Does the Full Power-Assisted Technique Used in Pedical Screw Placement Affect the Safety and Efficacy of Adolescent Idiopathic Scoliosis Surgery?

doi:10.1016/j.wneu.2018.04.047

World Neurosurgery

Volume 116, August 2018, Pages e79-e85

https://doi.org/10.1016/j.wneu.2018.04.047 Get rights and content

Highlights

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The FPA technique can maintain conceivable accuracy and safety of pedicle screw placement in a deformed spine.
•
The FPA technique can still improve the efficacy of pedicle screw placement in a deformed spine.
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The use of FPA tools to place a pedicle screw enhances a surgeon's penetration control in scoliosis surgery.
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The use of the FPA tool did not result in a significant difference in the pattern of screw misplacement.

Background

The new full power-assisted (FPA) technique used in pedicle screw placement during adolescent idiopathic scoliosis (AIS) surgery streamlines the surgical procedure and reduces repetitive surgeon tasks. However, the use of the FPA technique may also negatively affect the surgical safety and efficacy of patients with AIS.

Objective

The purpose of this study was to investigate the effect of the FPA technique on the accuracy of pedicle screw placement, as well as on operating time, blood loss, and clinical outcomes.

Methods

A total of 105 patients with AIS with major thoracic curves treated with posterior instrumentation and fusion were randomized into 2 groups. With the new FPA technique, 427 pedicle screws were implanted in the thoracic region in 35 patients (the FPA group), and using the conventional freehand (FH) technique, 896 screws were implanted in 70 patients (the FH group). The primary end point screw position was assessed using postoperative computed tomography. Secondary end points, such as operative time, blood loss, and clinical outcomes, were also assessed.

Results

The FPA technique did not significantly affect the accuracy rate of the pedicle screw placement, scoliosis correction, total operating time, or total blood loss. However, the surgical times for the screw insertion phase and for each screw placement were significantly shorter for the FPA group compared with the FH group (P < 0.001).

Conclusions

Compared with the conventional manual tools, use of the FPA technique seemed to be superior and had relatively shorter pedicle screw placement times, with comparable surgical safety and efficacy for patients with AIS.

Introduction

In recent years, the pedicle screw fixation system has been increasingly used in spine surgery. However, although biomechanical anchoring strength has improved, numerous studies have shown increased evidence acknowledging that repetitive forceful rotational movements, which are required for extensive pedicle screw placement, are associated with higher rates of pain and musculoskeletal disorders and adversely affect the normal work of surgeons.1, 2 In long-level screw placement for patients with scoliosis, such occupational hazards may be particularly dangerous.

The full power-assisted (FPA) pedicle screw placement system, such as PowerEase (Medtronic Surgical Technologies, Santa Rosa, California, USA), is a recent popular technique used by spine surgeons. The FPA system can increase the comfort, control, and speed of surgeons and surgical staff.³ Previous tests have shown that the use of power tools in spine surgeries requires less surgeon work and shorter surgical times.4, 5 However, there has still been some hesitation related to the use of FPA tools in scoliosis surgery because the rotated vertebrae and narrow pedicle width in a patient with scoliosis make it challenging to insert screws, and many experts worry that the use of this technique removes the critical sense of interosseous feel during this delicate and high-risk activity and may not result in a win-win situation for doctors and patients, as expected.6, 7

Thus far, no controlled trial has statistically verified the safety of adolescent idiopathic scoliosis surgery using the FPA technique in pedicle screw placement. More importantly, there is great uncertainty concerning how the FPA pedicle screw placement affects surgical times, blood loss, and clinical outcomes after the orthopedic procedure. Therefore, we designed a prospective randomized controlled trial performed at a single center to provide an opportunity to assess the surgical safety and efficacy of adolescent idiopathic scoliosis using the FPA technique in pedicle screw placement.

Section snippets

Study Population

After institutional review board approval was received, consecutive patients treated from June 2014 to June 2015 were included in the study. The patients provided informed consent. The following inclusion criteria were applied⁸: 1) having a diagnosis of adolescent idiopathic scoliosis by 2 different senior surgeons, 2) having a curve severity >45°, (3) undergoing thoracic pedicle screw fixation (T1-T12); and 3) having complete preoperative and postoperative computed tomography (CT) images.

Results

Comparisons of the main characteristics between the 2 groups at baseline are listed in Table 1. At the time of surgery, the mean patient age, gender, main curve magnitude, or curve patterns did not differ significantly between the 2 groups.

