1
|
Naessig S, Para A, Kummer N, Krol O, Passfall L, Ahmad W, Pierce K, Vira S, Diebo B, Neuman B, Jain A, Sciubba D, Passias P. Trends in usage of navigation and robotic assistance in elective spine surgeries: a study of 105,212 cases from 2007 to 2015. J Robot Surg 2023; 17:2855-2860. [PMID: 37801230 DOI: 10.1007/s11701-023-01682-z] [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: 03/09/2021] [Accepted: 07/16/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE Identify trends of navigation and robotic-assisted elective spine surgeries. METHODS Elective spine surgery patients between 2007 and 2015 in the Nationwide Inpatient Sample (NIS) were isolated by ICD-9 codes for Navigation [Nav] or Robotic [Rob]-Assisted surgery. Basic demographics and surgical variables were identified via chi-squared and t tests. Each system was analyzed from 2007 to 2015 for trends in usage. RESULTS Included 3,759,751 patients: 100,488 Nav; 4724 Rob. Nav were younger (56.7 vs 62.7 years), had lower comorbidity index (1.8 vs 6.2, all p < 0.05), more decompressions (79.5 vs 42.6%) and more fusions (60.3 vs 52.6%) than Rob. From 2007 to 2015, incidence of complication increased for Nav (from 5.8 to 21.7%) and Rob (from 3.3 to 18.4%) as well as 2-3 level fusions (from 50.4 to 52.5%) and (from 1.3 to 3.2%); respectively. Invasiveness increased for both (Rob: from 1.7 to 2.2; Nav: from 3.7 to 4.6). Posterior approaches (from 27.4 to 41.3%), osteotomies (from 4 to 7%), and fusions (from 40.9 to 54.2%) increased in Rob. Anterior approach for Rob decreased from 14.9 to 14.4%. Nav increased posterior (from 51.5% to 63.9%) and anterior approaches (from 16.4 to 19.2%) with an increase in osteotomies (from 2.1 to 2.7%) and decreased decompressions (from 73.6 to 63.2%). CONCLUSIONS From 2007 to 2015, robotic and navigation systems have been performed on increasingly invasive spine procedures. Robotic systems have shifted from anterior to posterior approaches, whereas navigation computer-assisted procedures have decreased in rates of usage for decompression procedures.
Collapse
Affiliation(s)
- Sara Naessig
- Department of Orthopedic and Neurosurgery, Division of Spine, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Ashok Para
- Department of Orthopedic and Neurosurgery, Division of Spine, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Nicholas Kummer
- Department of Orthopedic and Neurosurgery, Division of Spine, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Oscar Krol
- Department of Orthopedic and Neurosurgery, Division of Spine, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Lara Passfall
- Department of Orthopedic and Neurosurgery, Division of Spine, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Waleed Ahmad
- Department of Orthopedic and Neurosurgery, Division of Spine, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Katherine Pierce
- Department of Orthopedic and Neurosurgery, Division of Spine, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Shaleen Vira
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Bassel Diebo
- Department of Orthopedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Brian Neuman
- Department of Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Amit Jain
- Department of Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Daniel Sciubba
- Department of Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Peter Passias
- Department of Orthopedic and Neurosurgery, Division of Spine, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA.
