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Kastler A, Carneiro I, Perolat R, Rudel A, Pialat JB, Lazard A, Isnard S, Krainik A, Amoretti N, Grand S, Stacoffe N. Combined vertebroplasty and pedicle screw insertion for vertebral consolidation: feasibility and technical considerations. Neuroradiology 2024; 66:855-863. [PMID: 38453715 DOI: 10.1007/s00234-024-03325-y] [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] [Received: 11/15/2023] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To assess the feasibility and technical accuracy of performing pedicular screw placement combined with vertebroplasty in the radiological setting. METHODS Patients who underwent combined vertebroplasty and pedicle screw insertion under combined computed tomography and fluoroscopic guidance in 4 interventional radiology centers from 2018 to 2023 were retrospectively assessed. Patient demographics, vertebral lesion type, and procedural data were analyzed. Strict intra-pedicular screw positioning was considered as technical success. Pain score was assessed according to the Visual Analogue Scale before the procedure and in the 1-month follow-up consultation. RESULTS Fifty-seven patients (38 men and 19 women) with a mean age of 72.8 (SD = 11.4) years underwent a vertebroplasty associated with pedicular screw insertion for the treatment of traumatic fractures (29 patients) and neoplastic disease (28 patients). Screw placement accuracy assessed by post-procedure CT scan was 95.7% (89/93 inserted screws). A total of 93 pedicle screw placements (36 bi-pedicular and 21 unipedicular) in 32 lumbar, 22 thoracic, and 3 cervical levels were analyzed. Mean reported procedure time was 48.8 (SD = 14.7) min and average injected cement volume was 4.4 (SD = 0.9) mL. A mean VAS score decrease of 5 points was observed at 1-month follow-up (7.7, SD = 1.3 versus 2.7, SD = 1.7), p < .001. CONCLUSION Combining a vertebroplasty and pedicle screw insertion is technically viable in the radiological setting, with a high screw positioning accuracy of 95.7%.
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Affiliation(s)
- Adrian Kastler
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France.
| | - Inês Carneiro
- Neuroradiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Romain Perolat
- Radiology Unit, Carémeau University Hospital, Nimes, France
| | - Alexandre Rudel
- Diagnostic and Interventional MSK Unit, Pasteur II Hospital, Nice, France
| | | | - Arnaud Lazard
- Neurosurgery Unit, Grenoble University Hospital, Grenoble, France
| | - Stephanie Isnard
- Neurosurgery Unit, Grenoble University Hospital, Grenoble, France
| | - Alexandre Krainik
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France
| | - Nicolas Amoretti
- Diagnostic and Interventional MSK Unit, Pasteur II Hospital, Nice, France
| | - Sylvie Grand
- Diagnostic and Interventional Neuroradiology Unit, Grenoble University Hospital, Grenoble, France
| | - Nicolas Stacoffe
- Diagnostic and Interventional Radiology Unit, Lyon Sud Hospital, Lyon, France
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Palmer R, Ton A, Robertson D, Liu KG, Liu JC, Wang JC, Hah RJ, Alluri RK. Top 25 Most Cited Articles on Intraoperative Computer Tomography-Guided Navigation in Spine Surgery. World Neurosurg 2024; 184:322-330.e1. [PMID: 38342177 DOI: 10.1016/j.wneu.2024.02.024] [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] [Received: 01/09/2024] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND In recent years, the use of intraoperative computer tomography-guided (CT-guided) navigation has gained significant popularity among health care providers who perform minimally invasive spine surgery. This review aims to identify and analyze trends in the literature related to the widespread adoption of CT-guided navigation in spine surgery, emphasizing the shift from conventional fluoroscopy-based techniques to CT-guided navigation. METHODS Articles pertaining to this study were identified via a database review and were hierarchically organized based on the number of citations. An "advanced document search" was performed on September 28th, 2022, utilizing Boolean search operator terms. The 25 most referenced articles were combined into a primary list after sorting results in descending order based on the total number of citations. RESULTS The "Top 25" list for intraoperative CT-guided navigation in spine surgery cumulatively received a total of 2742 citations, with an average of 12 new citations annually. The number of citations ranged from 246 for the most cited article to 60 for the 25th most cited article. The most cited article was a paper by Siewerdsen et al., with 246 total citations, averaging 15 new citations per year. CONCLUSIONS Intraoperative CT-guided navigation is 1 of many technological advances that is used to increase surgical accuracy, and it has become an increasingly popular alternative to conventional fluoroscopy-based techniques. Given the increasing adoption of intraoperative CT-guided navigation in spine surgery, this review provides impactful evidence for its utility in spine surgery.
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Affiliation(s)
- Ryan Palmer
- Department of Orthopaedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, California, USA
| | - Andy Ton
- Department of Orthopaedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, California, USA.
| | - Djani Robertson
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Kevin G Liu
- Department of Orthopaedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, California, USA
| | - John C Liu
- Department of Neurological Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, California, USA
| | - Jeffrey C Wang
- Department of Neurological Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, California, USA
| | - Raymond J Hah
- Department of Orthopaedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, California, USA
| | - Ram K Alluri
- Department of Orthopaedic Surgery, Keck School of Medicine at The University of Southern California, Los Angeles, California, USA
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Stone L, McDonald M, Wojdyla L, Osorio JA. Integrating navigation assistance for redirecting freehanded spinal instrumentation: experience and technique. J Robot Surg 2023; 17:2729-2734. [PMID: 37665478 PMCID: PMC10678822 DOI: 10.1007/s11701-023-01686-9] [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] [Received: 03/21/2022] [Accepted: 07/16/2023] [Indexed: 09/05/2023]
Abstract
Retrospective review of all spinal fusions > 3 levels involving the thoracolumbar and/or sacroiliac at a single institution, by a single surgeon between 3/12/2020 and 8/13/2021 were reviewed. All screws that were secondarily navigated after identified as misdirected on intraoperative CT scan were included. Neuromonitoring reports were culled for mA threshold to triggered EMG response for all redirected screws. Intraoperative, post-de novo screw placement images (fluoroscopy scout and intraoperative CT) and post-redirection intraoperative scoliosis films and post-operative scoliosis films were independently reviewed by a senior neuroradiologist. Fifty redirected screws in the thoracic, lumbar, sacral, and ilium were identified as misdirected and redirected via navigation. The new trajectory of all screws was confirmed satisfactory by independent review between a senior neuroradiologist and neurosurgeon. Four screws could not be verified by post-operative imaging (4/50, 8%). All triggered EMG stimulated > 15 mA. No screws required return to the operating room for revision. No patients experienced a post-operative deficit. Redirection of misdirected thoracolumbar and sacroiliac screws can be performed using intraoperative CT and navigation as a means to detect and directly visualize appropriate placement.
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Affiliation(s)
- Lauren Stone
- Department of Neurological Surgery, UC San Diego, San Diego, CA, USA
| | - Marin McDonald
- Department of Neuroradiology, UC San Diego, San Diego, CA, USA
| | - Luke Wojdyla
- Department of Neuroradiology, UC San Diego, San Diego, CA, USA
| | - Joseph A Osorio
- Department of Neurological Surgery, UC San Diego, San Diego, CA, USA.
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Suri I, Suri M, Hu J, Dedhia SK, Yaeger K. Case Volume Justification of 3D-Navigated Spinal Procedures: A Cost-Benefit Analysis. J Med Syst 2023; 47:114. [PMID: 37938464 DOI: 10.1007/s10916-023-02000-8] [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] [Received: 08/05/2023] [Accepted: 09/28/2023] [Indexed: 11/09/2023]
Abstract
3D image-guidance platforms have transformed spinal surgery by enhancing visualization, increasing precision, and improving patient outcomes. However, with high procurement, operational, and maintenance costs relative to the standard of care, the benefits of acquiring these platforms must be thoroughly assessed. This study aims to develop a model that weighs the cost of a typical 3D navigation platform against its clinical benefits to determine the facility case volume required to justify its purchase. Using Medtronic's StealthStation and O-Arm as a market example, we calculated the break-even case volume by dividing the cost of the platform by the difference in gross margins between 3D navigation and the standard of care. Total gross margins earned from first-time and revision surgeries were calculated based on each payer's reimbursement rate and covered case volume, as well as each technology's revision rate. Values reported in literature and by Centers for Medicare and Medicaid Services databases were plugged into the model to calculate variables. At a 0% reimbursement rate from private payers for revision surgeries, an annual case volume of 158 spinal surgeries would be required to justify the per-year 3D navigation cost; at 100% private payer reimbursement, 352 surgeries would be required. Given these volumes, 61% of all US inpatient facilities cannot justify 3D navigation at 0% reimbursement, and 86% cannot justify it at 100% reimbursement. Accordingly, greater pricing flexibility, such as per-procedure models, is required for 3D navigation systems to standardize clinical outcomes across medical centers.
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Affiliation(s)
- Ikaasa Suri
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Neurosurgery, Mount Sinai Hospital, New York, NY, USA.
- Illuminant Surgical, Inc., Cambridge, MA, USA.
| | - Mehr Suri
- Stern School of Business, New York University, New York, NY, USA
| | - James Hu
- Illuminant Surgical, Inc., Cambridge, MA, USA
| | - Siddarth Ketan Dedhia
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Kurt Yaeger
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX, USA
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Deng H, Cong Y, Lei J, Li D, Ke C, Fan Z, Wang H, Wang P, Zhuang Y. Effect of O-arm on reduction quality and functional recovery of acetabular dome impaction fractures: a retrospective clinical study. BMC Musculoskelet Disord 2023; 24:858. [PMID: 37919740 PMCID: PMC10621090 DOI: 10.1186/s12891-023-06987-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 10/23/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Acetabular dome impaction fractures (ADIF) are difficult to reduce and have a high failure rate. Consistency between the acetabulum and the femoral head is usually assessed using intraoperative X-ray fluoroscopy to evaluate the quality of fracture reduction. This study examines the effects of intraoperative mobile 2D/3DX imaging system (O-arm) on the reduction quality and functional recovery of ADIF. METHODS We retrospectively analysed the data of 48 patients with ADIF treated at Honghui Hospital between October 2018 and October 2021.The patients were divided into the X-ray and O-arm groups. The residual step-off and gap displacements in the acetabular dome region were measured, and fracture reduction quality was evaluated. Hip function was evaluated using the modified Merle d'Aubigné and Postel scoring systems. RESULTS There were no significant intergroup differences in the preoperative general data (p > 0.05). The mean residual average step displacement in the acetabular dome region was 3.48 ± 2.43 mm and 1.61 ± 1.16 mm (p < 0.05), while the mean gap displacement was 6.72 ± 3.69 mm and 3.83 ± 1.67 mm (p < 0.05) in the X-ray and the O-arm groups, respectively. In the X-ray group, according to the fracture reduction criteria described by Verbeek and Moed et al., one case was excellent, 13 cases were good, 11 cases were poor; 56% were excellent or good. In the O-arm group, seven cases were excellent, 12 cases were good, and four cases were poor; overall in this group, 82.6% were excellent or good (p < 0.05). A total of 46 patients achieved fracture healing at the last follow-up. In the X-ray group, according to the modified Merle d'Aubigné and Postel function score, three cases were excellent,12 cases were good, six cases were middle, three cases were poor; 62.5% were excellent or good, In the O-arm group, 15 cases were excellent, four cases were good, two cases were middle, one case was poor; 86.4% were excellent or good (p < 0.05). CONCLUSIONS The application of O-arm in ADIF can improve fracture reduction quality and functional recovery.
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Affiliation(s)
- Hongli Deng
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, No. 555, East Youyi Road, Xi'an, Shaanxi, 710054, China
| | - Yuxuan Cong
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, No. 555, East Youyi Road, Xi'an, Shaanxi, 710054, China
| | - Jinlai Lei
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, No. 555, East Youyi Road, Xi'an, Shaanxi, 710054, China
| | - Dongyang Li
- Xi'an Medical University, No. 1, Xinwang Road, Weiyang District, Xi'an, Shaanxi, 710021, China
| | - Chao Ke
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, No. 555, East Youyi Road, Xi'an, Shaanxi, 710054, China
| | - Zhiqiang Fan
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, No. 555, East Youyi Road, Xi'an, Shaanxi, 710054, China
| | - Hu Wang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, No. 555, East Youyi Road, Xi'an, Shaanxi, 710054, China
| | - Pengfei Wang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, No. 555, East Youyi Road, Xi'an, Shaanxi, 710054, China
| | - Yan Zhuang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, No. 555, East Youyi Road, Xi'an, Shaanxi, 710054, China.
