UNASSIGNED: To explore the feasibility and accuracy of ultrasound volume navigation (UVN) combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation through a prospective randomized controlled study.
UNASSIGNED: Patients with thoracic and lumbar vertebral fractures scheduled for percutaneous pedicle screw fixation between January 2022 and January 2023 were enrolled. Among them, 60 patients met the selection criteria and were included in the study. There were 28 males and 32 females, with an average age of 49.5 years (range, 29-60 years). The cause of injury included 20 cases of traffic accidents, 21 cases of falls, 17 cases of slips, and 2 cases of heavy object impact. The interval from injury to hospital admission ranged from 1 to 5 days (mean, 1.57 days). The fracture located at T 12 in 15 cases, L 1 in 20 cases, L 2 in 19 cases, and L 3 in 6 cases. The study used each patient as their own control, randomly guiding pedicle screw implantation using UVN combined with X-ray fluoroscopy on one side of the vertebral body and the adjacent segment (trial group), while the other side was implanted under X-ray fluoroscopy (control group). A total of 4 screws and 2 rods were implanted in each patient. The implantation time and fluoroscopy frequency during implantation of each screw, angle deviation and distance deviation between actual and preoperative planned trajectory by imaging examination, and the occurrence of zygapophysial joint invasion were recorded.
UNASSIGNED: In terms of screw implantation time, fluoroscopy frequency, angle deviation, distance deviation, and incidence of zygapophysial joint invasion, the trial group showed superior results compared to the control group, and the differences were significant ( P<0.05).
UNASSIGNED: UVN combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation can yreduce screw implantation time, adjust dynamically, reduce operational difficulty, and reduce radiation damage.
UNASSIGNED: 通过前瞻性随机对照研究，探讨超声容积导航（ultrasound volume navigation，UVN）结合X线透视技术引导经皮椎弓根螺钉植入的可行性及准确性。.
UNASSIGNED: 以2022年1月—2023年1月因胸、腰椎骨折拟行经皮椎弓根螺钉内固定治疗的患者为研究对象，其中60例符合选择标准纳入研究。男28例，女32例；年龄29～60岁，平均49.5岁。致伤原因：交通事故伤20例，摔伤21例，跌倒伤17例，重物砸伤2例。受伤至入院时间1～5 d，平均1.57 d。骨折部位：T 1215例，L 120例，L 2 19例，L 3 6例。 研究采用患者自身左右侧对照，随机在骨折椎体上、下节段一侧椎弓根采用UVN结合X线透视技术引导植钉（试验组），另一侧于X线透视下植钉（对照组）；每例患者植入4枚螺钉、2根钉棒。记录每枚螺钉的植钉时间、植钉过程中透视次数，影像学检查实际螺钉与术前规划钉道角度差值、距离偏差值以及螺钉侵犯关节突关节数量。.
UNASSIGNED: 试验组植钉时间、透视次数、钉道角度差值、钉道距离偏差值、关节突关节侵犯率方面均优于对照组，差异均有统计学意义（ P<0.05）。.
UNASSIGNED: UVN结合X线透视技术引导下行经皮椎弓根螺钉植入能减少植钉时间，可实时动态调整，降低操作难度，减少辐射伤害。.

METHODS: Retrospective comparative study.
OBJECTIVE: To compare the accuracy of intra-operative navigation-assisted percutaneous pedicle screw insertion between bone fixed and skin fixed dynamic reference frame (DRF) in Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).
METHODS: Between October 2018 and September 2022, patients who underwent MIS-TLIF were included in this study with DRF fixed either on bone (group B) or skin (group S). Pedicle screws were inserted under the guidance of intra-operative Cone bean Computed tomography (cbCT) based navigation. Accuracy of pedicle screw placement was immediately checked by a final intra-operative cbCT Spin.
RESULTS: Among 170 patients, group B included 91 patients and group S included 79 patients. Out of total 680 screws, 364 screws (group B) and 316 screws (group S) were placed. Patient\'s demographic data and distribution of screws showed no statistically significant difference. The accuracy showed no significant difference between both the groups (94.5% in group B and 94.3% in group S).
CONCLUSIONS: Skin fixed DRF can serve as an alternate way for placement and avoids extra incision with similar accuracy in pedicle screw insertions with bone fixed DRF using intra-operative CT guided navigation in MIS TLIF.