| |
Collapse
|
2
|
Kim JH, Jitpakdee K, Kotheeranurak V, Quillo-Olvera J, Choi KC, Kim YJ, Lee CR, Kim JS. Is navigation beneficial for transforaminal endoscopic lumbar foraminotomy? A preliminary comparison study with fluoroscopic guidance. 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; 32:2808-2818. [PMID: 36920512 DOI: 10.1007/s00586-023-07624-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE The primary purpose of this study was to determine radiation exposure of the surgeon during transforaminal endoscopic lumbar foraminotomy (TELF). Secondary purpose of this study was to compare clinical and radiologic outcomes between TELF under C-arm fluoroscopic guidance (C-TELF) and O-arm navigation-guided TELF (O-TELF). METHODS The author reviewed patients' medical records who underwent TELF at our institute from June 2015 to November 2022. A total of 40 patients were included (18 patients with C-TELF and 22 with O-TELF). Basic demographic data were collected. Preoperative/postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) were recorded at the outpatient clinic. Radiologic features were compared on X-rays at each follow-up. The degree of foraminal expansion was measured/compared through MRI. In the C-TELF group, the amount of exposure was calculated with a dosimeter. RESULTS Average surgeon's effective dose in the C-TELF group was 0.036 mSv. In the case of the O-TELF group, there was no radiation exposure during operation. However, the operation time in the O-TELF group was about 37 min longer than that in the C-TELF group. There were significant improvements in VAS/ODI after operation in both groups. Complications were identified in three patients. CONCLUSION O-TELF showed similarly favorable clinical and radiologic outcomes to C-TELF in lumbar foraminal stenosis, including complication rate. Compared to C-TELF, O-TELF has an advantage of not wearing a lead apron since the operator is not exposed to radiation. However, the operation time was longer with O-TELF due to O-arm setting time. Because there are pros and cons, the choice of surgical method depends on the surgeon's preference.
Collapse
Affiliation(s)
- Jung-Hoon Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Khanathip Jitpakdee
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
- Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, Thai Red Cross Society, Si Racha, Chonburi, Thailand
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Javier Quillo-Olvera
- The Brain and Spine Care, Minimally Invasive Spine Surgery Group, Hospital H+, Queretaro City, Mexico
| | - Kyung-Chul Choi
- Seoul Top Spine Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Young-Jin Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Cho-Rong Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| |
Collapse
|
3
|
Chen CM, Lee JH, Yang MY, Jhang SW, Chang KS, Ou SW, Sun LW, Chen KT. Navigation-Assisted Full-Endoscopic Radiofrequency Rhizotomy Versus Fluoroscopy-Guided Cooled Radiofrequency Ablation for Sacroiliac Joint Pain Treatment: Comparative Study. Neurospine 2023; 20:141-149. [PMID: 37016862 PMCID: PMC10080431 DOI: 10.14245/ns.2346058.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/26/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: Sacroiliac joint (SIJ) pain is a common cause of chronic low back pain. Full-endoscopic rhizotomy of lateral branches of dorsal rami innervating SIJ is a potential option for patients’ refractory to medical treatment. The full-endoscopic rhizotomy is sometimes challenging under fluoroscopic guidance. This study is to evaluate the effectiveness of the navigation-assisted full-endoscopic rhizotomy for SIJ pain.Methods: The study was a retrospective match-paired study that enrolled consecutive patients undergoing navigation-assisted full-endoscopic rhizotomy for SIJ pain. The patient demographics, clinical outcomes, and operative parameters of endoscopic rhizotomy were compared with conventional cooled radiofrequency ablation (RFA) treatment.Results: The study enrolled 72 patients, including 36 patients in the endoscopic group. Thirty-six patients in the cooled RFA group were matched by age as the control. The follow-up time was at least 1 year. Patient characteristics were similar between the groups. The navigation-assisted endoscopic rhizotomy operation time was significantly longer than the cooled RFA. The visual analogue scale (VAS) for pain and Oswestry Disability Index (ODI) significantly decreased after each treatment. However, the between-group comparison revealed that the VAS and ODI of the patients after endoscopic rhizotomy were significantly lower than those after the cooled RFA group. There were no postoperative complications in the study.Conclusion: Navigation-assisted full-endoscopic rhizotomy is an alternative to SIJ pain treatment. Integrating intraoperative navigation can ensure accurate full-endoscopic rhizotomy to provide better durability of pain relief than the cooled RFA.