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Hadgaonkar S, Gupta A, Aiyer S, Bhilare P, Sancheti P. Learning curve across 2000 thoracolumbar pedicle screw placements using O-arm navigation: technical difficulties and their solutions. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3753-3763. [PMID: 37698694 DOI: 10.1007/s00586-023-07922-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/22/2023] [Accepted: 08/26/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Instrumentation using the intraoperative O-arm navigation technique appears safer than its predecessor techniques. However, only a handful of surgeons often used navigation during spinal surgeries. Too many operative glitches and unreliable navigation accuracy were the important reasons cited even by experienced surgeons for not using spinal navigation. We have studied the accuracy of pedicle screw placement during the learning curve and beyond it. We have also discussed in detail the intricacies of the technique and solutions to the difficulties encountered using spinal navigation. MATERIALS AND METHODS A total of 2000 thoracolumbar pedicle screws have been placed in the 324 spine surgeries meeting the inclusion and exclusion criteria included in this retrospective study. We have divided 2000 pedicle screw placements into consecutive groups of 200 each. We have compared these groups for the accuracy of screw placement with the surgeon's experience. RESULTS The accuracy of pedicle screw placement using the "in-versus-out" grading system in group 1 was 85.5% which significantly increased in group 2 to 93.5% (p-value: 0.0099), and thereafter, there was a nonsignificant increase in subsequent groups with the graph achieving the shape of a plateau. CONCLUSION Surgeons should learn the correct principles of the technique of O-arm navigation to prevent the loss of accuracy and place pedicle screws with high accuracy. There is a learning curve of around 30-35 surgeries or 200 pedicle screw placements to acclimatize with the technique of O-arm navigation and learn its principles.
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Affiliation(s)
- Shailesh Hadgaonkar
- Department of Spine Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Alok Gupta
- Department of Spine Surgery, Indraprastha Apollo Hospital, New Delhi, India.
| | - Siddharth Aiyer
- Department of Spine Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Pramod Bhilare
- Department of Spine Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Parag Sancheti
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
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Zawar A, Chhabra HS, Mundra A, Sharma S, Kalidindi KKV. Robotics and navigation in spine surgery: A narrative review. J Orthop 2023; 44:36-46. [PMID: 37664556 PMCID: PMC10470401 DOI: 10.1016/j.jor.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction In recent decades, there has been a rising trend of spinal surgical interventional techniques, especially Minimally Invasive Spine Surgery (MIS), to improve the quality of life in an effective and safe manner. However, MIS techniques tend to be difficult to adapt and are associated with an increased risk of radiation exposure. This led to the development of 'computer-assisted surgery' in 1983, which integrated CT images into spinal procedures evolving into the present day robotic-assisted spine surgery. The authors aim to review the development of spine surgeries and provide an overview of the benefits offered. It includes all the comparative studies available to date. Methods The manuscript has been prepared as per "SANRA-a scale for the quality assessment of narrative review articles". The authors searched Pubmed, Embase, and Scopus using the terms "(((((Robotics) OR (Navigation)) OR (computer assisted)) OR (3D navigation)) OR (Freehand)) OR (O-Arm)) AND (spine surgery)" and 68 articles were included for analysis excluding review articles, meta-analyses, or systematic literature. Results The authors noted that 49 out of 68 studies showed increased precision of pedicle screw insertion, 10 out of 19 studies show decreased radiation exposure, 13 studies noted decreased operative time, 4 out of 8 studies showed reduced hospital stay and significant reduction in rates of infections, neurological deficits, the need for revision surgeries, and rates of radiological ASD, with computer-assisted techniques. Conclusion Computer-assisted surgeries have better accuracy of pedicle screw insertion, decreased blood loss and operative time, reduced radiation exposure, improved functional outcomes, and lesser complications.
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Affiliation(s)
- Amogh Zawar
- Rajiv Gandhi Medical College and CSMH, Thane, Maharashtra. 400605, India
| | | | - Anuj Mundra
- Sri Balaji Action Medical Institute, A4 Block, Paschim Vihar, New Delhi, 110063, India
| | - Sachin Sharma
- Sri Balaji Action Medical Institute, A4 Block, Paschim Vihar, New Delhi, 110063, India
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Bonello JP, Koucheki R, Abbas A, Lex J, Nucci N, Yee A, Ahn H, Finkelstein J, Lewis S, Larouche J, Toor J. Comparison of major spine navigation platforms based on key performance metrics: a meta-analysis of 16,040 screws. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2937-2948. [PMID: 37474627 DOI: 10.1007/s00586-023-07865-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/28/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE The objective of this meta-analysis is to compare available computer-assisted navigation platforms by key performance metrics including pedicle screw placement accuracy, operative time, neurological complications, and blood loss. METHODS A systematic review was conducted using major databases for articles comparing pedicle screw accuracy of computer-assisted navigation to conventional (freehand or fluoroscopy) controls via post-operative computed tomography. Outcome data were extracted and pooled by random-effects model for analysis. RESULTS All navigation platforms demonstrated significant reduction in risk of breach, with Stryker demonstrating the highest accuracy compared to controls (OR 0.16 95% CI 0.06 to 0.41, P < 0.00001, I2 = 0%) followed by Medtronic. There were no significant differences in accuracy or most surgical outcome measures between platforms; however, BrainLab demonstrated significantly faster operative time compared to Medtronic by 30 min (95% CI - 63.27 to - 2.47, P = 0.03, I2 = 74%). Together, there was significantly lower risk of major breach in the navigation group compared to controls (OR 0.42, 95% CI 0.27-0.63, P < 0.0001, I2 = 56%). CONCLUSIONS When comparing between platforms, Stryker demonstrated the highest accuracy, and Brainlab the shortest operative time, both followed by Medtronic. No significant difference was found between platforms regarding neurologic complications or blood loss. Overall, our results demonstrated a 60% reduction in risk of major breach utilizing computer-assisted navigation, coinciding with previous studies, and supporting its validity. This study is the first to directly compare available navigation platforms offering insight for further investigation and aiding in the institutional procurement of platforms. LEVEL 3 EVIDENCE: Meta-analysis of Level 3 studies.
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Affiliation(s)
- John-Peter Bonello
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| | - Robert Koucheki
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Aazad Abbas
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Johnathan Lex
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
| | - Nicholas Nucci
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Canada
| | - Albert Yee
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Department of Orthopaedic Surgery, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Henry Ahn
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Canada
| | - Joel Finkelstein
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Department of Orthopaedic Surgery, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Stephen Lewis
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Canada
| | - Jeremie Larouche
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Department of Orthopaedic Surgery, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Jay Toor
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
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Wänman J, Burmeister F, Thorell D, Kyrk T, Blixt S, Gerdhem P, Mukka S, Bobinski L. Minimally Invasive Surgery for Thoracolumbar Spinal Fractures in Patients With Ankylosing Spondylitis. Int J Spine Surg 2023; 17:526-533. [PMID: 37268432 PMCID: PMC10478685 DOI: 10.14444/8478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Patients with ankylosing spondylitis (AS) are prone to spinal fractures even after low-energy trauma. Posterior fusion through open surgery has been the standard procedure for spinal fractures in patients with AS. Minimally invasive surgery (MIS) has been proposed as an alternative treatment option. There are few literature reports regarding patients with AS being treated for spinal fractures with MIS. This study aims to present the clinical outcome of a series of patients with AS treated with MIS for spinal fractures. METHODS We included a consecutive series of patients with AS who underwent MIS for thoracolumbar fractures between 2014 and 2021. The median follow-up was 38 (12-75) months. Medical records and radiographs were reviewed, and data on surgery, reoperations, complications, fracture healing, and mortality were recorded. RESULTS Forty-three patients (39 [91%] men) were included with a median (range) age of 73 (38-89) years. All patients underwent image-guided MIS with screws and rods. Three patients underwent reoperations, all due to wound infections. One patient (2%) died within 30 days and 7 (16%) died within the first year after surgery. Most patients with a radiographic follow-up of 12 months or more (29/30) healed with a bony fusion on computed tomography (97%). CONCLUSION Patients with AS and a spinal fracture are at risk of reoperation and have significant mortality during the first year. MIS provides adequate surgical stability for fracture healing with an acceptable number of complications and is an adequate choice in treating AS-related spinal fractures. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Johan Wänman
- Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden
| | - Fabian Burmeister
- Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden
| | - David Thorell
- Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden
| | - Tobias Kyrk
- Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden
| | - Simon Blixt
- Department of Clinical Science Intervention and Technology, Karolinska Institutet, Sweden
| | - Paul Gerdhem
- Department of Clinical Science Intervention and Technology, Karolinska Institutet, Sweden
- Department of Hand Surgery and Orthopaedics, Uppsala University Hospital, Sweden
- Department of Surgical Sciences, Uppsala University, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden
| | - Lukas Bobinski
- Department of Surgical and Perioperative Sciences (Orthopedics), Umeå University, Umeå, Sweden
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10
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Li H, Zhang P, Wang G, Liu H, Yang X, Wang G, Sun Z. Real-Time Navigation with Guide Template for Pedicle Screw Placement Using an Augmented Reality Head-Mounted Device: A Proof-of-Concept Study. Indian J Orthop 2023; 57:776-781. [PMID: 37128571 PMCID: PMC10147887 DOI: 10.1007/s43465-023-00859-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/26/2023] [Indexed: 05/03/2023]
Abstract
Objective This study aims to explore the real-time navigation with guide template using an augmented reality head-mounted device (ARHMD) for pedicle screw placement. Methods The spatial coordinate relationships between augmented reality images and real objects were established through the custom-made guide template, and the registration and tracking were completed using an ARHMD. The feasibility and accuracy of this method were verified by pedicle screw placement in 2 lumbar models. According to the Gertzbein-Robbins grading scale, the accuracy of pedicle screw placement was assessed. The navigation errors were estimated by measuring the deviation values of entry point and trajectory angle. Results A total of 20 pedicle K-wires were placed into L1-L5 in 2 lumbar models, which were successfully completed, with an average time of 11.5 min per model and 69 s per screw. The overall K-wires placement accuracy was 100% (20 screws). The navigation error was 2.77 ± 0.82 mm for the deviation value of entry point, and 3.03° ± 0.94° for the deviation value of trajectory angle. Conclusions The application of an ARHMD combined with guide template for pedicle screw placement is a promising navigation approach.
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Affiliation(s)
- Haowei Li
- Tsinghua University School of Medicine, Beijing, 100091 China
| | - Peihai Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218 China
| | - Guangzhi Wang
- Tsinghua University School of Medicine, Beijing, 100091 China
| | - Huiting Liu
- Peking Union Medical College Hospital, Beijing, 100730 China
| | - Xuejun Yang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218 China
| | - Guihuai Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218 China
| | - Zhenxing Sun
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218 China
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Delcont MR, Ou-Yang DC, Burger EL, Patel VV, Wessell NM, Kleck CJ. Alternative Uses of O-Arm and Stealth Navigation Technology Over 10 Years: The University of Colorado Experience. Orthopedics 2023; 46:e89-e97. [PMID: 35876781 DOI: 10.3928/01477447-20220719-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Intraoperative computed tomography scanning with O-arm and use of Stealth navigation can improve surgical outcomes in a variety of orthopedic subspecialties. In spine surgery, the accuracy, precision, and safety of pedicle screw and interbody implant placement has improved. This technology is now routinely used in percutaneous pedicle screw placement and minimally invasive sacroiliac joint fusion. Other applications include, but are not limited to, isthmic pars defect repair, lumbosacral pseudoarticulation resection in Bertolotti's syndrome, radiofrequency ablation, and en bloc tumor resection. Intraoperative navigation has numerous applications, and use of this technology should continue to evolve as the technology advances. [Orthopedics. 2023;46(2):e89-e97.].
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12
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Avrumova F, Lebl DR. Augmented reality for minimally invasive spinal surgery. Front Surg 2023; 9:1086988. [PMID: 36776471 PMCID: PMC9914175 DOI: 10.3389/fsurg.2022.1086988] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/28/2022] [Indexed: 01/28/2023] Open
Abstract
Background Augmented reality (AR) is an emerging technology that can overlay computer graphics onto the real world and enhance visual feedback from information systems. Within the past several decades, innovations related to AR have been integrated into our daily lives; however, its application in medicine, specifically in minimally invasive spine surgery (MISS), may be most important to understand. AR navigation provides auditory and haptic feedback, which can further enhance surgeons' capabilities and improve safety. Purpose The purpose of this article is to address previous and current applications of AR, AR in MISS, limitations of today's technology, and future areas of innovation. Methods A literature review related to applications of AR technology in previous and current generations was conducted. Results AR systems have been implemented for treatments related to spinal surgeries in recent years, and AR may be an alternative to current approaches such as traditional navigation, robotically assisted navigation, fluoroscopic guidance, and free hand. As AR is capable of projecting patient anatomy directly on the surgical field, it can eliminate concern for surgeon attention shift from the surgical field to navigated remote screens, line-of-sight interruption, and cumulative radiation exposure as the demand for MISS increases. Conclusion AR is a novel technology that can improve spinal surgery, and limitations will likely have a great impact on future technology.
