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Lee HH, Kang KY, Sung SY, Lee SB, Kim SH, Jung SI, Shin DH, Oh BH, Chae DS. Femoral Neck Fractures Treated by Closed Reduction and Internal Fixation with the Double Fluoroscope Technique: A Preliminary Study. J Clin Med 2024; 13:1418. [PMID: 38592215 PMCID: PMC10932226 DOI: 10.3390/jcm13051418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Fractures of the femur require significant radiation exposure during operations using fluoroscopy (C-arm), posing a high risk of radiation exposure to the medical staff and patients. To address this concern, in this study, we investigated the efficacy of using two fluoroscopy machines simultaneously. Methods: We categorized 30 patients with femoral neck fracture (FNF) into single and double C-arm groups. The operation and radiation exposure times during a closed reduction and internal fixation operation were investigated to evaluate whether the operation and radiation exposure times were effectively audited when the operation was performed using a double C-arm. Results: The total operation times were 93.21 ± 20.70 min and 66.69 ± 13.97 min for the single and double C-arm groups, respectively. Additionally, the total radiation times were 100.43 ± 24.59 s and 83.06 ± 19.53 s for the single and double C-arm groups, respectively. Operation and radiation exposure times in the two groups showed statistically significant differences (p < 0.05). Conclusion: The use of double C-arm in FNF can reduce operation and radiation exposure times. Hence, using the double C-arm in surgical treatment could reduce the risk of radiation exposure to medical staff and patients.
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Affiliation(s)
- Hyun Hee Lee
- Department of Orthopedic Surgery, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon 22711, Republic of Korea; (H.H.L.); (K.-Y.K.)
- College of Medicine, Yonsei Graduate School, Seoul 03722, Republic of Korea
| | - Kyung-Yil Kang
- Department of Orthopedic Surgery, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon 22711, Republic of Korea; (H.H.L.); (K.-Y.K.)
- College of Medicine, Catholic Kwandong Graduate School, Gangneung-si 25601, Republic of Korea
| | - Seung-Yong Sung
- Department of Orthopedic Surgery, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon 22711, Republic of Korea; (H.H.L.); (K.-Y.K.)
| | - Soo-Bin Lee
- Department of Orthopedic Surgery, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon 22711, Republic of Korea; (H.H.L.); (K.-Y.K.)
| | - Sang-Hee Kim
- Department of Orthopedic Surgery, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon 22711, Republic of Korea; (H.H.L.); (K.-Y.K.)
| | - Su-Il Jung
- Department of Orthopedic Surgery, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon 22711, Republic of Korea; (H.H.L.); (K.-Y.K.)
- College of Medicine, Catholic Kwandong Graduate School, Gangneung-si 25601, Republic of Korea
| | - Dong Hyuk Shin
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon 35365, Republic of Korea
| | - Byung Hak Oh
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon 35365, Republic of Korea
| | - Dong-Sik Chae
- Department of Orthopedic Surgery, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon 22711, Republic of Korea; (H.H.L.); (K.-Y.K.)
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Crawford AM, Striano BM, Giberson-Chen CC, Xiong GX, Lightsey HM, Schoenfeld AJ, Simpson AK. Projected Lifetime Cancer Risk Associated With Intraoperative Computed Tomography for Lumbar Spine Surgery. Spine (Phila Pa 1976) 2023; 48:893-900. [PMID: 37040462 DOI: 10.1097/brs.0000000000004685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/03/2023] [Indexed: 04/13/2023]
Abstract
STUDY DESIGN Retrospective cross-sectional study. OBJECTIVE (1) To determine the incremental increase in intraoperative ionizing radiation conferred by computed tomography (CT) as compared with conventional radiography; and (2) to model different lifetime cancer risks contextualized by the intersection between age, sex, and intraoperative imaging modality. SUMMARY OF BACKGROUND DATA Emerging technologies in spine surgery, like navigation, automation, and augmented reality, commonly utilize intraoperative CT. Although much has been written about the benefits of such imaging modalities, the inherent risk profile of increasing intraoperative CT has not been well evaluated. MATERIALS AND METHODS Effective doses of intraoperative ionizing radiation were extracted from 610 adult patients who underwent single-level instrumented fusion for lumbar degenerative or isthmic spondylolisthesis from January 2015 through January 2022. Patients were divided into those who received intraoperative CT (n=138) and those who underwent conventional intraoperative radiography (n=472). Generalized linear modeling was utilized with intraoperative CT use as a primary predictor and patient demographics, disease characteristics, and preference-sensitive intraoperative considerations ( e.g. surgical approach and surgical invasiveness) as covariates. The adjusted risk difference in radiation dose calculated from our regression analysis was used to prognosticate the associated cancer risk across age and sex strata. RESULTS (1) After adjusting for covariates, intraoperative CT was associated with 7.6 mSv (interquartile range: 6.8-8.4 mSv; P <0.001) more radiation than conventional radiography. (2) For the median patient in our population (a 62-year-old female), intraoperative CT use increased lifetime cancer risk by 2.3 incidents (interquartile range: 2.1-2.6) per 10,000. Similar projections for other age and sex strata were also appreciated. CONCLUSIONS Intraoperative CT use significantly increases cancer risk compared with conventional intraoperative radiography for patients undergoing lumbar spinal fusions. As emerging technologies in spine surgery continue to proliferate and leverage intraoperative CT for cross-sectional imaging data, strategies must be developed by surgeons, institutions, and medical technology companies to mitigate long-term cancer risks.
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Affiliation(s)
- Alexander M Crawford
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Brendan M Striano
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Carew C Giberson-Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Grace X Xiong
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Harry M Lightsey
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Andrew J Schoenfeld
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | - Andrew K Simpson
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
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La Rocca G, Mazzucchi E, Pignotti F, Nasto LA, Galieri G, Rinaldi P, De Santis V, Pola E, Sabatino G. Navigated, percutaneous, three-step technique for lumbar and sacral screw placement: a novel, minimally invasive, and maximally safe strategy. J Orthop Traumatol 2023; 24:32. [PMID: 37386233 DOI: 10.1186/s10195-023-00696-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 04/02/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Minimally invasive spine surgery is a field of active and intense research. Image-guided percutaneous pedicle screw (PPS) placement is a valid alternative to the standard free-hand technique, thanks to technological advancements that provide potential improvement in accuracy and safety. Herein, we describe the clinical results of a surgical technique exploiting integration of neuronavigation and intraoperative neurophysiological monitoring (IONM) for minimally invasive PPS. MATERIALS AND METHODS An intraoperative-computed tomography (CT)-based neuronavigation system was combined with IONM in a three-step technique for PPS. Clinical and radiological data were collected to evaluate the safety and efficacy of the procedure. The accuracy of PPS placement was classified according to the Gertzbein-Robbins scale. RESULTS A total of 230 screws were placed in 49 patients. Only two screws were misplaced (0.8%); nevertheless, no clinical sign of radiculopathy was experienced by these patients. The majority of the screws (221, 96.1%) were classified as grade A according to Gertzbein-Robbins scale, seven screws were classified as grade B, one screw was classified as grade D, and one last screw was classified as grade E. CONCLUSIONS The proposed three-step, navigated, percutaneous procedure offers a safe and accurate alternative to traditional techniques for lumbar and sacral pedicle screw placement. Level of Evidence Level 3. Trial registration Not applicable.
