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Kaasalainen T, Männistö V, Mäkelä T, Suojanen J, Nuorala A, Heliövaara A, Leikola J. Postoperative computed tomography imaging of pediatric patients with craniosynostosis: radiation dose and image quality comparison between multi-slice computed tomography and O-arm cone-beam computed tomography. Pediatr Radiol 2023; 53:1704-1712. [PMID: 36967418 PMCID: PMC10359214 DOI: 10.1007/s00247-023-05644-3] [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: 01/18/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND When postoperative multi-slice computed tomography (MSCT) imaging of patients with craniosynostosis is used, it is usually performed a few days after surgery in a radiology department. This requires additional anesthesia for the patient. Recently, intraoperative mobile cone-beam CT (CBCT) devices have gained popularity for orthopedic and neurosurgical procedures, which allows postoperative CT imaging in the operating room. OBJECTIVE This single-center retrospective study compared radiation dose and image quality of postoperative imaging performed using conventional MSCT scanners and O-arm CBCT. MATERIALS AND METHODS A total of 104 pediatric syndromic and non-syndromic patients who were operated on because of single- or multiple-suture craniosynostosis were included in this study. The mean volumetric CT dose index (CTDIvol) and dose-length product (DLP) values of optimized craniosynostosis CT examinations (58 MSCT and 46 CBCT) were compared. Two surgeons evaluated the subjective image quality. RESULTS CBCT resulted in significantly lower CTDIvol (up to 14%) and DLP (up to 33%) compared to MSCT. Multi-slice CT image quality was considered superior to CBCT scans. However, all scans were considered to be of sufficient quality for diagnosis. CONCLUSION The O-arm device allowed for an immediate postoperative CBCT examination in the operating theater using the same anesthesia induction. Radiation exposure was lower in CBCT compared to MSCT scans, thus further encouraging the use of O-arms. Cone-beam CT imaging with an O-arm is a feasible method for postoperative craniosynostosis imaging, yielding less anesthesia to patients, lower health costs and the possibility to immediately evaluate results of the surgical operation.
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Affiliation(s)
- Touko Kaasalainen
- HUS Diagnostic Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00290, Helsinki, Finland.
| | - Ville Männistö
- Department of Oral and Maxillofacial Surgery, Lahti Central Hospital, Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland
| | - Teemu Mäkelä
- HUS Diagnostic Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00290, Helsinki, Finland
- Department of Physics, University of Helsinki, Helsinki, Finland
| | - Juho Suojanen
- Department of Oral and Maxillofacial Surgery, Lahti Central Hospital, Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Antton Nuorala
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Arja Heliövaara
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Junnu Leikola
- Cleft Palate and Craniofacial Center, Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Jarvers JS, Spiegl UAJ, Pieroh P, von der Höh N, Völker A, Pfeifle C, Glasmacher S, Heyde CE. Does the intraoperative 3D-flat panel control of the planned implant position lead to an optimization and increased in safety in the anatomically demanding region C1/2? BMC Surg 2023; 23:37. [PMID: 36803456 PMCID: PMC9938545 DOI: 10.1186/s12893-023-01934-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 02/08/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the applicability and advantages of intraoperative imaging using a 3D flat panel in the treatment of C1/2 instabilities. MATERIALS Prospective single-centered study including surgeries at the upper cervical spine between 06/2016 and 12/2018. Intraoperatively thin K-wires were placed under 2D fluoroscopic control. Then an intraoperative 3D-scan was carried out. The image quality was assessed based on a numeric analogue scale (NAS) from 0 to 10 (0 = worst quality, 10 = perfect quality) and the time for the 3D-scan was measured. Additionally, the wire positions were evaluated regarding malpositions. RESULTS A total of 58 patients were included (33f, 25 m, average age 75.2 years, r.:18-95) with pathologies of C2: 45 type II fractures according to Anderson/D'Alonzo with or without arthrosis of C1/2, 2 Unhappy triad of C1/2 (Odontoid fracture Type II, anterior or posterior C1 arch-fracture, Arthrosis C1/2) 4 pathological fractures, 3 pseudarthroses, 3 instabilities of C1/2 because of rheumatoid arthritis, 1 C2 arch fracture). 