographic results.
Methods Consecutive patients with adult idiopathic scoliosis undergoing primary surgery by the senior author were identified. All type D (absent/slit like channel) pedicles were identified on preoperative CT. Three-dimensional visualization software was used to measure screw angulation and purchase. Radiographs were measured by a fellowship trained spine surgeon. The freehand technique was used to place all screws in a juxtapedicular fashion without any fluoroscopic, radiographic, navigational or robotic assistance.
Results Seventy-three juxtapedicular screws were analyzed. The most common level was T7 (9 screws) on the left and T5 (12 screws) on the right. The average medial angulation was 20.7° (range, 7.1°–36.3°), lateral vertebral body purchase was 13.4 mm (range, 0–28.9 mm), and medial vertebral body purchase was 21.1 mm (range, 8.9–31.8 mm). More than half (53.4%) of the screws had bicortical purchase. Two screws were lateral on CT scan, defined by the screw axis lateral to the lateral vertebral body cortex. No screws were medial. There was a difference in medial angulation between screws with (n = 58) and without (n = 15) lateral body purchase (22.0 ± 4.9 vs. 15.5 ± 4.5, p < 0.001). Three of 73 screws were repositioned after intraoperative CT. There were no neurovascular complications. The mean coronal cobb corrections for main thoracic and lumbar curves were 83.0% and 80.5%, respectively, at an average of 17.5 months postoperative.
Conclusion Freehand juxtapedicular screw placement is a safe technique for type D pedicles in adult idiopathic scoliosis patients.
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Neurospine 2021;18(3):570-579. Published online September 30, 2021
Objective To evaluate the effect of coronal alignment on: (1) surgical invasiveness and operative complexity and (2) postoperative complications.
Methods A retrospective, cohort study of adult spinal deformity patients was conducted. Alignment groups were: (1) neutral alignment (NA): coronal vertical axis (CVA) ≤ 3 cm and sagittal vertical axis (SVA) ≤ 5 cm; (2) coronal malalignment (CM) only: CVA > 3 cm; (3) Sagittal malalignment (SM) only: SVA > 5 cm; and (4) coronal and sagittal malalignment (CCSM): CVA > 3 cm and SVA > 5 cm.
Results Of 243 patients, alignment groups were: NA 115 (47.3%), CM 48 (19.8%), SM 38 (15.6%), and CCSM 42 (17.3%). Total instrumented levels (TILs) were highest in CM (14.5 ± 3.7) and CCSM groups (14 ± 4.0) (p < 0.001). More 3-column osteotomies (3COs) were performed in SM (21.1%) and CCSM (28.9%) groups than CM (10.4%) (p = 0.003). CM patients had more levels instrumented (p = 0.029), posterior column osteotomies (PCOs) (p < 0.001), and TLIFs (p = 0.002) than SM patients. CCSM patients had more TLIFs (p = 0.012) and higher estimated blood loss (EBL) (p = 0.003) than SM patients. CVA displayed a stronger relationship with TIL (p = 0.002), EBL (p < 0.001), and operative time (p < 0.001) than SVA, which had only one significant association with EBL (p = 0.010). Both SM/CCSM patients had higher readmissions (p = 0.003) and reoperations (p < 0.001) than CM patients.
Conclusion Amount of preoperative CM was a better predictor of surgical invasiveness than the amount of SM, despite 3COs more commonly performed in SM patients. CM patients had more instrumented levels, PCOs, and TLIFs than SM patients.
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Clinical, Radiographic, and Genetic Analyses in a Population-Based Cohort of Adult Spinal Deformity in the Older Population Jun Jae Shin, Byeongwoo Kim, Juwon Kang, Junjeong Choi, Bong Ju Moon, Dal Sung Ryu, Seung Hwan Yoon, Dong Kyu Chin, Jung-Kil Lee, Keung Nyun Kim, Yoon Ha Neurospine.2021; 18(3): 608. CrossRef
Letter to the Editor. Suggested addition to the classification system for multirod constructs Asham Khan, John Pollina, Jeffrey P. Mullin Journal of Neurosurgery: Spine.2021; 34(4): 688. CrossRef
Commentary: Quad S2-Alar-Iliac Screw Fixation via Navigated Spinal Robotics With Software Planning: 2-Dimensional Operative Video Arunit J S Chugh, Manish K Kasliwal Operative Neurosurgery.2020; 19(5): E524. CrossRef
The “Kickstand Rod” Technique for Coronal Imbalance in Patients With Spinal Deformity: A Case Report With Review of Literature Brian Fiani, Ryan Jarrah Cureus.2020;[Epub] CrossRef
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