C-arm assessment of cervical pedicle screw: screw coaxial fluoroscopy and oblique view.
ABSTRACT Oblique view and screw coaxial fluoroscopy were used to assess cervical pedicle screw position in human cadaveric spine, results of which were compared with those of direct visual inspection by an anatomist.
To determine whether clinicians can detect misplaced cervical pedicle screws with accurate sensitivity and specificity using conventional C-arm equipment.
In the cervical region, pedicle screws have not been used so popularly as in lumbar or in thoracic regions. The reasons are related to the risk of inserting screw in small pedicle. So far, no method has been studied to assess the position of cervical pedicle screw during the operation.
Ten human cadavers were prepared for this study. Headed and nonheaded pedicle screws were inserted bilaterally from C3-C7. Using C-arm oblique and screw coaxial fluoroscopy, the depth of penetration was recorded in 2-dimension scale (superoinferior and mediolateral direction) by 6 different observers. The vertebrae were all harvested, and the penetration depth was recorded by an anatomist under direct visualization. The accuracy of C-arm measurements was analyzed. The results of nonheaded and headed screws also were compared.
A total of 98 pedicle screw positions were finally enrolled into the study. The oblique view can verify screw position with the sensitivity of 86.1% and specificity of 64.5%. Coaxial fluoroscopy had a sensitivity of 89.8% and a specificity of 56.9% in superoinferior direction. Mediolaterally coaxial fluoroscopy had a sensitivity of 70.0% and a specificity of 51.3%.
C-arm assessment of pedicle position has acceptable accuracy. With C-arm swing motion of the coaxial fluoroscopy, headed screws were also inspected without any difference as nonheaded screws. Measurements for superoinferior direction showed better sensitivity than those for mediolateral direction, which are supposed to be related to be elliptical shape and thin lateral margin of cervical pedicle.
- SourceAvailable from: Juliane Zenner[Show abstract] [Hide abstract]
ABSTRACT: Clinical studies reported frequent failure with anterior instrumented multilevel cervical corpectomies. Hence, posterior augmentation was recommended but necessitates a second approach. Thus, an author group evaluated the feasibility, pull-out characteristics, and accuracy of anterior transpedicular screw (ATPS) fixation. Although first success with clinical application of ATPS has already been reported, no data exist on biomechanical characteristics of an ATPS-plate system enabling transpedicular end-level fixation in advanced instabilities. Therefore, we evaluated biomechanical qualities of an ATPS prototype C4–C7 for reduction of range of motion (ROM) and primary stability in a non-destructive setup among five constructs: anterior plate, posterior all-lateral mass screw construct, posterior construct with lateral mass screws C5 + C6 and end-level fixation using pedicle screws unilaterally or bilaterally, and a 360° construct. 12 human spines C3–T1 were divided into two groups. Four constructs were tested in group 1 and three in group 2; the ATPS prototypes were tested in both groups. Specimens were subjected to flexibility test in a spine motion tester at intact state and after 2-level corpectomy C5–C6 with subsequent reconstruction using a distractable cage and one of the osteosynthesis mentioned above. ROM in flexion–extension, axial rotation, and lateral bending was reported as normalized values. All instrumentations but the anterior plate showed significant reduction of ROM for all directions compared to the intact state. The 360° construct outperformed all others in terms of reducing ROM. While there were no significant differences between the 360° and posterior constructs in flexion–extension and lateral bending, the 360° constructs were significantly more stable in axial rotation. Concerning primary stability of ATPS prototypes, there were no significant differences compared to posterior-only constructs in flexion–extension and axial rotation. The 360° construct showed significant differences to the ATPS prototypes in flexion–extension, while no significant differences existed in axial rotation. But in lateral bending, the ATPS prototype and the anterior plate performed significantly worse than the posterior constructs. ATPS was shown to confer increased primary stability compared to the anterior plate in flexion–extension and axial rotation with the latter yielding significance. We showed that primary stability after 2-level corpectomy reconstruction using ATPS prototypes compared favorably to posterior systems and superior to anterior plates. From the biomechanical point, the 360° instrumentation was shown the most efficient for reconstruction of 2-level corpectomies. Further studies will elucidate whether fatigue testing will enhance the benefit of transpedicular anchorage with posterior constructs and ATPS.European Spine Journal 04/2011; · 2.47 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Palmitoylation, the posttranslational thioester-linked modification of a 16-carbon saturated fatty acid onto the cysteine residue of a protein, has garnered considerable attention due to its implication in a multitude of disease states. The signature DHHC motif (Asp-His-His-Cys) identifies a family of protein acyltransferases (PATs) that catalyze the S-palmitoylation of target proteins via a two-step mechanism. In the first step, autopalmitoylation, palmitate is transferred from palmitoyl-CoA to the PAT, creating a palmitoyl:PAT intermediate and releasing reduced CoA. The palmitoyl moiety is then transferred to a protein substrate in the second step of the reaction. We have developed an in vitro, single-well, fluorescence-based enzyme assay that monitors the first step of the PAT reaction by coupling the production of reduced CoA to the reduction of NAD+ using the α-ketoglutarate dehydrogenase complex. This assay is suitable for determining PAT kinetic parameters, elucidating lipid donor specificity and measuring PAT inhibition by 2-bromopalmitate. Finally, it can be used for high-throughput screening (HTS) campaigns for modulators of protein palmitoylation.Analytical Biochemistry 01/2014; 460:1–8. · 2.58 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Upper thoracic vertebral bodies are difficult to access using standard anterior approaches. It may require sternotomy and claviculectomy, which carries significant possibility of morbidities. We report a case of inferiorly migrated cervicothoracic junction disc treated successfully by anterior upper-vertebral transcorporeal approach. This specific technique obviated the need of sternotomy, created favorable working space and saved the motion segment at cervicothoracic junction. This report is the first transcorporeal approach to a disc fragment at T1-2 space without fusion.Journal of Korean Neurosurgical Society 01/2011; 49(1):61-4. · 0.60 Impact Factor