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Zhao J, Jiang H, Zhuge Y, Gao R, Wang C, Ma J, Zhou X. Risk Factors for the Drift Phenomenon in O-arm Navigation-Assisted Pedicle Screw Placement during Spinal Deformity Surgery. Orthop Surg 2022; 15:118-123. [PMID: 36394161 PMCID: PMC9837212 DOI: 10.1111/os.13557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 09/10/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Intraoperative O-arm navigation systems improve the accuracy of spinal instrumentation placement. However, deviation of the pedicle screw from the guide line might occur. The aim of the present study was to explore the causes of and countermeasures for the drift phenomenon during pedicle screw implantation with the aid of an O-arm three-dimensional navigation system in spinal deformity surgery. METHODS This was a retrospective analysis of 341 patients with spinal deformity who underwent O-arm navigation system-assisted pedicle screw placement from July 2015 to June 2019. The patient's general condition, Cobb angle, apical vertebra position, softness index, spinal release status, fixed reference frame position, and distance between the navigation vertebral body and the reference frame were collected and compared by independent-samples t test or Pearson's chi-square analysis. The potential risk factors for the drift phenomenon were identified using binary logistic regression analysis. RESULTS The drift phenomenon occurred in 57 patients during the first navigation-assisted pedicle screw placement, for an incidence of 16.7% (57/341). There were significant differences in factors such as the apical vertebra position, softness index, spinal release status, and distance between the vertebral body and the reference frame when the drift phenomenon occurred (P < 0.05). Binary logistic regression analysis showed that the softness index, spinal release status, and distance between the vertebral body and the reference frame when drifting occurred were independent risk factors for the drift phenomenon during O-arm navigation-assisted pedicle screw placement. CONCLUSION During the use of an O-arm navigation system to assist with pedicle screw placement, pedicle screws should not be placed away from the reference frame, and spinal osteotomy and release should be performed after pedicle screw placement. In addition, the accuracy of O-arm navigation-assisted pedicle screw placement will be affected more in those with larger softness indices.
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Affiliation(s)
- Jianquan Zhao
- Present address:
Department of Orthopaedic Surgery, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
| | - Heng Jiang
- Present address:
Department of Orthopaedic Surgery, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
| | - Yingjie Zhuge
- Present address:
Department of Orthopaedic Surgery, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina,Department of Orthopaedic SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong UniversityShanghaiChina
| | - Rui Gao
- Present address:
Department of Orthopaedic Surgery, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
| | - Ce Wang
- Present address:
Department of Orthopaedic Surgery, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
| | - Jun Ma
- Present address:
Department of Orthopaedic Surgery, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
| | - Xuhui Zhou
- Present address:
Department of Orthopaedic Surgery, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
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High Accuracy and Safety of Intraoperative CT-Guided Navigation for Transpedicular Screw Placement in Revision Spinal Surgery. J Clin Med 2022; 11:jcm11195853. [PMID: 36233720 PMCID: PMC9573638 DOI: 10.3390/jcm11195853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Intraoperative CT-guided navigation (iCT-navigation) has been reported to improve the accuracy and safety of transpedicular screw placement in primary spinal surgery. However, due to a disrupted bony anatomy and scarring tissue, revision spinal surgery can be challenging. The purpose of this study was to evaluate the accuracy and safety of iCT-navigation for screw placement at the virgin site versus the revision site in revision thoracolumbar spinal surgery. Method: In total, 254 screws were inserted in 27 revision surgeries, in which 114 (44.9%) screws were inserted at the site with previous laminectomy or posterolateral fusion (the revision site), 64 (25.2%) were inserted at the virgin site, and 76 (29.9%) were inserted to replace the pre-existing screws. CT scans were conducted for each patient after all screws were inserted to intraoperatively confirm the screw accuracy. Results: In total, 248 (97.6%) screws were considered accepted. The rate of accepted screws at the virgin site was 98.4% (63/64) versus 95.6% (109/114) at the revision site (p: 0.422). There were six (2.4%) unaccepted screws, which were immediately revised during the same operation. There was no neurological injury noted in our patients. Conclusion: With the use of iCT-navigation, the rate of accepted screws at the revision site was found to be comparable to that at the virgin site. We concluded that iCT-navigation could achieve high accuracy and safety for transpedicular screw placement in revision spinal surgery and allow for the immediate revision of unaccepted screws.
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Conrads N, Grunz JP, Huflage H, Luetkens KS, Feldle P, Grunz K, Köhler S, Westermaier T. Accuracy of pedicle screw placement using neuronavigation based on intraoperative 3D rotational fluoroscopy in the thoracic and lumbar spine. Arch Orthop Trauma Surg 2022; 143:3007-3013. [PMID: 35794344 DOI: 10.1007/s00402-022-04514-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In spinal surgery, precise instrumentation is essential. This study aims to evaluate the accuracy of navigated, O-arm-controlled screw positioning in thoracic and lumbar spine instabilities. MATERIALS AND METHODS Posterior instrumentation procedures between 2010 and 2015 were retrospectively analyzed. Pedicle screws were placed using 3D rotational fluoroscopy and neuronavigation. Accuracy of screw placement was assessed using a 6-grade scoring system. In addition, screw length was analyzed in relation to the vertebral body diameter. Intra- and postoperative revision rates were recorded. RESULTS Thoracic and lumbar spine surgery was performed in 285 patients. Of 1704 pedicle screws, 1621 (95.1%) showed excellent positioning in 3D rotational fluoroscopy imaging. The lateral rim of either pedicle or vertebral body was protruded in 25 (1.5%) and 28 screws (1.6%), while the midline of the vertebral body was crossed in 8 screws (0.5%). Furthermore, 11 screws each (0.6%) fulfilled the criteria of full lateral and medial displacement. The median relative screw length was 92.6%. Intraoperative revision resulted in excellent positioning in 58 of 71 screws. Follow-up surgery due to missed primary malposition had to be performed for two screws in the same patient. Postsurgical symptom relief was reported in 82.1% of patients, whereas neurological deterioration occurred in 8.9% of cases with neurological follow-up. CONCLUSIONS Combination of neuronavigation and 3D rotational fluoroscopy control ensures excellent accuracy in pedicle screw positioning. As misplaced screws can be detected reliably and revised intraoperatively, repeated surgery for screw malposition is rarely required.
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Affiliation(s)
- Nora Conrads
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Karsten Sebastian Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Philipp Feldle
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Katharina Grunz
- Department of Orthopedics and Trauma Surgery, Klinikum Würzburg Mitte - Standort Juliusspital, Juliuspromenade 19, 97070, Würzburg, Germany
| | - Stefan Köhler
- Department of Neurosurgery, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany.,Die Neurochirurgie-Praxis, Eichhornstraße 28, 97070, Würzburg, Germany
| | - Thomas Westermaier
- Department of Neurosurgery, University Hospital Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany.,Department of Neurosurgery, Helios-Amper-Klinikum Dachau, Krankenhausstraße 15, 85221, Dachau, Germany
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Naik RR, Hoblidar A, Bhat SN, Ampar N, Kundangar R. A Hybrid 3D-2D Image Registration Framework for Pedicle Screw Trajectory Registration between Intraoperative X-ray Image and Preoperative CT Image. J Imaging 2022; 8:jimaging8070185. [PMID: 35877629 PMCID: PMC9324544 DOI: 10.3390/jimaging8070185] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/11/2022] [Accepted: 06/19/2022] [Indexed: 12/04/2022] Open
Abstract
Pedicle screw insertion is considered a complex surgery among Orthopaedics surgeons. Exclusively to prevent postoperative complications associated with pedicle screw insertion, various types of image intensity registration-based navigation systems have been developed. These systems are computation-intensive, have a small capture range and have local maxima issues. On the other hand, deep learning-based techniques lack registration generalizability and have data dependency. To overcome these limitations, a patient-specific hybrid 3D-2D registration principled framework was designed to map a pedicle screw trajectory between intraoperative X-ray image and preoperative CT image. An anatomical landmark-based 3D-2D Iterative Control Point (ICP) registration was performed to register a pedicular marker pose between the X-ray images and axial preoperative CT images. The registration framework was clinically validated by generating projection images possessing an optimal match with intraoperative X-ray images at the corresponding control point registration. The effectiveness of the registered trajectory was evaluated in terms of displacement and directional errors after reprojecting its position on 2D radiographic planes. The mean Euclidean distances for the Head and Tail end of the reprojected trajectory from the actual trajectory in the AP and lateral planes were shown to be 0.6–0.8 mm and 0.5–1.6 mm, respectively. Similarly, the corresponding mean directional errors were found to be 4.90 and 20. The mean trajectory length difference between the actual and registered trajectory was shown to be 2.67 mm. The approximate time required in the intraoperative environment to axially map the marker position for a single vertebra was found to be 3 min. Utilizing the markerless registration techniques, the designed framework functions like a screw navigation tool, and assures the quality of surgery being performed by limiting the need of postoperative CT.
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Affiliation(s)
- Roshan Ramakrishna Naik
- Manipal Institute of Technology, Manipal Academy of Higher Education Manipal, Manipal 576104, India;
| | - Anitha Hoblidar
- Manipal Institute of Technology, Manipal Academy of Higher Education Manipal, Manipal 576104, India;
- Correspondence: (A.H.); (S.N.B.)
| | - Shyamasunder N. Bhat
- Kasturba Medical College, Manipal Academy of Higher Education Manipal, Manipal 576104, India; (N.A.); (R.K.)
- Correspondence: (A.H.); (S.N.B.)
| | - Nishanth Ampar
- Kasturba Medical College, Manipal Academy of Higher Education Manipal, Manipal 576104, India; (N.A.); (R.K.)
| | - Raghuraj Kundangar
- Kasturba Medical College, Manipal Academy of Higher Education Manipal, Manipal 576104, India; (N.A.); (R.K.)
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Brown NJ, Shahrestani S, Kurtz JS, Beyer RS, Pham MH, Osorio J. Successful use of stereotactic navigation in posterior spinal fusion T10-S2 with bilateral iliac screw fixation in a patient with prior spinal surgeries and osteoporosis: A case report. Int J Surg Case Rep 2022; 97:107380. [PMID: 35839654 PMCID: PMC9403018 DOI: 10.1016/j.ijscr.2022.107380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Degenerative lumbar scoliosis is a prominent cause of adult spinal deformity with an increasing prevalence as the population ages. This pathology is associated with debilitating symptoms, including radicular back pain and lower extremity claudication. Surgical realignment of the spine and restoration of sagittal imbalance can reduce low back pain. Chronic sacroiliac dysfunction commonly causes low back radicular pain. We present a complicated case where stereotactic navigation facilitated an extensive fusion and decompression procedure for adult spinal deformity in an obese patient with multiple prior surgeries for scoliosis and sacroiliac joint pathology. CASE PRESENTATION A 69-year-old, obese female with scoliosis refractory to multiple interventions presented with severe, radicular lower back pain. On examination of the right lower extremity (RLE), she had mild weakness (3/5 strength) and reduced sensation to light touch over its anterolateral aspect (dermatome L4). She was unable to perform single leg stance or tandem walk. Imaging revealed moderate mid-lumbar levoscoliosis, severe degenerative disc disease and facet hypertrophy changes in the setting of prior multilevel lumbar fusion, and consecutive nerve root impingement between L1 and L5 (worst at L3-4). DEXA scan was consistent with osteoporosis. The patient underwent lumbar laminectomy with posterior fusion of T10-ilium, transforaminal lumbar interbody fusion, osteotomy, and decompression using stereotactic navigation. The presence of SI titanium dowels from her previous SI fusion procedure posed a challenge with respect to achieving pelvic fixation. CLINICAL DISCUSSION Iliac screw placement is a critical adjunctive to lumbosacral fusion, notably for prevention of pseudoarthrosis; however, patients with prior SI fusion may present a biomechanical challenge to surgeons due to obstruction of the surgical site. The O-arm neuronavigation system was successfully used to bypass this obstruction and provide sacroiliac fixation in this procedure. CONCLUSION Stereotactic navigation (The O-arm Surgical Imaging System) can effectively be used to circumvent prior SI fusion in osteoporotic bone.
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Affiliation(s)
- Nolan J. Brown
- Department of Neurosurgery, University of California Irvine, Irvine, CA, USA,Corresponding author at: UC Irvine Department of Neurosurgery, 101 The City Drive South, Orange, CA 92868, USA.
| | - Shane Shahrestani
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Department of Mechanical Engineering, California Institute of Technology, Pasadena, CA, USA
| | - Joshua S. Kurtz
- Department of Neurosurgery, University of California Irvine, Irvine, CA, USA
| | - Ryan S. Beyer
- Department of Neurosurgery, University of California Irvine, Irvine, CA, USA
| | - Martin H. Pham
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Joseph Osorio
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
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Pan HK, Liu CW, Pan RY. Comparison of suture anchor penetration rate between navigation-assisted and traditional shoulder arthroscopic capsulolabral repair. PLoS One 2022; 17:e0267943. [PMID: 35511770 PMCID: PMC9070905 DOI: 10.1371/journal.pone.0267943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 04/19/2022] [Indexed: 11/27/2022] Open
Abstract
Proper placement of suture anchors is an important step in Bankart repair as improper placement can lead to failure. Concern surrounding suture anchor placement inspired the use navigation systems in shoulder arthroscopy. We aimed to demonstrate the technological advantage of using the O-arm (Medtronic Navigation, Denver, CO, USA) image guidance system to provide real-time images during portal and anchor placements in shoulder arthroscopy. Consecutive patients (from July to October 2014) who were admitted for arthroscopic capsulolabral repair surgeries were included. Ten patients were randomly enrolled in the navigation group and 10 in the traditional group. The glenoid was divided into four zones, and the penetration rates in each zone were compared between the two groups. In zone III, the most inferior region of the glenoid, the penetration rate was 40.9% in the traditional group and 15.7% in the navigation group (P = 0.077), demonstrating a trend toward improved accuracy of anchor placement with the aid of the navigation system; however, this was not statistically significant. Average surgical time in the navigation and traditional groups was 177.6±40.2 and 117.7±17.6 mins, respectively. American Shoulder and Elbow Surgeons Shoulder Scores showed no difference before and 6 months after surgery. This pilot study showed a trend toward decreased penetration rate in O-arm-navigated capsulolabral repair surgeries and decreased risks of implant misplacement; however, possibly due to the small sample size, the difference was not statistically significant. Further large-scale studies are needed to confirm the possible benefit of the navigation system. Even with the use of navigation systems, there were still some penetrations in zone III of the glenoid. This penetration may be attributed to the micro-motion of the acromioclavicular joint. Although the navigation group showed a significant increase in surgical time, with improvements in instrument design, O-arm-navigated arthroscopy will gain popularity in clinical practice.
