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Jitpakdee K, Boadi B, Härtl R. Image-Guided Spine Surgery. Neurosurg Clin N Am 2024; 35:173-190. [PMID: 38423733 DOI: 10.1016/j.nec.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The realm of spine surgery is undergoing a transformative shift, thanks to the integration of image-guided navigation technology. This innovative system seamlessly blends real-time imaging data with precise location tracking. While the indispensable expertise of experienced spine surgeons remains irreplaceable, navigation systems bring a host of valuable advantages to the operating room. By offering a comprehensive view of the surgical anatomy, these systems empower surgeons to conduct procedures with accuracy, while minimizing radiation exposure for both patients and medical professionals. Moreover, image-guided navigation paves the way for integration of other state-of-the-art technologies, such as augmented reality and robotics. These innovations promise to further revolutionize the field, providing greater precision and expanding the horizons of what is possible in the world of spinal procedures. This article explores the evolution, classification, and impact of image-guided spine surgery, underscoring its pivotal role in enhancing efficacy and safety while setting the stage for the incorporation of future technological advancements.
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Affiliation(s)
- Khanathip Jitpakdee
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Thai Red Cross Society, 290 Jermjompol, Si Racha, Chonburi 20110, Thailand
| | - Blake Boadi
- Department of Neurosurgery, Weill Cornell Medicine, New York-Presbyterian - Och Spine, 525 East 68th Street, Box 99, New York, NY 10021, USA
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Medicine, New York-Presbyterian - Och Spine, 525 East 68th Street, Box 99, New York, NY 10021, USA.
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Vißmann S, Schöttes P, Topcuoglu F, Strohmann T, Stahl JP, Rohde S. [Precision and safety of positioning pedicle screws in the thoracic and lumbar spine using a hand-guided aiming sleeve : A CT control study]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:297-304. [PMID: 37989763 DOI: 10.1007/s00113-023-01392-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND For the implantation of pedicle screws, navigation-supported systems are nowadays used more and more to avoid screw misalignment by making the direction of the screw more predictable. OBJECTIVE Examination of the precision after instrumentation of the pedicle screw with the hand-guided aiming sleeve. The aim was to verify that the implementation of the pedicle screws is plannable and precise by using 2D X‑ray only. METHOD This retrospective study analyzed 27 consecutive trauma patients (17-84 years, 13f/14m) with vertebral body fractures. The position and precision of 108 screws, implanted using the hand-guided aiming sleeve was investigated. To determine the position the actual course of the screws was examined using the postoperative 3D CT data set (GE Optima 540, General Electric Company Boston, MA, USA; slice thickness 1.25 mm). The screws were then compared to the previously defined ideal position of the tip of the screw. In addition to the absolute and relative deviation from the ideal target point, the convergence angle and the parallelism to the cover plate were determined. RESULTS Of 108 implanted pedicle screws, 90 (83%) were within target. The remaining 18 (17%) represented a clinically irrelevant screw deviation: A lateral deviation was found in 17 pedicle screws (16%) and a medial deviation in 1 (1%). The average deviation from the ideal target point in the vertebral body was 2.3 mm ventrally with a standard deviation of ± 2.3 mm. No screw misalignment or pedicle perforation was found. CONCLUSION The transcutaneous implantation of pedicle screws with a hand-guided aiming sleeve in the thoracic and lumbar spine represents a safe and precise procedure. The risk of misalignment needing a revision is lower compared to other methods of navigated screw implantation reported in the literature [1-6]. A CT-based preliminary planning is not necessary. The method is economical, special technical equipment is not required.
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Affiliation(s)
- Silke Vißmann
- Klinik für Radiologie und Neuroradiologie, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Dortmund, Deutschland.
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Münsterstraße 240, 44137, Dortmund, Deutschland.