36 patients were treated from anterior [29 AOTAF (combined anterior odontoid and transarticular C1/2 screw fixation), 6 lag screws, 1 cement augmented lag screw] and 22 patients from posterior (regarding to Goel/Harms). The median image quality was 8.2 (r.: 6-10). In 41 patients (70.7%) the image quality was 8 or higher and in none of the patients below 6. All of those 17 patients the image quality below 8 (NAS 7 = 16; 27.6%, NAS 6 = 1, 1.7%), had dental implants. A total of 148 wires were analyzed. 133 (89.9%) showed a correct positioning. In the other 15 (10.1%) cases a repositioning had to be done (n = 8; 5.4%) or it had to be drawn back (n = 7; 4.7%). A repositioning was possible in all cases. The implementation of an intraoperative 3D-Scan took an average of 267 s (r.: 232-310 s). No technical problems occurred. CONCLUSION Intraoperative 3D imaging in the upper cervical spine is fast and easy to perform with sufficient image quality in all patients. Potential malposition of the primary screw canal can be detected by initial wire positioning before the Scan. The intraoperative correction was possible in all patients. Trial registration German Trials Register (Registered 10 August 2021, DRKS00026644-Trial registration: German Trials Register (Registered 10 August 2021, DRKS00026644- https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00026644 ).
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Affiliation(s)
- J.-S. Jarvers
- grid.9647.c0000 0004 7669 9786Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103 Leipzig, Germany
| | - U. A. J. Spiegl
- grid.9647.c0000 0004 7669 9786Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103 Leipzig, Germany
| | - P. Pieroh
- grid.9647.c0000 0004 7669 9786Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103 Leipzig, Germany
| | - N. von der Höh
- grid.9647.c0000 0004 7669 9786Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103 Leipzig, Germany
| | - A. Völker
- grid.9647.c0000 0004 7669 9786Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103 Leipzig, Germany
| | - C. Pfeifle
- grid.9647.c0000 0004 7669 9786Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103 Leipzig, Germany
| | - S. Glasmacher
- grid.9647.c0000 0004 7669 9786Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103 Leipzig, Germany
| | - C. E. Heyde
- grid.9647.c0000 0004 7669 9786Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20, 04103 Leipzig, Germany
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Alomari S, Lubelski D, Lehner K, Tang A, Wolinsky JP, Theodore N, Sciubba DM, Larry Lo SF, Belzberg A, Weingart J, Witham T, Gokaslan ZL, Bydon A. Safety and Accuracy of Freehand Pedicle Screw Placement and the Role of Intraoperative O-Arm: A Single-Institution Experience. Spine (Phila Pa 1976) 2023; 48:180-188. [PMID: 36190990 DOI: 10.1097/brs.0000000000004497] [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: 03/30/2022] [Accepted: 08/02/2022] [Indexed: 11/05/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim was to investigate the accuracy of pedicle screw placement by freehand technique and to compare revision surgery rates among three different imaging verification pathways. SUMMARY OF BACKGROUND DATA Studies comparing different imaging modalities in freehand screw placement surgery are limited. MATERIALS AND METHODS A single-institution retrospective chart review identified adult patients who underwent freehand pedicle screw placement in the thoracic, lumbar or sacral levels. Patients were stratified into three cohorts based on the intraoperative imaging modality used to assess the accuracy of screw position: intraoperative X-rays (cohort 1); intraoperative O-arm (cohort 2); or intraoperative computed tomography (CT)-scan (cohort 3). Postoperative CT scans were performed on all patients in cohorts 1 and 2. Postoperative CT scan was not required in cohort 3. Screw accuracy was assessed using the Gertzbein-Robbins grading system. RESULTS A total of 9179 pedicle screws were placed in the thoracic or lumbosacral spine in 1311 patients. 210 (2.3%) screws were identified as Gertzbein-Robbins grades C-E on intraoperative/postoperative CT scan, 137 thoracic screws, and 73 lumbar screws ( P <0.001). Four hundred and nine patients underwent placement of 2754 screws followed by intraoperative X-ray (cohort 1); 793 patients underwent placement of 5587 screws followed by intraoperative O-arm (cohort 2); and 109 patients underwent placement of 838 screws followed by intraoperative CT scan (cohort 3). Postoperative CT scans identified 65 (2.4%) and 127 (2.3%) malpositioned screws in cohorts 1 and 2, respectively. Eleven screws (0.12%) were significantly malpositioned and required a second operation for screw revision. Nine patients (0.69%) required revision operations: eight of these patients were from cohort 1 and one patient was from cohort 2. CONCLUSION When compared to intraoperative X-ray, intraoperative O-arm verification decreased the revision surgery rate for malpositioned screws from 0.37% to 0.02%. In addition, our analysis suggests that the use of intraoperative O-arm can obviate the need for postoperative CT scans.