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Affiliation(s)
- Giuseppe La Rocca
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Rome School of Medicine, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Edoardo Mazzucchi
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Rome School of Medicine, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Fabrizio Pignotti
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Rome School of Medicine, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Luigi Aurelio Nasto
- Department of Orthopaedics and Spine Surgery, Azienda Ospedaliera Universitaria "Luigi Vanvitelli", Università Della Campania Luigi Vanvitelli, Via De Crecchio 4, 80138, Naples, Italy
| | - Gianluca Galieri
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Rome School of Medicine, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | | | | | - Enrico Pola
- Department of Orthopaedics and Spine Surgery, Azienda Ospedaliera Universitaria "Luigi Vanvitelli", Università Della Campania Luigi Vanvitelli, Via De Crecchio 4, 80138, Naples, Italy.
| | - Giovanni Sabatino
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Rome School of Medicine, Rome, Italy
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
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Montgomery CT, Blue R, Spadola M, Ajmera S, Jabarkheel R, Schuster J. Navigated lumbar drain placement: A description of technique and case example. Surg Neurol Int 2023; 14:116. [PMID: 37151471 PMCID: PMC10159304 DOI: 10.25259/sni_100_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
Background:
Lumbar drain (LD) placement can be a difficult procedure leading to postprocedure complications, particularly in patients with persistent cerebrospinal fluid leaks or a large body habitus. The objective of this technical case report is to describe the use of Medtronic’s SureTrak Navigation system for navigated LD placement.
Case Description:
The patient was an 18-year-old morbidly obese male who initially underwent a suboccipital craniectomy with duraplasty and a C1 laminectomy for Chiari Malformation. Postoperatively, he developed a pseudomeningocele and was taken to the operating room for wound revision, duraplasty repair, and LD placement. Medtronic’s SureTrak Navigation system was used for LD placement before wound revision. Successful LD placement was achieved in a single pass using the SureTrak Navigation. The patient did well postoperatively, and LD removal occurred on postoperative day 6. The patient was discharged in good condition without evidence of a cerebral spinal fluid leak.
Conclusion:
Navigation using the SureTrak system is a reasonable option to use in patients with a high body mass index and a persistent cerebrospinal fluid leak. When the patient is already undergoing an operative procedure, it can aid in an efficient low-risk intervention completed in a single prone positioning.
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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.
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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
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Nie JZ, Weber MW, Revelt NJ, Nordmann NJ, Watson VL, Nie JW, Menezes SA, Delfino K, Cozzens JW, Espinosa JA, Amin D, Acakpo-Satchivi L. Comparison of Using Intraoperative Computed Tomography-Based 3-Dimensional Navigation and Fluoroscopy in Anterior Cervical Diskectomy and Fusion for Cervical Spondylosis. World Neurosurg 2022; 161:e740-e747. [PMID: 35231621 DOI: 10.1016/j.wneu.2022.02.089] [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: 12/29/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Anterior cervical diskectomy and fusion (ACDF) is a highly successful procedure to treat spinal cord or nerve root compression; however, complications can still occur. With advancements in imaging, 3-dimensional (3D) reconstruction allows real-time instrument tracking in a surgical field relative to the patient's anatomy. Here, we compare plate positioning and short-term outcomes when using 3D navigation to fluoroscopy in ACDF for degenerative spine disease. METHODS All ACDFs for cervical spondylosis performed by 6 surgeons at a single center between 2010 and 2018 were included. ACDFs were divided into those performed using 3D navigation or fluoroscopy. Records were assessed for patient demographics, American Society of Anesthesiology score, number of operated interspaces, operative time, length of stay, perioperative complications, and 90-day readmissions. Postoperative images were reviewed for lateral and angular plate deviations. RESULTS A total of 193 ACDFs performed with 3D navigation and 728 performed with fluoroscopy were included. After controlling for demographics and surgical characteristics, using 3D navigation was associated with less lateral plate deviation (P = 0.048) and longer operative times per interspace (P < 0.001) but was not associated with angular plate deviation (P = 0.724), length of stay (P = 0.393), perioperative complications (P = 0.844), and 90-day readmissions (P = 0.539). CONCLUSIONS Using 3D navigation in ACDF for degenerative disease is associated with slightly more midline plate positioning and comparable short-term outcomes as using fluoroscopy and can be a suitable alternative. Advantages of using this technology, such as improved visualization of anatomy, should be weighed against disadvantages, such as increased operative time, on a per-patient basis.
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Affiliation(s)
- Jeffrey Z Nie
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA.
| | - Matthew W Weber
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Nicolas J Revelt
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Nathan J Nordmann
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Victoria L Watson
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - James W Nie
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA; University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Stephanie A Menezes
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Kristin Delfino
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Jeffrey W Cozzens
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Jose A Espinosa
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Devin Amin
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Leslie Acakpo-Satchivi
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA; Neurological Surgery, Springfield Clinic, Springfield, Illinois, USA
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Driver J, Dorman JK, Chi JH. A Novel Mobile Device-Based Navigation System for Placement of Posterior Spinal Fixation. Oper Neurosurg (Hagerstown) 2022; 22:249-254. [DOI: 10.1227/ons.0000000000000116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
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Campbell DH, McDonald D, Araghi K, Araghi T, Chutkan N, Araghi A. The Clinical Impact of Image Guidance and Robotics in Spinal Surgery: A Review of Safety, Accuracy, Efficiency, and Complication Reduction. Int J Spine Surg 2021; 15:S10-S20. [PMID: 34607916 DOI: 10.14444/8136] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Image guidance (IG) and robotic-assisted (RA) surgery are modern technological advancements that have provided novel ways to perform precise and accurate spinal surgery. These innovations supply real-time, three-dimensional imaging information to aid in instrumentation, decompression, and implant placement. Although nothing can replace the knowledge and expertise of an experienced spine surgeon, these platforms do have the potential to supplement the individual surgeon's capabilities. Specific advantages include more precise pedicle screw placement, minimally invasive surgery with less reliance on intraoperative fluoroscopy, and lower radiation exposure to the surgeon and staff. As these technologies have become more widely adopted over the years, novel uses such as tumor resection have been explored. Disadvantages include the cost of implementing IG and robotics platforms, the initial learning curve for both the surgeon and the staff, and increased patient radiation exposure in scoliosis surgery. Also, given the relatively recent transition of many procedures from inpatient settings to ambulatory surgery centers, access to current devices may be cost prohibitive and not as readily available at some centers. Regarding patient-related outcomes, much further research is warranted. The short-term benefits of minimally invasive surgery often bolster the perioperative and early postoperative outcomes in many retrospective studies on IG and RA surgery. Randomized controlled trials limiting such confounding factors are warranted to definitively show potential independent improvements in patient-related outcomes specifically attributable to IG and RA alone. Nonetheless, irrespective of these current unknowns, it is clear that these technologies have changed the field and the practice of spine surgery. Surgeons should be familiar with the potential benefits and tradeoffs of these platforms when considering adopting IG and robotics in their practices.
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Affiliation(s)
- David H Campbell
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | - Donnell McDonald
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | | | | | - Norman Chutkan
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona.,The CORE Institute, Phoenix, Arizona
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Bovonratwet P, Gu A, Chen AZ, Samuel AM, Vaishnav AS, Sheha ED, Gang CH, Qureshi SA. Computer-Assisted Navigation Is Associated With Decreased Rates of Hardware-Related Revision After Instrumented Posterior Lumbar Fusion. Global Spine J 2021; 13:1104-1111. [PMID: 34159837 DOI: 10.1177/21925682211019696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To (1) define utilization trends for navigated instrumented posterior lumbar fusion (PLF), (2) compare reasons and rates of revision at 30-day, 60-day, 90-day, and 1-year follow-up, and (3) compare 90-day perioperative complications between navigated versus conventional instrumented PLF. METHODS Patients who underwent navigated or conventional instrumented PLF were identified from the Humana insurance database using the PearlDiver Patient Records between 2007-2017. Usage of navigation was characterized. Patient demographics and operative characteristics (number of levels fused, interbody usage) were compared between the 2 treatment groups. Propensity score matching was done and comparisons were made for revision rates at different follow-up periods (categorized by reasons) and other 90-day perioperative complications. RESULTS This study included 1,648 navigated and 23 429 conventional instrumented PLF. Navigated cases increased over the years studied to approximately 10% in 2017. Statistical analysis after propensity score matching revealed significantly lower rates of hardware-related revision at 90-day follow-up in the navigated cohort (0.49% versus 1.15%, P = .033). At 1-year follow-up, the navigated cohort continued to have significantly lower rates of hardware-related revision (1.70% versus 2.73%, P = .044) as well as all cause revision (2.67% versus 4.00%, P = .032). There were no statistical differences between the 2 cohorts in any of the 90-day perioperative complications studied, such as cellulitis and blood transfusion (P > .05 for all). CONCLUSIONS These findings suggest that navigation is associated with reductions in hardware-related revisions after instrumented PLF. However, these results should be interpreted cautiously in the setting of potential confounding by other unmeasured variables.