Collapse
Affiliation(s)
- Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
- Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan
- College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan
| | - Jae Hwan Lee
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
| | - Meng-Yin Yang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung Taiwan
- College of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Shang-Wun Jhang
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
| | - Kai-Sheng Chang
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
| | - Su-Wei Ou
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
| | - Li-Wei Sun
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Changhua, Taiwan
| | - Kuo-Tai Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital Chiayi, Puzi, Taiwan
- Corresponding Author Kuo-Tai Chen Department of Neurosurgery, Chang Gung Memorial Hospital Chiayi, No. 6, W. sec., Jiapu Rd., Puzi City, Chiayi County 613, Taiwan
| |
Collapse
|
4
|
Gong J, Huang X, Luo L, Liu H, Wu H, Tan Y, Li C, Tang Y, Zhou Y. Radiation Dose Reduction and Surgical Efficiency Improvement in Endoscopic Transforaminal Lumbar Interbody Fusion Assisted by Intraoperative O-arm Navigation: A Retrospective Observational Study. Neurospine 2022; 19:376-384. [PMID: 35793934 PMCID: PMC9260536 DOI: 10.14245/ns.2143324.662] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/10/2022] [Indexed: 01/25/2023] Open
Abstract
Objective: Endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) has gained increasing popularity among spine surgeons. However, with the use of fluoroscopy, intraoperative radiation exposure remains a major concern. Here, we aim to introduce Endo-TLIF assisted by O-arm-based navigation and compare the results between O-arm navigation and fluoroscopy groups.Methods: Sixty-four patients were retrospectively analyzed from May 2019 to September 2020; the nonnavigation group comprised 34 patients, and the navigation group comprised 30 patients. Data on radiation dose, blood loss, postoperative drains, surgery time, complications, and length of hospital stay (LOS) were collected. Clinical outcomes were evaluated from postoperative data such as fusion rate, Oswestry Disability Index (ODI), and visual analogue scale (VAS). Radiation dose and surgery time were selected as primary outcomes; the others were second outcomes.Results: All patients were followed up for at least 12 months. No significant differences were detected in intraoperative hemorrhage, postoperative drains, hospital LOS, or complications between the 2 groups. The radiation dose was significantly lower in the navigation group compared with the nonnavigation group. The time of cannula placement and pedicle screw fixation was significantly reduced in the navigation group. No significant differences were detected between the clinical outcomes in the 2 groups (VAS and ODI scores).Conclusion: The present study demonstrates that O-arm-assisted Endo-TLIF is efficient and safe. Compared with fluoroscopy, O-arm navigation could reduce the radiation exposure and surgical time in Endo-TLIF surgery, with similar clinical outcomes. However, the higher doses exposed to patients remains a negative effect of this technology.
Collapse
Affiliation(s)
- Junfeng Gong
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Xinle Huang
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Liwen Luo
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Huan Liu
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Hao Wu
- Department of Clinical Laboratory, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Ying Tan
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Changqing Li
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Yu Tang
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
- Corresponding Author Yue Zhou Department of Orthopedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
- Corresponding Author Yue Zhou Department of Orthopedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China
| |
Collapse
|
5
|
Fisher C, Harty J, Yee A, Li CL, Komolibus K, Grygoryev K, Lu H, Burke R, Wilson BC, Andersson-Engels S. Perspective on the integration of optical sensing into orthopedic surgical devices. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:010601. [PMID: 34984863 PMCID: PMC8727454 DOI: 10.1117/1.jbo.27.1.010601] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
SIGNIFICANCE Orthopedic surgery currently comprises over 1.5 million cases annually in the United States alone and is growing rapidly with aging populations. Emerging optical sensing techniques promise fewer side effects with new, more effective approaches aimed at improving patient outcomes following orthopedic surgery. AIM The aim of this perspective paper is to outline potential applications where fiberoptic-based approaches can complement ongoing development of minimally invasive surgical procedures for use in orthopedic applications. APPROACH Several procedures involving orthopedic and spinal surgery, along with the clinical challenge associated with each, are considered. The current and potential applications of optical sensing within these procedures are discussed and future opportunities, challenges, and competing technologies are presented for each surgical application. RESULTS Strong research efforts involving sensor miniaturization and integration of optics into existing surgical devices, including K-wires and cranial perforators, provided the impetus for this perspective analysis. These advances have made it possible to envision a next-generation set of devices that can be rigorously evaluated in controlled clinical trials to become routine tools for orthopedic surgery. CONCLUSIONS Integration of optical devices into surgical drills and burrs to discern bone/tissue interfaces could be used to reduce complication rates across a spectrum of orthopedic surgery procedures or to aid less-experienced surgeons in complex techniques, such as laminoplasty or osteotomy. These developments present both opportunities and challenges for the biomedical optics community.
