Background Context: Intraoperative detection of a pedicle wall breach implicitly reduces surgical risk, but the reliability of intraoperative neuromonitoring has been contested. Hydroxyapatite (HA) has been promulgated to increase pedicle screw resistance and negatively influence the accuracy of electromyography.
Purpose: The primary purpose of this experiment is to evaluate the effect of HA on pedicle screw electrical resistance using a controlled laboratory model.
Study Design: Controlled laboratory study.
Methods: Stimulation of pedicle screws was performed in normal saline (0.9% NaCl). The experimental group included 8 HA coated (HAC) pedicle screws and matched manufacturer control pedicle screws without HAC (Ti6Al4V). All screws were stimulated at 5, 10-, 15-, 20-, and 25-mm submersion depths. Circuit current return was recorded, and pedicle screw electrical resistance was calculated according to Ohm's Law. Data were assessed for normality and variance. Mann-Whitney U and Kruskal-Wallis tests compared groups with Bonferroni correction for multiple testing. Effect size is reported with 95% confidence intervals (95CI). p values <.05 were considered significant.
Results: Current return was detected for all screws (N=24) following subclinical 8.5 µA stimulation at 5, 10-, 15-, 20-, and 25-mm submersion depths (N=144). The effect estimate of HA on pedicle screw electrical resistance is -0.07 (-0.17 to 0.01 95CI). The estimated effect of HA on pedicle screw electrical resistance did not differ across manufacturers. Electrical resistance values were inversely related to submersion depth. Electrical resistance values were lower in the experimental group at 10 mm (p=.04), 15 mm (p=.04), and 25 mm (p=.02) submersion depths. The HA effect ranged from -0.03 to -0.08 as submersion depth varied.
Conclusions: We found no evidence that HA increased pedicle screw electrical resistance in a matched manufacturer control laboratory model. Electrical stimulation of pedicle screws may be reliable for pedicle breach detection in the presence of HA. Future research should investigate if laboratory findings translate to clinical practice and confirm that electrical stimulation of pedicle screws is a reliable method to detect pedicle breach in the presence of HA.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.spinee.2021.11.009 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Robotic Systems in Spinal Surgery: A Review of Accuracy, Radiation Exposure, Hospital Readmission Rate, Cost, and Adverse Events.
World Neurosurg
January 2025
Department of Neurosurgery, Louisiana State University Health Sciences Center at Shreveport, 1501 Kings Highway, Shreveport, LA, 71103.
Background: Recent advances within the last decade have allowed robotics to become commonplace in the operating room. In the field of neurosurgery, robotics assist surgeons in pedicle screw placement and vertebral fusion procedures. The purpose of this review is to look at currently used spinal robots available on the market and compare their overall accuracy, cost, radiation exposure, general adverse events, and hospital readmission rates.
View Article and Find Full Text PDFPreserving Cervical Mobility: A Novel Robot-Assisted Approach for Atlas Fracture Fixation.
Am J Case Rep
January 2025
Department of Orthopedic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
BACKGROUND The management of unstable atlas fractures remains a subject of ongoing debate and controversy. The conservative surgical treatment commonly involves fusion, resulting in severe loss of cervical spine mobility, and a large incisions and extensive tissue dissection are required. We aim to introduce a novel concept and surgical approach for treating atlas fracture, one that involves minimizing trauma while maintaining mobility of the upper cervical spine without resorting to fusion.
View Article and Find Full Text PDF[Anterior approach for the revision surgery following bone cement augmentation in osteoporotic vertebral compression fractures].
Zhongguo Gu Shang
January 2025
Department of Orthopaedics, Sir Run Run Shaw Hospital, Hangzhou 310016, Zhejiang, China.
Objective: To observe the clinical outcomes of anterior approach for the revision surgery following unsuccessful bone cement augmentation in osteoporotic vertebral compression fractures.
Methods: A total of 10 patients who experienced unsuccessful bone cement augmentation underwent anterior revision surgery between January 2020 and December 2021. There were 2 males and 8 females.
Comment on: "Comparison of the Accuracy of Pedicle Screw Placement Using a Fluoroscopy-Assisted Free-Hand Technique With Robotic-Assisted Navigation Using an O-Arm or 3D C-Arm in Scoliosis Surgery" by C. Li et al.
Global Spine J
January 2025
Department of Neurosurgery, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria.
Delayed diagnosis of spinal osteoblastoma presenting with radicular pain and scoliosis: A case report.
Int J Surg Case Rep
January 2025
University of Tunis El Manar, Faculty of Medicine of Tunis, 1007, Tunisia; Department of Orthopedic Surgery, Hospital Mongi Slim La Marsa, Tunisia.
Introduction And Importance: Osteoblastoma is a rare benign bone tumor, accounting for 1 % of primary bone tumors, often affecting the spine and sacrum. Accurate diagnosis is essential for appropriate treatment and prognosis.
Case Presentation: A 19-year-old male presented with two years of persistent nocturnal radicular and low back pain unresponsive to anti-inflammatory medications.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!