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Sorger JM. How to objectively evaluate the impact of image-guided surgery technologies. Eur J Nucl Med Mol Imaging 2024; 51:2869-2877. [PMID: 37971499 DOI: 10.1007/s00259-023-06504-w] [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: 09/11/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE This manuscript aims to provide a better understanding of methods and techniques with which one can better quantify the impact of image-guided surgical technologies. METHODS A literature review was conducted with regard to economic and technical methods of medical device evaluation in various countries. Attention was focused on applications related to image-guided interventions that have enabled procedures to be performed in a minimally invasive manner, produced superior clinical outcomes, or have become standard of care. RESULTS The review provides examples of successful implementations and adoption of image-guided surgical techniques, mostly in the field of neurosurgery. Failures as well as newly developed technologies still undergoing cost-efficacy analysis are discussed. CONCLUSION The field of image-guided surgery has evolved from solely using preoperative images to utilizing highly specific tools and software to provide more information to the interventionalist in real time. While deformations in soft tissue often preclude the use of such instruments outside of neurosurgery, recent developments in optical and radioactive guidance have enabled surgeons to better account for organ motion and provide feedback to the surgeon as tissue is cut. These technologies are currently undergoing value assessments in many countries and hold promise to improve outcomes for patients, surgeons, care teams, payors, and society in general.
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Lavigne J, Stacoffe N, Heidelberg D, Wagner P, Pialat JB. A Feasibility Study of CT-Guided Osteosynthesis under Local Anesthesia. J Pers Med 2023; 13:1493. [PMID: 37888104 PMCID: PMC10608047 DOI: 10.3390/jpm13101493] [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: 09/11/2023] [Revised: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Evaluation of local anesthesia for perioperative pain control in patients undergoing CT-guided percutaneous osteosynthesis. METHODS A total of 12 patients underwent percutaneous osteosynthesis under local anesthesia. Intraoperative pain was assessed after the procedure using numerical rating scale (NRS). Patients were also asked to rate their overall experience of the operation using the following scale: "highly comfortable, comfortable, hardly comfortable, uncomfortable" and, finally, "Would you be willing to repeat this intervention again under the same conditions if necessary?" Patients were also clinically followed up at 1 month, 3 months, and 6 months using the EQ5D5L scale to assess their pain and quality of life. RESULTS Patients underwent percutaneous osteosynthesis for osteoporotic (n = 9), pathological (n = 2), or traumatic fractures (n = 1), including the thoraco-lumbar spine (n = 8) or the pelvis (n = 4). The mean of NRS value experienced during the procedure was 3.4/10 (0-8). The overall feeling was highly comfortable (42%), comfortable (50%), hardly comfortable (8%), and uncomfortable (0%). Finally, 75% of patients answered "YES" to the question of repeating the operation under the same conditions if necessary. At follow-up, a significant reduction in pain was observed postoperatively. According to the EQ5D5L scale, there was a significant improvement in pain, mobility, self-activities, autonomy, and perceived quality of life at 3 and 6 months. CONCLUSION Radiological percutaneous osteosynthesis is an effective technique that can be performed under local anesthesia with a comfortable experience for most of the patients.
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Affiliation(s)
- Joris Lavigne
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (N.S.); (D.H.); (J.-B.P.)
| | - Nicolas Stacoffe
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (N.S.); (D.H.); (J.-B.P.)
| | - Damien Heidelberg
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (N.S.); (D.H.); (J.-B.P.)
| | - Philippe Wagner
- Centre D’étude des Maladies Osseuses, INSERM U1033, Université Lyon 1, 69008 Lyon, France;
| | - Jean-Baptiste Pialat
- Department of Radiology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (N.S.); (D.H.); (J.-B.P.)