Collapse
Affiliation(s)
- Carl Fisher
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - James Harty
- Cork University Hospital and South Infirmary Victoria University Hospital, Department of Orthopaedic Surgery, Cork, Ireland
| | - Albert Yee
- University of Toronto, Sunnybrook Research Institute, Department of Surgery, Holland Bone and Joint Program, Division of Orthopaedic Surgery, Sunnybrook Health Sciences; Orthopaedic Biomechanics Laboratory, Physical Sciences Platform, Toronto, Canada
| | - Celina L. Li
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Katarzyna Komolibus
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Konstantin Grygoryev
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Huihui Lu
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Ray Burke
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
| | - Brian C. Wilson
- University of Toronto, Princess Margaret Cancer Centre/University Health Network, Department of Medical Biophysics, Toronto, Canada
| | - Stefan Andersson-Engels
- Biophotonics@Tyndall, IPIC, Tyndall National Institute, Lee Maltings, Dyke Parade, Cork, Ireland
- University College Cork, Department of Physics, Cork, Ireland
| |
Collapse
|
6
|
The Effect of Educational Intervention on the Improvement of Nontechnical Skills in Circulating Nurses. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5856730. [PMID: 34692835 PMCID: PMC8536428 DOI: 10.1155/2021/5856730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/05/2021] [Accepted: 10/05/2021] [Indexed: 02/07/2023]
Abstract
Background Nontechnical skills are necessary for clinicians' safe performance and prevention of errors in the operating room. Educational intervention is a useful way to improve these skills, which are a vital area for improvement. Circulating nurses are surgical team members whose work depends heavily on using nontechnical skills. This study is aimed at assessing the effect of an educational intervention on the improvement of circulating nurses' nontechnical skills. Methods This semiexperimental study was conducted on 300 circulating nurses divided into the intervention and no intervention groups each containing 150 participants. The nontechnical skills were assessed using the circulating practitioners' list of nontechnical skills. Then, the intervention group received training regarding these skills, and the two groups were evaluated again. After all, the data were entered into the SPSS 24 software and were analyzed using descriptive statistics and Wilcoxon and Mann–Whitney tests. Furthermore, Kendall's tau, independent sample t-test, and one-way ANOVA were used for assessment of relationship between median scores and demographics. Results The results revealed a significant improvement in the scores of all domains of nontechnical skills in the intervention group (p < 0.05). The highest and lowest improvements were observed in teamwork (42%) and situational awareness (16.7%), respectively. After the intervention, the scores of some of the behaviors were still below the average level or were not improved significantly. Conclusions Circulating nurses' nontechnical skills can be improved by educational interventions. However, regarding the low scores or no improvements in the scores of some behaviors, other intervention types such as policymaking and correcting the existing hierarchies in the operating room can be useful to complete the educational interventions.
