Pedicle Screws Placement Accuracy in Thoracolumbar Spine Using O-arm Navigation VS Standard Cervical Distractor Screws

NCT ID: NCT04196153

Last Updated: 2020-09-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-10-10

Study Completion Date

2021-10-31

Brief Summary

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Pedicle screw instrumentation is used nowadays mostly in spine fusion which is a surgical option for treating variety of conditions such as vertebral fractures, degenerative spine diseases, spine tumors and spine deformities. However, pedicle screws misplacement and breach may occur and be a great cause of morbidity. The breach rate can be as high as 20-39.8% but most of the time only small number is associated with complications. Surgeons use assistive technique to avoid screw breached and improve screw placement accuracy. Investigators aim in this study to compare accuracy of pedicle screws placement using two guidance techniques are O-arm navigation the latest assistive imaging technique that uses three-dimensional (3-D) real time images to allow the surgeons follow the screw's trajectory, and standard cervical distractor screws to mark the entry point and trajectory.

Detailed Description

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Conditions

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Pedicle Screws Surgery, Computer-Assisted/Adverse Effects Bone Screws Imaging, Three-Dimensional/Methods

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Neuronavigation / O-arm group

Under neural navigation with the use of intraoperative three dimensional imaging quality O-arm , pedicle screws inserted at the thoraolumbar/lumbar spine after insertion of the reference frame at the spinous process above or below the level of instrumentation followed by O-Arm imaging and uploading the images to the stelth navigation system and pedicle tract identification using instrumented tools guided by the Navigation polyaxial screws is inserted.

Group Type ACTIVE_COMPARATOR

Pedicle screws instrumentation

Intervention Type PROCEDURE

The screws are inserted in two or more consecutive levels to prevent motion at the segments that are being fused. It will be done using one of the two guidance technique depending on which arm the patient will be randomized to.

Cervical distractor screws group

pedicle screws inserted using marker screws after posterior exposure of thoracolumbar /lumbar spine by either open midline posterior exposure or minimal invasive posterior wiltse style exposure with expandable tubular retractor, anatomical landmark for insertion of pedical screws identified and followed by inserting of a cervical distraction screw size 3 / 12 mm as a stable marker using high speed drill. C-arm floro is used to take antroposterior and lateral view to confirm the position of the marker screws at this stage.free hand technique supported by the images provided to cannulate the pedicle with the use of information on the images taken for all the marker screws simultaneously.

Group Type ACTIVE_COMPARATOR

Pedicle screws instrumentation

Intervention Type PROCEDURE

The screws are inserted in two or more consecutive levels to prevent motion at the segments that are being fused. It will be done using one of the two guidance technique depending on which arm the patient will be randomized to.

Interventions

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Pedicle screws instrumentation

The screws are inserted in two or more consecutive levels to prevent motion at the segments that are being fused. It will be done using one of the two guidance technique depending on which arm the patient will be randomized to.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients who need a thoracolumbar spine surgery that require pedicle screw insertion.

Exclusion Criteria

* Patients whose surgeries in cervical spine
* Patients whose surgeries are for correction of deformities such as scoliosis and kyphosis, patients with infections or tumors.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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King Abdullah International Medical Research Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mohammed A Khashab, MD

Role: PRINCIPAL_INVESTIGATOR

Assistant Professor of Orthopedic, College of Medicine, KSAU-HS

Locations

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King Abdulaziz Medical City

Jeddah, Eastern Province, Saudi Arabia

Site Status RECRUITING

Countries

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Saudi Arabia

Central Contacts

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Muath M Alswat, MD

Role: CONTACT

966548496502

Facility Contacts

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Ahmad Deeb

Role: primary

+966-11-8011111 ext. 18950

References

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BOUCHER HH. A method of spinal fusion. J Bone Joint Surg Br. 1959 May;41-B(2):248-59. doi: 10.1302/0301-620X.41B2.248. No abstract available.

Reference Type BACKGROUND
PMID: 13641310 (View on PubMed)

Gaines RW Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg Am. 2000 Oct;82(10):1458-76. doi: 10.2106/00004623-200010000-00013.