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Affiliation(s)
- Hsiao-Kai Pan
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Che-Wei Liu
- Department of Orthopedics, Cathy General Hospital, Taipei, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- * E-mail: (CWL); (RYP)
| | - Ru-Yu Pan
- Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- * E-mail: (CWL); (RYP)
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Simulation Training in Spine Surgery. J Am Acad Orthop Surg 2022; 30:400-408. [PMID: 35446299 DOI: 10.5435/jaaos-d-21-00756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 01/19/2022] [Indexed: 02/01/2023] Open
Abstract
Simulated surgery is part of a growing paradigm shift in surgical education as a whole. Various modalities from cadaver models to virtual reality have been developed and studied within the context of surgical education. Simulation training in spine surgery has an immense potential to improve education and ultimately improve patient safety. This is due to the inherent risk of operating the spine and the technical difficulty of modern techniques. Common procedures in the modern orthopaedic armamentarium, such as pedicle screw placement, can be simulated, and proficiency is rapidly achieved before application in patients. Furthermore, complications such as dural tears can be simulated and effectively managed in a safe environment with simulation. New techniques with steeper learning curves, such as minimally invasive techniques, can now be safely simulated. Hence, augmenting surgical education through simulation has great potential to benefit trainees and practicing orthopaedic surgeons in modern spine surgery techniques. Additional work will aim to improve access to such technologies and integrate them into the current orthopaedic training curriculum.
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Fan X, Mirza SK, Li C, Evans LT, Ji S, Paulsen KD. Accuracy of Stereovision-Updated Versus Preoperative CT-Based Image Guidance in Multilevel Lumbar Pedicle Screw Placement: A Cadaveric Swine Study. JB JS Open Access 2022; 7:JBJSOA-D-21-00129. [PMID: 35350121 PMCID: PMC8937011 DOI: 10.2106/jbjs.oa.21.00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Change in vertebral position between preoperative imaging and the surgical procedure reduces the accuracy of image-guided spinal surgery, requiring repeated imaging and surgical field registration, a process that takes time and exposes patients to additional radiation. We developed a handheld, camera-based, deformable registration system (intraoperative stereovision, iSV) to register the surgical field automatically and compensate for spinal motion during surgery without further radiation exposure. Methods We measured motion-induced errors in image-guided lumbar pedicle screw placement in 6 whole-pig cadavers using state-of-the-art commercial spine navigation (StealthStation; Medtronic) and iSV registration that compensates for intraoperative vertebral motion. We induced spinal motion by using preoperative computed tomography (pCT) of the lumbar spine performed in the supine position with accentuated lordosis and performing surgery with the animal in the prone position. StealthStation registration of pCT occurred using metallic fiducial markers implanted in each vertebra, and iSV data were acquired to perform a deformable registration between pCT and the surgical field. Sixty-eight pedicle screws were placed in 6 whole-pig cadavers using iSV and StealthStation registrations in random order of vertebral level, relying only on image guidance without invoking the surgeon's judgment. The position of each pedicle screw was assessed with post-procedure CT and confirmed via anatomical dissection. Registration errors were assessed on the basis of implanted fiducials. Results The frequency and severity of pedicle screw perforation were lower for iSV registration compared with StealthStation (97% versus 68% with Grade 0 medial perforation for iSV and StealthStation, respectively). Severe perforation occurred only with StealthStation (18% versus 0% for iSV). The overall time required for iSV registration (computational efficiency) was ∼10 to 15 minutes and was comparable with StealthStation registration (∼10 min). The mean target registration error was smaller for iSV relative to StealthStation (2.81 ± 0.91 versus 8.37 ± 1.76 mm). Conclusions Pedicle screw placement was more accurate with iSV registration compared with state-of-the-art commercial navigation based on preoperative CT when alignment of the spine changed during surgery. Clinical Relevance The iSV system compensated for intervertebral motion, which obviated the need for repeated vertebral registration while providing efficient, accurate, radiation-free navigation during open spinal surgery.
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Affiliation(s)
- Xiaoyao Fan
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Sohail K. Mirza
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire,PEERClinic for Back Pain and Spine Surgery, Fairfax, Virginia
| | - Chen Li
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Linton T. Evans
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire,Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Songbai Ji
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire,Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Keith D. Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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21
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Liu JB, Wu JL, Zuo R, Li CQ, Zhang C, Zhou Y. Does MIS-TLIF or TLIF result in better pedicle screw placement accuracy and clinical outcomes with navigation guidance? BMC Musculoskelet Disord 2022; 23:153. [PMID: 35172784 PMCID: PMC8848978 DOI: 10.1186/s12891-022-05106-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 02/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Although previous studies have suggested that navigation can improve the accuracy of pedicle screw placement, few studies have compared navigation-assisted transforaminal lumbar interbody fusion (TLIF) and navigation-assisted minimally invasive TLIF (MIS-TLIF). The entry point of pedicle screw insertion in navigation-assisted MIS-TLIF (NM-TLIF) may deviate from the planned entry point due to an uneven bone surface, which may result in misplacement. The purpose of this study was to explore the pedicle screw accuracy and clinical consequences of MIS-TLIF and TLIF, both under O-arm navigation, to determine which surgical method is better. Methods A retrospective study of 54 patients who underwent single-segment NM-TLIF or navigation-assisted TLIF (N-TLIF) was conducted. In addition to the patients’ demographic characteristics, intraoperative indicators and complications, the Oswestry Disability Index (ODI) and visual analog scale (VAS) score were recorded and analyzed preoperatively and at the 1-, 6-, and 12-month and final postoperative follow-ups. The clinical qualitative accuracy and absolute quantitative accuracy of pedicle screw placement were assessed by postoperative CT. Multifidus muscle injury was evaluated by T2-weighted MRI. Results Compared with N-TLIF, NM-TLIF was more advantageous in terms of the incision length, intraoperative blood loss, drainage volume, time to ambulation, length of hospital stay, blood transfusion rate and analgesia rate (P < 0.05). The ODI and VAS scores for low back pain were better than those of N-TLIF at 1 month and 6 months post-surgery (P < 0.05). There was no significant difference in the clinical qualitative screw placement accuracy (97.3% vs. 96.2%, P > 0.05). The absolute quantitative accuracy results showed that the axial translational error, sagittal translational error, and sagittal angle error in the NM-TLIF group were significantly greater than those in the N-TLIF group (P < 0.05). The mean T2-weighted signal intensity of the multifidus muscle in the NM-TLIF group was significantly lower than that in the N-TLIF group (P < 0.05). Conclusions Compared with N-TLIF, NM-TLIF has the advantages of being less invasive, yielding similar or better screw placement accuracy and achieving better symptom relief in the midterm postoperative recovery period. However, more attention should be given to real-time adjustment for pedicle insertion in NM-TLIF rather than just following the entry point and trajectory of the intraoperative plan.
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Affiliation(s)
- Jia Bin Liu
- Department of Orthopaedics, Xinqiao Hospital, Amy Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Jun Long Wu
- Department of Orthopaedics, The Hospital of People Liberation Army Hong Kong Garrison, Hong Kong, 999077, People's Republic of China.,Department of Orthopaedics, The 941 Hospital of Chinese People Liberation Army, Xining, 810007, People's Republic of China
| | - Rui Zuo
- Department of Orthopaedics, Xinqiao Hospital, Amy Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Chang Qing Li
- Department of Orthopaedics, Xinqiao Hospital, Amy Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China
| | - Chao Zhang
- Department of Orthopaedics, Xinqiao Hospital, Amy Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China.
| | - Yue Zhou
- Department of Orthopaedics, Xinqiao Hospital, Amy Medical University (Third Military Medical University), Chongqing, 400037, People's Republic of China.
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Kendlbacher P, Tkatschenko D, Czabanka M, Bayerl S, Bohner G, Woitzik J, Vajkoczy P, Hecht N. Workflow and performance of intraoperative CT, cone-beam CT, and robotic cone-beam CT for spinal navigation in 503 consecutive patients. Neurosurg Focus 2022; 52:E7. [PMID: 34973677 DOI: 10.3171/2021.10.focus21467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/13/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE A direct comparison of intraoperative CT (iCT), cone-beam CT (CBCT), and robotic cone-beam CT (rCBCT) has been necessary to identify the ideal imaging solution for each individual user's need. Herein, the authors sought to analyze workflow, handling, and performance of iCT, CBCT, and rCBCT imaging for navigated pedicle screw instrumentation across the entire spine performed within the same surgical environment by the same group of surgeons. METHODS Between 2014 and 2018, 503 consecutive patients received 2673 navigated pedicle screws using iCT (n = 1219), CBCT (n = 646), or rCBCT (n = 808) imaging during the first 24 months after the acquisition of each modality. Clinical and demographic data, workflow, handling, and screw assessment and accuracy were analyzed. RESULTS Intraoperative CT showed image quality and workflow advantages for cervicothoracic cases, obese patients, and long-segment instrumentation, whereas CBCT and rCBCT offered independent handling, around-the-clock availability, and the option of performing 2D fluoroscopy. All modalities permitted reliable intraoperative screw assessment. Navigated screw revision was possible with each modality and yielded final accuracy rates > 92% in all groups (iCT 96.2% vs CBCT 92.3%, p < 0.001) without a difference in the accuracy of cervical pedicle screw placement or the rate of secondary screw revision surgeries. CONCLUSIONS Continuous training and an individual setup of iCT, CBCT, and rCBCT has been shown to permit safe and precise navigated posterior instrumentation across the entire spine with reliable screw assessment and the option of immediate revision. The perceived higher image quality and larger scan area of iCT should be weighed against the around-the-clock availability of CBCT and rCBCT technology with the option of single-handed robotic image acquisition.
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Affiliation(s)
- Paul Kendlbacher
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin.,2Department of Neurosurgery, Goethe Universität Frankfurt, Frankfurt am Main
| | | | - Marcus Czabanka
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin.,2Department of Neurosurgery, Goethe Universität Frankfurt, Frankfurt am Main
| | - Simon Bayerl
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin
| | - Georg Bohner
- 3Department of Neuroradiology, Charité-Universitätsmedizin Berlin; and
| | - Johannes Woitzik
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin.,4Department of Neurosurgery, University at Oldenburg, Germany
| | - Peter Vajkoczy
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin
| | - Nils Hecht
- 1Department of Neurosurgery, Charité-Universitätsmedizin Berlin
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Shao X, Huang Z, Yang J, Deng Y, Yang J, Sui W. Efficacy and safety for combination of t-EMG with O-arm assisted pedicle screw placement in neurofibromatosis type I scoliosis surgery. J Orthop Surg Res 2021; 16:731. [PMID: 34930400 PMCID: PMC8686534 DOI: 10.1186/s13018-021-02882-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Due to the characteristics of neurofibromatosis type I (NF-1) scoliosis, the precise placement of pedicle screws still remains to be a challenge. Triggered screw electromyography (t-EMG) has been proved to exhibit high sensitivity to identify mal-positioned pedicle screws, but no previous study assessed the combination of t-EMG with O-arm-assisted pedicle screw placement in NF-1 scoliosis surgery. Objective To evaluate efficacy and safety for combination of t-EMG with O-arm-assisted pedicle screw placement in NF-1 scoliosis surgery. Materials and methods From March 2018 to April 2020, sixty-five NF-1 scoliosis patients underwent t-EMG and O-arm-assisted pedicle screw fixation were retrospectively reviewed. The channel classification system was applied to classify the pedicle morphology based on pedicle width measurement by preoperative computed tomography scans. The minimal t-EMG threshold for screw path inspection was used as 8 mA, and operative screw redirection was also recorded. All pedicle screws were verified using a second intraoperative O-arm scan. The correlation between demographic and clinical data with amplitude of t-EMG were also analyzed. Results A total of 652 pedicle screws (T10-S1) in 65 patients were analyzed. The incidence of an absent pedicle (channel classification type C or D morphology) was 150 (23%). Overall, abnormal t-EMG threshold was identified in 26 patients with 48 screws (7.4%), while 16 out of the 48 screws were classified as G0, 14 out of the 48 screws were classified as G1, and 18 out of the 48 screws were classified as G2. The screw redirection rate was 2.8% (18/652). It showed that t-EMG stimulation detected 3 unacceptable mal-positioned screws in 2 patients (G2) which were missed by O-arm scan. No screw-related neurological or vascular complications were observed. Conclusions Combination of t-EMG with O-arm-assisted pedicle screw placement was demonstrated to be a safe and effective method in NF-1 scoliosis surgery. The t-EMG could contribute to detecting the rupture of the medial wall which might be missed by O-arm scan. Combination of t-EMG with O-arm could be recommended for routine use of screw insertion in NF-1 scoliosis surgery.