| | - Philippus Schöttes
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Münsterstraße 240, 44137, Dortmund, Deutschland
| | - Fatma Topcuoglu
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Münsterstraße 240, 44137, Dortmund, Deutschland
| | - Thorsten Strohmann
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Münsterstraße 240, 44137, Dortmund, Deutschland
| | - Jens-Peter Stahl
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Münsterstraße 240, 44137, Dortmund, Deutschland
| | - Stefan Rohde
- Klinik für Radiologie und Neuroradiologie, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Dortmund, Deutschland
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Crawford BD, Nchako CM, Rebehn KA, Israel H, Place HM. Transpedicular Screw Placement Accuracy Using the O-Arm Versus Freehand Technique at a Single Institution. Global Spine J 2022; 12:447-451. [PMID: 33000646 PMCID: PMC9121168 DOI: 10.1177/2192568220956979] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE The objective of this study was to assess the effectiveness of the O-arm as an intraoperative imaging tool by comparing accuracy of pedicle screw placement to freehand technique. METHODS The study comprised a total of 1161 screws placed within the cervical (n = 187) thoracic (n = 657), or lumbar (n = 317) spinal level. A pedicle breach was determined by any measurable displacement of the screw outside of the pedicle cortex in any plane on postoperative images. Each pedicle screw was subsequently classified by its placement relative to the targeted pedicle. Statistical analysis was then performed to determine the frequency and type of pedicle screw mispositioning that occurred using the O-arm versus freehand technique. RESULTS A total of 155 cases (O-arm 84, freehand 71) involved the placement of 454 pedicle screws in the O-arm group and 707 pedicle screws in the freehand group. A pedicle breach occurred in 89 (12.6%) screws in the freehand group and 55 (12.1%) in the O-arm group (P = .811). Spinal level operated upon did not influence pedicle screw accuracy between groups (P > .05). Three screws required revision surgery between the 2 groups (O-arm 1, freehand 2, P > .05). The most frequent breach type was a lateral pedicle breach (O-arm 22/454, 4.8%; freehand 54/707, 7.6%), without a significant difference between groups (P > .05). CONCLUSIONS The use of the O-arm coupled with navigation does not assure improved transpedicular screw placement accuracy when compared with the freehand technique.
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Affiliation(s)
- Benjamin D. Crawford
- Saint Louis University School of Medicine, Saint Louis, MO, USA,Benjamin D. Crawford, Saint Louis University School of Medicine, 1402 South Grand Boulevard, Saint Louis, MO 63104, USA.
| | | | - Kelsey A. Rebehn
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Heidi Israel
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Howard M. Place
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
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Dang J, Fu J, Liu D, Zhang Z, Mi Z, Cheng D, Liu X, Zhang Y, Zhu D, Wang L, Shi Y, Fan H. Clinical application of 3D-printed patient-specific guide plate combined with computer navigation in acetabular reconstruction following resection of periacetabular tumors. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:76. [PMID: 35282055 PMCID: PMC8848447 DOI: 10.21037/atm-21-7013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/13/2022] [Indexed: 11/24/2022]
Abstract
Background The precise acetabular reconstruction has historically been a challenging procedure. 3D-printed patient-specific guide (PSG) and computer navigation (CN) technologies have been used to assist acetabular component positioning and pelvic reconstruction. This precise reconstruction approach may translate into clinical benefit. Methods The clinical data of 84 patients who underwent periacetabular malignant tumor resection and screw-rod-acetabular cage system reconstruction in our center from January 2013 to December 2020 were retrospectively analyzed. Patients were divided into four groups: free hand (FH) group, PSG group, CN group, and PSG combined with computer navigation (PSG + CN) group. The operation time, intraoperative blood loss, and number of fluoroscopy views were recorded. The oncological prognosis, radiographic measurements of the acetabulum, limb function data, and postoperative complications were compared among groups. And finally, we evaluated the risk factors for mechanical failure of the prosthesis. Results The postoperative X-ray and computed tomography (CT) scan revealed that the vertical offset discrepancy (VOD) between affected side and contralateral side was 8.4±1.9, 5.9±2.2, 4.1±1.3, and 2.4±1.2 mm in each groups; the horizontal offset discrepancy (HOD) was 9.0±1.9, 6.1±2.2, 3.2±1.3, and 2.1±1.2 mm, correspondingly; the abduction angle discrepancy (ABAD) was 8.6°±1.8°, 5.6°±2.0°, 2.5°±1.3°, and 1.8°±0.9°, respectively; the anteversion angle discrepancy (ANAD) was 5.9°±1.6°, 3.6°±1.7°, 2.9°±1.6°, and 1.9°±0.9°, correspondingly. Statistical results show that the PSG + CN group was superior to the FH group and the PSG group in terms of acetabular position and limb function (P<0.05). Body mass index (P=0.040) and resection type (P=0.042) were found to be the high-risk factors for mechanical failure of the prosthesis. Conclusions PSG + CN has potential advantages in improving the accuracy and safety of acetabular positioning and reconstruction.