METHODS: Prospective randomized controlled trial.
OBJECTIVE: No prospective studies have directly compared clinical and radiographic outcomes of unilateral vs bilateral instrumented lateral lumbar interbody fusion (LLIF) for lumbar degenerative disease (LDD). We compared the short-term radiographic, clinical outcomes, and some complications of the unilateral percutaneous pedicle screw (PPS) (UPS) vs bilateral PPS (BPS) fixation in short-level spinal fusion with LLIF for LDD.
METHODS: This was a prospective randomized controlled study of 33 patients who underwent UPS or BPS fixation after LLIF for LDD; 18 patients were assigned to the UPS group and 15 patients to the BPS group. Clinical outcomes, complication rates, and fusion rates were assessed.
RESULTS: The two groups were similar in age, sex, preoperative diagnosis, and level of surgery. Blood loss, length of hospital stay, and numeric rating scale score one year after surgery did not differ between groups. The operative time was longer in the BPS than UPS group (120.2 vs 88.8 min, respectively; P = .029). Both groups showed improvement in disc height and dural sac in the immediate postoperative computed tomography and magnetic resonance imaging, which did not differ significantly between groups. The subsidence grade and fusion rate did not differ, but cage subsidence was more severe in the UPS than BPS group.
CONCLUSIONS: Unilateral and bilateral PPS fixation after LLIF yielded similar short-term clinical and radiological outcomes. However, severe cage subsidence was more common in the UPS group, which suggests that BPS fixation after LLIF may be a better choice over the long term.

UNASSIGNED: Minimally invasive lumbar fusion has recently become a widely used technique worldwide. This randomized active controlled study was conducted to demonstrate the non-inferiority of the K-wireless Minimally Invasive Spine (MIS) Percutaneous Pedicle Screw (PPS) system compared with use of the six pedicle screw systems currently used in our practices with respect to the accuracy of pedicle screw placement.Also to compare the screw-insertion time and number of fluoroscopic observations during screw insertion between the groups.
UNASSIGNED: A total of 80 patients with degenerative spinal diseases or vertebral fractures were assigned, including 41 patients in the K-wireless MIS PPS system group (K-wireless group) and 39 in the control group (K-wire group).The accuracy of the screw insertion, screw-insertion time, number of fluoroscopic observations during screw insertion, and the incidence of adverse events were compared between the K-wireless group and the K-wire group. The accuracy rate was calculated as the number of screws with no breach divided by the total number of screws.
UNASSIGNED: The accuracy rates of screw insertion were 85.7% and 75.0% in the K-wireless and K-wire groups, respectively, with an intergroup difference of 10.7% (95% confidence interval: 2.3-19.1%). The K-wireless group demonstrated non-inferiority compared with the K-wire group. The mean screw-insertion time was significantly shorter in the K-wireless group (2.62 and 2.97 min in the K-wireless and K-wire groups, respectively; P=0.005). There were also significantly fewer fluoroscopies in the K-wireless group (10.7 and 17.4 in the K-wireless and K-wire groups, respectively; P<0.001). There were no device-related or study treatment-related adverse events in either group.
UNASSIGNED: The accuracy of pedicle screw insertion using the K-wireless MIS PPS system was not inferior to that of existing products. In terms of safety, no product-related or treatment-related adverse events were identified in this study and no new safety concerns were noted.

Background and Objectives: Spine surgery using a percutaneous pedicle screw placement (PPSP) is widely implemented for spinal trauma. However, percutaneous systems have been reported to have weak screw-rod connections. In this study, conventional open and percutaneous systems were biomechanically evaluated and compared. Material and Methods: The experiments were performed in two stages: the first stage was a break test, whereas the second stage was a fatigue test. Four systems were used for the experiments. System 1 was intended for conventional open surgery (titanium rod with a 6.0 mm diameter, using a clamp connecting mechanism). System 2 was a percutaneous pedicle screw (PPS) system for trauma (titanium alloy rod with a 6.0 mm diameter, using ball ring connections). System 3 was a PPS system for trauma (cobalt-chromium alloy rod with a 6.0 mm diameter, using sagittal adjusting screw connections). System 4 was a general-purpose PPS system (titanium alloy rod with a 5.5 mm diameter, using a mechanism where the adapter in the head holds down the screw). Results: Stiffness values of 54.8 N/mm, 43.1 N/mm, 90.9 N/mm, and 39.3 N/mm were reported for systems 1, 2, 3, and 4, respectively. The average number of load cycles in the fatigue test was 134,393, 40,980, 1,550,389, and 147,724 for systems 1 to 4, respectively. At the end of the test, the displacements were 0.2 mm, 16.9 mm, 1.2 mm, and 8.6 mm, respectively. System 1, with a locking mechanism, showed the least displacement at the end of the test. Conclusion: A few PPS systems showed better results in terms on stiffness and life than the open system. The experiments showed that mechanical strength varies depending on the spinal implant. The experiments conducted are essential and significant to provide the mechanical strength required for surgical reconstruction.

