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Jan U. Mueller, Joerg Baldauf, Sascha Marx, Michael Kirsch, Henry W. S. Schroeder and Dirk T. Pillich

S ince the introduction of pedicle screw fixation in spine surgery, loosening and pull-out of pedicle screws have become well-known problems. In many patients, especially those with osteoporosis, pedicle screw anchoring may be problematic, 23 , 55 and several efforts to cope with this challenge have failed. Increasing screw length and diameter leads to an improved screw-bone interface in nonosteoporotic vertebrae but not in osteoporotic vertebrae; 6 and increased screw diameter, in particular, increases the risk of pedicle rupture. 23 Bicortical

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Atilla Akbay, Serkan İnceoğlu, Ryan Milks, Richard Schlenk, Selcuk Palaoglu and Edward C. Benzel

T he evolution of spinal fixation was initiated by Harrington 12 who used rod fixation for scoliosis correction. During the last 20 years, several posterior instrumentation systems and numerous techniques have been developed for the treatment of trauma- or deformity-induced spinal instability. At present, pedicle screws, laminar or pedicle hooks, and sublaminar wires constitute the main methods of spinal column fixation. The biomechanical stability of pedicle screw/rod systems has been demonstrated to be superior to hook/rod instrumentation and wiring. 14, 20

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Jin Sup Yeom, Moon Sang Chung, Choon-Ki Lee, Yeongho Kim, Namkug Kim and Jae Bum Lee

O ne of the main purposes of CT scanning after pedicle screw insertion is to determine whether the screws are properly positioned or penetrate the pedicular walls. When a neurological symptom manifests postoperatively, the decision is critical in determining whether reoperation should be performed. Metal artifact appearing around a pedicle screw system, however, makes it difficult to interpret CT scans ( Fig. 1 left ). 5 The bone window setting has been commonly used to reduce the metal artifact, but the artifact cannot be removed completely. Consequently

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Mohamad Bydon, Risheng Xu, Anubhav G. Amin, Mohamed Macki, Paul Kaloostian, Daniel M. Sciubba, Jean-Paul Wolinsky, Ali Bydon, Ziya L. Gokaslan and Timothy F. Witham

P edicle screws are a mainstay in the treatment of spinal disorders requiring instrumented arthrodesis. 14 , 34 Their ability to stabilize the spinal column via a posterior fixation entry point has rendered them the standard to which many other fixation techniques are compared. 36 , 37 , 39 However, pedicle screw placement may be challenging, particularly in the cervical and thoracic spine because of the smaller pedicle size and complex morphology. 11 , 12 , 14 , 19 , 23 , 32 , 34 , 36 , 41 , 43 As a result, conventional methods based on anatomical

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Langston T. Holly and Kevin T. Foley

-arm unit is tracked throughout the acquisition of the images by the image guidance system, providing an automated and highly accurate registration solution. Three-dimensional fluoroscopy represents a significant advancement in the field of image guidance, and it will potentially facilitate other emerging technologies such as minimally invasive spinal surgery. In this study we sought to evaluate the feasibility and accuracy of 3D fluoroscopic image guidance for the placement of percutaneous thoracic and lumbar pedicle screws in a cadaveric model. Materials and

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Robert F. Heary, Christopher M. Bono and Margaret Black

failure unless structural anterior column support is also provided. In contrast to the lumbar spine, placing pedicle screws into the thoracic spine is more technically challenging. The pedicles in this region are smaller and exhibit a high degree of inter- and intraspecimen variability. 12, 21, 29 Correct placement depends on a comprehensive familiarity of pedicle anatomy, reliable intraoperative imaging, and meticulous surgical technique. 3, 30 Screw position is sometimes suboptimal. Computerized tomography scanning has been validated as an accurate method by which

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Timothy C. Ryken, Brent D. Owen, Gary E. Christensen and Joseph M. Reinhardt

) Engineering Patient–Specific Drill Templates and Bioabsorbable Posterior Cervical Plates. Spine and Peripheral Nerves Meeting, Phoenix, Arizona, March 7–10, 2007; 2) Rapid Prototype Patient-Specific Drill Templates for Cervical Pedicle Screw Placement. American Association of Neurological Surgeons Annual Meeting, San Francisco, California, April 24, 2006; and 3) Patient Specific Drill Templates for Cervical Pedicle Screw Placement. American Association of Neurological Surgeons, New Orleans, Louisiana, April 2005. References 1 Abumi K , Kaneda K , Shono Y

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Marin F. Stančić, Vladimir Mićcović and Mark Potočnjak

satisfactory level. The greatest disadvantage of a laminectomy procedure is that it destabilizes the spine by exaggerating spinal deformity. 9 Failure of pedicle screw fixation techniques, even in cases in which a laminectomy has not been performed, has been observed. 10 These hardware failures are related primarily to excessive preload forces introduced at the time of surgery, as well as to excessive flexion loading. 1 We hypothesized that a hook—rod distraction system could be a suitable adjunct to pedicle screw fixation in load bearing. The proposed fixation system is

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Oliver P. Gautschi, Bawarjan Schatlo, Karl Schaller and Enrico Tessitore

P edicle screw placement is a well-known and increasingly performed technique used to achieve fixation and fusion in thoracolumbar surgery. Since its first introduction by Harrington and Tullos in 1969 18 and further development by Roy-Camille et al., 53 Louis, 39 and Steffee et al. 56 in the late 1980s, it has become the mainstay of spinal instrumentation. This technique is used for degenerative, neoplastic, infectious, and malformative pathologies associated with axial instability. Despite technical advances over the last few decades, pedicle screw

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Un Yong Choi, Jeong Yoon Park, Kyung Hyun Kim, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim and Yong Eun Cho

instability can occur and additional posterior screw fixation is essential. 2 , 7 , 14 , 15 Generally, bilateral pedicle screw fixation after MIS TLIF is accepted as standard procedure and provides rigid fixation and biomechanical and clinical advantages. 23 , 27 , 28 Pedicle screw fixation after interbody fusion has traditionally been performed bilaterally, but some authors have recently showed that unilateral pedicle screw fixation is as effective for spinal fusion as bilateral pedicle screw fixation and that it has a lower operating time and a shorter length of