Accuracy And Safety of Trans Pedicular Screw Fixation of The Sub-axial Cervical Spine Using A Triad- Dependent Technique

NCT ID: NCT05855642

Last Updated: 2023-05-11

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

Total Enrollment

20 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-06-01

Study Completion Date

2024-06-01

Brief Summary

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The use of the pedicle screw system has become increasingly popular for treating an unstable cervical spine resulting from traumatic, degenerative, inflammatory, and neoplastic conditions. Because the cervical pedicle screw (CPS) has superior bio mechanical stability as the lateral mass screw or trans articular screw , pedicle screws allow for shorter instrumentation with improved spinal alignment. However, CPS insertion is technically demanding because of the anatomical variations in cervical pedicle size, lack of anatomical landmarks, small pedicle diameter, and the large transverse angle of cervical pedicles . The potential risk of injury to neurovascular structures, such as the vertebral artery, spinal cord, or nerve roots, caused by CPS remains a great concern. Therefore, accurate and safe CPS insertion techniques are necessary.

Detailed Description

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The use of the pedicle screw system has become increasingly popular for treating an unstable cervical spine resulting from traumatic, degenerative, inflammatory, and neoplastic conditions. Because the cervical pedicle screw (CPS) has superior bio mechanical stability as the lateral mass screw or trans articular screw , pedicle screws allow for shorter instrumentation with improved spinal alignment. However, CPS insertion is technically demanding because of the anatomical variations in cervical pedicle size, lack of anatomical landmarks, small pedicle diameter, and the large transverse angle of cervical pedicles . The potential risk of injury to neurovascular structures, such as the vertebral artery, spinal cord, or nerve roots, caused by CPS remains a great concern. Therefore, accurate and safe CPS insertion techniques are necessary.

Although a number of studies have evaluated the morphometric of cervical pedicles to support accurate placement of pedicle screws , the results are inconclusive. Therefore, several techniques using lateral fluoroscopy , pedicle axis view by oblique fluoroscopy , laminoframinotomy and computer-assisted navigation systems for CPS insertion have been advocated. Determining an appropriate entry point for screw insertion as well as a proper trajectory angle of the screw on the axial plane is important for successful pedicle screw placement. Here, we present our method using a fashioned triad- dependent technique (TDT) which is a combination of three methods 1-preoperative planning of the selected pedicle using 3-diamentional multi-slice CT to measure pedicle transverse angle (PTA) , pedicle outer diameter(POD)and pedicle trajectory -contralateral lamina angle 2-AP and oblique fluoroscopy to determine pedicle entry point (PEP), parallelism to vertebral end plate and 4 direction cortical violation (medial, lateral, superior, inferior) 3-interlaminar confirmatory key hole for tactile cue of medial ,superior, and inferior borders of the pedicle and related nerve root to evaluate the accuracy and safety of pedicle screw placement in patients with sub axial cervical spine disorders treated using our method.

Conditions

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Pedicle Screw CPS

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Study Groups

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Patients

All patients presented with degenerative or traumatic cervical spine matched the inclusion criteria will enrolled in our study from April 2023 to April 2024.

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

1. traumatic sub axial cervical spine injuries.
2. degenerative cervical spine disorders necessitating cervical fusion

Exclusion Criteria

1. congenital anomaly of the cervical spine
2. scoliotic deformity of the cervical spine
3. sever osteoporosis
4. congenital malformation of the pedicle.
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Assiut University

OTHER

Sponsor Role lead

Responsible Party

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Mahmoud Abdelrahman Saleh El Attar

principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Central Contacts

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Mahmoud S El Attar

Role: CONTACT

00201014919050

References

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Kotani Y, Cunningham BW, Abumi K, McAfee PC. Biomechanical analysis of cervical stabilization systems. An assessment of transpedicular screw fixation in the cervical spine. Spine (Phila Pa 1976). 1994 Nov 15;19(22):2529-39. doi: 10.1097/00007632-199411001-00007.

Reference Type BACKGROUND
PMID: 7855677 (View on PubMed)

Jones EL, Heller JG, Silcox DH, Hutton WC. Cervical pedicle screws versus lateral mass screws. Anatomic feasibility and biomechanical comparison. Spine (Phila Pa 1976). 1997 May 1;22(9):977-82. doi: 10.1097/00007632-199705010-00009.

Reference Type BACKGROUND
PMID: 9152447 (View on PubMed)

Karaikovic EE, Daubs MD, Madsen RW, Gaines RW Jr. Morphologic characteristics of human cervical pedicles. Spine (Phila Pa 1976). 1997 Mar 1;22(5):493-500. doi: 10.1097/00007632-199703010-00005.

Reference Type BACKGROUND
PMID: 9076880 (View on PubMed)

Ludwig SC, Kramer DL, Vaccaro AR, Albert TJ. Transpedicle screw fixation of the cervical spine. Clin Orthop Relat Res. 1999 Feb;(359):77-88. doi: 10.1097/00003086-199902000-00009.

Reference Type BACKGROUND
PMID: 10078131 (View on PubMed)

Bredow J, Beyer F, Oppermann J, Kraus B, Meyer C, Stein G, Eysel P, Koy T. A novel classification of screw placement accuracy in the cervical spine. Technol Health Care. 2016 Nov 14;24(6):919-925. doi: 10.3233/THC-161246.

Reference Type BACKGROUND
PMID: 27497461 (View on PubMed)

Aoude AA, Fortin M, Figueiredo R, Jarzem P, Ouellet J, Weber MH. Methods to determine pedicle screw placement accuracy in spine surgery: a systematic review. Eur Spine J. 2015 May;24(5):990-1004. doi: 10.1007/s00586-015-3853-x. Epub 2015 Mar 7.

Reference Type BACKGROUND
PMID: 25749690 (View on PubMed)

Jo DJ, Seo EM, Kim KT, Kim SM, Lee SH. Cervical pedicle screw insertion using the technique with direct exposure of the pedicle by laminoforaminotomy. J Korean Neurosurg Soc. 2012 Nov;52(5):459-65. doi: 10.3340/jkns.2012.52.5.459. Epub 2012 Nov 30.

Reference Type BACKGROUND
PMID: 23323166 (View on PubMed)

Yukawa Y, Kato F, Ito K, Horie Y, Hida T, Nakashima H, Machino M. Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope. Eur Spine J. 2009 Sep;18(9):1293-9. doi: 10.1007/s00586-009-1032-7. Epub 2009 Jun 2.

Reference Type BACKGROUND
PMID: 19488794 (View on PubMed)

Other Identifiers

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ASTPSF

Identifier Type: -

Identifier Source: org_study_id

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