Background and Objectives: This study aimed to investigate the process and morphology of thoracic and lumbosacral bone fusion in patients with adult spinal deformity (ASD) who underwent circumferential minimally invasive spine surgery (CMIS) by lateral lumbar interbody fusion (LLIF) and percutaneous pedicle screws (PPSs) without bone grafting in the thoracic spine and who have risk factors for bone fusion failure in the thoracic spine. Materials and Methods: This retrospective study included 61 patients with spinal deformities (46 women and 15 men) who underwent CMIS with LLIF and PPSs at our hospital after 2016 and completed a 3-year postoperative follow-up. The rate and morphology of bone fusion and rod fracture rate in the thoracic and lumbosacral vertebrae were evaluated. Patients were divided into the thoracic spine spontaneous bone fusion group and the bone fusion failure group. The data of various spinopelvic parameters and the incidence of complications were compared. The vertebral body conditions in the thoracic spine were classified as less degenerative (type N), osteophyte (type O), and diffuse idiopathic skeletal hyperostosis (DISH) (type D). Results: After three postoperative years, the bone fusion rates were 54%, 95%, and 89% for the thoracic, lumbar, and lumbosacral spine, respectively. Screw loosening in the thoracic vertebrae was significantly higher in the bone fusion failure group, while no significant differences were observed in the spinopelvic parameters, Oswestry Disability Index (ODI), and rate of proximal junctional kyphosis and rod fractures. Type N vertebral body condition and screw loosening were identified as risk factors for spontaneous bone fusion failure in the thoracic spine. Conclusion: This study indicated that spontaneous bone fusion is likely to be obtained without screw loosening, and even if bone fusion is not obtained, there is no effect on clinical results with the mid-term (3-year) results of CMIS without bone grafting in the thoracic spine.

To compare clinical efficacy, radiographic outcome, and radiation exposure between mini-open pedicle screw (MPS) fixation with the Wiltse approach and percutaneous pedicle screw (PPS) fixation in treatment of young and middle-aged patients with thoracolumbar burst fractures.
Of 60 patients with thoracolumbar vertebrae fractures treated in our hospital from January 2017 to January 2018, 30 were randomly assigned to the MPS group and 30 were randomly assigned to the PPS group. Clinical efficacy, radiographic outcome, and radiation exposure were compared between the 2 groups.
The average age of patients was 42.2 ± 6.7 years in the MPS group and 43.0 ± 6.9 years in the PPS group (P = 0.668). There was no significant difference between the 2 groups in blood loss, hospital stay, postoperative visual analog scale score for back pain, and Oswestry Disability Index score. The vertebral body height and vertebral body angle of the MPS group were significantly better than those of the PPS group at the last follow-up. There was no significant difference in the accuracy rate of pedicle screw placement between the MPS group and the PPS group; the facet joint violation was significantly higher in the PPS group. The average radiation exposure dosage was lower in the MPS group.
Both MPS fixation with the Wiltse approach and PPS fixation are safe and effective in the treatment of single-segment thoracolumbar vertebral fractures. Nevertheless, considering the surgical duration, radiation exposure, facet joint violation, vertebral body height, and vertebral body angle at the last follow-up, MPS fixation with the Wiltse approach is a better choice than PPS.