- Faculté de Médecine Lyon-Sud, Université Claude Bernard Lyon 1, 69495 Pierre-Bénite, France
- Unité CNRS UMR 5220, INSERM U1294, Université Lyon 1, INSA Lyon, Université Jean Monnet, 42100 Saint-Etienne, France
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Croci DM, Nguyen S, Streitmatter SW, Sherrod BA, Hardy J, Cole KL, Gamblin AS, Bisson EF, Mazur MD, Dailey AT. O-Arm Accuracy and Radiation Exposure in Adult Deformity Surgery. World Neurosurg 2023; 171:e440-e446. [PMID: 36528322 DOI: 10.1016/j.wneu.2022.12.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE In long thoracolumbar deformity surgery, accurate screw positioning is critical for spinal stability. We assessed pedicle and pelvic screw accuracy and radiation exposure in patients undergoing long thoracolumbar deformity fusion surgery (≥4 levels) involving 3-dimensional fluoroscopy (O-Arm/Stealth) navigation. METHODS In this retrospective single-center cohort study, all patients aged >18 years who underwent fusion in 2016-2018 were reviewed. O-Arm images were assessed for screw accuracy. Effective radiation doses were calculated. The primary outcome was pedicle screw accuracy (Heary grade). Secondary outcomes were pelvic fixation screw accuracy, radiation exposure, and screw-related perioperative and postoperative complications or revision surgery within 3 years. RESULTS Of 1477 pedicle screws placed in 91 patients (mean 16.41 ± 5.6 screws/patient), 1208 pedicle screws (81.8%) could be evaluated by 3-dimensional imaging after placement. Heary Grade I placement was achieved in 1150 screws (95.2%), Grade II in 47 (3.9%), Grade III in 10 (0.82%), Grade IV in 1 (0.08%), and Grade V in 0; Grade III-V were replaced intraoperatively. One of 60 (1.6%) sacroiliac screws placed showed medial cortical breach and was replaced. The average O-Arm-related effective dose was 29.54 ± 14.29 mSv and effective dose/spin was 8.25 ± 2.65 mSv. No postoperative neurological worsening, vascular injuries, or revision surgeries for screw misplacement were recorded. CONCLUSIONS With effective radiation doses similar to those in interventional neuroendovascular procedures, the use of O-Arm in multilevel complex deformity surgery resulted in high screw accuracy, no need for surgical revision because of screw malposition, less additional imaging, and no radiation exposure for the surgical team.
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Affiliation(s)
- Davide Marco Croci
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Sarah Nguyen
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Seth W Streitmatter
- Medical Imaging Physics and Radiation Safety, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Brandon A Sherrod
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Jeremy Hardy
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Kyril L Cole
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Austin S Gamblin
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Erica F Bisson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Marcus D Mazur
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Andrew T Dailey
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
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González-Vargas PM, Calero Félix L, Martín-Gallego Á, Thenier-Villa JL, de la Lama Zaragoza AR, Conde Alonso C. Evaluation of the implantation of transpedicular screws in spinal instrumentation with free-hand technique and navigation-assisted with intraoperative computed tomography: An analytical-positional study. NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:71-81. [PMID: 35248301 DOI: 10.1016/j.neucie.2021.01.002] [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: 08/17/2020] [Accepted: 01/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Spinal instrumentation using transpedicular screws has been used for decades to stabilize the spine. In October 2018, an intraoperative CT system was acquired in the Neurosurgery service of the University Hospital Complex of Vigo, this being the first model of these characteristics in the Spanish Public Health System, so we began a study from January 2015 to December 2019 to assess the precision of the transpedicular screws implanted with this system compared with a control group performed with the classical technique and final fluoroscopic control. METHODS The study was carried out in patients who required transpedicular instrumentation surgery, in total 655 screws were placed, 339 using the free-hand technique (Group A) and 316 assisted with intraoperative CT navigation (Group B) (p>0.05). Demographic characteristics, related to surgery and the screw implantation grades were assessed using the Gertzbein-Robbins classification. RESULTS 92 patients were evaluated, between 12 and 86 years (average: 57.1 years). 161 thoracic screws (24.6%) and 494 lumbo-sacral screws (75.4%) were implanted. Of the thoracic screws, 33 produced a pedicle rupture. For the lumbo-sacral screws, 71 have had pedicle violation. The overall correct positioning rate for the free-hand group was 72.6% and for the CT group it was 96.5% (p<0.05). CONCLUSION The accuracy rate is higher in thoracic-lumbar instrumentation in the navigation group versus free-hand group with fluoroscopic control.
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Affiliation(s)
- Pedro Miguel González-Vargas
- Department of Neurosurgery, University Hospital Complex of Vigo, Pontevedra, Spain; Neuroscience Research Group, Galicia Sur Health Research Institute, Vigo, Pontevedra, Spain.
