Application of intraoperative O-arm-assisted real-time navigation technique for spinal fixation

This study explored the combined use of the O-arm and real-time navigation during spinal fixation. The clinical data for 60 patients undergoing spinal fixation, at Beijing Tsinghua Chang Gung Hospital between May 5, 2015 and May 1, 2017, were retrospectively analyzed. Pre-, intra-, and postoperative imaging findings were assessed. The patients were classified into the occipitocervical fusion(32 cases) and thoracic/lumbar/sacral spine fixation(28 cases, including 6 cases of percutaneous pedicle screw) groups. Lesion resections were performed microscopically. An O-arm, combined with real-time navigation, was used to assess spinal fixation. Efficacy was evaluated using operative times, X-ray times, screw positioning, and complications. Within the occipitocervical fusion group, 182 screws were placed in the cervical spine and 96 in the occipital bone. However, 6 screws penetrated the bone cortex and were adjacent to the vertebral arteries, based on O-arm three-dimensional imaging; therefore, the precision rate was 96.7%. Within the thoracic/lumbar/sacral spine fixation group, 148 pedicle screws were implanted, with 4 initially outside the vertebral body,yielding a precision rate of 97.3%. Ten percutaneous pedicle screws were implanted and well positioned. O-arm scans were performed 3 times/patient, with an average of 20–30 min/time. Screw implantation times were 5–7 min(cervical spine), 8–10 min(thoracic spine), and 6–8 min(lumbar spine). Intraoperative O-arm scans, combined with real-time navigation technology, allow real-time observation of screw angles and depths, improving the accuracy and safety of posterior screw fixations and reducing the radiation dose and frequency experienced by patients and surgeons.

Observation on the Efficacy of Autologous Blood Transfusion Combined with Controlled Hypotension in Patients with Spinal Internal Fixation during the Outbreak of New Coronavirus Pneumonia in Western Guangxi (in Guixi)

Objective: To explore the therapeutic effect of autologous blood reinfusion combined with controlled hypotension in surgical spinal fixation during the outbreak of COVID-19. Methods: 30 patients with spinal internal fixation autologous blood transfusion combined with controlled hypotension were selected as the subjects during the epidemic period from December 2019 to June 2020 in our hospital and during the operation, on the basis of routine blood pressure reduction, the American Haemonetice Corporation autologous blood continuous reinfusion system was used to infuse the blood recovered during the operation to the patient through filtration and other procedures. Results: 30 patients had no complications such as fever and hemolysis;And after the operation, the tube was dialed according to the drainage volume, the cervical thoracic and lumbar brace was customized, and the patient walked on the ground for one week;After no abnormalities, the patient was discharged. Intraoperative comparison of white blood cells (WBC), red blood cells (RBC), red blood cell pressure (HCT), hemoglobin (HGB), and coagulation time (PT) of patients with autologous blood before and after transfusion showed statistically significant differences before and after surgery (P < 0.001). Conclusion: During the new coronavirus pneumonia epidemic, the internal fixation of spinal surgery used a recovery machine to collect intraoperative blood for reinfusion. Intraoperative antihypertensive drugs were used to control blood pressure within a certain safe range. The postoperative clinical observation effect was significant and safe;especially at present the clinical significance during the epidemic was significant.

Large deflection deformation behavior of a Zr-based bulk metallic glass for compliant spinal fixation application

A novel compliant spinal fixation designed based on the concept of compliant mechanisms can reduce the stress-shielding effect and adjacent segment degeneration(ASD)effectively,but propose higher requirements for the properties of the used materials.Bulk metallic glasses(BMGs),as a kind of young biomaterials,exhibiting excellent comprehensive properties,which are attractive for compliant spinal fixation.Here,according to the practical service condition of the basic elements in compliant spinal fixation,large deflection deformation behaviors of Zr_(61)Ti_(2)Cu_(25)Al_(12)(at.%,ZT1)BMG beam,including elastic,yielding and plastic were investigated systematically.It was shown that the theoretical nonlinear analytical solution curve as the benchmark not only with the capacity to predict the nonlinear load-deflection relation within the elastic deformation regime,but also assists to capture the yielding event roughly,which can be used as a powerful design tool for engineers.To capture the beginning of the yielding event exactly,bending proof strength(σ_(p),0.05%)accompanied with tiny permanent strain of 0.05% was proposed and determined for BMGs in biomedical implant applications,which is of significance for setting the allowable operating limits of the basic flexible elements.By approach of interrupted loading-unloading cycles,plastic deformation driven by the bending moment can be classified into two typical stages:the initial stage which mainly characterized by the nucleation and intense interaction of abundant shear bands when the plastic strain below the critical value,and the second stage which dominated by the progressive propagation of shear bands and coupled with the emergence of shear offsets on tensile side.The plasticity of BMG beam structures depends on the BMG's inherent plastic zone size(rp).When the half beam thickness less than that of the rp,the plastic deformation of BMGs will behave in a stable manner,which can be acted as the margin of safety effectively.

Cortical bone trajectory fixation in cemented vertebrae in lumbar degenerative disease:A case report

BACKGROUND Percutaneous vertebroplasty(PVP)has been widely used in osteoporotic vertebral compression fracture(OVCF).Following surgery,the bone cement would be positioned permanently.However,in some cases of lumbar degenerative disease,the cemented vertebrae needs to be fixed after decompression and fusion procedure.It is difficult to implant traditional pedicle screws into the cemented vertebrae because of the bone cement filling.At present,the main treatment strategy is to skip the cemented vertebra and conduct a long segment fixation.This article presents a cortical bone trajectory(CBT)fixation technique for cemented vertebrae.CASE SUMMARY PVP involving the L3 and L4 was performed in an 82-year-old man due to OVCF.During the surgery,bone cement leakage occurred,resulting in compression of the root of the right L3 nerve.We performed a partial facetectomy to retrieve the leaked bone cement and to relieve the patient’s neurological symptoms.After 3 mo,the patient developed lumbar disc herniation in L3/4,potentially due to instability caused by the previous surgery.Therefore,it was necessary to perform intervertebral fusion and fixation.It was difficult to implant traditional trajectory pedicle screws in L3 and L4 because of the bone cement filling.Hence,we implanted CBT screws in the L3 and L4 vertebrae.As a result,the patient’s symptoms resolved and he reported satisfaction with the surgery at follow-up after 8 mo.CONCLUSION It is feasible to utilize CBT in cemented vertebrae for the treatment of lumbar degenerative disease.

Effects of Deformation and Phase Transformation Microstructures on Springback Behavior and Biocompatibility in β-Type Ti-15Mo Alloy

This study examined the mechanical properties, springback behavior from three-point bending loading–unloading tests and biocompatibility from human osteoblast cell adhesion and proliferation experiments in Ti-15Mo alloy with different microstructures. The springback ratio increased after the appearance of deformation microstructures including {332} < 113 > twins and dislocations, due to the increased bending strength and unchanged Young’s modulus. By contrast, the change in springback ratio was dependent on the competing effect of the simultaneous increase in bending strength and Young’s modulus after phase transformation, namely, the isothermal ω-phase formation. Good cell adhesion and proliferation were observed on the alloy surface, and they were not significantly affected by the deformation twins, dislocations and isothermal ω-phase.The diversity of deformation and phase transformation microstructures made it possible to control the springback behavior effectively while keeping the biocompatibility of the alloy as an implant rod used for spinal fixation devices.