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Affiliation(s)
- Patawut Bovonratwet
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Alex Gu
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Aaron Z Chen
- Weill Cornell Medical College, New York, NY, USA
| | - Andre M Samuel
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Avani S Vaishnav
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Evan D Sheha
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Catherine H Gang
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Rousseau J, Dreuil S, Bassinet C, Cao S, Elleaume H. Surgivisio® and O-arm®O2 cone beam CT mobile systems for guidance of lumbar spine surgery: Comparison of patient radiation dose. Phys Med 2021; 85:192-199. [PMID: 34111631 DOI: 10.1016/j.ejmp.2021.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To compare patient radiation doses in cone beam computed tomography (CBCT) of two mobile systems used for navigation-assisted mini-invasive orthopedic surgery: O-arm®O2 and Surgivisio®. METHODS The study focused on imaging of the spine. Thermoluminescent dosimeters were used to measure organs and effective doses (ED) during CBCT. An ionization-chamber and a solid-state sensor were used to measure the incident air-kerma (Ki) at the center of the CBCT field-of-view and Ki during 2D-imaging, respectively. The PCXMC software was used to calculate patient ED in 2D and CBCT configurations. The image quality in CBCT was evaluated with the CATPHAN phantom. RESULTS The experimental ED estimate for the low-dose 3D-modes was 2.41 and 0.35 mSv with O-arm®O2 (Low Dose 3D-small-abdomen) and Surgivisio® (3DSU-91 images), respectively. PCXMC results were consistent: 1.54 and 0.30 mSv. Organ doses were 5 to 12 times lower with Surgivisio®. Ki at patient skin were comparable on lateral 2D-imaging (0.5 mGy), but lower with O-arm®O2 on anteroposterior (0.3 versus 0.9 mGy). Both systems show poor low contrast resolution and similar high contrast spatial resolution (7 line-pairs/cm). CONCLUSIONS This study is the first to evaluate patient ED and organ doses with Surgivisio®. A significant difference in organs doses was observed between the CBCT systems. The study demonstrates that Surgivisio® used on spine delivers approximately five to six times less patient ED, compared to O-arm®O2, in low dose 3D-modes. Doses in 2D-mode preceding CBCT were higher with Surgivisio®, but negligible compared to CBCT doses under the experimental conditions tested.
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Affiliation(s)
- Julia Rousseau
- Pôle Imagerie, CHU Grenoble Alpes, Avenue Maquis du Grésivaudan, 38700 La Tronche, France.
| | - Serge Dreuil
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), 31 Avenue de la Division Leclerc, 92260 Fontenay-aux-Roses, France.
| | - Céline Bassinet
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), 31 Avenue de la Division Leclerc, 92260 Fontenay-aux-Roses, France.
| | - Sophie Cao
- Pôle Coordination des Gestes Chirurgicaux et Interventionnels, CHU Grenoble Alpes, Avenue Maquis du Grésivaudan, 38700 La Tronche, France.
| | - Hélène Elleaume
- INSERM UA07 Team STROBE, ESRF 71 Avenue des Martyrs, 38000 Grenoble, France.
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Fujiwara Y, Tan Y, Kadiri V, Uotani K, Yamauchi T, Tanaka M. Intraoperative O-arm navigation guided anterior cervical corpectomy and fusion with minimally invasive cervical pedicle screw fixation (MICEPS) for severe ossification of the cervical posterior longitudinal ligament (OPLL): A technical note. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Peltonen JI, Kaasalainen T, Kortesniemi M. Metal artifacts in intraoperative O-arm CBCT scans. BMC Med Imaging 2021; 21:2. [PMID: 33407232 PMCID: PMC7789607 DOI: 10.1186/s12880-020-00538-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/14/2020] [Indexed: 08/23/2023] Open
Abstract
Background Cone-beam computed tomography (CBCT) has become an increasingly important medical imaging modality in orthopedic operating rooms. Metal implants and related image artifacts create challenges for image quality optimization in CBCT. The purpose of this study was to develop a robust and quantitative method for the comprehensive determination of metal artifacts in novel CBCT applications. Methods The image quality of an O-arm CBCT device was assessed with an anthropomorphic pelvis phantom in the presence of metal implants. Three different kilovoltage and two different exposure settings were used to scan the phantom both with and without the presence of metal rods. Results The amount of metal artifact was related to the applied CBCT imaging protocol parameters. The size of the artifact was moderate with all imaging settings. The highest applied kilovoltage and exposure level distinctly increased artifact severity. Conclusions The developed method offers a practical and robust way to quantify metal artifacts in CBCT. Changes in imaging parameters may have nonlinear effects on image quality which are not anticipated based on physics.
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Affiliation(s)
- Juha I Peltonen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029, Helsinki, Finland.
| | - Touko Kaasalainen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029, Helsinki, Finland
| | - Mika Kortesniemi
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029, Helsinki, Finland
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Boddapati V, Lombardi JM, Urakawa H, Lehman RA. Intraoperative image guidance for the surgical treatment of adult spinal deformity. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:91. [PMID: 33553384 PMCID: PMC7859785 DOI: 10.21037/atm-20-2765] [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] [Received: 03/23/2020] [Accepted: 06/11/2020] [Indexed: 01/02/2023]
Abstract
Operative management of adult spinal deformity (ASD) has been increasing in recent years secondary to an aging society. The advance of intraoperative image guidance, such as the development of navigation and robotics systems has contributed to the growth and safety of ASD surgery. Currently, intraoperative image guidance is mainly used for pedicle screw placement and the evaluation of alignment correction in ASD surgery. Though it is expected that the use of navigation and robotics would result in increasing pedicle screw accuracy as reported in other spine surgeries, there are no well-powered studies specifically focusing on ASD surgery. Currently, deformity correction relies heavily on preoperative planning, however, a few studies have shown the possibility that intraoperative image modalities may accurately predict postoperative spinopelvic parameters. Future developments of intraoperative image guidance are needed to overcome the remaining challenges in ASD surgery such as radiation exposure to patient and surgeon. More novel imaging modalities may result in evolution in ASD surgery. Overall there is a paucity of literature focusing on intraoperative image guidance in ASD surgery, therefore, further studies are warranted to assess the efficacy of intraoperative image guidance in ASD surgery. This narrative review sought to provide the current role and future perspectives of intraoperative image guidance focusing on ASD surgery.
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Affiliation(s)
- Venkat Boddapati
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph M. Lombardi
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | | | - Ronald A. Lehman
- The Spine Hospital, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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Luan FJ, Zhang J, Mak KC, Liu ZH, Wang HQ. Low Radiation X-rays: Benefiting People Globally by Reducing Cancer Risks. Int J Med Sci 2021; 18:73-80. [PMID: 33390775 PMCID: PMC7738971 DOI: 10.7150/ijms.48050] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/13/2020] [Indexed: 12/29/2022] Open
Abstract
Modern medical imaging facilitates the diagnosis and treatment of human diseases. However, few people are aware of the cons of radiation exposure from medical imaging. Emerging evidence reveals that cumulative doses of radiation exposure will increase the morbidity and mortality of pertaining cancer. As a special young population, patients with adolescent idiopathic scoliosis (AIS) suffer more radiation harms from repeated diagnostic imaging, most of which can be avoided in clinical practice. Accumulating evidence highlights reduced cancer risks of radiation exposure for AIS patients with low/zero radiation imaging modalities proposed, amongst which easy conversion from anterior-posterior (AP) to posterior-anterior (PA) projection for whole-spine radiographs should be stressed. It can greatly reduce radiation doses without compromising the quality of diagnostic imaging. Tight collimation combined with PA projection can further reduce radiation harms, and need to be spread to benefit people globally.