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Affiliation(s)
- Xiexiang Shao
- Spine Center, Xin Hua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, People's Republic of China
| | - Zifang Huang
- Department of Spine Surgery, Sun Yat-Sen University First Affiliated Hospital, No. 58 Second Zhongshan Road, Guangzhou, Guangdong, People's Republic of China
| | - Jingfan Yang
- Spine Center, Xin Hua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, People's Republic of China
| | - Yaolong Deng
- Spine Center, Xin Hua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, People's Republic of China
| | - Junlin Yang
- Spine Center, Xin Hua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, People's Republic of China.
| | - Wenyuan Sui
- Spine Center, Xin Hua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, People's Republic of China.
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Fan X, Durtschi MS, Li C, Evans LT, Ji S, Mirza SK, Paulsen KD. Hand-Held Stereovision System for Image Updating in Open Spine Surgery. Oper Neurosurg (Hagerstown) 2021; 19:461-470. [PMID: 32365204 DOI: 10.1093/ons/opaa057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 02/02/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Image guidance in open spinal surgery is compromised by changes in spinal alignment between preoperative images and surgical positioning. We evaluated registration of stereo-views of the surgical field to compensate for vertebral alignment changes. OBJECTIVE To assess accuracy and efficiency of an optically tracked hand-held stereovision (HHS) system to acquire images of the exposed spine during surgery. METHODS Standard midline posterior approach exposed L1 to L6 in 6 cadaver porcine spines. Fiducial markers were placed on each vertebra as "ground truth" locations. Spines were positioned supine with accentuated lordosis, and preoperative computed tomography (pCT) was acquired. Spines were re-positioned in a neutral prone posture, and locations of fiducials were acquired with a tracked stylus. Intraoperative stereovision (iSV) images were acquired and 3-dimensional (3D) surfaces of the exposed spine were reconstructed. HHS accuracy was assessed in terms of distances between reconstructed fiducial marker locations and their tracked counterparts. Level-wise registrations aligned pCT with iSV to account for changes in spine posture. Accuracy of updated computed tomography (uCT) was assessed using fiducial markers and other landmarks. RESULTS Acquisition time for each image pair was <1 s. Mean reconstruction time was <1 s for each image pair using batch processing, and mean accuracy was 1.2 ± 0.6 mm across 6 cases. Mean errors of uCT were 3.1 ± 0.7 and 2.0 ± 0.5 mm on the dorsal and ventral sides, respectively. CONCLUSION Results suggest that a portable HHS system offers potential to acquire accurate image data from the surgical field to facilitate surgical navigation during open spine surgery.
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Affiliation(s)
- Xiaoyao Fan
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | | | - Chen Li
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Linton T Evans
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Songbai Ji
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.,Department of Biomedical Engineering, Worcester Institute of Polytechnic, Worcester, Massachusetts
| | - Sohail K Mirza
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.,PEERClinic for Back Pain and Spine Surgery, Fairfax, Virginia
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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25
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Lu YJ, Miao YM, Zhu TF, Wu Q, Shen X, Lu DD, Zhu XS, Gan MF. Comparison of the Wiltse Approach and Percutaneous Pedicle Screw Fixation Under O-arm Navigation for the Treatment of Thoracolumbar Fractures. Orthop Surg 2021; 13:1618-1627. [PMID: 34142446 PMCID: PMC8313162 DOI: 10.1111/os.13053] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 03/29/2021] [Accepted: 04/28/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives The aim of this study was to evaluate the clinical outcomes of the Wiltse approach and percutaneous pedicle screw placement under O‐arm navigation for the treatment of thoracolumbar fracture. Methods We enrolled a total of 54 patients with neurologically intact thoracolumbar fracture who received minimally invasive treatments between October 2014 and October 2018 in this retrospective study. Among these, 28 patients (22 males and six females, with a mean age of 48.6 ± 9.6 years) were treated with pedicle screw fixation through the Wiltse approach (WPSF), and another 26 (15 males and 11 females, with a mean age of 45.7 ± 10.6 years) received percutaneous pedicle screw fixation under O‐arm navigation (OPSF). Statistical methods were used to perform a detailed comparison of clinical outcomes, radiologic findings, and complications between the two groups obtained preoperatively, postoperatively, and at last follow‐up. Results All patients underwent surgery successfully and finished a follow‐up of more than 12 months. No serious complications, such as infection, blood vessel injury, or spinal cord or nerve root injury occurred. Visual analog scale (VAS) scores, Oswestry disability index (ODI) scores, local Cobb angle (LCA), vertebral wedge angle (VWA), and R value were notably improved after surgery, though there was no clear discrepancy between the groups at each time point (P > 0.05). During the follow‐up period, no patients developed neurological impairment or implant‐related complications, and no patients underwent revision surgery. The WPSF group had a significantly shorter operation time than the OPSF group (68.1 ± 9.8 vs 76.1 ± 9.0 minutes, P = 0.005). Moreover, the WPSF group showed less cost of surgery than the WPSF group (48142.1 ± 1430.1 vs 59035.4 ± 1152.7 CNY, P < 0.001). There were no significant differences between the two groups in terms of the intraoperative bleeding, length of incision, or postoperative hospitalization time (P > 0.05). The accuracy of pedicle screw placement was 95.2% (160/168) in the WPSF group and 96.8% (151/156) in the OPSF group, with no significant difference between the groups (P = 0.432). Conclusion Both WPSF and OPSF were safe and effective for the treatment of thoracolumbar fracture. Although the two groups showed favorable clinical and radiologic outcomes through to final follow‐up, we recommended the minimally invasive WPSF given its shorter operation time and lower cost of surgery.
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Affiliation(s)
- Ying-Jie Lu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi-Ming Miao
- Department of Orthopaedic Surgery, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Tian-Feng Zhu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qian Wu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xu Shen
- Department of Orthopaedic Surgery, Suzhou Dushuhu Public Hospital (Dushuhu Public Hospital Affiliated to Soochow University), Suzhou, China
| | - Dong-Dong Lu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xue-Song Zhu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Min-Feng Gan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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26
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Use of Intraoperative CT Improves Accuracy of Spinal Navigation During Screw Fixation in Cervico-thoracic Region. Spine (Phila Pa 1976) 2021; 46:530-537. [PMID: 33273435 DOI: 10.1097/brs.0000000000003827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective analysis of a single-center consecutive series of patients. OBJECTIVE To test the hypothesis that using a mobile intraoperative computed tomography in combination with spinal navigation would result in better accuracy of lateral mass and pedicle screws between C3 and T5 levels, compared to cone-beam computed tomography and traditional 2D fluoroscopy. SUMMARY OF BACKGROUND DATA Use of spinal navigation associated with 3D imaging has been shown to improve accuracy of screw positioning in the cervico-thoracic region. However, use of iCT imaging compared to a cone-beam CT has not been fully investigated in these types of surgical interventions. METHODS We retrospectively analyzed a series of patients who underwent posterior cervico-thoracic fixations using different intraoperative imaging systems in a single hospital. We identified three different groups of patients: Group A, operated under 2D-fluoroscopic guidance without navigation; Group B: O-arm guidance with navigation; Group C: iCT AIRO guidance with navigation. Primary outcome was the rate of accurately placed screws, measured on intra or postoperative CT scan with Neo et al. classification for cervical pedicles screws and Gertzbein et al. for thoracic pedicle screws. Screws in cervical lateral masses were evaluated according to a new classification created by the authors. RESULTS Data on 67 patients and 495 screws were available. Overall screw accuracy was 92.8% (95.6% for lateral mass screws, 81.6% for cervical pedicle screws, and 90% for thoracic pedicle screws). Patients operated with iCT AIRO navigation had significantly fewer misplaced screws (2.4%) compared to 2D-fluoroscopic guidance (9.1%) and O-arm navigation (9.7%) (P = 0.0152). Accuracy rate of iCT navigation versus O-arm navigation was significantly higher (P = 0.0042), and there was no statistically significant difference in surgical time between the three Groups (P = 0.5390). CONCLUSION Use of high-quality CT associated with spinal navigation significantly improved accuracy of screw positioning in the cervico-thoracic region.Level of Evidence: 3.
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27
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Venier A, Croci D, Robert T, Distefano D, Presilla S, Scarone P. Use of Intraoperative Computed Tomography Improves Outcome of Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Single-Center Retrospective Cohort Study. World Neurosurg 2021; 148:e572-e580. [PMID: 33482416 DOI: 10.1016/j.wneu.2021.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To provide data about surgical workflow, accuracy, complications, radiation exposure, and learning curve effect in patients who underwent minimally invasive (MIS) transforaminal lumbar interbody fusion with navigation coupled with mobile intraoperative computed tomography. METHODS A retrospective analysis was performed of data from consecutive patients who underwent single- or double-level MIS transforaminal lumbar interbody fusion at a single institution; mobile intraoperative computed tomography combined with a navigation system was used as the sole intraoperative imaging method to place pedicular screws; decompression and interbody fusion were performed through a 22-mm tubular retractor. Clinical data, perioperative complications, accuracy of pedicular screw placement, and radiation exposure were analyzed. A learning curve effect on surgical time and accuracy was assessed. RESULTS A total of 408 screws in 100 patients were analyzed. In all cases, spinal navigation allowed for identification of pedicular trajectories and greatly facilitated nerve root decompression through the MIS approach. Overall accuracy according to Heary classification was 95.3%. Nineteen screws (4.7%) presented a minor lateral breach (<2 mm), not clinically significant. Surgical time, blood loss, and patient radiation exposure compared favorably with reported values from other series using three-dimensional navigation. A learning curve effect on surgical time, but not on screw accuracy, was identified. CONCLUSIONS MIS transforaminal lumbar interbody fusion can now be performed without any radiation exposure to the surgeon and operating room staff, with almost absolute accuracy during screw positioning and tubular decompression. A learning curve effect on surgical time, but not on overall screw accuracy, may be expected.
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Affiliation(s)
- Alice Venier
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Davide Croci
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Thomas Robert
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Lugano, Switzerland; Facoltà di scienze biomediche, Università della Svizzera italiana, Lugano, Switzerland
| | - Daniela Distefano
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - Stefano Presilla
- Medical Physics Service, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Pietro Scarone
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Lugano, Switzerland.
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28
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Chen X, Zheng F, Zhang G, Gao X, Wang Y, Huang W, Lin H. An experimental study on the safe placement of sacroiliac screws using a 3D printing navigation module. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1512. [PMID: 33313257 PMCID: PMC7729361 DOI: 10.21037/atm-20-7080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background In this experimental study, we evaluated the use of digital 3D navigation printing in minimizing complications arising from sacroiliac screw misplacement. Methods A total of 13 adult pelvic specimens were studied using 3D navigation printing. Mimics software was used for preoperative planning and for obtaining sacrum median sagittal resection and long axis resection of the S1 pedicle center by 3D segmentation. The ideal screw path had its origin at the post-median part of the auricular surface of the sacroiliac joint, the midpoint at the mid-position of the lateral recess and outlet of the anterior sacral foramina; and the endpoint at the S1 sagittal resection. A sacroiliac screw fixed the pelvic specimens with the assistance of the navigation module. The distance between the start point (ilium surface) and endpoint (sacral median sagittal resection) of the screw path was measured after the pre- and postoperative 3D pelvis module was 3D-registered according to the standard precision range. The origin/endpoint qualified rates of the postoperative (n/26) and preoperative (26/26) screw paths were analyzed by the chi-square test. Results No screw misplacement occurred in the screw paths of any of the 13 pelvic specimens. The mean distance between the preoperative and postoperative origin of the screw path was 1.5415±0.6806 mm, and the mean distance between the preoperative and postoperative endpoint was 2.2809±0.4855 mm. The qualified rate of origin was 23/26 when the precision grade was 2.4 mm (P>0.05, χ2=1.41), while the qualified rate of endpoint was 21/26 when the precision grade was 2.7 mm (P>0.05, χ2=3.54). Conclusions In this experimental study, using a 3D printing navigation module helped attain an accurate and safe sacroiliac screw implantation.