For patients in the FH cohort, the major curve was corrected from 67.8° ± 18.7° to 24.1°±7.6° immediately after the operation, representing an overall correction rate of 64.5%. In the FPA group, the preoperative major curve of 63.7°± 15.8° was corrected to

Discussion

Since Roy-Camille first introduced pedicle screw fixation of the spine, it has become the most popular form of posterior spinal instrumentation when correcting spinal deformity.¹³ However, performing such pedicle screw placement requires a surgeon to keep their shoulder up for many hours per day, as well as the performance of repetitive forceful rotational movements of the upper extremities, which are known to contribute to various musculoskeletal injuries among spine surgeons. According to the

Conclusions

Compared with conventional manual tools, the use of the FPA technique seems to be superior, leading to a relatively shorter time for the pedicle tract preparation and screw placement, with comparable surgical safety and efficacy for patients with adolescent idiopathic scoliosis.

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Cited by (9)

Utility of Power Tool and Intraoperative Neuromonitoring for Percutaneous Pedicle Screw Placement in Single Position Surgery: A Technical Note
2022, World Neurosurgery
Citation Excerpt :
While robot-assisted spinal surgery is attracting attention,7-9 the usefulness of assistive devices must also be evaluated. Save for its use in certain spinal surgeries, such as patients with adolescent idiopathic scoliosis, the power tool may not be commonly used in spinal surgery and its utilization is rarely reported.10 As one of the few reports of power tool usage suggested, placing PPSs using a power tool may result in shorter fluoroscopy time and a better accuracy rate than when using a manual tool.11
This study aimed to demonstrate the utility of power tools and intraoperative neuromonitoring of percutaneous pedicle screw (PPS) insertion (so-called PPS monitoring) by SINGLE-position surgery (SPS) after lateral lumbar interbody fusion.
A retrospective analysis of medical records from a single center was performed to identify patients who underwent SPS for lateral lumbar interbody fusion and posterior fixation using PPS during intraoperative computed tomography navigation from 2020 to 2021. We investigated the PPS insertion time and screw positional accuracy of patients who underwent SPS involving power tools and PPS monitoring during this period. In this technical note, we report on this surgical technique.
Twenty-four patients (mean age 72.0 ± 8.5 years, range 53–81 years) were included in this study. There were no intraoperative complications in all cases. Posterior fixation using PPS was added in all cases, and a total of 106 PPSs were inserted. It took an average of 6.2 ± 2.4 seconds to insert the PPS from the PPS insertion point to the end using a power tool and PPS monitoring. Moreover, there were no cases of pedicle breaches.
Similar to previous reports related to power tools in the prone position, the lateral decubitus SPS technique can also use power tools to save PPS insertion time. Furthermore, we suggest that the use of PPS monitoring may prevent erroneous PPS insertions by using intraoperative computed tomography navigation in advance.
Freehand power-assisted pedicle screw placement in scoliotic patients: results on 5522 consecutive pedicle screws
2024, Musculoskeletal Surgery
Ergonomics in Spine Surgery
2022, Clinical Spine Surgery
Accuracy of Pedicle Screw Placement Methods in Pediatrics and Adolescents Spinal Surgery: A Systematic Review and Meta-Analysis
2022, Global Spine Journal
Power-assisted Pedicle Screw Technique Protects against Risk of Surgeon Overuse Injury: A Comparative Electromyography Study of the Neck and Upper Extremity Muscle Groups in a Simulated Surgical Environment
2022, Spine
Comparative analysis of the effectiveness of the combined method of inserting pedicle screws with the free-hand technique in patients with idiopathic scoliosis
2022, Hirurgia Pozvonochnika

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: Conflict of interest statement: This study was supported by the Fundamental Research Funds for the Central Universities (grant number 021414380313), the Youth Fund of the National Natural Science Foundation (grant number 81702234), and the Nanjing Clinical Medical Center and Jiangsu Provincial Key Medical Center.

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Original ArticleDoes the Full Power-Assisted Technique Used in Pedical Screw Placement Affect the Safety and Efficacy of Adolescent Idiopathic Scoliosis Surgery?

Highlights

Background

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Study Population

Results

Discussion

Conclusions

Spine Deformity

Injury

J Arthroplasty

J Biomech

Occupational hazards facing orthopedic surgeons

Am J Orthop (Belle Mead NJ)

Musculoskeletal disorders among spine surgeons: results of a survey of the Scoliosis Research Society membership

Spine (Phila Pa 1976)

Biomechanical evaluation of the POWEREASE Tapper/Driver System

Medtronic Internal White Paper

Thoracic pedicle screw placement: free-hand technique

Neurol India

How accurately do novice surgeons place thoracic pedicle screws with the free hand technique?

Spine (Phila Pa 1976)

The superiority of intraoperative O-arm navigation-assisted surgery in instrumenting extremely small thoracic pedicles of adolescent idiopathic scoliosis: a case-control study

Medicine (Baltimore)

A prospective, randomized, multicenter Food and Drug Administration investigational device exemptions study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part I: evaluation of clinical outcomes

Spine (Phila Pa 1976)

Original Article
Does the Full Power-Assisted Technique Used in Pedical Screw Placement Affect the Safety and Efficacy of Adolescent Idiopathic Scoliosis Surgery?