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Affiliation(s)
- Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kurt Lehner
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anthony Tang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jean-Paul Wolinsky
- Department of Neurological Surgery, Northwestern University, Chicago, IL
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY
| | - Allan Belzberg
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jon Weingart
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Timothy Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Peleg O, Ianculovici C, Shuster A, Mijiritsky E, Oz I, Kleinman S. Three-dimensional intraoperative computed tomography imaging for zygomatic fracture repair. J Korean Assoc Oral Maxillofac Surg 2021; 47:382-387. [PMID: 34713813 PMCID: PMC8564091 DOI: 10.5125/jkaoms.2021.47.5.382] [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: 03/06/2021] [Revised: 06/10/2021] [Accepted: 06/28/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives Zygomatic complex (ZMC) fractures comprise up to 40% of all facial fractures. Misaligned bone fragments and misplaced fixation hardware traditionally detected postoperatively on plain radiographs of the skull might require re-operation. The intraoperative O-Arm (Medtronic, USA) is a three-dimensional (3D) computed tomographic imaging system. Materials and Methods This retrospective single-center study evaluated the utility of O-Arm scanning during corrective surgeries for ZMC and zygomatic arch (ZA) fractures from 2018 to 2020. Three females and 16 males (mean age, 31.52 years; range, 22-48 years) were included. Fracture instability (n=6) and facial deformity (n=15) were the most frequent indications for intraoperative 3D O-Arm scan. Results The images demonstrated that all fracture lines were properly reduced and fixed. Another scan performed at the end of the fixation or reduction stage, however, revealed suboptimal results in five of the 19 cases, and further reduction and fixation of the fracture lines were required. Conclusion Implementation of an intraoperative O-Arm system in ZMC and ZA fracture surgeries assists in obtaining predictable and accurate results and obviates the need for revision surgeries. The device should be considered for precise operations such as ZMC fracture repairs.
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Affiliation(s)
- Oren Peleg
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Clariel Ianculovici
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Shuster
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Oral and Maxillofacial Surgery, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitan Mijiritsky
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itay Oz
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Kleinman
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lange N, Meyer B, Meyer HS. Navigation for surgical treatment of disorders of the cervical spine - A systematic review. J Orthop Surg (Hong Kong) 2021; 29:23094990211012865. [PMID: 34711079 DOI: 10.1177/23094990211012865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Computer-assisted navigation (CAN) is a well-established tool in spinal instrumentation surgery. Different techniques - each with specific advantages and disadvantages - are used in the cervical spine. METHODS A structured summary of different spinal navigation techniques and a review of the literature were done to discuss the advantages and disadvantages of specific navigation tools in the cervical spine. RESULTS In cervical spine surgery, CAN increases the accuracy of pedicle screw placement, reduces screw mispositioning and leads to fewer revision surgeries. Due to the mobility of the cervical spine, preoperative CT followed by region matching or intraoperative CT are recommended. CONCLUSIONS CAN increases pedicle screw placement accuracy and should be used in spinal instrumentation for the cervical spine whenever possible.
