European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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The purpose of this study was to measure the structures of the ventral of lateral masses using cadaver specimens and to quantitatively compare the safety zone for the two major techniques used on each vertebral level from C3 to C6. ⋯ The safety width of the Magerl technique was shorter at C6 because the vertebral artery runs more laterally at C6. The height for the Magerl technique was not significantly different from C3 to C6, however, the safety height for the Roy-Camille technique was significantly shorter at C5 and C6. Our findings suggest that it is important to ensure that the screw(s) penetrate through the cranial side of the ventral aspect of a lateral mass when performing the Magerl technique at all vertebral levels, and to carefully select the screw length when using the Roy-Camille technique, especially at C5 and C6, in order to avoid nerve root injury.
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Review Comparative Study
Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques.
With the advances and improvement of computer-assisted surgery devices, computer-guided pedicle screws insertion has been applied to the lumbar, thoracic and cervical spine. The purpose of the present study was to perform a systematic review of all available prospective evidence regarding pedicle screw insertion techniques in the thoracic and lumbar human spine. ⋯ In conclusion, navigation does indeed exhibit higher accuracy and increased safety in pedicle screw placement than free-hand technique and use of fluoroscopy.
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In low back pain if serious pathology is suspected diagnostic imaging could be performed. One of the imaging techniques available for this purpose is computed tomography (CT), however, insight in the diagnostic performance of CT is unclear. ⋯ We found no studies evaluating the accuracy of CT for pathologies such as vertebral cancer, infection and fractures and this remains unclear. Our results should be interpreted with some caution. Sensitivity and specificity, regarding the detection of lumbar disc herniation, showed that a substantial part of the patients is still classified as false-negative and false-positive. In future, the diagnostic performance of CT must be assessed in high quality prospective cohort studies with an unselected population of patients with low back pain.