| | - Lourdes Calero Félix
- Department of Neurosurgery, University Hospital Complex of Vigo, Pontevedra, Spain; Neuroscience Research Group, Galicia Sur Health Research Institute, Vigo, Pontevedra, Spain
| | - Álvaro Martín-Gallego
- Department of Neurosurgery, University Hospital Complex of Vigo, Pontevedra, Spain; Neuroscience Research Group, Galicia Sur Health Research Institute, Vigo, Pontevedra, Spain
| | - José Luis Thenier-Villa
- Neuroscience Research Group, Galicia Sur Health Research Institute, Vigo, Pontevedra, Spain; Department of Neurosurgery, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Adolfo Ramón de la Lama Zaragoza
- Department of Neurosurgery, University Hospital Complex of Vigo, Pontevedra, Spain; Neuroscience Research Group, Galicia Sur Health Research Institute, Vigo, Pontevedra, Spain
| | - Cesáreo Conde Alonso
- Department of Neurosurgery, University Hospital Complex of Vigo, Pontevedra, Spain; Neuroscience Research Group, Galicia Sur Health Research Institute, Vigo, Pontevedra, Spain
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Farshad M, Fürnstahl P, Spirig JM. First in man in-situ augmented reality pedicle screw navigation. NORTH AMERICAN SPINE SOCIETY JOURNAL 2021; 6:100065. [PMID: 35141630 PMCID: PMC8819976 DOI: 10.1016/j.xnsj.2021.100065] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 12/29/2022]
Abstract
Background Augmented reality (AR) is a rising technology gaining increasing utility in medicine. By superimposing the surgical site and the operator's visual field with computer-generated information, it has the potential to enhance the cognitive skills of surgeons. This is the report of the first in man case with "direct holographic navigation" as part of a randomized controlled trial. Case description A pointing instrument was equipped with a sterile fiducial marker, which was used to obtain a digital representation of the intraoperative bony anatomy of the lumbar spine. Subsequently, a previously validated registration method was applied to superimpose the surgery plan with the intraoperative anatomy. The registration result is shown in situ as a 3D AR hologram of the preoperative 3D vertebra model with the planned screw trajectory and entry point for validation and approval by the surgeon. After achieving alignment with the surgery plan, a borehole is drilled and the pedicle screw placed. Postoperativ computer tomography was used to measure accuracy of this novel method for surgical navigation. Outcome Correct screw positions entirely within bone were documented with a postoperative CT, with an accuracy similar to current standard of care methods for surgical navigation. The patient was mobilized uneventfully on the first postoperative day with little pain medication and dismissed on the fourth postoperative day. Conclusion This first in man report of direct AR navigation demonstrates feasibility in vivo. The continuation of this randomized controlled study will evaluate the value of this novel technology.
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Affiliation(s)
- Mazda Farshad
- Spine Division, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
- Corresponding author.
| | - Philipp Fürnstahl
- ROCS: Research in Orthopedic Computer Science, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - José Miguel Spirig
- Spine Division, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
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González-Vargas PM, Calero Félix L, Martín-Gallego Á, Thenier-Villa JL, de la Lama Zaragoza AR, Conde Alonso C. Evaluation of the implantation of transpedicular screws in spinal instrumentation with free-hand technique and navigation-assisted with intraoperative computed tomography: An analytical-positional study. Neurocirugia (Astur) 2021; 33:S1130-1473(21)00010-5. [PMID: 33663907 DOI: 10.1016/j.neucir.2021.01.001] [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: 08/17/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Spinal instrumentation using transpedicular screws has been used for decades to stabilize the spine. In October 2018, an intraoperative CT system was acquired in the Neurosurgery service of the University Hospital Complex of Vigo, this being the first model of these characteristics in the Spanish Public Health System, so we began a study from January 2015 to December 2019 to assess the precision of the transpedicular screws implanted with this system compared with a control group performed with the classical technique and final fluoroscopic control. METHODS The study was carried out in patients who required transpedicular instrumentation surgery, in total 655 screws were placed, 339 using the free-hand technique (Group A) and 316 assisted with intraoperative CT navigation (Group B) (p>0.05). Demographic characteristics, related to surgery and the screw implantation grades were assessed using the Gertzbein-Robbins classification. RESULTS 92 patients were evaluated, between 12 and 86 years (average: 57.1 years). 161 thoracic screws (24.6%) and 494 lumbo-sacral screws (75.4%) were implanted. Of the thoracic screws, 33 produced a pedicle rupture. For the lumbo-sacral screws, 71 have had pedicle violation. The overall correct positioning rate for the free-hand group was 72.6% and for the CT group it was 96.5% (p<0.05). CONCLUSION The accuracy rate is higher in thoracic-lumbar instrumentation in the navigation group versus free-hand group with fluoroscopic control.