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Halvachizadeh S, Berk T, Pieringer A, Ried E, Hess F, Pfeifer R, Pape HC, Allemann F. Is the Additional Effort for an Intraoperative CT Scan Justified for Distal Radius Fracture Fixations? A Comparative Clinical Feasibility Study. J Clin Med 2020; 9:jcm9072254. [PMID: 32708535 PMCID: PMC7408788 DOI: 10.3390/jcm9072254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/05/2020] [Accepted: 07/14/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION It is currently unclear whether the additional effort to perform an intraoperative computed tomography (CT) scan is justified for articular distal radius fractures (DRFs). The purpose of this study was to assess radiological, functional, and clinical outcomes after surgical treatment of distal radius fractures when using conventional fluoroscopy vs. intraoperative CT scans. METHODS Inclusion criteria: Surgical treatment of DRF between 1 January 2011 and 31 December 2011, age 18 and above. Group distribution: intraoperative conventional fluoroscopy (Group Conv) or intraoperative CT scans (Group CT). EXCLUSION CRITERIA Use of different image intensifier devices or incomplete data. DRF classification according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification. Outcome variables included requirement of revision surgeries, duration of surgery, absorbed radiation dose, and requirement of additional CT scans during hospitalization. RESULTS A total of 187 patients were included (Group Conv n = 96 (51.3%), Group CT n = 91 (48.7%)). AO Classification: Type A fractures n = 40 (50%) in Group Conv vs. n = 16 (17.6%) in Group CT, p < 0.001; Type B: 10 (10.4%) vs. 11 (12.1%), not significant (n.s.); Type C: 38 (39.6%) vs. 64 (70.3%), p < 0.001. In Group Conv, four (4.2%) patients required revision surgeries within 6 months, but in Group CT no revision surgery was required. The CT scan led to an intraoperative screw exchange/reposition in 23 (25.3%) cases. The duration of the initial surgery (81.7 ± 46.4 min vs. 90.1 ± 43.6 min, n.s.) was comparable. The radiation dose was significantly higher in Group CT (6.9 ± 1.3 vs. 2.8 ± 7.8 mGy, p < 0.001). In Group Conv, 11 (11.5%) patients required additional CT scans during hospitalization. CONCLUSION The usage of intraoperative CT was associated with improved reduction and more adequate positioning of screws postoperatively with comparable durations of surgery. Despite increased efforts by utilizing the intraoperative CT scan, the decrease in reoperations may justify its use.
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Affiliation(s)
- Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (T.B.); (A.P.); (E.R.); (R.P.); (H.-C.P.); (F.A.)
- Harald-Tscherne Research Laboratory, University Hospital Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland
- Correspondence: ; Tel.: +41-794-648-233
| | - Till Berk
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (T.B.); (A.P.); (E.R.); (R.P.); (H.-C.P.); (F.A.)
| | - Alexander Pieringer
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (T.B.); (A.P.); (E.R.); (R.P.); (H.-C.P.); (F.A.)
| | - Emanuael Ried
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (T.B.); (A.P.); (E.R.); (R.P.); (H.-C.P.); (F.A.)
| | - Florian Hess
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Frauenfeld, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland;
| | - Roman Pfeifer
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (T.B.); (A.P.); (E.R.); (R.P.); (H.-C.P.); (F.A.)
- Harald-Tscherne Research Laboratory, University Hospital Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (T.B.); (A.P.); (E.R.); (R.P.); (H.-C.P.); (F.A.)
- Harald-Tscherne Research Laboratory, University Hospital Zurich, Sternwartstrasse 14, 8091 Zurich, Switzerland
| | - Florin Allemann
- Department of Trauma, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; (T.B.); (A.P.); (E.R.); (R.P.); (H.-C.P.); (F.A.)
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