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Affiliation(s)
- Jingyi Dang
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jun Fu
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Dong Liu
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhao Zhang
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhenzhou Mi
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Debin Cheng
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xincheng Liu
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yushen Zhang
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Dongze Zhu
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lei Wang
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yubo Shi
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hongbin Fan
- Department of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Budu A, Sims-Williams H, Radatz M, Bacon A, Bhattacharyya D, Athanassacopoulos M, Ivanov M. Comparison of Navigated versus Fluoroscopic-Guided Pedicle Screw Placement Accuracy and Complication Rate. World Neurosurg 2020; 144:e541-e545. [PMID: 32891853 DOI: 10.1016/j.wneu.2020.08.207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/29/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Accurate placement of the pedicle screw is requisite for any successful spinal instrumentation procedure. Screw insertion can be achieved using free-hand and fluoroscopic- or navigation-guided techniques. We sought to assess the variation in accuracy between fluoroscopic- and navigation-guided techniques, which are both used in Sheffield Teaching Hospitals National Health Service Trust, a tertiary spine referral center. METHODS Using a retrospective study design, we assessed all the pedicle screws placed between 2013 and 2018. Radiographic and clinical assessment of all cases was performed. RESULTS We studied 176 spinal instrumented cases, with a total of 831 screws implanted, out of which 296 (35.6%) were navigated and 535 (64.4%) were fluoroscopic guided. Pathology treated included spinal stenosis, spondylolisthesis, tumors, and trauma. Suboptimal screw position was identified in 2.03% (n = 6) of the navigation-guided series and 4.11% (n = 22) of the fluoroscopic-guided series with an overall screw misplacement rate of 3.4%. Evaluating surgeons' individual accuracy rates revealed that suboptimal screw placement registered a higher variation for the fluoroscopy-guided technique, and the misplacement rate was higher for surgeons with a lower volume of cases. CONCLUSIONS Use of navigation during spinal instrumentation helps lower the rate of screw misplacement for spinal surgeons who are at the beginning of their learning curve or do not frequently perform this kind of procedure. Navigation-guided spinal instrumentation is more accurate compared with fluoroscopic-guided techniques and appears to have a lower complication rate.
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Affiliation(s)
- Alexandru Budu
- Department of Neurosurgery, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK.
| | - Hugh Sims-Williams
- Department of Neurosurgery, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | - Mathias Radatz
- Department of Neurosurgery, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | - Andrew Bacon
- Department of Neurosurgery, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | - Dev Bhattacharyya
- Department of Neurosurgery, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | - Michael Athanassacopoulos
- Department of Orthopaedics, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | - Marcel Ivanov
- Department of Neurosurgery, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK; Department of Orthopaedics, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
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Beer P, Park BH, Steffen F, Smolders DLA, Pozzi A, Knell SC. Influence of a customized three-dimensionally printed drill guide on the accuracy of pedicle screw placement in lumbosacral vertebrae: An ex vivo study. Vet Surg 2020; 49:977-988. [PMID: 32255212 DOI: 10.1111/vsu.13417] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 12/19/2019] [Accepted: 03/07/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare the accuracy of pedicle screw insertion (PSI) into canine lumbosacral vertebrae with custom-made three-dimensionally (3D)-printed drill guides or freehand insertion. STUDY DESIGN Ex vivo study. SAMPLE POPULATION Nineteen canine lumbosacral specimens. METHODS Drill guides for PSI were designed on the basis of safe screw insertion trajectories by using preoperative computed tomography (CT) and produced by 3D printing of templates. Right and left sides of the specimens were randomly allocated to two groups; 4-mm pedicle screws were inserted in L5-L6 and L7-S1 spinal segments either freehand (control group) or with custom-made drill guides (guide group). Sixty-six screws were inserted with each method. Insertion angles (α, β), bone stock, and vertebral canal breach were assessed according to postoperative CT. χ2 Tests were used to compare vertebral canal breach between groups and vertebrae. RESULTS Breaches in the vertebral canal were less common (P < .001) when screws were placed with a guide in the guide group (9/66, 14%) than without a guide (30/66, 45%). The rate of vertebral canal breach differed at L5 (P = .021) but not at L6 (P = .05), L7 (P = .075) or S1 (P = .658). The angle of insertion (α) did not differ between specimens with and without breaches (guide, P = .068; control, P = .394). CONCLUSION The use of a customized 3D-printed guide generally improved the accuracy of PSI in canine lumbosacral vertebrae, although statistical significance was reached only at L5. CLINICAL SIGNIFICANCE The use of customized drill guides may be considered as an alternative to freehand PSI in the lumbosacral area, especially for L5-L6 vertebrae.
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Affiliation(s)
- Patricia Beer
- Clinic for Small Animal Surgery, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Brian H Park
- Clinic for Small Animal Surgery, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Frank Steffen
- Clinic for Small Animal Surgery, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Decvn Lucas A Smolders
- Clinic for Small Animal Surgery, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Antonio Pozzi
- Clinic for Small Animal Surgery, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - Sebastian C Knell
- Clinic for Small Animal Surgery, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
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