Collapse
|
7
|
Kutaish H, Acker A, Drittenbass L, Stern R, Assal M. Computer-assisted surgery and navigation in foot and ankle: state of the art and fields of application. EFORT Open Rev 2021; 6:531-538. [PMID: 34377544 PMCID: PMC8335956 DOI: 10.1302/2058-5241.6.200024] [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] [Indexed: 11/05/2022] Open
Abstract
Computer-assisted orthopaedic surgery (CAOS) is a real-time navigation guidance system that supports surgeons intraoperatively.Its use is reported to increase precision and facilitate less-invasive surgery.Advanced intraoperative imaging helps confirm that the initial aim of surgery has been achieved and allows for immediate adjustment when required.The complex anatomy of the foot and ankle, and the associated wide range of challenging procedures should benefit from the use of CAOS; however, reports on the topic are scarce.This article explores the fields of applications of real-time navigation and CAOS in foot and ankle surgery. Cite this article: EFORT Open Rev 2021;6:531-538. DOI: 10.1302/2058-5241.6.200024.
Collapse
Affiliation(s)
- Halah Kutaish
- Centre for Surgery of the Foot & Ankle, Hirslanden Clinique La Colline, Switzerland.,Faculty of Medicine, Geneva University, Switzerland
| | - Antoine Acker
- Centre for Surgery of the Foot & Ankle, Hirslanden Clinique La Colline, Switzerland
| | - Lisca Drittenbass
- Centre for Surgery of the Foot & Ankle, Hirslanden Clinique La Colline, Switzerland
| | - Richard Stern
- Centre for Surgery of the Foot & Ankle, Hirslanden Clinique La Colline, Switzerland
| | - Mathieu Assal
- Centre for Surgery of the Foot & Ankle, Hirslanden Clinique La Colline, Switzerland.,Faculty of Medicine, Geneva University, Switzerland
| |
Collapse
|
8
|
Soulioti E, Efstathiou G, Papanastasiou J, Igoumenou V, Kostopanagiotou G, Batistaki C. Low-dose epidural anesthesia for percutaneous spinal fusion and kyphoplasty due to metastatic fracture of L2 lumbar vertebrae. J Anaesthesiol Clin Pharmacol 2021; 36:560-562. [PMID: 33840943 PMCID: PMC8022040 DOI: 10.4103/joacp.joacp_157_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/28/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Eleftheria Soulioti
- 2 Department of Anesthesiology, Faculty of Medicine, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece
| | - Georgia Efstathiou
- 2 Department of Anesthesiology, Faculty of Medicine, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece
| | - John Papanastasiou
- 1 Department of Orthopedics, Faculty of Medicine, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece
| | - Vasilios Igoumenou
- 1 Department of Orthopedics, Faculty of Medicine, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece
| | - Georgia Kostopanagiotou
- 2 Department of Anesthesiology, Faculty of Medicine, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece
| | - Chrysanthi Batistaki
- 2 Department of Anesthesiology, Faculty of Medicine, National and Kapodistrian University of Athens, "Attikon" Hospital, Athens, Greece
| |
Collapse
|
9
|
Results of using robotic-assisted navigational system in pedicle screw placement. PLoS One 2019; 14:e0220851. [PMID: 31425528 PMCID: PMC6699687 DOI: 10.1371/journal.pone.0220851] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/24/2019] [Indexed: 11/19/2022] Open
Abstract
Recent technical developments have resulted in robotic-assisted pedicle screw placement techniques. However, the use of robotic-assisted navigational techniques is still subject to controversy. This study aims to assess the accuracy and safety of a self-developed navigation system, the point spine navigation system (PSNS), for robotic-assisted pedicle screw placement surgery. Fifty-nine pedicle screws were implanted in three porcine vertebrae at the T6–T10 and L1–L5 levels, with the assistance of the PSNS. The navigation and planning system provides virtual surgical guide images, including sagittal, coronal, axial, oblique planes, and customized three-dimensional reconstructions for each vertebra to establish accurate pedicle screw trajectories and placement tracts. After pedicle screw placement, post-operative spiral computer tomographic scans were performed and screws were evaluated using the Gertzbein–Robbins classification. Differences between the actual pedicle screw position and pre-operative planning paths, including the angle, shortest distance, and entry trajectory were recorded. The 59 pedicle screw placements were all within a safe zone, and there was no spinal canal perforation or any other damage under postoperative computed tomography image data. Fifty-one screws were categorized as group A, seven screws were noted as group B, and one screw was identified as group E under the Gertzbein–Robbins classification. The mean entry point deviation was 2.71 ± 1.72°, mean trajectory distance was 1.56 ± 0.66 mm, and average shortest distance between two paths was 0.96 ± 0.73 mm. Pedicle placement remains a challenging procedure with high reported incidences of nerve and vascular injuries. The implementation of a robotic-assisted navigational system yields an acceptable level of accuracy and safety for the pedicle screw placement surgery.
