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Chatelain LS, Kourilsky A, Lot G, Rogers A. Airo® navigation versus freehand fluoroscopy technique: A comparative study of accuracy and radiological exposure for thoracolumbar screws placement. Neurochirurgie 2023; 69:101437. [PMID: 36967084 DOI: 10.1016/j.neuchi.2023.101437] [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: 10/21/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE The aim was to compare the accuracy of freehand fluoroscopy and CT based navigation on thoracolumbar screws placement and their respective effects on radiological exposure to the patient. No previous study directly compared the Airo® navigation system to freehand technique. METHODS In this monocentric retrospective study, 156 consecutive patients who underwent thoracolumbar spine surgery were included. Epidemiological data and surgical indications were noted. Heary classification was used for thoracic screws and Gertzbein-Robbins classification for lumbar screws. Radiological exposure was collected for each surgery. RESULTS A total of 918 screws were implanted. We analyzed 725 lumbar screws (Airo® 287; freehand fluoroscopy 438) and 193 thoracic screws (Airo® 49; freehand fluoroscopy 144). Overall, lumbar screws accuracy (Gertzbein-Robbins grade A and B) was good in both groups (freehand fluoroscopy 91.3%; Airo® 97.6%; P<0.05). We found significantly less Grade B and C in the Airo® group. Thoracic accuracy was also good in both groups (Heary 1 and 2; freehand fluoroscopy 77.8%; Airo® 93.9%), without reaching statistical significance. Radiological exposure was significantly higher in the Airo® group with a mean effective dose of 9.69 mSv versus 0.71mSv for freehand fluoroscopy. CONCLUSION Our study confirmed that the use of Airo® navigation yielded good accuracy. It however exposed the patient to higher radiological exposure compared with freehand fluoroscopy technique. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- L S Chatelain
- Fondation Rothschild, Department of Neurosurgery, 25-29, rue Manin, 75019 Paris, France.
| | - A Kourilsky
- Fondation Rothschild, Department of Neurosurgery, 25-29, rue Manin, 75019 Paris, France
| | - G Lot
- Fondation Rothschild, Department of Neurosurgery, 25-29, rue Manin, 75019 Paris, France
| | - A Rogers
- Fondation Rothschild, Department of Neurosurgery, 25-29, rue Manin, 75019 Paris, France; American Hospital of Paris, 55, boulevard du Château, 92200 Neuilly-sur-Seine, France
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Beisemann N, Gierse J, Mandelka E, Hassel F, Grützner PA, Franke J, Vetter SY. Comparison of three imaging and navigation systems regarding accuracy of pedicle screw placement in a sawbone model. Sci Rep 2022; 12:12344. [PMID: 35853991 PMCID: PMC9296669 DOI: 10.1038/s41598-022-16709-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/14/2022] [Indexed: 02/06/2023] Open
Abstract
3D-navigated pedicle screw placement is increasingly performed as the accuracy has been shown to be considerably higher compared to fluoroscopy-guidance. While different imaging and navigation devices can be used, there are few studies comparing these under similar conditions. Thus, the objective of this study was to compare the accuracy of two combinations most used in the literature for spinal navigation and a recently approved combination of imaging device and navigation system. With each combination of imaging system and navigation interface, 160 navigated screws were placed percutaneously in spine levels T11-S1 in ten artificial spine models. 470 screws were included in the final evaluation. Two blinded observers classified screw placement according to the Gertzbein Robbins grading system. Grades A and B were considered acceptable and Grades C-E unacceptable. Weighted kappa was used to calculate reliability between the observers. Mean accuracy was 94.9% (149/157) for iCT/Curve, 97.5% (154/158) for C-arm CBCT/Pulse and 89.0% for CBCT/StealthStation (138/155). The differences between the different combinations were not statistically significant except for the comparison of C-arm CBCT/Pulse and CBCT/StealthStation (p = 0.003). Relevant perforations of the medial pedicle wall were only seen in the CBCT group. Weighted interrater reliability was found to be 0.896 for iCT, 0.424 for C-arm CBCT and 0.709 for CBCT. Under quasi-identical conditions, higher screw accuracy was achieved with the combinations iCT/Curve and C-arm CBCT/Pulse compared with CBCT/StealthStation. However, the exact reasons for the difference in accuracy remain unclear. Weighted interrater reliability for Gertzbein Robbins grading was moderate for C-arm CBCT, substantial for CBCT and almost perfect for iCT.
