Tell me please what would be your planning if you have for each pedicle a patient-specific pullout prediction ? Would you selectively base augmentation of this information ? Would you extent or shorten the montage ?
Jean-Marc Valiadis achieving fixation & fusion is difficult in these patients due to poor bone stock. Augmentation methods like multi-level instrumentation, bioactive cement augmentation, fenestrated or expandable pedicle screws might help to improve pedicle screw fixation.
Hi Nida, Thanks for you answer. I should have been more precise: how do you state that you need these additional techniques ? What is your rational ? I have developed a model based on patient's CT. It provides for each patient pedicle a pullout estimate. Would it help to decide whether or not you need augmentation ? (paper on request). Cheers.
The rationale depends on clinical, radiographic and mechanical status. However, I would definitely appreciate if you can share your paper. It's a very interesting topic for research since there is no definite answer. Though answers would be more experience-oriented not evidence based.
Hi Nida, thanks for your interest. The joined paper(*) describes how it's possible, given a clinical patient's CT, to predict a pedicular screw maximum pullout for each patient's pedicle. This is far beyond the rule of thumb and may give patient specific rational for cannulated/fenestrated screws use (as an example). It's all about patient's safety and risk control. I'll be happy to share more of my work with you. Cheers. (* a former version was presented at ISTA 2019.). [email protected]
Hi Nida, I forgot to say that this model works as a black box for the surgeon: the only thing to do is to send CTs.
In return, you have the full capacities of each targeted pedicle in terms of screws sizes and pullouts estimates.
The paper describes the founding of the computations which is totally transparent in daily use for the practitioner.
Cheers.
Jean-Marc Valiadis this is outstanding! I have rarely seen accuracy of 0.99. I believe you should submit some of your work to Spine Summit/AANS-CNS 2022 as this year its focus is on innovative technologies and all spine surgeons would be really amazed by your credible work.
Nida, thanks a lot for your encouragement and advice. We (an engineer quoted in the paper, and I) had already achieved this high accuracy using µCT on the same cadaveric vertebra and the same load/displacement curves. So it was possible. Then it took more than 10 man/years to do it with clinical imagery in an integrated software! My current aim is to validate the concept with a clinical trial in a one or two step protocol (implying a six months follow up postop). The enrollment period is open. Submitting a paper for a european scientist is easy, as easy as throwing a message in a bottle in the ocean. So I am ready to come in the US and present my work to you and other scientists who would like to help because of their influence in surgeon associations, or to be involved in a clinical trial. Augmented screws are simply not popular in France; however it is the first and obvious use of my work. As it is much more common in the USA, I'll be more than happy to share more of this work with american surgeons. Please tell me if you are comfortable with this idea. Cheers.
Absolutely! This is great. Your work will obviously be accredited and everyone would love to collaborate with you and your team.
Good. Are you still working in LA ? Could we meet there ? May be we could arrange something in two or three weeks in order to have time for you to gather other scientists interested by a presentation. Cheers. nb: Salt Lake City is another practical option during the ANNS/CNS meeting if you attend it.
Jean-Marc Valiadis yes of course. That sounds great. Are you talking about pediatric AANS/CNS meeting at salt lake? I believe the best target for your work would be Spine AANS/CNS meeting aka Spine Summit.
Absolutely, aged spine is the obvious target. This Spine Summit taking place in feb is a good place to meet at first to present the project and to define targets for meetings submission 2022-2023 with the present material.
A secondary target could be considering a clinical trial which is the next step.
I let you my mail, mobile and the initial research paper on non clinical modality (µCT) which sat the sky limits for the clinical model.
Do you plan to attend to the whole 23–26 meeting ? Tell me when we could meet, this trip needs a bit of preparation (visa, bookings etc...).
Thanks very much for your guiding again.
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Jean-Marc Valiadis Perfect. My email is [email protected] - you can contact me.
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