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Wednesday, January 30, 2013

Vascular Complications During Thoracic Pedicle Screw Placement: What?. Is this even Possible, yes!.

Surgery insight: During surgical performance or surgical procedures and providing patient care, there is nothing like oh you mean that?, well that is very simple or take for granted in a casual way, one must show at most attention and care in every small to big steps, so do the neuromonitoring and anesthesia professionals, you can be of great help to surgeon when you detect changes or unusual activity that can get surgeons attention right away. Ofcourse for surgeons, there is no room for error but absolutely there is no room for Oh I have done 1000s of surgery, pricking a nerve or artery during my pedicle screw insertion is not going to happen, oh well, it did. The following paper describes a case and death of a patient two weeks after the surgery, so be diligent.
While reading this article :Thoracic pedicle screw placement: Free-hand technique  by Yongjung J. Kim, Lawrence G. Lenke regarding Scoliosis and thoraci pedicle screw placement, I came across the two back reference that startled me, an important and interesting reference about how vascular complications can occur by careless pedicle screw placement?..
Vascular complications 
22.Heini P, Scholl E, Wyler D, Eggli S. Fatal cardiac tamponade associated with posterior 
spinal instrumentation. A case report. Spine 1998;23:2226–30.  
Heini et al[22] described a case of fatal cardiac tamponade that
was due to a prick injury of the right coronary artery by a Kirschner
Neurology India | December 2005 | Vol 53 | Issue 4
CMYK517 517 Kim et al: Thoracic pedicle screw placement
wire. The injury was confirmed by autopsy after the patient died
12 days after surgery.
14. Suk SI, Kim WJ, Lee SM, Kim JH, Chung ER. Thoracic pedicle screw fixation in 
spinal deformities: are they really safe? Spine 2001;26:2049–57.   
Suk et al [14] described a case of an over­penetrated screw causing irritation of the thoracic aorta resulting in severe chest pain.
 25. Minor ME, Morrissey NJ, Peress R, Carroccio A, Ellozy S, Agarwal G, et al. 
Endovascular treatment of an iatrogenic thoracic aortic injury after spinal 
instrumentation: case report. J Vasc Surg 2004;39:893–6
 Recently Minor et al [25] reported endovascular  treatment of an iatrogenic aortic injury by misplaced thoracic pedicle screw at T5. 
I have not yet read all these three papers, I will comment further after I go through them all.

What is O-Arm, is the X-Ray imaging finally getting a Facelift in tech?

Interesting tech developments seems to be happening in X-Ray imaging, came across news about O-Arm today and also noticed the fluoroscopic ultra-imaging developments and check those below, as well as the link to Hologic?...This area or technology can be quite useful to surgeons and hospitals, this is something they better look at for efficient surgical procedures and precision detection.
Here is the O-Arm, will this help surgeon view different angles, depth and positioning of pedicle screws and so on?.
Gene writes about O-Arm Imaging system- Link:

O-arm™ Imaging System

by  on  • 11:54 am
multi2D lr O arm™ Imaging System
Have you seen the O-arm™ Imaging System before? We haven’t. Until today, that is. We learned about it this morning when a company’s rep left O-arm™ brochures (and no food) in our physicians’ lounge. The device byBreakaway Imaging, LLC, of Littleton, MA, was FDA-cleared last year and is now distributed by Medtronic.
So here’s the scoop about the device that has a robotics-assisted positioning system:

Also note the following C-Arm Mini, interesting:

The Next Generation in Mini C-arm Imaging with Flat Detector Technology

New and Innovative Flat Detector Mini C-arm Design
  • Ergonomic flat detector design with ease of positioning for patient/surgeon access
  • Greatest range of motion in a new innovative mini C-arm design
  • Forward tube source design now offers greater C-arm depth
  • Flat detector technology with 75 micron array and 2k x 1.5k resolution

And, finally, the following Dorsal Column Stabilization Outflow: 

Artis zeego, dorsal spinal stabilization workflow