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Affiliation(s)
- Pedro Miguel González-Vargas
- Department of Neurosurgery, University Hospital Complex of Vigo, Pontevedra, Spain; Neuroscience Research Group, Galicia Sur Health Research Institute, Vigo, Pontevedra, Spain.
| | - Lourdes Calero Félix
- Department of Neurosurgery, University Hospital Complex of Vigo, Pontevedra, Spain; Neuroscience Research Group, Galicia Sur Health Research Institute, Vigo, Pontevedra, Spain
| | - Álvaro Martín-Gallego
- Department of Neurosurgery, University Hospital Complex of Vigo, Pontevedra, Spain; Neuroscience Research Group, Galicia Sur Health Research Institute, Vigo, Pontevedra, Spain
| | - José Luis Thenier-Villa
- Neuroscience Research Group, Galicia Sur Health Research Institute, Vigo, Pontevedra, Spain; Department of Neurosurgery, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Adolfo Ramón de la Lama Zaragoza
- Department of Neurosurgery, University Hospital Complex of Vigo, Pontevedra, Spain; Neuroscience Research Group, Galicia Sur Health Research Institute, Vigo, Pontevedra, Spain
| | - Cesáreo Conde Alonso
- Department of Neurosurgery, University Hospital Complex of Vigo, Pontevedra, Spain; Neuroscience Research Group, Galicia Sur Health Research Institute, Vigo, Pontevedra, Spain
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Pertsch NJ, Leary OP, Camara-Quintana JQ, Liu DD, Niu T, Woo AS, Ng TT, Oyelese AA, Fridley JS, Gokaslan ZL. A modern multidisciplinary approach to a large cervicothoracic chordoma using staged en bloc resection with intraoperative image-guided navigation and 3D-printed modeling: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2023. [PMID: 36045932 PMCID: PMC9394173 DOI: 10.3171/case2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/11/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cervicothoracic junction chordomas are uncommon primary spinal tumors optimally treated with en bloc resection. Although en bloc resection is the gold standard for treatment of mobile spinal chordoma, tumor location, size, and extent of involvement frequently complicate the achievement of negative margins. In particular, chordoma involving the thoracic region can require a challenging anterior access, and en bloc resection can lead to a highly destabilized spine. OBSERVATIONS Modern technological advances make en bloc resection more technically feasible than ever before. In this case, the successful en bloc resection of a particularly complex cervicothoracic junction chordoma was facilitated by a multidisciplinary surgical approach that maximized the use of intraoperative computed tomography–guided spinal navigation and patient-specific three-dimensional–printed modeling. LESSONS The authors review the surgical planning and specific techniques that facilitated the successful en bloc resection of this right-sided chordoma via image-guided parasagittal osteotomy across 2 stages. The integration of emerging visualization technologies into complex spinal column tumor management may help to provide optimal oncological care for patients with challenging primary tumors of the mobile spine.
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Affiliation(s)
- Nathan J. Pertsch
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Owen P. Leary
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
| | - Joaquin Q. Camara-Quintana
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
| | - David D. Liu
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Tianyi Niu
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
| | - Albert S. Woo
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Plastic Surgery, and
| | - Thomas T. Ng
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Thoracic Surgery, Rhode Island Hospital, Providence, Rhode Island
| | - Adetokunbo A. Oyelese
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
| | - Jared S. Fridley
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
| | - Ziya L. Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
- Departments of Neurosurgery,
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Virk S, Qureshi S. Narrative review of intraoperative imaging guidance for decompression-only surgery. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:88. [PMID: 33553381 PMCID: PMC7859763 DOI: 10.21037/atm-20-5854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Decompression of the spine is defined as removal of bony and soft tissue structures in order to provide space for the spinal cord and/or nerve roots. This definition, however, underscores the dangers and complexity of safely providing anatomical space for these neurologic structures. Complications such as neurologic injury, vascular injury, and durotomy can make these procedures hazardous for the patient and surgeon. Furthermore, inability to fully decompress the neural elements will result in continued symptoms for patients. Intraoperative image guidance can provide important anatomical landmarks to perform these decompressive surgeries safely and efficiently. In particular, performing decompression surgery utilizing minimally invasive techniques with image guidance can allow for the least amount of muscle/soft tissue trauma possible. Within our article we outline research on the forefront of use of intra-operative imaging guidance for spine surgery and implications for decompression surgery. We also outline a case from the senior author to illustrate an example of image-guided spine decompression for cervical radiculopathy. Future technology, such as augmented reality and robotics, is also discussed in the context of image guided decompression. The authors hope this article shows surgeons that use of image guidance in specific clinical situations can allow for better/safer spinal decompression procedures.
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Affiliation(s)
- Sohrab Virk
- Department of Orthopedic Surgery, Northwell Health, Great Neck, NY, USA
| | - Sheeraz Qureshi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
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