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Affiliation(s)
- Fu-Jun Luan
- Department of Orthopaedics, Yongchuan Hospital of Chongqing Medical University, Chongqing City, P. R. China, 402160
| | - Jun Zhang
- Department of Orthopaedics, Baoji Municipal Central Hospital, Baoji, Shaanxi, China, 721008
| | - Kin-Cheung Mak
- Spine Central, Specialist Central, The Hong Kong Adventist Hospital, Hong Kong SAR, China
| | - Zhi-Heng Liu
- Department of Orthopaedics, Chinese PLA No.986 Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, P. R. China, 710054
| | - Hai-Qiang Wang
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, P. R. China, 712046
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Jamshidi AM, Massel DH, Liounakos JI, Silman Z, Good CR, Schroerlucke SR, Cannestra A, Hsu V, Lim J, Zahrawi F, Ramirez PM, Sweeney TM, Wang MY. Fluoroscopy time analysis of a prospective, multi-centre study comparing robotic- and fluoroscopic-guided placement of percutaneous pedicle screw instrumentation for short segment minimally invasive lumbar fusion surgery. Int J Med Robot 2020; 17:e2188. [PMID: 33217131 DOI: 10.1002/rcs.2188] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/20/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND As minimally invasive spine surgery becomes more widespread, concerns regarding radiation exposure to surgeons and patients alike have become a growing concern. Robotic guidance has been developed as a way to increase the accuracy of instrumentation while decreasing radiation burden. METHODS A retrospective analysis of a large, multi-centre, prospective study comparing robotic-guided (RG) to fluoroscopic-guided (FG) (Multi-centre, Partially Randomized, Controlled Trial of MIS Robotic vs. Freehand in Short Adult Degenerative Spinal Fusion Surgeries) was performed to evaluate for differences in radiation exposure between study groups. RESULTS RG was associated with 78.3% (p < 0.001) and 79.8% (p < 0.001) reduction in total and per screw fluoroscopy times, respectively, as compared to FG. RG was also associated with a 50.8% (p < 0.001) reduction in total operative fluoroscopy time. CONCLUSIONS RG was associated with significantly lower fluoroscopy times compared to FG. This suggests that utilization of robotic navigation systems may result in decreased operative radiation exposure, which is a growing concern for surgeons performing minimally invasive spine surgery.
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Affiliation(s)
- Aria M Jamshidi
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
| | - Dustin H Massel
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA.,Department of Orthopedic Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
| | - Jason I Liounakos
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
| | - Zmira Silman
- Israel Academic College, Tel Aviv University, Ramat Gan, Israel
| | | | | | | | - Victor Hsu
- Rothman Institute, Willow Grove, Pennsylvania, USA
| | - Jae Lim
- Atlantic Brain & Spine, Reston, Viginia, USA
| | - Faissal Zahrawi
- AdventHealth Neuroscience Institute, Celebration, Florida, USA
| | | | | | - Michael Y Wang
- Department of Neurological Surgery, University of Miami-Miller School of Medicine, Miami, Florida, USA
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Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVE Examine patients' and physicians' estimates of radiation exposure related to spine surgery. SUMMARY OF BACKGROUND DATA Patients are commonly exposed to radiation when undergoing spine surgery. Previous studies suggest that patients and physicians have limited knowledge about radiation exposure in the outpatient setting. This has not been assessed for intraoperative imaging. METHODS A questionnaire was developed to assess awareness/knowledge of radiation exposure in outpatient and intraoperative spine care settings. Patients and surgeons estimated chest radiograph (CXR) equivalent radiation from: cervical and lumbar radiographs (anterior-posterior [AP] and lateral), computed tomography (CT), magnetic resonance imaging (MRI), intraoperative fluoroscopy, and intraoperative CT (O-arm). Results were compared to literature-reported radiation doses. RESULTS Overall, 100 patients and 26 providers completed the survey. Only 31% of patients were informed about outpatient radiation exposure, and only 23% of those who had undergone spine surgery had been informed about intraoperative radiation exposure. For lumbar radiographs, patients and surgeons underestimated CXR-equivalent radiation exposures: AP by five-fold (P < 0.0001) and seven-fold (P < 0.0001), respectively, and lateral by three-fold (P < 0.0001) and four-fold (P = 0.0002), respectively. For cervical CT imaging, patients and surgeons underestimated radiation exposure by 18-fold (P < 0.0001) and two-fold (P = 0.0339), respectively. For lumbar CT imaging, patients and surgeons underestimated radiation exposure by 31-fold (P < 0.0001) and three-fold (P = 0.0001), respectively. For intraoperative specific cervical and lumbar imaging, patients underestimated radiation exposure for O-arm by 11-fold (P < 0.0001) and 22-fold (P = 0.0002), respectively. Surgeons underestimated radiation exposure of lumbar O-arm by three-fold (P = 0.0227). CONCLUSION This study evaluated patient and physician knowledge of radiation exposure related to spine procedures. Underestimation of radiation exposure in the outpatient setting was consistent with prior study findings. The significant underestimation of intraoperative cross-sectional imaging (O-arm) is notable and needs attention in the era of increased use of such technology for imaging, navigation, and robotic spine surgery. LEVEL OF EVIDENCE 4.
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Strong MJ, Yee TJ, Khalsa SSS, Saadeh YS, Swong KN, Kashlan ON, Szerlip NJ, Park P, Oppenlander ME. The feasibility of computer-assisted 3D navigation in multiple-level lateral lumbar interbody fusion in combination with posterior instrumentation for adult spinal deformity. Neurosurg Focus 2020; 49:E4. [DOI: 10.3171/2020.5.focus20353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/26/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe lateral lumbar interbody fusion (LLIF) technique is used to treat many common spinal degenerative pathologies including kyphoscoliosis. The use of spinal navigation for LLIF has not been broadly adopted, especially in adult spinal deformity. The purpose of this study was to evaluate the feasibility as well as the intraoperative and navigation-related complications of computer-assisted 3D navigation (CaN) during multiple-level LLIF for spinal deformity.METHODSRetrospective analysis of clinical and operative characteristics was performed for all patients > 18 years of age who underwent multiple-level CaN LLIF combined with posterior instrumentation for adult spinal deformity at the University of Michigan between 2014 and 2020. Intraoperative CaN-related complications, LLIF approach–related postoperative complications, and medical postoperative complications were assessed.RESULTSFifty-nine patients were identified. The mean age was 66.3 years (range 42–83 years) and body mass index was 27.6 kg/m2 (range 18–43 kg/m2). The average coronal Cobb angle was 26.8° (range 3.6°–67.0°) and sagittal vertical axis was 6.3 cm (range −2.3 to 14.7 cm). The average number of LLIF and posterior instrumentation levels were 2.97 cages (range 2–5 cages) and 5.78 levels (range 3–14 levels), respectively. A total of 6 intraoperative complications related to the LLIF stage occurred in 5 patients. Three of these were CaN-related and occurred in 2 patients (3.4%), including 1 misplaced lateral interbody cage (0.6% of 175 total lateral cages placed) requiring intraoperative revision. No patient required a return to the operating room for a misplaced interbody cage. A total of 12 intraoperative complications related to the posterior stage occurred in 11 patients, with 5 being CaN-related and occurring in 4 patients (6.8%). Univariate and multivariate analyses revealed no statistically significant risk factors for intraoperative and CaN-related complications. Transient hip weakness and numbness were found to be in 20.3% and 22.0% of patients, respectively. At the 1-month follow-up, weakness was observed in 3.4% and numbness in 11.9% of patients.CONCLUSIONSUse of CaN in multiple-level LLIF in the treatment of adult spinal deformity appears to be a safe and effective technique. The incidence of approach-related complications with CaN was 3.4% and cage placement accuracy was high.
