TY - JOUR
T1 - Guided pedicle screw insertion
T2 - Techniques and training
AU - Manbachi, Amir
AU - Cobbold, Richard S.C.
AU - Ginsberg, Howard J.
N1 - Funding Information:
The authors thank Ulrich Bühner, Masoud Hashemi, and Bahman Lashkari for helpful discussions. RSCC is grateful to Natural Sciences and Engineering Research Council of Canada for partial financial support under grant no. 3297-2007 , and AM acknowledges scholarship support from the Ontario Graduate Scholarship for Science and Technology . HJG would like to thank the many engineering students, medical students, neurosurgical residents, and spinal fellows who have helped contribute to a better understanding of the problems in spinal fusion surgery.
Funding Information:
Author disclosures: AM: Fellowship Support: Ontario Graduate Scholarship (OGS) (C, Paid directly to institution/employer). RSCC: Grant: Natural Sciences and Engineering Council of Canada (D, Paid directly to institution/employer). HJG: Nothing to disclose.
Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 2014/1/1
Y1 - 2014/1/1
N2 - Background context: In spinal fusion surgery, the accuracy with which screws are inserted in the pedicle has a direct effect on the surgical outcome. Accurate placement generally involves considerable judgmental skills that have been developed through a lengthy training process. Because the impact of misaligning one or more pedicle screws can directly affect patient safety, a number of navigational and trajectory verification approaches have been described and evaluated in the literature to provide some degree of guidance to the surgeon. Purpose: To provide a concise review to justify the need and explore the current state of developing navigational or trajectory verification techniques for ensuring proper pedicle screw insertion along with simulation methods for better educating the surgical trainees. Study design: Recent literature review. Methods: To justify the need to develop new methods for optimizing pedicle screw paths, we first reviewed some of the recent publications relating to the statistical outcomes for different types of navigation along with the conventional freehand (unassisted) screw insertion. Second, because of the importance of providing improved training in the skill of accurate screw insertion, the training aspects of relevant techniques are considered. The third part is devoted to the description of specific navigational assist methods or trajectory verification techniques and these include computer-assisted navigation, three-dimensional simulations, and also electric impedance and optical and ultrasonic image-guided methods. Conclusions: This article presents an overview of the need and the current status of the guidance methods available for improving the surgical outcomes in spinal fusion procedures. It also describes educational aids that have the potential for reducing the training process.
AB - Background context: In spinal fusion surgery, the accuracy with which screws are inserted in the pedicle has a direct effect on the surgical outcome. Accurate placement generally involves considerable judgmental skills that have been developed through a lengthy training process. Because the impact of misaligning one or more pedicle screws can directly affect patient safety, a number of navigational and trajectory verification approaches have been described and evaluated in the literature to provide some degree of guidance to the surgeon. Purpose: To provide a concise review to justify the need and explore the current state of developing navigational or trajectory verification techniques for ensuring proper pedicle screw insertion along with simulation methods for better educating the surgical trainees. Study design: Recent literature review. Methods: To justify the need to develop new methods for optimizing pedicle screw paths, we first reviewed some of the recent publications relating to the statistical outcomes for different types of navigation along with the conventional freehand (unassisted) screw insertion. Second, because of the importance of providing improved training in the skill of accurate screw insertion, the training aspects of relevant techniques are considered. The third part is devoted to the description of specific navigational assist methods or trajectory verification techniques and these include computer-assisted navigation, three-dimensional simulations, and also electric impedance and optical and ultrasonic image-guided methods. Conclusions: This article presents an overview of the need and the current status of the guidance methods available for improving the surgical outcomes in spinal fusion procedures. It also describes educational aids that have the potential for reducing the training process.
KW - Image-guided surgery
KW - Pedicle screw insertion
KW - Resident training
KW - Spinal fusion surgery
KW - Surgical navigation
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U2 - 10.1016/j.spinee.2013.03.029
DO - 10.1016/j.spinee.2013.03.029
M3 - Review article
C2 - 23623511
AN - SCOPUS:84890546801
SN - 1529-9430
VL - 14
SP - 165
EP - 179
JO - Spine Journal
JF - Spine Journal
IS - 1
ER -