Collapse
|
10
|
Virk S, Qureshi S. Navigation in minimally invasive spine surgery. JOURNAL OF SPINE SURGERY 2019; 5:S25-S30. [PMID: 31380490 DOI: 10.21037/jss.2019.04.23] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Minimally invasive spine (MIS) surgery is associated with limited dissection as compared to open surgical procedures and this can result in decreased visualization. The use of computer-assisted navigation technology, however, allows surgeons greater visualization of bony and soft tissue anatomy through limited MIS incisions. This article outlines the potential benefits of intraoperative navigation during minimally invasive spinal surgery procedures to reduce intra-operative radiation exposure and enhance surgical accuracy. We also offer the senior author's surgical setup and technique related to a skin-based navigation system. Future research is required into the use of augmented reality for surgeons during a navigated MIS surgery.
Collapse
Affiliation(s)
- Sohrab Virk
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz Qureshi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| |
Collapse
|
11
|
Kaliya-Perumal AK, Limthongkul W, Oh JYL. Utilization of Spinal Navigation to Facilitate Hassle-Free Rod Placement during Minimally-Invasive Long-Construct Posterior Instrumentation. Asian Spine J 2019; 13:511-514. [PMID: 30691260 PMCID: PMC6547385 DOI: 10.31616/asj.2018.0233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 10/21/2018] [Indexed: 11/23/2022] Open
Abstract
During minimally-invasive long-construct posterior instrumentation, it may be challenging to contour and place the rod as the screw heads are not visualized. To overcome this, we utilized the image data merging (IDM) facility of our spinal navigation system to visualize a coherent whole image of the construct throughout the procedure. Here, we describe this technique that was used for a patient in whom L1-L5 posterior instrumentation was performed. Using an IDM facility, screws are color coded and after placement, the final image is saved. Saved images of all previous screws are displayed and observed while placing the subsequent screws. Therefore, the entry point, depth, and mediolateral alignment of subsequent screws can be adjusted to fall in line with previous screws such that the rod can be placed without hassle. Moreover, final adjustments to the construct are kept to a minimum. The possibility of screw pullout due to force engaging the rod on poorly aligned screws is thus avoided.
Collapse
Affiliation(s)
- Arun-Kumar Kaliya-Perumal
- Spine Division, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.,Department of Orthopaedic Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Affiliated to The Tamil Nadu Dr MGR Medical University, Chennai, India
| | - Worawat Limthongkul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jacob Yoong-Leong Oh
- Spine Division, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| |
Collapse
|
12
|
Kulkarni A, Patel A. Motion preservation surgery: excision of juxta C5-C6 intervertebral disc osteoid osteoma using 3D C-arm based navigation: technical report. SICOT J 2018; 4:56. [PMID: 30516129 PMCID: PMC6280673 DOI: 10.1051/sicotj/2018052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/28/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Precise targeted excision of the C5-C6 osteoid osteoma with placement of reference array on clavicle with minimal disturbance of anatomy and motion. METHODS A 20-year-old male presented with an osteoid osteoma in the superior end plate of the C6 vertebra abutting the spinal canal causing intractable pain. The authors curetted the nidus using a 3D C-arm-based intraoperative scan integrated with an optical navigation system through a minimal access anterior cervical exposure. The patient reference array was affixed to the left clavicle using a threaded pin. RESULTS The postoperative CT-scan revealed complete excision. Follow-up MRI and CT after 12 months revealed C5-C6 intervertebral disc to be intact without evidence of any tumor recurrence. VAS for neck pain improved from 8/10 to 2/10 immediately postoperatively and 0/10 at 1 year follow-up with no limitation of cervical movement. A motion segment was preserved with this technique. CONCLUSIONS Navigation allowed safe curettage of the nidus with minimal disturbance to the anatomy and motion. The site of attachment of patient reference array on clavicle can be recommended as stable, meeting all the criteria for optimal accuracy and stability.