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Retrospective Review of Revision Surgery After Image-guided Instrumented Spinal Surgery Compared With Traditional Instrumented Spinal Surgery. Clin Spine Surg 2020; 33:E317-E321. [PMID: 32049676 DOI: 10.1097/bsd.0000000000000949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
STUDY DESIGN Retrospective cohort series. OBJECTIVE The objective of this study was to determine if the use of image-guided navigation offers a clinically significant advantage over fluoroscopy-assisted pedicle screw and non-navigated screw placement in reducing the risk of revision surgery for malpositioned screws in instrumented spinal surgery. SUMMARY OF BACKGROUND DATA Use image-guided navigation has become increasingly commonplace in instrumented spine surgery, but there is a lack of information regarding differences in the rates of clinically relevant screw malposition with image-guided compared with non-navigated screw placement. MATERIALS AND METHODS This is a retrospective cohort series of consecutive patients who underwent instrumented spinal surgery by the senior authors at 2 academic tertiary care centers in New York. RESULTS A total of 663 instrumented spinal surgeries were analyzed, including 271 instances with image-guided navigation. For the image-guided navigation cohort, 110 of the patients underwent screw placement using O-Arm image-guidance, yielding data on 1115 screws. The remaining 161 surgeries utilizing image-guided screw placement were performed using Brainlab Spine Navigation, for a total of 1001 screws. A fluoroscopy-assisted technique or freehand technique was used in 419 instances, with a total of 3689 screws. Of the non-navigated cohort, 10 patients required a surgical revision of screw placement, for a total of 15 malpositioned screws. Amongst the image-guided navigation cohort, 1 patient in the O-Arm group and 2 in the Brainlab group required revision surgery, with 3 malpositioned screws in total. The rate of revision surgery for a malpositioned screw placed via non-navigated techniques was 2.39%. This risk was decreased to 1.11% with the use of the intraoperative image-guided navigation. However, no comparisons between non-navigated and image-guided screw placement reached statistical significance. CONCLUSION Although not reaching statistical significance, these data suggest there may be an advantage offered by image-guided screw placement in instrumented spinal surgery.
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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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Chang CC, Chang HK, Wu JC, Tu TH, Cheng H, Huang WC. Comparison of Radiation Exposure Between O-Arm Navigated and C-Arm Guided Screw Placement in Minimally Invasive Transforaminal Lumbar Interbody Fusion. World Neurosurg 2020; 139:e489-e495. [DOI: 10.1016/j.wneu.2020.04.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/29/2022]
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Wang TY, Hamouda F, Mehta VA, Sankey EW, Yarbrough C, Lark R, Abd-El-Barr MM. Effect of Instrument Navigation on C-arm Radiation and Time during Spinal Procedures: A Clinical Evaluation. Int J Spine Surg 2020; 14:375-381. [PMID: 32699760 DOI: 10.14444/7049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction As minimally invasive spine surgery gains popularity, a focused effort must be made to reduce intraoperative radiation exposure to levels as low as reasonably achievable. Here, we demonstrate the clinical efficacy of a novel technology to aid in instrument navigation that aims to reduce intraoperative radiation exposure, number of fluoroscopic images, and time required to perform the most radiation intensive portions of a multitude of spinal procedures. Methods An internally randomized controlled study was performed over a 1-month period in order to clinically evaluate the effect of the C-arm assisted instrument tracking system, TrackX, on surgeon workflow, time, and radiation emitted. Three surgeons performed multiple spinal procedures on a total of 10 study patients and an additional 3 control patients. The surgeries encompassed minimally invasive spinal techniques and spanned extreme lateral interbody fusion, oblique lumbar interbody fusion, transforaminal lumbar interbody fusion along with percutaneous iliac screw placement, hardware removal, and kyphoplasty. The tasks studied included skin marking, first dilator insertion, localization for hardware placement and hardware removal. Results Overall radiation reduction was 83% (P < .0001). Overall reduction in x-rays taken was 78% (P < .0001). Overall time reduction was 81% (P = .0003). Statistical significance held for each surgeon studied and for nearly every procedure type. In these 10 study procedures, over 2 hours of overall operating room time was saved, all while requiring negligible set up time and no system calibration or supplementary x-rays to be taken. There were no adverse outcomes for any study patient, and there was no case where TrackX was not able to successfully complete a given portion of a procedure. Conclusions TrackX instrument navigation is a clinically efficacious and accurate instrument tracking modality. This is the first instrument navigational technology that reduces radiation exposure and images required to complete a procedure while decreasing operative time. TrackX thus allows increased surgical efficiency while increasing operative efficiency and improving intraoperative safety. Level of Evidence 2.
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Affiliation(s)
- Timothy Y Wang
- Duke University Medical Center, Department of Neurological Surgery, Durham, North Carolina
| | | | - Vikram A Mehta
- Duke University Medical Center, Department of Neurological Surgery, Durham, North Carolina
| | - Eric W Sankey
- Duke University Medical Center, Department of Neurological Surgery, Durham, North Carolina
| | - Chester Yarbrough
- Duke University Medical Center, Department of Neurological Surgery, Durham, North Carolina
| | - Robert Lark
- Duke University Medical Center, Department of Neurological Surgery, Durham, North Carolina
| | - Muhammad M Abd-El-Barr
- Duke University Medical Center, Department of Neurological Surgery, Durham, North Carolina
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Koch C, Pauwels F, Schweizer‐Gorgas D. Technical set‐up and case illustrations of orthopaedic cone beam computed tomography in the standing horse. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- C. Koch
- Department of Clinical Veterinary Medicine Vetsuisse Faculty Swiss Institute of Equine Medicine (ISME) Agroscope University of Bern Bern Switzerland
| | - F. Pauwels
- Division of Clinical Radiology, Vetsuisse Faculty University of Bern Bern Switzerland
| | - D. Schweizer‐Gorgas
- Division of Clinical Radiology, Vetsuisse Faculty University of Bern Bern Switzerland
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Kochanski RB, Lombardi JM, Laratta JL, Lehman RA, O'Toole JE. Image-Guided Navigation and Robotics in Spine Surgery. Neurosurgery 2020; 84:1179-1189. [PMID: 30615160 DOI: 10.1093/neuros/nyy630] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/04/2018] [Indexed: 01/27/2023] Open
Abstract
Image guidance (IG) and robotics systems are becoming more widespread in their utilization and can be invaluable intraoperative adjuncts during spine surgery. Both are highly reliant upon stereotaxy and either pre- or intraoperative radiographic imaging. While user-operated IG systems have been commercially available longer and subsequently are more widely utilized across centers, robotics systems provide unique theoretical advantages over freehand and IG techniques for placing instrumentation within the spine. While there is a growing plethora of data showing that IG and robotic systems decrease the incidence of malpositioned screws, less is known about their impact on clinical outcomes. Both robotics and IG may be of particular value in cases of substantial deformity or complex anatomy. Indications for the use of these systems continue to expand with an increasing body of literature justifying their use in not only guiding thoracolumbar pedicle screw placement, but also in cases of cervical and pelvic instrumentation as well as spinal tumor resection. Both techniques also offer the potential benefit of reducing occupational exposures to ionizing radiation for the operating room staff, the surgeon, and the patient. As the use of IG and robotics in spine surgery continues to expand, these systems' value in improving surgical accuracy and clinical outcomes must be weighed against concerns over cost and workflow. As newer systems incorporating both real-time IG and robotics become more utilized, further research is necessary to better elucidate situations where these systems may be particularly beneficial in spine surgery.