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Affiliation(s)
- Xuanhuang Chen
- Department of Orthopedics, the Affiliated Hospital of Putian University, Putian, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Feng Zheng
- Department of Orthopedics, the Affiliated Hospital of Putian University, Putian, China
| | - Guodong Zhang
- Department of Orthopedics, the Affiliated Hospital of Putian University, Putian, China
| | - Xiaoqiang Gao
- Department of Orthopedics, the Affiliated Hospital of Putian University, Putian, China
| | - Ya Wang
- National Key Discipline of Human Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Wenhua Huang
- National Key Discipline of Human Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Haibin Lin
- Department of Orthopedics, the Affiliated Hospital of Putian University, Putian, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Tanasansomboon T, Tejapongvorachai T, Yingsakmongkol W, Limthongkul W, Kotheeranurak V, Singhatanadgige W. Minimally Invasive Percutaneous Modified Iliac Screw Placement Using Intraoperative Navigation: A Technical Note. World Neurosurg 2020; 146:240-245. [PMID: 33253948 DOI: 10.1016/j.wneu.2020.11.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The modified iliac screw fixation technique was proposed to be an interesting alternative option for spinopelvic fixation. In this study, we describe a new minimally invasive technique for percutaneous placement of modified iliac screws. METHODS A 64-year-old man with ankylosing spondylitis suffered from a 3-column fracture at the L5 vertebra without any neurologic deficit. We performed percutaneous pedicle screw fixation from L2 to S1 with additional modified iliac screws augmentation using an intraoperative navigation. We inserted both S1 pedicle screw and modified iliac screw within a stab incision on each side of the patient's back without using rod connector. RESULTS The patient's severe low back pain subsided on the day following the operation. There was no clinical low back pain at 2-week follow-up. The 1-year follow-up x-ray showed that the fracture was healed successfully without signs of screw loosening or breakage. CONCLUSIONS The modified iliac screws can be placed safely via percutaneous approach with an intraoperative image guidance. By using this new technique, surgeons can easily adjust the screw head to align with S1 pedicle screw via the same small incision. The rod connectors are not necessary for this technique. This method also prevents the acute angle that can develop between the screw head and shaft of the screw, which is typically found in S2 alar-iliac screw technique.
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Affiliation(s)
| | | | - Wicharn Yingsakmongkol
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Worawat Limthongkul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vit Kotheeranurak
- Orthopaedic Department, Queen Savang Vadhana Memorial Hospital, Thai Red Cross Society, Sriracha, Chonburi, Thailand
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Stübig T, Windhagen H, Krettek C, Ettinger M. Computer-Assisted Orthopedic and Trauma Surgery. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:793-800. [PMID: 33549155 PMCID: PMC7947640 DOI: 10.3238/arztebl.2020.0793] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/06/2020] [Accepted: 08/24/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There are many ways in which computer-assisted orthopedic and trauma surgery (CAOS) procedures can help surgeons to plan and execute an intervention. METHODS This study is based on data derived from a selective search of the literature in the PubMed database, supported by a Google Scholar search. RESULTS For most applications the evidence is weak. In no sector did the use of computer-assisted surgery yield any relevant clinical or functional improvement. In trauma surgery, 3D-navigated sacroiliac screw fixation has become clinically established for the treatment of pelvic fractures. One randomized controlled trial showed a reduction in the rate of screw misplacement: 0% with 3D navigation versus 20.4% with the conventional procedure und 16.6% with 2D navigation. Moreover, navigation-assisted pedicle screw stabilization lowers the misplacement rate. In joint replacements, the long-term results showed no difference in respect of clinical/functional scores, the time for which the implant remained in place, or aseptic loosening. CONCLUSION Computer-assisted procedures can improve the precision of certain surgical interventions. Particularly in joint replacement and spinal surgery, the research is moving away from navigation in the direction of robotic procedures. Future studies should place greater emphasis on clinical and functional results.
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Affiliation(s)
- Timo Stübig
- Department of Traumatology, Hannover Medical School
| | - Henning Windhagen
- Department of Orthopedic Surgery, Hannover Medical School, Annastift
| | | | - Max Ettinger
- Department of Orthopedic Surgery, Hannover Medical School, Annastift
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31
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Perforation Rate of Pedicle Screws Using Hybrid Operating Room Combined With Intraoperative Computed Tomography Navigation for Adolescent Idiopathic Scoliosis: Impact of Distance From the Reference Frame and Other Risk Factors. Spine (Phila Pa 1976) 2020; 45:E1357-E1364. [PMID: 32890303 DOI: 10.1097/brs.0000000000003673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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O'Connor TE, O'Hehir MM, Khan A, Mao JZ, Levy LC, Mullin JP, Pollina J. Mazor X Stealth Robotic Technology: A Technical Note. World Neurosurg 2020; 145:435-442. [PMID: 33059080 DOI: 10.1016/j.wneu.2020.10.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/01/2020] [Accepted: 10/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Minimally invasive techniques in spine surgery have continued to advance as robotic technology has evolved over several generations. Although traditional techniques for placing pedicle screws are still widespread in practice, newer technology has increased the reliability of accurately placing instrumentation with smaller incisions and subsequent decreased length of stay. Additionally, advancements in planning software have improved the ability to align posterior instrumentation to assist with rod placement on multilevel constructs. METHODS This paper describes the surgical techniques and operative workflow for placing pedicle screws with the latest robotic technology. The robotic platform, registration, surgical planning, and placement of instrumentation are discussed in detail. Advantages of the Mazor X Stealth Edition compared with the previous generation robot include obviating the need for K wires and eliminating the need for a percutaneous pin, as navigation is integrated into the robot. RESULTS Our use of this new technology has been encouraging. Using the techniques described in this paper, the first 90 pedicle screws placed with the Mazor X Stealth Edition robot yielded 100% grade A accuracy on the Gertzbein-Robbins scale confirmed on immediate postoperative CT. There were no complications experienced in any case. CONCLUSIONS In our experience, this robotic technology has the potential to improve patient outcomes and is associated with advanced surgical planning compared with more traditional techniques.
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Affiliation(s)
- Timothy E O'Connor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA.
| | - Mary Margaret O'Hehir
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Jennifer Z Mao
- Department of Biomedical Sciences, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA; Department of Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - Lauren C Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Buffalo General Medical Center, Kaleida Health, Buffalo, New York, USA
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Starkweather CK, Morshed R, Rutledge C, Tarapore P. Navigated Placement of Two Odontoid Screws Using the O-Arm Navigation System: A Technical Case Report. Cureus 2020; 12:e10724. [PMID: 33145130 PMCID: PMC7599040 DOI: 10.7759/cureus.10724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Odontoid fractures are common cervical spine fractures and lead to atlantoaxial instability depending on their type. Fractures through the base of the odontoid neck are considered for surgery. While the management of these fractures is controversial and may include external immobilization or posterior fusion, an odontoid screw offers the advantages of directly crossing the fracture site while preserving motion at C1-2. Although intraoperative navigation is routinely utilized in spine surgery, there are few reports of navigated anterior odontoid screw placement. In this report, we describe the safe and accurate placement of two anterior odontoid screws using the O-arm navigation system in an octogenarian with a type II odontoid fracture. Details of the technical approach are also provided. The follow-up imaging at three months confirmed the healing of the fracture. Intraoperative navigation using the O-arm system allows for safe and accurate placement of two odontoid screws.
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Affiliation(s)
- Clara K Starkweather
- Neurological Surgery, University of California San Francisco, San Francisco, USA
| | - Ramin Morshed
- Neurological Surgery, University of California San Francisco, San Francisco, USA
| | - Caleb Rutledge
- Neurological Surgery, University of California San Francisco, San Francisco, USA
| | - Phiroz Tarapore
- Neurological Surgery, San Francisco General Hospital, San Francisco, USA.,Neurological Surgery, San Francisco Veteran's Hospital, San Francisco, USA
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Luo Y, Li Z, Jiang S, Hu L, Liu W, Li W. A novel fluoroscopy-based robot system for pedicle screw fixation surgery. Int J Med Robot 2020; 16:1-8. [PMID: 32949442 DOI: 10.1002/rcs.2171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/01/2020] [Accepted: 09/17/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Robot-assisted pedicle screw insertion has gained popularity in the spinal surgery field. Due to high cost, these spinal robots are not extensively applied in clinical surgeries. Developing an effective robot system with low cost and high clinical acceptability is one of the future trends. METHODS We developed a novel fluoroscopy-based robot system for pedicle screw insertion. Four live pigs were conducted with percutaneous pedicle screw insertion. Robot-assisted surgery was performed on the left side of pedicle, while the right opposite side is placed by freehand. The respect accuracy, surgical time and fluoroscopy time were recorded. RESULTS Robot-assisted group achieved 100% (23/23) accuracy. The average times (6.4 ± 1.7) for intraoperative fluoroscopy usage per procedure were lesser than freehand group (12.5 ± 3.6), and the surgical time (6.8 ± 2.1 min) per screw was reduced compared with freehand group (12.1 ± 4.8 min). CONCLUSIONS Our robot system is cost-effective and feasible for pedicle screw placement. Low economic cost makes it easier for extensive application in primary hospitals.
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Affiliation(s)
- Yanzhong Luo
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Zhuofu Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Shuai Jiang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
| | - Lei Hu
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Wenyong Liu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China
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Sasaki Y, Ochiai N, Kotani T, Kenmoku T, Hashimoto E, Kishida S, Sakuma T, Muramatsu Y, Ueno K, Nakayama K, Iijima Y, Minami S, Ohtori S. Clinical application of intraoperative O-arm navigation in reverse shoulder arthroplasty. J Orthop Sci 2020; 25:836-842. [PMID: 31864765 DOI: 10.1016/j.jos.2019.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 11/07/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Inaccurate fixation and positioning of the glenoid component using conventional techniques are problematic in reversed shoulder arthroplasty (RSA). Our objective was to investigate the accuracy of O-arm navigation of the glenoid component in RSA. METHODS This retrospective case-control study comprised 2 groups of 25 patients who underwent reversed shoulder arthroplasty with or without intraoperative O-arm navigation. The intraoperative goal was to place the component neutrally in the glenoid in the axial plane and 10° inferiorly tilted in the scapular plane. Glenoid version angle and inclination were measured by computed tomography obtained preoperatively and a year postoperatively. Operative time, intraoperative bleeding, and the presence of postoperative complications were recorded. RESULTS Compared with the ideal, the range of error for version was 7.3° (SD 3.6°) in the control group and 5.6° (SD 3.6°) in the navigated group (P = 0.278), and the range of error for inclination was 18.3° (SD 11.7°) in the control group and 4.9° (SD 3.8°) in the navigated group (P = 0.0004). The mean operative time was 164.6 (SD 21.2) min in the control group and 192.0 (SD 16.2) min in the navigated group (P = 0.001). The mean intraoperative bleeding was 201.0 (SD 37.0) mL in the control group and 185.3 (SD 35.6) mL in the navigated group (P = 0.300). There were no complications reported related to the intraoperative O-arm navigation. CONCLUSION O-arm navigation may be a useful tool for the placement with inferior tilt of the glenoid procedure in reversed shoulder arthroplasty.
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Affiliation(s)
- Yu Sasaki
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan.
| | - Nobuyasu Ochiai
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Toshiaki Kotani
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan
| | - Tomonori Kenmoku
- Department of Orthopedics Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Eiko Hashimoto
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Shunji Kishida
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan
| | - Tsuyoshi Sakuma
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan
| | - Yuta Muramatsu
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan
| | - Keisuke Ueno
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan
| | - Keita Nakayama
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan
| | - Yasushi Iijima
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan
| | - Shohei Minami
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2, Ebaradai, Sakura City, Chiba, 285-8765, Japan
| | - Seiji Ohtori
- Department of Orthopedics Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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Tamaki R, Wada K, Okazaki K. Surgical Technique and Accuracy of S2 Alar-Iliac Screw Insertion Using Intraoperative O-Arm Navigation: An Analysis of 120 Screws. World Neurosurg 2020; 144:e326-e330. [PMID: 32841800 DOI: 10.1016/j.wneu.2020.08.123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the surgical technique and accuracy of S2 alar-iliac (SAI) screw placement using intraoperative O-arm-based 3-dimensional navigation (O-arm). METHODS This study involved 60 patients who underwent SAI screw placement using the O-arm system between September 2013 and September 2019. These surgeries were performed by 5 different surgeons. For O-arm-based SAI screw insertion, a reference frame was attached to the spinous process of the lower lumbar spine (usually L4) so as not to interfere with SAI screw insertion and to facilitate simultaneous L5-S posterior interbody fusion with navigation. The navigated probe, iliac tap, and screwdriver were used for SAI screw insertion. Screw placement accuracy and screw length were assessed using postoperative computed tomography. Perioperative complications were also evaluated. RESULTS Mean age at surgery was 68.1 (range, 30-83) years. In total, 120 screws were inserted. Rate of accurate screw placement was 98.3% (118/120 screws). The 2 misplaced screws breached the anterior cortex of the sacrum. Mean screw length was 85.6 (range, 70-90) mm. There were no significant neurovascular or visceral complications perioperatively. CONCLUSIONS SAI screw placement can be safely performed using the intraoperative O-arm system and our surgical technique.