OBJECTIVE: To examine effects of percutaneous endoscopic débridement and allograft via the transforaminal approach combined with percutaneous pedicle screw fixation as treatment for single-level thoracic tuberculosis.
METHODS: This multicenter retrospective analysis included 75 patients with single-level thoracic tuberculosis who underwent percutaneous endoscopic débridement and allograft via the transforaminal approach combined with percutaneous pedicle screw fixation and were followed for >36 months between January 2012 and December 2014.
RESULTS: Follow-up was 36-48 months (average 41.1 ± 2.2 months). Intraoperative blood loss was low (average 30.5 ± 7.9 mL), and bed rest time was short (average 1.5 ± 0.3 days). No recurrence was observed in all 75 patients. Except for 3 patients, almost all patients (96%) achieved grade I or II fusion in interbody bone grafting. Segmental Cobb angle was 13.5° ± 4.1° before surgery, 10.5° ± 3.7° immediately after surgery, and 11.7° ± 3.9° at 36 months of follow-up. All patients achieved complete recovery of neurologic function (American Spinal Injury Association grade E), including 15 patients with spinal cord injury (American Spinal Injury Association grade D) before surgery. The visual analog scale and 36-Item Short-Form Health Survey scores significantly improved at 1, 3, 12, and 36 months of follow-up. No complications related to internal fixation occurred within the follow-up period; complication rate was 9.0%.
CONCLUSIONS: Median follow-up clinical experience with percutaneous endoscopic débridement and allograft via the transforaminal approach combined with percutaneous pedicle screw fixation indicates that the technique is safe, effective, feasible, and minimally invasive.

BACKGROUND: The major limitation of computer-based three-dimensional fluoroscopy is increased radiation exposure of patients and operating room staff. Combining spine navigation with intraoperative three-dimensional fluoroscopy (io3DF) can likely overcome this shortcoming, while increasing pedicle screw accuracy rate. We compared data from a cohort of patients undergoing lumbar percutaneous pedicle screw placement using io3DF alone or in combination with spine navigation.
METHODS: This study consisted of 168 patients who underwent percutaneous pedicle screw implantation between 2009 and 2016. The primary endpoint was to compare pedicle screw accuracy between the 2 groups. Secondary endpoints were to compare radiation exposure of patients and operating room staff, duration of surgery, and postoperative complications.
RESULTS: In group 1, 438 screws were placed without navigation guidance; in group 2, 276 screws were placed with spine navigation. Mean patient age in both groups was 58.6 ± 14.1 years. The final pedicle accuracy rate was 97.9% in group 1 and 99.6% in group 2. Average radiation dose per patient was significantly larger in group 1 (571.9 mGym2) than in group 2 (365.6 mGym2) (P = 0.000088). Surgery duration and complication rate were not significantly different between the 2 groups (P > 0.05).
CONCLUSIONS: io3DF with spine navigation minimized radiation exposure of patients and operating room staff and provided an excellent percutaneous pedicle screw accuracy rate with no permanent complications compared with io3DF alone. This setup is recommended, especially for patients with a complex degenerative spine condition.

BACKGROUND: In the last decade, posterior instrumented fusion using percutaneous pedicle screws (PPSs) had been growing in popularity, and its safety and good clinical results have been reported. However, there have been few previous reports of the accuracy of PPS placement compared with that of conventional open screw insertion in an institution. This study aimed to evaluate the accuracy of PPS placement compared with that of conventional open technique.
METHODS: One hundred patients were treated with posterior instrumented fusion of the thoracic and lumbar spine from April 2008 to July 2013. Four cases of revised instrumentation surgery were excluded. In this study, the pedicle screws inserted below Th7 were investigated, therefore, a total of 455 screws were enrolled. Two hundred and ninety-three pedicle screws were conventional open-inserted screws (O-group) and 162 screws were PPSs (P-group). We conducted a comparative study about the accuracy of placement between the two groups. Postoperative computed tomography scans were carried out to all patients, and the pedicle screw position was assessed according to a scoring system described by Zdichavsky et al. (Eur J Trauma 30:241-247, 2004; Eur J Trauma 30:234-240, 2004) and a classification described by Wiesner et al. (Spine 24:1599-1603, 1999).
RESULTS: Based on Zdichavsky\'s scoring system, the number of grade Ia screws was 283 (96.6 %) in the O-group and 153 (94.4 %) in the P-group, whereas 5 screws (1.7 %) in the O-group and one screw (0.6 %) in the P-group were grade IIIa/IIIb. Meanwhile, the pedicle wall penetrations based on Wiesner classification were demonstrated in 20 screws (6.8 %) in the O-group, and 12 screws (7.4 %) in the P-group. No neurologic complications were observed and no screws had to be replaced in both groups.
CONCLUSIONS: The PPSs could be ideally inserted without complications. There were no statistically significant differences about the accuracy between the conventional open insertion and PPS placement.