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Affiliation(s)
- Ryan B Kochanski
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Joseph M Lombardi
- Department of Orthopedic Surgery, Columbia University, New York, New York
| | - Joseph L Laratta
- Department of Orthopedic Surgery, Columbia University, New York, New York
| | - Ronald A Lehman
- Department of Orthopedic Surgery, Columbia University, New York, New York
| | - John E O'Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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Abstract
INTRODUCTION Traditionally, fluoroscopy and postoperative computed tomographic (CT) scans are used to evaluate screw position after pediatric cervical spine fusion. However, noncontained screws detected postoperatively can require revision surgery. Intraoperative O-arm is a 3-dimensional CT imaging technique, which allows intraoperative evaluation of screw position and potentially avoids reoperations because of implant malposition. This study's objective was to evaluate the use of intraoperative O-arm in determining the accuracy of cervical implants placed by a free-hand technique using anatomic landmarks or fluoroscopic guidance in pediatric cervical spine instrumentation. METHODS A single-center retrospective study of consecutive examinations of children treated with cervical spine instrumentation and intraoperative O-arm from 2014 to 2018 was performed. In total, 44 cases (41 children, 44% men) with a mean age of 11.9 years (range, 2.1 to 23.5 y) were identified. Instability (n=16, 36%) and deformity (n=10, 23%) were the most frequent indications. Primary outcomes were screw revision rate, neurovascular complications caused by noncontained screws, and radiation exposure. RESULTS A total of 272 screws were inserted (60 occipital and 212 cervical screws). All screws were evaluated on fluoroscopy as appropriately placed. Four screws (1.5%) in 4 cases (9%) were noncontained on O-arm imaging and required intraoperative revision. A mean of 7.7 levels (range, 5 to 13) were scanned. The mean CT dose index and dose-length product were 15.2±6.87 mGy and 212.3±120.48 mGy×cm. Mean effective dose was 1.57±0.818 mSv. There was no association between screw location and noncontainment (P=0.129). No vertebral artery injuries, dural injuries, or neurologic deficits were related to the 4 revised screws. CONCLUSIONS Intraoperative non-navigated O-arm is a safe and efficient method to evaluate screw position in pediatric patients undergoing cervical spine instrumentation. Noncontained screws were detected in 9% of cases (n=4). O-arm delivers low radiation doses, allows for intraoperative screw revision, and negates the need for postoperative CT scans after confirmation of optimal implant position. LEVEL OF EVIDENCE Level IV.
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Tonetti J, Boudissa M, Kerschbaumer G, Seurat O. Role of 3D intraoperative imaging in orthopedic and trauma surgery. Orthop Traumatol Surg Res 2020; 106:S19-S25. [PMID: 31734181 DOI: 10.1016/j.otsr.2019.05.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/03/2019] [Accepted: 05/09/2019] [Indexed: 02/02/2023]
Abstract
Intraoperative three-dimensional (3D) imaging is now feasible because of recent technological advances such as 3D cone-beam CT (CBCT) and flat-panel X-ray detectors (FPDs). These technologies reduce the radiation dose to the patient and surgical team. The aim of this study is to review the advantages of 3D intraoperative imaging in orthopedic and trauma surgery by answering the following 5 questions: What are its technical principles? CBCT with a FPD produces non-distorted digital images and frees up the surgical field. The high quality of these 3D intraoperative images allows them to be integrated into surgical navigation systems. Human-robot comanipulation will likely follow soon after. Conventional multislice CT technology has also improved to the point where it can be used in the operating room. What can we expect from 3D intraoperative imaging and which applications have been validated clinically? We reviewed the literature on this topic for the past 10 years. The expected benefits were determined during the implantation of pedicular screws: more accurate implantation, fewer surgical revisions and time savings. There are few studies in trauma or arthroplasty cases, as robotic comanipulation is a more recent development. What is the tolerance for irradiation to the patient and surgical team? The health drawbacks are the harmful radiation-induced effects. The deterministic effects that we will develop are correlated to the absorbed dose in Gray units (Gy). The stochastic and carcinogenic effects are related to the effective dose in milliSievert (mSv) of linear evolution without threshold. The International Commission on Radiological Protection (ICRP) states that irradiation for medical purposes with risk of detriment is acceptable if it is justified by an optimization attempt. The radioprotection limits must be known but do not constitute opposable restrictions. The superiority of intraoperative 3D imaging over fluoroscopy has been demonstrated for spine surgery and sacroiliac screw fixation. How does the environment need to be adapted? The volume, access, wall protection and floor strength of the operating room must take into account the features of each machine. The instrumentation implants and need for specialized staff result in additional costs. Not every system can track movements during the CBCT acquisition thus transient suspension of assisted ventilation may be required. Is it financially viable? This needs to be calculated based on the expected clinical benefits, which mainly correspond to the elimination of expenses tied to surgical revisions. Our society's search for safety has driven the investments in this technology. LEVEL OF EVIDENCE: V, Expert opinion.
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Affiliation(s)
- Jérôme Tonetti
- Clinique universitaire de chirurgie orthopédique et traumatologie, hôpital Michallon, CS 10217, 38043 Grenoble cedex 09, France.
| | - Mehdi Boudissa
- Clinique universitaire de chirurgie orthopédique et traumatologie, hôpital Michallon, CS 10217, 38043 Grenoble cedex 09, France
| | - Gael Kerschbaumer
- Clinique universitaire de chirurgie orthopédique et traumatologie, hôpital Michallon, CS 10217, 38043 Grenoble cedex 09, France
| | - Olivier Seurat
- Clinique universitaire de chirurgie orthopédique et traumatologie, hôpital Michallon, CS 10217, 38043 Grenoble cedex 09, France
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Abstract
STUDY DESIGN Prospective observational study. OBJECTIVE To assess staff and patient radiation exposure during augmented reality surgical navigation in spine surgery. SUMMARY OF BACKGROUND DATA Surgical navigation in combination with intraoperative three-dimensional imaging has been shown to significantly increase the clinical accuracy of pedicle screw placement. Although this technique may increase the total radiation exposure compared with fluoroscopy, the occupational exposure can be minimized, as navigation is radiation free and staff can be positioned behind protective shielding during three-dimensional imaging. The patient radiation exposure during treatment and verification of pedicle screw positions can also be reduced. METHODS Twenty patients undergoing spine surgery with pedicle screw placement were included in the study. The staff radiation exposure was measured using real-time active personnel dosimeters and was further compared with measurements using a reference dosimeter attached to the C-arm (i.e., a worst-case staff exposure situation). The patient radiation exposures were recorded, and effective doses (ED) were determined. RESULTS The average staff exposure per procedure was 0.21 ± 0.06 μSv. The average staff-to-reference dose ratio per procedure was 0.05% and decreased to less than 0.01% after a few procedures had been performed. The average patient ED was 15.8 ± 1.8 mSv which mainly correlated with the number of vertebrae treated and the number of cone-beam computed tomography acquisitions performed. A low-dose protocol used for the final 10 procedures yielded a 32% ED reduction per spinal level treated. CONCLUSION This study demonstrated significantly lower occupational doses compared with values reported in the literature. Real-time active personnel dosimeters contributed to a fast optimization and adoption of protective measures throughout the study. Even though our data include both cone-beam computed tomography for navigation planning and intraoperative screw placement verification, we find low patient radiation exposure levels compared with published data. LEVEL OF EVIDENCE 3.
