Fluoroscopy-based percutaneous posterior screw placement in the lateral position using the tunnel view technique: technical note

Single-Position Transpsoas Corpectomy and Posterior Instrumentation in the Thoracolumbar Spine for Different Clinical Scenarios

BACKGROUND

The concept of single-position spine surgery has been gaining momentum because it has proven to reduce operative time, blood loss, and hospital length of stay with similar or better outcomes than traditional dual-position surgery. The latest development in single-position spine surgery techniques combines either open or posterior pedicle screw fixation with transpsoas corpectomy while in the lateral or prone positioning.

OBJECTIVE

To provide, through a multicenter study, the results of our first patients treated by single-position corpectomy.

METHODS

This is a multicenter retrospective study of patients who underwent corpectomy and instrumentation in the lateral or prone position without repositioning between the anterior and posterior techniques. Data regarding demographics, diagnosis, neurological status, surgical details, complications, and radiographic parameters were collected. The minimum follow-up for inclusion was 6 months.

RESULTS

Thirty-four patients were finally included in our study (24 male patients and 10 female patients), with a mean age of 51.2 (SD ± 17.5) years. Three-quarter of cases (n = 27) presented with thoracolumbar fracture as main diagnosis, followed by spinal metastases and primary spinal infection. Lateral positioning was used in 27 cases, and prone positioning was used in 7 cases. The overall rate of complications was 14.7%.

CONCLUSION

This is the first multicenter series of patients who underwent single-position corpectomy and fusion. This technique has shown to be safe and effective to treat a variety of spinal conditions with a relatively low rate of complications. More series are required to validate this technique as a possible standard approach when thoracolumbar corpectomies are indicated.

Accuracy Assessment of Percutaneous Pedicle Screw Placement Using Cone Beam Computed Tomography with Metal Artifact Reduction

Metal artifact reduction (MAR) algorithms are used with cone beam computed tomography (CBCT) during augmented reality surgical navigation for minimally invasive pedicle screw instrumentation. The aim of this study was to assess intra- and inter-observer reliability of pedicle screw placement and to compare the perception of baseline image quality (NoMAR) with optimized image quality (MAR). CBCT images of 24 patients operated on for degenerative spondylolisthesis using minimally invasive lumbar fusion were analyzed retrospectively. Images were treated using NoMAR and MAR by an engineer, thus creating 48 randomized files, which were then independently analyzed by 3 spine surgeons and 3 radiologists. The Gertzbein and Robins classification was used for screw accuracy rating, and an image quality scale rated the clarity of pedicle screw and bony landmark depiction. Intra-class correlation coefficients (ICC) were calculated. NoMAR and MAR led to similarly good intra-observer (ICC > 0.6) and excellent inter-observer (ICC > 0.8) assessment reliability of pedicle screw placement accuracy. The image quality scale showed more variability in individual image perception between spine surgeons and radiologists (ICC range 0.51−0.91). This study indicates that intraoperative screw positioning can be reliably assessed on CBCT for augmented reality surgical navigation when using optimized image quality. Subjective image quality was rated slightly superior for MAR compared to NoMAR.