Collapse
Affiliation(s)
- Arvind Kulkarni
- Mumbai Spine Scoliosis & Disc Replacement Centre, Bombay Hospital & Medical Research Center, Marine Lines, Mumbai 400002, India - Saifee Hospital, Maharishi Karve Marg, Charni Road, Mumbai, India
| | - Ankit Patel
- Mumbai Spine Scoliosis & Disc Replacement Centre, Bombay Hospital & Medical Research Center, Marine Lines, Mumbai 400002, India
| |
Collapse
|
13
|
Singh S, Sardhara JC, Khatri D, Joseph J, Parab AN, Bhaisora KS, Das KK, Mehrotra A, Srivastava AK, Behari S. Technical pearls and surgical outcome of early transitional period experience in minimally invasive lumbar discectomy: A prospective study. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2018; 9:122-129. [PMID: 30008531 PMCID: PMC6024740 DOI: 10.4103/jcvjs.jcvjs_47_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: There is growing indications of minimally invasive spine surgery. The inherent attitude and institutive learning curve limit transition from standard open surgery to minimally invasive surgery demanding understanding of new instruments and correlative anatomy. Materials and Methods: In this prospective study, 80 patients operated for lumbar disc prolapse were included in the study (between January 2016 and March 2018). Fifty patients (Group A) operated by various minimally invasive spine surgery (MISS) techniques for herniated disc disease were compared with randomly selected 30 patients (Group B) operated between the same time interval by standard open approach. Surgical outcome with Oswestry Disability Index (ODI) and patient satisfaction score was calculated in pre- and postoperative periods. Results: Mean preoperative ODI score in Group A was 31.52 ± 7.5 standard deviation (SD) (range: 6“46; interquartile range [IQR]: 8; median: 32.11) and postoperative ODI score was 9.20 ± 87.8 SD (range: 0“38; IQR: 11; median: 6.67). Mean preoperative ODI score in Group B was 26.47 ± 4.9 SD (range: 18“38; IQR: 4; median: 25) and postoperative ODI score was 12.27 ± 8.4 SD (range: 3“34; IQR: 12; median: 10.0). None of the patients was unsatisfied in either group. On comparing the patient satisfaction score among two groups, no significant difference (P = 0.27) was found. Discussion: On comparing the change in ODI and preoperative ODI among both groups, we found a significant difference between the groups. It is worth shifting from open to MISS accepting small learning curve. The satisfaction score of MISS in early transition period is similar to open procedure. Conclusion: The MISS is safe and effective procedure even in transition period for the central and paracentral prolapsed lumbar intervertebral disc treatment. The results are comparable, and patient satisfaction and symptomatic relief are not compromised.