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Pennington Z, Cottrill E, Westbroek EM, Goodwin ML, Lubelski D, Ahmed AK, Sciubba DM. Evaluation of surgeon and patient radiation exposure by imaging technology in patients undergoing thoracolumbar fusion: systematic review of the literature. Spine J 2019; 19:1397-1411. [PMID: 30974238 DOI: 10.1016/j.spinee.2019.04.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Minimally invasive spine techniques are becoming increasingly popular owing to their ability to reduce operative morbidity and recovery times. The downside to these new procedures is their need for intraoperative radiation guidance. PURPOSE To establish which technologies provide the lowest radiation exposure to both patient and surgeon. STUDY DESIGN/SETTING Systematic review OUTCOME MEASURES: Average intraoperative radiation exposure (in mSv per screw placed) to surgeon and patient. Average fluoroscopy time per screw placed. METHODS We reviewed the available English medical literature to identify all articles reporting patient and/or surgeon radiation exposure in patients undergoing image-guided thoracolumbar instrumentation. Quantitative meta-analysis was performed for studies providing radiation exposure or fluoroscopy use per screw placed to determine which navigation modality was associated with the lowest intraoperative radiation exposure. Values on meta-analysis were reported as mean ± standard deviation. RESULTS We identified 4956 unique articles, of which 85 met inclusion/exclusion criteria. Forty-one articles were included in the meta-analysis. Patient radiation exposure per screw placed for each modality was: conventional fluoroscopy without navigation (0.26±0.38 mSv), conventional fluoroscopy with pre-operative CT-based navigation (0.027±0.010 mSv), intraoperative CT-based navigation (1.20±0.91 mSv), and robot-assisted instrumentation (0.04±0.30 mSv). Values for fluoroscopy used per screw were: conventional fluoroscopy without navigation (11.1±9.0 seconds), conventional fluoroscopy with navigation (7.20±3.93 s), 3D fluoroscopy (16.2±9.6 s), intraoperative CT-based navigation (19.96±17.09 s), and robot-assistance (20.07±17.22 s). Surgeon dose per screw: conventional fluoroscopy without navigation (6.0±7.9 × 10-3 mSv), conventional fluoroscopy with navigation (1.8±2.5 × 10-3 mSv), 3D Fluoroscopy (0.3±1.9 × 10-3 mSv), intraoperative CT-based navigation (0±0 mSv), and robot-assisted instrumentation (2.0±4.0 × 10-3 mSv). CONCLUSION All image guidance modalities are associated with surgeon radiation exposures well below current safety limits. Intraoperative CT-based (iCT) navigation produces the lowest radiation exposure to surgeon albeit at the cost of increased radiation exposure to the patient relative to conventional fluoroscopy-based methods.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 5-185A, Baltimore, MD 21287, USA
| | - Ethan Cottrill
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 5-185A, Baltimore, MD 21287, USA
| | - Erick M Westbroek
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 5-185A, Baltimore, MD 21287, USA
| | - Matthew L Goodwin
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 5-185A, Baltimore, MD 21287, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 5-185A, Baltimore, MD 21287, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 5-185A, Baltimore, MD 21287, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 5-185A, Baltimore, MD 21287, USA.
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Spyrantis A, Cattani A, Seifert V, Freiman TM, Setzer M. Minimally invasive percutaneous robotic thoracolumbar pedicle screw implantation combined with three-dimensional fluoroscopy can reduce radiation: A cadaver and phantom study. Int J Med Robot 2019; 15:e2022. [PMID: 31216120 DOI: 10.1002/rcs.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/26/2019] [Accepted: 06/04/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Andrea Spyrantis
- Department of Neurosurgery, Center of Neurology and Neurosurgery (ZNN), University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Adriano Cattani
- Department of Neurosurgery, Center of Neurology and Neurosurgery (ZNN), University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, Center of Neurology and Neurosurgery (ZNN), University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Thomas M Freiman
- Department of Neurosurgery, Center of Neurology and Neurosurgery (ZNN), University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
| | - Matthias Setzer
- Department of Neurosurgery, Center of Neurology and Neurosurgery (ZNN), University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany
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Guha D, Jakubovic R, Alotaibi NM, Klostranec JM, Saini S, Deorajh R, Gupta S, Fehlings MG, Mainprize TG, Yee A, Yang VX. Optical Topographic Imaging for Spinal Intraoperative Three-Dimensional Navigation in Mini-Open Approaches: A Prospective Cohort Study of Initial Preclinical and Clinical Feasibility. World Neurosurg 2019; 125:e863-e872. [DOI: 10.1016/j.wneu.2019.01.201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/20/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
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Ahmed AK, Zygourakis CC, Kalb S, Zhu AM, Molina CA, Jiang B, Blitz AM, Bydon A, Crawford NR, Theodore N. First spine surgery utilizing real-time image-guided robotic assistance. Comput Assist Surg (Abingdon) 2019; 24:13-17. [PMID: 30821536 DOI: 10.1080/24699322.2018.1542029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Robotics in spinal surgery has significant potential benefits for both surgeons and patients, including reduced surgeon fatigue, improved screw accuracy, decreased radiation exposure, greater options for minimally invasive surgery, and less time required to train residents on techniques that can have steep learning curves. However, previous robotic systems have several drawbacks, which are addressed by the innovative ExcelsiusGPSTM robotic system. The robot is secured to the operating room floor, not the patient. It has a rigid external arm that facilitates direct transpedicular drilling and screw placement, without requiring K-wires. In addition, the ExcelsisuGPSTM has integrated neuronavigation, not present in other systems. It also has surveillance marker that immediately alerts the surgeon in the event of loss of registration, and a lateral force meter to alert the surgeon in the event of skiving. Here, we present the first spinal surgery performed with the assistance of this newly approved robot. The surgery was performed with excellent screw placement, minimal radiation exposure to the patient and surgeon, and the patient had a favorable outcome. We report the first operative case with the ExcelsisuGPSTM, and the first spine surgery utilizing real-time image-guided robotic assistance.
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Affiliation(s)
- A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Corinna C Zygourakis
- Department of Neurosurgery, Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Samuel Kalb
- Department of Neurosurgery, Johns Hopkins School of Medicine , Baltimore , MD , USA.,Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center , Phoenix , AZ , USA
| | - Alex M Zhu
- Department of Neurosurgery, Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Camilo A Molina
- Department of Neurosurgery, Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Bowen Jiang
- Department of Neurosurgery, Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Ari M Blitz
- Department of Neuroradiology, Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Neil R Crawford
- Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center , Phoenix , AZ , USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins School of Medicine , Baltimore , MD , USA
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Yu JY, Fridley J, Gokaslan Z, Telfeian A, Oyelese AA. Minimally Invasive Thoracolumbar Corpectomy and Stabilization for Unstable Burst Fractures Using Intraoperative Computed Tomography and Computer-Assisted Spinal Navigation. World Neurosurg 2019; 122:e1266-e1274. [DOI: 10.1016/j.wneu.2018.11.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/02/2018] [Accepted: 11/04/2018] [Indexed: 12/31/2022]
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[Navigation in lumbar spinal surgery: When is it useful?]. DER ORTHOPADE 2018; 48:59-68. [PMID: 30560400 DOI: 10.1007/s00132-018-03671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Spinal navigation has evolved greatly since its implementation in the mid-1990s and is now widely used in lumbar spine surgery. However, navigation is not yet accepted as a standard technique. APPLICATIONS In addition to the classic use in lumbar pedicle screw instrumentation, navigation technology, especially in combination with intraoperative 3D imaging, can be applied in a wide range of indications and in all lumbar approaches. The technology is particularly helpful in minimally invasive operations. The concept of "total navigation" stands for an efficient use of the technique from skin incision on and aims at complete elimination of radiation exposure for the surgical team. ADVANTAGES AND PITFALLS High accuracy and low radiation exposure of the OR team are indisputable advantages of navigated operations, while time savings and economic benefits are yet to be demonstrated. Regular use and standardized workflow are essential for the safe and effective application of lumbar navigation. Currently, lumbar navigation technology is already of great importance, yet the complex technology requires intensive training. With improved user comfort and image quality, spinal navigation will continue to spread in the future.
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Hammerle D, Osterhoff G, Allemann F, Werner CML. Comparison of intraoperative 2D vs. 3D imaging in open reduction and fixation of distal radius fractures. Eur J Trauma Emerg Surg 2018; 46:557-563. [PMID: 30350005 DOI: 10.1007/s00068-018-1036-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE In the volar plating of distal radius fractures, intraoperative three-dimensional (3D) imaging is designed to allow better judgment regarding screw and implant positioning compared with conventional intraoperative two-dimensional (2D) imaging. We evaluated the impact of these two imaging modalities on the rates of intraoperative revision and secondary surgery, as well as the need for implant removal during follow-up. METHODS A retrospective analysis of consecutive patients who underwent volar plate osteosynthesis for isolated distal radius fractures between January 2008 and April 2016 was performed. Patient files were evaluated for intraoperative imaging findings, intraoperative and postoperative revision rates, and implant removal during follow-up. Additional analyses of radiation exposure, operation time, and hospitalization time were performed. RESULTS A total of 314 patients were analyzed (mean age: 54 ± 19 years; 210 females). For 246 patients, only 2D imaging was performed, while the remaining 68 patients underwent both 2D and 3D imaging (O-Arm, Medtronic). The intraoperative revision rate was significantly (p < 0.001) higher with 3D imaging (32.4%) compared with 2D imaging (2.0%). The postoperative revision rates were similar between both the groups (2.9% vs. 2.0%; p = 0.674). Compared with 2D imaging, the use of the Medtronic O-Arm resulted in a significantly lower implant removal rate (8.8% vs. 18.7%; p = 0.036) during follow-up. CONCLUSION Compared with conventional 2D imaging, the use of intraoperative 3D imaging significantly increased the intraoperative revision rate and has the potential for positive long-term effects for lowering the risk of requiring an implant removal.
