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      Progress of the Anterior Transpedicular Screw in Lower Cervical Spine: A Review

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          Abstract

          The anterior transpedicular screws (ATPS) fixation is a valuable discovery in the field of lower cervical spine (LCS) reconstruction, as it has the advantages of both anterior and posterior approaches. In recent years, with in-depth research on ATPS fixation related to anatomy, biomechanical tests, and clinical applications, its firm stability and excellent biomechanical properties have been recognized by more and more surgeons. Although ATPS fixation has been gradually applied in clinic settings under the promotion of emerging distinctive instruments, its long-term efficacy still needs to be further clarified due to the lack of large sample size studies and long-term follow-up. Nevertheless, it is believed that with the maturity of digital devices and the development of precision medicine, ATPS fixation has a promising prospect.

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          Most cited references34

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          Construction and Accuracy Assessment of Patient-Specific Biocompatible Drill Template for Cervical Anterior Transpedicular Screw (ATPS) Insertion: An In Vitro Study

          Background With the properties of three-column fixation and anterior-approach-only procedure, anterior transpedicular screw (ATPS) is ideal for severe multilevel traumatic cervical instabilities. However, the accurate insertion of ATPS remains challenging. Here we constructed a patient-specific biocompatible drill template and evaluated its accuracy in assisting ATPS insertion. Methods After ethical approval, 24 formalin-preserved cervical vertebrae (C2–C7) were CT scanned. 3D reconstruction models of cervical vertebra were obtained with 2-mm-diameter virtual pin tracts at the central pedicles. The 3D models were used for rapid prototyping (RP) printing. A 2-mm-diameter Kirschner wire was then inserted into the pin tract of the RP model before polymethylmethacrylate was used to construct the patient-specific biocompatible drill template. After removal of the anterior soft tissue, a 2-mm-diameter Kirschner wire was inserted into the cervical pedicle with the assistance of drill template. Cadaveric cervical spines with pin tracts were subsequently scanned using the same CT scanner. A 3D reconstruction was performed of the scanned spines to get 3D models of the vertebrae containing the actual pin tracts. The deviations were calculated between 3D models with virtual and actual pin tracts at the middle point of the cervical pedicle. 3D models of 3.5 mm-diameter screws were used in simulated insertion to grade the screw positions. Findings The patient-specific biocompatible drill template was constructed to assist ATPS insertion successfully. There were no significant differences between medial/lateral deviations (P = 0.797) or between superior/inferior deviations (P = 0.741). The absolute deviation values were 0.82±0.75 mm and 1.10±0.96 mm in axial and sagittal planes, respectively. In the simulated insertion, the screws in non-critical position were 44/48 (91.7%). Conclusions The patient-specific drill template is biocompatible, easy-to-apply and accurate in assisting ATPS insertion. Its clinical applications should be further researched.
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            Cost-effectiveness of single-level anterior cervical discectomy and fusion five years after surgery.

            Longitudinal cohort. OBJECTIVE.: The purpose of this study is to determine the cost per quality-adjusted life year (cost/QALY) gained for single-level instrumented anterior cervical discectomy and fusion (ACDF) over 5 years.
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              Incidence, Risk Factors, and Clinical Implications of Postoperative Hematoma Requiring Reoperation Following Anterior Cervical Discectomy and Fusion.

              Retrospective study of prospectively collected data.
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                Author and article information

                Journal
                Med Sci Monit
                Med. Sci. Monit
                Medical Science Monitor
                Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
                International Scientific Literature, Inc.
                1234-1010
                1643-3750
                2019
                21 August 2019
                : 25
                : 6281-6290
                Affiliations
                [1 ]Department of Orthopedics, Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, Jiangxi, P.R. China
                [2 ]Medical Department of Graduate School, Nanchang University, Nanchang, Jiangxi, P.R. China
                [3 ]Department of Orthopedics, Dongguan Houjie Town People’s Hospital, Dongguan, Guangdong, P.R. China
                [4 ]Department of Surgery, Wujin Hospital Affiliated to Jiangsu University, Changzhou, Jiangsu, P.R. China
                Author notes
                Corresponding Author: Liang Deng, e-mail: dengliang001137@ 123456163.com
                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                [*]

                Yuan-Wei Zhang and Ting Zeng contributed equally to this work

                Article
                918061
                10.12659/MSM.918061
                6714593
                31432800
                0c4df8a1-c698-446a-8e38-b75178d00fec
                © Med Sci Monit, 2019

                This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International ( CC BY-NC-ND 4.0)

                History
                : 12 June 2019
                : 06 August 2019
                Categories
                Review Articles

                bone screws,computers,neurosurgery,spine
                bone screws, computers, neurosurgery, spine

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