Reference Type BACKGROUND
PMID: 11057475 (View on PubMed)

Liljenqvist UR, Halm HF, Link TM. Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine (Phila Pa 1976). 1997 Oct 1;22(19):2239-45. doi: 10.1097/00007632-199710010-00008.

Reference Type BACKGROUND
PMID: 9346144 (View on PubMed)

Krag MH, Beynnon BD, Pope MH, DeCoster TA. Depth of insertion of transpedicular vertebral screws into human vertebrae: effect upon screw-vertebra interface strength. J Spinal Disord. 1988;1(4):287-94. doi: 10.1097/00002517-198800140-00002.

Reference Type BACKGROUND
PMID: 2980257 (View on PubMed)

Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res. 1986 Feb;(203):7-17.

Reference Type BACKGROUND
PMID: 3955999 (View on PubMed)

Broom MJ, Banta JV, Renshaw TS. Spinal fusion augmented by luque-rod segmental instrumentation for neuromuscular scoliosis. J Bone Joint Surg Am. 1989 Jan;71(1):32-44.

Reference Type BACKGROUND
PMID: 2913001 (View on PubMed)

Puvanesarajah V, Liauw JA, Lo SF, Lina IA, Witham TF. Techniques and accuracy of thoracolumbar pedicle screw placement. World J Orthop. 2014 Apr 18;5(2):112-23. doi: 10.5312/wjo.v5.i2.112. eCollection 2014 Apr 18.

Reference Type BACKGROUND
PMID: 24829874 (View on PubMed)

Vaccaro AR, Rizzolo SJ, Balderston RA, Allardyce TJ, Garfin SR, Dolinskas C, An HS. Placement of pedicle screws in the thoracic spine. Part II: An anatomical and radiographic assessment. J Bone Joint Surg Am. 1995 Aug;77(8):1200-6. doi: 10.2106/00004623-199508000-00009.

Reference Type BACKGROUND
PMID: 7642665 (View on PubMed)

Verma R, Krishan S, Haendlmayer K, Mohsen A. Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws. Eur Spine J. 2010 Mar;19(3):370-5. doi: 10.1007/s00586-009-1258-4. Epub 2010 Jan 6.

Reference Type BACKGROUND
PMID: 20052504 (View on PubMed)

Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976). 1990 Jan;15(1):11-4. doi: 10.1097/00007632-199001000-00004.

Reference Type BACKGROUND
PMID: 2326693 (View on PubMed)

Kim TT, Drazin D, Shweikeh F, Pashman R, Johnson JP. Clinical and radiographic outcomes of minimally invasive percutaneous pedicle screw placement with intraoperative CT (O-arm) image guidance navigation. Neurosurg Focus. 2014 Mar;36(3):E1. doi: 10.3171/2014.1.FOCUS13531.

Reference Type BACKGROUND
PMID: 24580001 (View on PubMed)

Luo TD, Polly DW Jr, Ledonio CG, Wetjen NM, Larson AN. Accuracy of Pedicle Screw Placement in Children 10 Years or Younger Using Navigation and Intraoperative CT. Clin Spine Surg. 2016 Apr;29(3):E135-8. doi: 10.1097/BSD.0000000000000230.

Reference Type BACKGROUND
PMID: 27007788 (View on PubMed)

Scarone P, Vincenzo G, Distefano D, Del Grande F, Cianfoni A, Presilla S, Reinert M. Use of the Airo mobile intraoperative CT system versus the O-arm for transpedicular screw fixation in the thoracic and lumbar spine: a retrospective cohort study of 263 patients. J Neurosurg Spine. 2018 Oct;29(4):397-406. doi: 10.3171/2018.1.SPINE17927. Epub 2018 Jul 6.

Reference Type BACKGROUND
PMID: 29979141 (View on PubMed)

Tajsic T, Patel K, Farmer R, Mannion RJ, Trivedi RA. Spinal navigation for minimally invasive thoracic and lumbosacral spine fixation: implications for radiation exposure, operative time, and accuracy of pedicle screw placement. Eur Spine J. 2018 Aug;27(8):1918-1924. doi: 10.1007/s00586-018-5587-z. Epub 2018 Apr 17.

Reference Type BACKGROUND
PMID: 29667139 (View on PubMed)

Other Identifiers

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kashabmo

Identifier Type: -

Identifier Source: org_study_id

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