AI Article Synopsis
- - The study examined the frequency and risk factors associated with medial breaches of the pedicle wall during robotic-assisted cortical bone trajectory (RA-CBT) screw placements in 145 adult patients from January 2019 to July 2022.
- - Out of 784 screws analyzed, 30 (3.8%) exhibited a medial breach, with a notable correlation to lower bone quality (measured by Hounsfield units), the placement of screws on the right side, and screws in the upper instrumented vertebra.
- - Despite these breaches, no patients required additional surgery for screw repositioning, and there were no significant differences in clinical outcomes between patients with or without a medial breach.
Article Abstract
Objective: We describe the incidence of, and identify the risk factors for, a medial breach of the pedicle wall during robotic-assisted cortical bone trajectory (RA-CBT) screw insertion.
Methods: We analyzed a consecutive series of adult patients who underwent RA-CBT screw placement from January 2019 to July 2022. To assess the pedicle wall medial breach, postoperative computed tomography (CT) images were analyzed. Patient demographic data and screw data were compared between patients with and without a medial breach. The Hounsfield units (HUs) on the L1 midvertebral axial CT scan was used to evaluate bone quality.
Results: Of 784 CBT screws in 145 patients, 30 (3.8%) had a medial breach in 23 patients (15.9%). One screw was grade 2, and the others were grade 1. Patients with a medial breach had a lower HU value compared with the patients without a medial breach (123.3 vs. 150.5; P = 0.027). A medial breach was more common in the right than left side (5.5% vs. 2.0%; P = 0.014). More than one half of the screws with a medial breach were found in the upper instrumented vertebra (UIV) compared with the middle construct or lowest instrumented vertebra (6.7% vs. 1.3% vs. 2.7%; P = 0.003). Binary logistic regression showed that low HU values, right-sided screw placement, and UIV were associated with a medial breach. No patients returned to the operating room for screw malposition. No differences were found in the clinical outcomes between patients with and without a medial breach.
Conclusions: The incidence of pedicle wall medial breach was 3.8% of RA-CBT screws in the postoperative CT images. A low HU value measured in the L1 axial image, right-sided screw placement, and UIV were associated with an increased risk of medial breach for RA-CBT screw placement.
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| http://dx.doi.org/10.1016/j.wneu.2024.01.168 | DOI Listing |
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