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Affiliation(s)
- Ryo Tamaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Keiji Wada
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
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Wang ZW, Wang Z, Fan XW, Du PY, Sun JY, Ding WY, Yang DL. Precise Surgical Treatment of Thoracic Ossification of Ligamentum Flavum Assisted by O-Arm Computer Navigation: A Retrospective Study. World Neurosurg 2020; 143:e409-e418. [PMID: 32750521 DOI: 10.1016/j.wneu.2020.07.196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE O-arm computer navigation-assisted technology (OACNAT) has been widely used in the treatment of thoracic ossification of ligamentum flavum (TOLF) in recent years, but there are few in-depth studies on the safety and effectiveness of this approach. The purpose of this study was to investigate the clinical effect of accurate surgical treatment for TOLF with OACNAT. METHODS From January 2010 to January 2018, the clinical data of 64 patients with TOLF who underwent laminectomy and internal fixation in the Third Hospital of Hebei Medical University were retrospectively reviewed. The patients were divided into group A (with OACNAT, n = 33) and group B (without OACNAT, n = 31) according to the application of OACNAT during the operation. The possible operation-related variables, imaging results, and clinical effects were compared between the 2 groups. RESULTS In terms of demographics, there were no significant differences between group A and group B in age, sex, body mass index, smoking, drinking, heart disease, hypertension and diabetes (P > 0.05). In terms of operation-related variables, imaging results, and clinical efficacy, there were significant differences in operation time, wound length, postoperative modified Japanese Orthopaedic Association (JOA) score, JOA score improvement rate, accuracy of screw placement, number of intraoperative fluoroscopy procedures, and cerebrospinal fluid leakage between group A and group B (P < 0.05). There were no significant differences in other variables between the 2 groups (P > 0.05). In contrast to group A, in group B, 2 patients had incorrect segmental localization, 3 patients had residual ossified ligamentum flavum after the operation, and 1 patient had postoperative neurologic impairment. On further analysis, compared with group B, group A had a shorter operation time, more accurate screw placement, fewer fluoroscopy procedures, higher JOA score improvement rate, and lower incidence of complications. CONCLUSIONS The use of OACNAT accurately located the position, size, shape, and boundary of ossification of the ligamentum flavum during the operation, which could guide accurate decompression and improve the accuracy of pedicle screw placement. This approach not only reduced the incidence of incorrect segmental localization and incomplete or excessive decompression but also reduced the risk of related complications and improved the accuracy, safety, and effectiveness of the operation.
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Affiliation(s)
- Zhi-Wei Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Zheng Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Xi-Wen Fan
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Pei-Yu Du
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Jia-Yuan Sun
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China
| | - Wen-Yuan Ding
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China; Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Shijiazhuang, P.R. China
| | - Da-Long Yang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China.
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Sun J, Wu D, Wang Q, Wei Y, Yuan F. Pedicle Screw Insertion: Is O-Arm-Based Navigation Superior to the Conventional Freehand Technique? A Systematic Review and Meta-Analysis. World Neurosurg 2020; 144:e87-e99. [PMID: 32758654 DOI: 10.1016/j.wneu.2020.07.205] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although O-arm-based navigation (ON) has been considered a better choice than the conventional freehand (FH) technique for spine surgery, clinical evidence showing the accuracy of ON compared with the FH technique is limited. The purpose of this study was to evaluate the accuracy of pedicle screw insertion under ON compared with the FH technique. METHODS The Cochrane Library, Ovid, Web of Science, PubMed, Embase, and CNKI online databases were searched up to January 2020. Because only a few randomized controlled trials were anticipated, prospective and retrospective comparative studies were also evaluated to compare the accuracy of pedicle screw insertion between ON and FH. Statistical analysis was performed using Stata 16.0. The primary outcomes extracted from articles that met the selection criteria were expressed as odds ratios for dichotomous outcomes with a 95% confidence interval. A χ2 test and I2 statistics were used to evaluate heterogeneity. RESULTS A total of 20 reviews were included in this meta-analysis without identifying additional studies from the references of published articles. These reviews included 1422 patients and 9982 screws. ON was used to insert 4797 pedicle screws and 5185 pedicle screws were inserted using the conventional FH technique with C-arm assistance. The meta-analysis showed that ON is significantly more accurate than FH pedicle screw insertion (odds ratio, 2.46; 95% confidence interval, 1.92-3.16; I2 = 43.4%; P = 0.021). I2 indicates that the studies have a moderate statistical heterogeneity; subgroup analysis decreased heterogeneity significantly. CONCLUSIONS Compared with conventional methods, navigation provides greater accuracy in the placement of pedicle screws, accelerates the insertion, and reduces the complications associated with screw insertion. However, it may increase exposure time to radiation, which may harm the patient's or surgeon's health.
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Affiliation(s)
- Jun Sun
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Dongying Wu
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Qiuan Wang
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yangyang Wei
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Feng Yuan
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
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Florio M, Capasso L, Olivi A, Vitiello C, Leone A, Liuzza F. 3D - Navigated percutaneous screw fixation of pelvic ring injuries - a pilot study. Injury 2020; 51 Suppl 3:S28-S33. [PMID: 32723529 DOI: 10.1016/j.injury.2020.07.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Screw fixation of pelvic ring fractures is a common, but demanding procedure and navigation techniques were introduced to increase the precision of screw placement. The purpose of this case series is to demonstrate a lower screw malposition rate using percutaneous fixation of pelvic ring fractures and sacroiliac dislocations guided by navigation system based on 3D-fluoroscopic images compared to traditional imaging techniques and to evaluate the functional outcomes of this innovative procedure. PATIENT AND METHODS 10 cases of disrupted pelvic ring lesions treated in our hospital from February 2018 to December 2018 were included for closed reduction and percutaneous screw fixation of using with O-Arm and the acquisition by the Navigator. Preoperative assessment was performed on the patients by means of X Ray imaging and CT scan. Routine CT was carried out on third postoperative day to evaluate screw placement. Measures of radiation exposure were extracted directly from reports provided by system. Quality of life was evaluated by SF 36-questionnaire 6 months after surgery. RESULTS 12 iliosacral- and 2 ramus pubic-screws were inserted. In post-operative CT-scans the screw position was assessed and graded using the score described by Smith. No wound infection or iatrogenic neurovascular damage were observed. No re-operations were performed. The exposure to radiation is, for the patient, slightly greater than that resulting from the use of traditional fluoroscopic systems, while it is naught for the surgical team, which at the time of image acquisition is located outside the room. DISCUSSION AND CONCLUSION The execution of an intraoperative 3D-fluoroscopic scan can on its own suffice as a post-operative control examination since its accuracy is similar to that of the post-operative CT. The use of a navigated 3d fluoroscopy exposes the patient to an amount of radiation slightly greater than that of traditional fluoroscopy, but the dose is lower than a CT examination. For the operating team, exposure to radiation is naught. 3D-fluoroscopic navigation is a safe tool providing high accuracy of percutaneous screw placement for pelvic ring fractures. Finally, despite the small cohort of patients studied, the excellent results obtained regarding the patients' quality of life and the absence of complications allow us to look positively at the future of this technique, which needs further studies and improvement.
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Affiliation(s)
- Michela Florio
- Department of Orthopaedics, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
| | - Luigi Capasso
- Department of Orthopaedics, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy.
| | - Alessandro Olivi
- Department of Neurosurgery A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
| | - Carla Vitiello
- Department of Radiology, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
| | - Antonio Leone
- Department of Radiology, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
| | - Francesco Liuzza
- Department of Orthopaedics, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
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Wang YC, Zhou ZZ, Wang B, Zhang K, Chen H, Chen KW, Mao HQ. Occipitocervical Fusion via Cervical Pedicle Fixation Assisted with O-arm Navigation. Orthop Surg 2020; 12:1100-1107. [PMID: 32697041 PMCID: PMC7454157 DOI: 10.1111/os.12704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To describe the clinical outcomes of occipitocervical fusion (OCF) using cervical pedicle fixation with assistance of O‐arm navigation and present its clinical feasibility. Methods From January 2015 to December 2016, eight patients with a variety of diagnoses were surgically treated with occipitocervical fusion using cervical pedicle screws under O‐arm navigation. All patients received full workup consisting of clinical and radiological assessments. Perioperative parameters including operating time, intraoperative blood loss, postoperative complications, surgical outcomes were recorded. Postoperative data were acquired resorting to the scheduled follow‐up 3, 6 and 12 months after their discharge and annually afterwards. The Japanese Orthopaedic Association (JOA) Scores and American Spinal Injury Association (ASIA) Scale were used to evaluate neurological function. The accuracy of screw placement was classified according to a modified classification of Gertzbein and Robbins. The fusion status was evaluated in reference to the Bridwell's posterior fusion grades. Results The patient cohort comprised of five males and three females, with the average age of 51.9 years (range from 18 to 74 years). The patients all showed indications for OCF and were performed with polyaxial screws through cervical pedicles. The average operation time was 274 min (range from 226 to 380 min), with the intraoperative blood loss of 437.5 mL and the blood transfusion volume of 481.3 mL. The average follow‐up time was 23.5 months (range from 17 to 32 months). All patients exhibited radiographic evidence of osseous fusion by X‐ray and computed tomography (CT) at the final follow‐up. No neurovascular complications were found during the follow‐up time, and the clinical symptoms were observed to be significantly improved in all the patients. Thirty‐four cervical pedicle screws were implanted within the eight patients, with the accuracy of cervical pedicle screw placements as 94.1% (32/34), among which, two pedicle screws were found to broken through the cervical pedicles that were evaluated as Grade II. Conclusions Occipitocervical fusion via cervical pedicle fixation assisted with O‐arm navigation is a feasible and safe procedure with a vast range of indications.
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Affiliation(s)
- Yu-Cheng Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Orthopaedic Surgery, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, China
| | - Zhang-Zhe Zhou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bin Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Orthopaedic Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Kai Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hao Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Kang-Wu Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hai-Qing Mao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
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C-Arm-Free Circumferential Minimally Invasive Surgery for Adult Spinal Deformity: Technical Note. World Neurosurg 2020; 143:235-246. [PMID: 32673800 DOI: 10.1016/j.wneu.2020.07.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/02/2020] [Accepted: 07/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Circumferential minimally invasive surgery (cMIS), as a technique for reducing the complications of adult spinal deformity surgery, is receiving considerable attention. Conventional cMIS is performed using intraoperative fluoroscopy. In this work, we describe a new cMIS technique without using C-arm fluoroscopy for correcting adult spinal deformities. CASE DESCRIPTION A 70-year-old woman with symptomatic adult spinal deformity was referred to our hospital. The patient's daily life has been affected by severe low back pain for more than 4 years. The surgery was performed without C-arm fluoroscopy. The percutaneous pedicle screws and intervertebral cages were inserted only under navigation guidance. The patient was successfully treated with surgery, and her low back pain was well controlled. Her clinical outcomes were as follows: Oswestry Disability Index improved from 64% to 14% and the low back pain visual analog scale score improved from 75 mm to 24 mm at 1 year of final follow-up. CONCLUSIONS C-arm-free cMIS for adult spinal deformity is a useful technique that reduces percutaneous screw and cage misplacement. With this new technique, the surgeons and the operation room staff can avoid the risk of an adverse event of intraoperative radiation.
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Ding B, Zhou T, Zhao J. A novel system for accurate lumbar spine pedicle screw placement based on three-dimensional computed tomography reconstruction. J Orthop Translat 2020; 23:101-106. [PMID: 32642424 PMCID: PMC7322241 DOI: 10.1016/j.jot.2020.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/23/2020] [Indexed: 12/04/2022] Open
Abstract
Objectives The accuracy of pedicle screw placement strongly affects the outcome of spinal surgery and has mainly relied on the surgeons’ experience. There is no simple, low-cost, and effective pedicle screw placement system to assist new spinal surgeons with less experience. Methods We designed a localization system with six parameters (starting point height [SP-H], starting point length [SP-L], transverse section angle, sagittal section angle [SSA], pedicle width [W] and height [H]) based on preoperative computed tomography reconstruction and combined it with the Roussouly classification to guide lumbar spine pedicle screw placement and analysed the change patterns of the six parameters in 50 participants. Results Based on the system, we confirmed that combining SP-H and SP-L can localize the entrance of the pedicle screw. Furthermore, we considered that SP-L and transverse section angle would be a new standard for determination of the transverse orientation of the pedicle screw. More importantly, the linear regression equations between H and W and SP-H and H were concealed. In addition, H and W can guide the appropriate selection of pedicle screw. Moreover, change patterns of SSA combined with the Roussouly classification indicate that SSA of L3 can be used as a benchmark to guide the establishment of sagittal alignment of the lumbar spine. Conclusions Understanding and applying the six-parameter localization system are essential for achieving accuracy in lumbar spine pedicle screw placement, and the system is a useful guide in the establishment of sagittal alignment. The translational potential of this article This study provides a new pedicle-screw placement system for accurate lumbar spine pedicle screw placement based on three-dimensional CT reconstruction, requiring six parameters to guide the system.
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Affiliation(s)
- Baozhi Ding
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, PR China
| | - Tangjun Zhou
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, PR China
| | - Jie Zhao
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedics, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, PR China
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Wang M, Li D, Shang X, Wang J. A review of computer-assisted orthopaedic surgery systems. Int J Med Robot 2020; 16:1-28. [PMID: 32362063 DOI: 10.1002/rcs.2118] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/07/2020] [Accepted: 04/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Computer-assisted orthopaedic surgery systems have great potential, but no review has focused on computer-assisted surgery systems for the spine, hip, and knee. METHODS A systematic search was performed in Web of Science and PubMed. We searched the literature on computer-assisted orthopaedic surgery systems from 2008 to the present and focused on three aspects of systems: training, planning, and intraoperative navigation. RESULTS AND DISCUSSION In this review study, we reviewed 34 surgical training systems, 31 surgical planning systems, and 41 surgical navigation systems. The functions and characteristics of the surgical systems were compared and analysed, and the current concerns about and the impact of the surgical systems on doctors and surgery were clarified. CONCLUSION Computer-assisted orthopaedic surgery systems are still in the development stage. Future surgical training systems should include synthetic models with patient anatomy. Surgical planning systems with automatic planning should be developed, and surgical navigation systems with multimodal fusion, robotic assistance and imaging should be developed.