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Affiliation(s)
- Nils Beisemann
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Berufsgenossenschaftliche Unfallklinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Jula Gierse
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Berufsgenossenschaftliche Unfallklinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Eric Mandelka
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Berufsgenossenschaftliche Unfallklinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Frank Hassel
- Department of Spine Surgery, Loretto Hospital, Mercystrasse 6, 79100, Freiburg im Breisgau, Germany
| | - Paul A Grützner
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Berufsgenossenschaftliche Unfallklinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Berufsgenossenschaftliche Unfallklinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
| | - Sven Y Vetter
- Research Group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Berufsgenossenschaftliche Unfallklinik (BG Trauma Center) Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany.
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Hagan MJ, Syed S, Leary OP, Persad-Paisley EM, Lin Y, Zheng B, Shao B, Abdulrazeq H, Yu JYH, Telfeian AE, Gokaslan ZL, Fridley JS, Oyelese AA. Pedicle Screw Placement Using Intraoperative Computed Tomography and Computer-Aided Spinal Navigation Improves Screw Accuracy and Avoids Postoperative Revisions: Single-Center Analysis of 1400 Pedicle Screws. World Neurosurg 2022; 160:e169-e179. [PMID: 34990843 DOI: 10.1016/j.wneu.2021.12.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Intraoperative computed tomography and navigation (iCT-Nav) is increasingly used to aid spinal instrumentation. We aimed to document the accuracy and revision rate of pedicle screw placement across many screws placed using iCT-Nav. We also assess patient-level factors predictive of high-grade pedicle breach. METHODS Medical records of patients who underwent iCT-Nav pedicle screw placement between 2015 and 2017 at a single center were retrospectively reviewed. Screw placement accuracy was individually assessed for each screw using the 2-mm incremental grading system for pedicle breach. Predictors of high-grade (>2 mm) breach were identified using multiple logistic regression. RESULTS In total, 1400 pedicle screws were placed in 208 patients undergoing cervicothoracic (29; 13.9%), thoracic (30; 14.4), thoracolumbar (19; 9.1%) and lumbar (130; 62.5%) surgeries. iCT-Nav afforded high-accuracy screw placement, with 1356 of 1400 screws (96.9%) being placed accurately. In total, 37 pedicle screws (2.64%) were revised intraoperatively during the index surgery across 31 patients, with no subsequent returns to the operating room because of screw malpositioning. After correcting for potential confounders, males were less likely to have a high-grade breach (odds ratio [OR] 0.21; 95% confidence interval [CI] 0.10-0.59, P = 0.003) whereas lateral (OR 6.21; 95% CI 2.47-15.52, P < 0.001) or anterior (OR 5.79; 95% CI2.11-15.88, P = 0.001) breach location were predictive of a high-grade breach. CONCLUSIONS iCT-Nav with postinstrumentation intraoperative imaging is associated with a reduced need for costly postoperative return to the operating room for screw revision. In comparison with studies of navigation without iCT where 1.5%-1.7% of patients returned for a second surgery, we report 0 revision surgeries due to screw malpositioning.
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Affiliation(s)
- Matthew J Hagan
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Sohail Syed
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Owen P Leary
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | | | - Yang Lin
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Bryan Zheng
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Belinda Shao
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Hael Abdulrazeq
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - James Y H Yu
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Albert E Telfeian
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jared S Fridley
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Adetokunbo A Oyelese
- The Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA; Department of Neurosurgery, Rhode Island Hospital, Providence, Rhode Island, USA.
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