Collapse
Affiliation(s)
- Suyash Singh
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jayesh C Sardhara
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Deepak Khatri
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jeena Joseph
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abhijit N Parab
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh S Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
14
|
Huang M, Barber SM, Steele WJ, Boghani Z, Desai VR, Britz GW, West GA, Trask TW, Holman PJ. Videoexoscopic real-time intraoperative navigation for spinal neurosurgery: a novel co-adaptation of two existing technology platforms, technical note. J Robot Surg 2017; 12:251-255. [DOI: 10.1007/s11701-017-0721-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 06/16/2017] [Indexed: 11/29/2022]
|
15
|
Wu AM, Chen CH, Shen ZH, Feng ZH, Weng WQ, Li SM, Chi YL, Yin LH, Ni WF. The Outcomes of Minimally Invasive versus Open Posterior Approach Spinal Fusion in Treatment of Lumbar Spondylolisthesis: The Current Evidence from Prospective Comparative Studies. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8423638. [PMID: 28154826 PMCID: PMC5244007 DOI: 10.1155/2017/8423638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/04/2016] [Indexed: 12/13/2022]
Abstract
Purpose. To investigate the evidence of minimally invasive (MI) versus open (OP) posterior lumbar fusion in treatment of lumbar spondylolisthesis from current prospective literatures. Methods. The electronic literature database of Pubmed, Embase, and Cochrane library was searched at April 2016. The data of operative time, estimated blood loss and length of hospital stay, visual analog scale (VAS) of both lower back pain and leg pain, Oswestry disability index (ODI), SF-36 PCS (physical component scores) and SF-36 MCS (mental component scores), complications, fusion rate, and secondary surgery were extracted and analyzed by STATA 12.0 software. Results. Five nonrandom prospective comparative studies were included in this meta-analysis. The meta-analysis showed that the MI group had a significantly longer operative time than OP group, less blood loss, and shorter hospital stay. No significant difference was found in back pain, leg pain, ODI, SF-36 PCS, SF-36 MCS, complications, fusion rate, and secondary surgery between MI and OP groups. Conclusion. The prospective evidence suggested that MI posterior fusion for spondylolisthesis had less EBL and hospital stay than OP fusion; however it took more operative time. Both MI and OP fusion had similar results in pain and functional outcomes, complication, fusion rate, and secondary surgery.
Collapse
Affiliation(s)
- Ai-Min Wu
- Department of Orthopedics, Second Affiliated Hospital of Wenzhou Medical University, Second Medical College of Wenzhou Medical University, Zhejiang Spine Center, Wenzhou, Zhejiang, China
| | - Chun-Hui Chen
- Department of Orthopedics, Second Affiliated Hospital of Wenzhou Medical University, Second Medical College of Wenzhou Medical University, Zhejiang Spine Center, Wenzhou, Zhejiang, China
| | - Zhi-Hao Shen
- Department of Orthopedics, Hainan Medical College, Haikou, Hainan, China
| | - Zhen-Hua Feng
- Department of Orthopedics, Second Affiliated Hospital of Wenzhou Medical University, Second Medical College of Wenzhou Medical University, Zhejiang Spine Center, Wenzhou, Zhejiang, China
| | - Wan-Qing Weng
- Department of Orthopedics, Second Affiliated Hospital of Wenzhou Medical University, Second Medical College of Wenzhou Medical University, Zhejiang Spine Center, Wenzhou, Zhejiang, China
| | - Shu-Min Li
- Department of Orthopedics, Second Affiliated Hospital of Wenzhou Medical University, Second Medical College of Wenzhou Medical University, Zhejiang Spine Center, Wenzhou, Zhejiang, China
| | - Yong-Long Chi
- Department of Orthopedics, Second Affiliated Hospital of Wenzhou Medical University, Second Medical College of Wenzhou Medical University, Zhejiang Spine Center, Wenzhou, Zhejiang, China
| | - Li-Hui Yin
- Laboratory of Internal Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wen-Fei Ni
- Department of Orthopedics, Second Affiliated Hospital of Wenzhou Medical University, Second Medical College of Wenzhou Medical University, Zhejiang Spine Center, Wenzhou, Zhejiang, China
| |
Collapse
|
16
|
Lefranc M, Peltier J. Evaluation of the ROSA™ Spine robot for minimally invasive surgical procedures. Expert Rev Med Devices 2016; 13:899-906. [DOI: 10.1080/17434440.2016.1236680] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- M. Lefranc
- Department of Neurosurgery, Amiens University Medical Center, Amiens, France
| | - J. Peltier
- Department of Neurosurgery, Amiens University Medical Center, Amiens, France
| |
Collapse
|