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Affiliation(s)
- Monan Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Donghui Li
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Xiping Shang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Jian Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
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Zhang P, Liu H, Sun Z, Wang J, Wang G. The Application of O-arm and Navigation System in Precise Localization of Spinal Cord lesions: a Case Series study. Clin Neurol Neurosurg 2020; 196:105922. [PMID: 32622109 DOI: 10.1016/j.clineuro.2020.105922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study on the clinical efficacy of precise localization of O-arm and navigation system in spinal cord lesions. METHODS From Augst 2015 to September 2019, 22 patients with spinal cord lesions were arranged in the group.The intraoperative cross-sectional images were acquired by O-arm image system, which were transferred to the Stealth navigation system, and fused with pre-opreative MRI images. The image fusion was completed by the Medtronic Synergy Cranial software. The fused images were used to locate spinal cord lesions, assisted by the navigation system. The navigation errors were evaluated by measuring the maximum distance between the end of the lesion in MRI and its real position. RESULTS The image fusion were completed in all patients, and we successfully completed the image-guided surgeries of the spinal cord lesions. The time of image processing was between 7 min and 19 min, and the mean value was 15.1 ± 2.2 min. The navigation error was between 0.9 mm and 5.3 mm, the mean value was 1.6 ± 0.9 mm. CONCLUSION The application of precise localization of O-arm and navigation system in spinal cord lesions is clinically reliable and feasible.
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Affiliation(s)
- Peihai Zhang
- Department of neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218, China.
| | - Huiting Liu
- Peking Union Medical College Hospital, Beijing, 100730, China
| | - Zhenxing Sun
- Department of neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218, China
| | - James Wang
- Department of neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218, China
| | - Guihuai Wang
- Department of neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218, China.
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Momin AA, Steinmetz MP. Evolution of Minimally Invasive Lumbar Spine Surgery. World Neurosurg 2020; 140:622-626. [PMID: 32434014 DOI: 10.1016/j.wneu.2020.05.071] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/07/2020] [Indexed: 12/14/2022]
Abstract
Spine surgery has evolved over centuries from first being practiced with Hippocratic boards and ladders to now being able to treat spinal pathologies with minimal tissue invasion. With the advent of new imaging and surgical technologies, spine surgeries can now be performed minimally invasively with smaller incisions, less blood loss, quicker return to daily activities, and increased visualization. Modern minimally invasive procedures include percutaneous pedicle screw fixation techniques and minimally invasive lateral approach for lumbar interbody fusion (i.e., minimally invasive transforaminal lumbar interbody fusion, extreme lateral interbody fusion, oblique lateral interbody fusion) and midline lumbar fusion with cortical bone trajectory screws. Just as evolutions in surgical techniques have helped revolutionize the field of spine surgery, imaging technologies have also contributed significantly. The advent of computer image guidance has allowed spine surgeons to advance their ability to refine surgical techniques, increase the accuracy of spinal hardware placement, and reduce radiation exposure to the operating room staff. As the field of spine surgery looks to the future, many novel technologies are on the horizon, including robotic spine surgery, artificial intelligence, and machine learning to help improve preoperative planning, improve surgical execution, and optimize patient selection to ensure improved postoperative outcomes and patient satisfaction. As more spine surgeons begin incorporating these novel minimally invasive techniques into practice, the field of minimally invasive spine surgery will continue to innovate and evolve over the coming years.
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Affiliation(s)
- Arbaz A Momin
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Education Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael P Steinmetz
- Center for Spine Health, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Wallace N, Schaffer NE, Freedman BA, Nassr A, Currier BL, Patel R, Aleem IS. Computer-assisted navigation in complex cervical spine surgery: tips and tricks. JOURNAL OF SPINE SURGERY 2020; 6:136-144. [PMID: 32309652 DOI: 10.21037/jss.2019.11.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Stereotactic navigation is quickly establishing itself as the gold standard for accurate placement of spinal instrumentation and providing real-time anatomic referencing. There have been substantial improvements in computer-aided navigation over the last decade producing improved accuracy with intraoperative scanning while shortening registration time. The newest iterations of modeling software create robust maps of the anatomy while tracking software localizes instruments in multiple display modes. As a result, stereotactic navigation has become an effective adjunct to spine surgery, particularly improving instrumentation accuracy in the setting of atypical anatomy. This article provides an overview of stereotactic navigation applied to complex cervical spine surgery, details the means for registration and direct referencing, and shares our preferred methods to implement this promising technology.
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Affiliation(s)
- Nicholas Wallace
- Department of Orthopedic Surgery, Division of Spine Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Nathaniel E Schaffer
- Department of Orthopedic Surgery, Division of Spine Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Rakesh Patel
- Department of Orthopedic Surgery, Division of Spine Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Ilyas S Aleem
- Department of Orthopedic Surgery, Division of Spine Surgery, University of Michigan, Ann Arbor, MI, USA
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Zhang Z. Freehand Pedicle Screw Placement Using a Universal Entry Point and Sagittal and Axial Trajectory for All Subaxial Cervical, Thoracic and Lumbosacral Spines. Orthop Surg 2020; 12:141-152. [PMID: 31828963 PMCID: PMC7031565 DOI: 10.1111/os.12599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/29/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Existing techniques of freehand pedicle screw placement primarily focus on various entry points with or without axial trajectory. The objective of this paper is to propose a universal entry point and sagittal and axial trajectory for all subaxial cervical, thoracic and lumbosacral spines freehand pedicle screw placements, and to report the results from a single-surgeon clinical experience with freehand pedicle screw placement. METHODS Two spine vertebrae specimens and 20 cases of three-dimensional (3D) reconstructions of spine CT images were used for observation of the entry point and sagittal and axial trajectory. The author retrospectively reviewed a total of 610 consecutive patients who underwent open, freehand pedicle screw fixation using a universal entry point and sagittal and axial trajectory for all subaxial cervical, thoracic and lumbosacral spine placements, during an 8-year period from January 2010 to December 2017. The junction of the lateral margin of the superior articulating process and the transverse process for the thoracic and lumbosacral spines, or lateral mass for the subaxial cervical spine, was determined. The entry point was chosen at 1 mm, 2 mm, and 3 mm (2 mm on average) caudally and medially to this junction for subaxial cervical, thoracic and lumbosacral spines placements, respectively. Both sagittal and axial trajectories were perpendicular to the sagittal and axial planes of the laminae of the isthmus. Among them, 68 patients underwent postoperative computed tomography (CT) scans, including 26 cervical cases, 19 scoliosis thoracic cases, 10 non-scoliosis thoracic cases, 8 lumbar cases, and 5 sacral cases. Placements of pedicle screws were assessed using CT data and outcome-based classifications systems. RESULTS After placing the iron scurf at the junction of the lateral margin of the superior articulating process and the transverse process, the present universal entry point was located at 1 o'clock or 11 o'clock of the pedicle's axial view. After inserting the 2.5 mm Gram needle or the pedicle virtual pin tracts according to the entry point and sagittal and axial trajectory described above, the presented trajectory was located in the pedicle's axial trajectory as in the described technique. A total of 766 pedicle screws were placed in 68 CT scan patients with a 99% accuracy rate in the non-kyphoscoliosis group and 92% in the kyphoscoliosis group. CONCLUSIONS Freehand pedicle screw placement based on the universal entry point and sagittal and axial trajectory for all subaxial cervical, thoracic and lumbosacral spines can be performed with acceptable safety and accuracy.
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Affiliation(s)
- Zheng‐feng Zhang
- Department of OrthopaedicsXinqiao Hospital, Third Military Medical UniversityChongqingChina
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Lee YC, Lee R. Image-guided pedicle screws using intraoperative cone-beam CT and navigation. A cost-effectiveness study. J Clin Neurosci 2020; 72:68-71. [PMID: 31964560 DOI: 10.1016/j.jocn.2020.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
Image-guided surgery using intraoperative cone-beam CT and navigation improves screw placement accuracy rates. However, this technology is associated with high acquisition costs. The aim of this study is to evaluate the costs of revision surgery from symptomatic pedicle screw malposition to justify whether the costs of acquiring intraoperative navigation justify the expected benefits. This is a retrospective cost-effectiveness analysis of consecutive patients who had pedicle screw instrumentation using intraoperative cone-beam CT and navigation compared with patients who underwent freehand pedicle screw instrumentation at our institution over 4 years. The costs associated with revision surgery for symptomatic pedicle screw malposition (excess length of stay, intensive care, theatre time, implants and additional outpatient appointments) were calculated. A total of 19 patients had symptomatic screw malpositioning requiring revision surgery. None of these patients had screws inserted under navigation. Revision surgery accounted for an extra 304 bed days and an additional 97 h theatre time. The total extra spent over 4 years was £464,038. When compared to the costs of revision surgery for screw malpositioning, it was cost neutral to acquire and maintain this technology. Intraoperative image-guided surgery reduces reoperation rates for symptomatic screw malposition and is cost-effective in high volume centers with improved patients outcomes. High acquisition and maintenance cost of such technologies is economically justifiable.
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Affiliation(s)
- Yu Chao Lee
- Spinal Surgery Unit, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, United Kingdom
| | - Robert Lee
- Spinal Surgery Unit, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, United Kingdom.
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Lin CW, Chang CC, Chen HT, Chen YJ, Lin CS, Hsu HC, Tsou HK. 3D Real-Time Image-Guided Navigation Spine Corpectomy with Ultrasonic Bone Cutter: Technical Note. World Neurosurg 2019; 135:197-204. [PMID: 31706972 DOI: 10.1016/j.wneu.2019.10.186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Surgical interventions for congenital scoliosis are challenging for spine surgeons. The coordination of 3-dimensional (3D), real-time, image-guided navigation with an ultrasonic bone cutter allows surgeons to localize the affected area of the spine accurately and remove the lesion without damaging soft tissue structures. The goal of this technical paper is to report a previously undescribed method of hemivertebrectomy that combines 3D, real-time, image-guided navigation and an ultrasonic bone cutter. We highlight the feasibility and safety of this method in spinal surgery. METHODS Three patients with congenital scoliosis were treated with this technique. We present three illustrative cases comprising hemivertebrectomies for congenital scoliosis. Intraoperative photos demonstrating the technique are also provided. RESULTS All surgeries were completed without complications. The hemivertebrae were completely removed, and marked correction of congenital scoliosis was noted. CONCLUSIONS We believe that the combination of 3D, real-time image navigation and an ultrasonic bone cutter improves hemivertebrectomy by increasing accuracy and avoiding dura laceration, major organ damage, or potential vessel damage.
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Affiliation(s)
- Chung-Wei Lin
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City, Taiwan (R.O.C.)
| | - Chien-Chun Chang
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City, Taiwan (R.O.C.); Department of Biological Science and Technology, National Chiao Tung University, Hsinchu City, Taiwan (R.O.C.); Ph.D. Degree Program of Biomedical Science and Engineering, National Chiao Tung University, Hsinchu City, Taiwan (R.O.C.); Spine Center, China Medical University Hospital, China Medical University, Taichung City, Taiwan (R.O.C.)
| | - Hsien-Te Chen
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City, Taiwan (R.O.C.); Department of Sports Medicine, College of Health Care, China Medical University, Taichung City, Taiwan (R.O.C.); Spine Center, China Medical University Hospital, China Medical University, Taichung City, Taiwan (R.O.C.).
| | - Yen-Jen Chen
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City, Taiwan (R.O.C.); Spine Center, China Medical University Hospital, China Medical University, Taichung City, Taiwan (R.O.C.); School of Medicine, China Medical University, Taichung City, Taiwan (R.O.C.)
| | - Chih-Sheng Lin
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu City, Taiwan (R.O.C.); Ph.D. Degree Program of Biomedical Science and Engineering, National Chiao Tung University, Hsinchu City, Taiwan (R.O.C.)
| | - Horng-Chaung Hsu
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung City, Taiwan (R.O.C.); School of Medicine, China Medical University, Taichung City, Taiwan (R.O.C.)
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung City, Taiwan (R.O.C.); Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan (R.O.C.)
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Abstract
An orthopaedic surgeon's knowledge of anatomical landmarks is crucial, but other modalities supplement this by providing guidance and feedback to a surgeon. Advances in imaging have enabled three-dimensional visualization of the surgical field and patient anatomy, whereas advances in computer technology have allowed for real-time tracking of instruments and implants. Together, these innovations have given rise to intraoperative navigation systems. The authors review these advances in intraoperative navigation across orthopaedic subspecialties, focusing on the most recent evidence on patient outcomes and complications, the associated learning curve, and the effects on operative time, radiation exposure, and cost. In spine surgery, navigated pedicle screw placement may increase accuracy and safety, especially valuable when treating complex deformities. Improved accuracy of pelvic and peri-articular tumor resection and percutaneous fixation of acetabular and femoral neck fractures has also been achieved using navigation. Early applications in arthroscopy have included surface-based registration for tunnel positioning for anterior cruciate ligament reconstruction and osteochondroplasty for femoro-acetabular impingement. Navigated arthroplasty techniques have addressed knee gap balancing and mechanical axis restoration as well as acetabular cup and glenoid baseplate positioning. Among these orthopaedic subspecialties, significant variation is found in the clinical relevance and dedication to research of navigation techniques.
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