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Affiliation(s)
- Diego Hammerle
- Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Kantonsspital St.Gallen, Rorschacher Strasse 95, 9007, St.gallen, Switzerland.
| | - Georg Osterhoff
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinik Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Florin Allemann
- Klinik für Traumatologie, Universitätsspital Zürich, Rämistrasse 100, 8091, Zurich, Switzerland
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Bohoun CA, Naito K, Yamagata T, Tamrakar S, Ohata K, Takami T. Safety and accuracy of spinal instrumentation surgery in a hybrid operating room with an intraoperative cone-beam computed tomography. Neurosurg Rev 2018; 42:417-426. [PMID: 29663092 DOI: 10.1007/s10143-018-0977-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/20/2018] [Accepted: 03/28/2018] [Indexed: 11/25/2022]
Abstract
Although spinal instrumentation technique has undergone revolutionary progress over the past few decades, it may still carry significant surgery-related risks. The purpose of the present study was to assess the radiological accuracy of spinal screw instrumentation using a hybrid operating room (OR) and quantify the related radiation exposure. This retrospective study included 33 cases of complex spine fusion surgeries that were conducted using a hybrid OR with a flat panel detector (FPD) angiography system. Twelve cases (36.4%) were cervical, and 21 (63.6%) were thoracolumbar. The average number of spine fusion levels was 3 and 4.8, respectively, at the cervical and thoracolumbar spine levels. A FPD angiography system was used for intraoperative cone-beam computed tomography (CBCT) to obtain multi-slice spine images. All operations were conducted under optimized radiation shielding. Entrance surface doses (ESDs) and exposure times were recorded in all cases. A total of 313 screws were placed. Satisfactory screw insertion could be achieved in all cases with safe screw placement in 97.4% and acceptable placement in 2.6%. None of the cases showed any significant anatomical violation by the screws. The radiation exposure to the patients was absolutely consistent with the desired ESD value, and that to the surgeons, under the annual dose limit. These results suggest that the hybrid OR with a FPD angiography system is helpful to achieve safe and precise spinal fusion surgery, especially in complex cases.
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Affiliation(s)
- Christian A Bohoun
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kentaro Naito
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Toru Yamagata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
- Department of Neurosurgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 531-0021, Japan
| | - Samantha Tamrakar
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Kenji Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Toshihiro Takami
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
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Abstract
Orthopaedic surgeons are routinely exposed to intraoperative radiation and, therefore, follow the principle of "as low as reasonably achievable" with regard to occupational safety. However, standardized education on the long-term health effects of radiation and the basis for current radiation exposure limits is limited in the field of orthopaedics. Much of orthopaedic surgeons' understanding of radiation exposure limits is extrapolated from studies of survivors of the atomic bombings in Hiroshima and Nagasaki, Japan. Epidemiologic studies on cancer risk in surgeons and interventional proceduralists and dosimetry studies on true radiation exposure during trauma and spine surgery recently have been conducted. Orthopaedic surgeons should understand the basics and basis of radiation exposure limits, be familiar with the current literature on the incidence of solid tumors and cataracts in orthopaedic surgeons, and understand the evidence behind current intraoperative fluoroscopy safety recommendations.
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Comparison of 30-Day Complications Between Navigated and Conventional Single-level Instrumented Posterior Lumbar Fusion: A Propensity Score Matched Analysis. Spine (Phila Pa 1976) 2018; 43:447-453. [PMID: 28700450 DOI: 10.1097/brs.0000000000002327] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort comparison study. OBJECTIVE To compare perioperative outcomes between navigated and conventional single-level instrumented posterior lumbar fusions in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. SUMMARY OF BACKGROUND DATA Although multiple studies have investigated the accuracy of pedicle screw placement and radiation exposure with navigation, no study has compared perioperative complications between navigated and conventional posterior lumbar fusion. The potential benefits of navigation include improved accuracy of screw placement and reduced surgeon radiation exposure, but this is balanced by potential operative time and surgical site contamination/infection related to this bulky technology. METHODS Patients who underwent navigated or conventional single-level posterior instrumented lumbar fusions were identified in the 2010-2015 NSQIP database. The usage of navigation was characterized. Patient characteristics and comorbidities were compared between the two treatment groups. Propensity score matching was done and comparisons were made for operative time, hospital length of stay, postoperative complications, and 30-day readmissions between the two cohorts. RESULTS The percentage of navigated cases tended to increase over years studied to approximately 10%. After propensity matching to control potential confounding factors, statistical analysis revealed no significant difference in operative time and for most adverse events including wound infection, return to the operating room, and readmission. There were significantly lower blood transfusions in the navigated cohort (2.84% vs. 7.15%, P < 0.001). Patients who underwent navigated surgery also had a shorter mean hospital length of stay (0.2 day difference, P = 0.016). CONCLUSION The reduced blood loss and mildly reduced hospital length of stay identified for the navigated cases are probably markers of more minimally invasive surgery in the navigated cohort. The current study could not identify other differences in operative time, wound infection, or return to the operating room/readmission between navigated and conventional single level posterior instrumented lumbar cases. LEVEL OF EVIDENCE 3.
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Nakahara T, Iwabuchi Y, Katagiri M, Matsusaka Y, Itoh K, Ogata Y, Jinzaki M. RADIATION EXPOSURE TO OPERATORS PERFORMING PHARMACOLOGIC STRESS TESTING IN 99mTc MYOCARDIAL PERFUSION IMAGING: A PROSPECTIVE STUDY. RADIATION PROTECTION DOSIMETRY 2017; 176:235-241. [PMID: 28115658 DOI: 10.1093/rpd/ncx001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/05/2017] [Indexed: 06/06/2023]
Abstract
This prospective study investigated radiation exposure dose (RED) to main operator (MO) and supervisory operator (SO) performing dypiridamole stress testing in a 1-d rest/stress 99mTc tetrofosmin single-photon emission computed tomography (SPECT) of consecutive 42 patients. MO was instructed to be close to the patients during the entire procedures including the vasodilator and radiotracer injection. SO mainly recorded the data on the procedures apart from the patients. RED, procedure time (PT) and internal radioactivity (IR) of patients were measured before and after a secondary tracer injection for stress SPECT, respectively. RED was significantly greater to MO than to SO (6.2 ± 2.7 vs 2.5 ± 2.1 μSV per stress procedure, p < 0.0001). Multivariate analyses revealed that IR and PT were significantly independent factors to predict RED to both operators. Operators performing pharmacologic stress procedure should be aware that IR and PT are independent factors for RED in 99mTc myocardial perfusion imaging.
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Affiliation(s)
- Tadaki Nakahara
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yu Iwabuchi
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mari Katagiri
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yohji Matsusaka
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kazunari Itoh
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yuji Ogata
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Janssen I, Lang G, Navarro-Ramirez R, Jada A, Berlin C, Hilis A, Zubkov M, Gandevia L, Härtl R. Can Fan-Beam Interactive Computed Tomography Accurately Predict Indirect Decompression in Minimally Invasive Spine Surgery Fusion Procedures? World Neurosurg 2017; 107:322-333. [DOI: 10.1016/j.wneu.2017.07.167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 12/29/2022]
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Zhang YH, White I, Potts E, Mobasser JP, Chou D. Comparison Perioperative Factors During Minimally Invasive Pre-Psoas Lateral Interbody Fusion of the Lumbar Spine Using Either Navigation or Conventional Fluoroscopy. Global Spine J 2017; 7:657-663. [PMID: 28989845 PMCID: PMC5624381 DOI: 10.1177/2192568217716149] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
STUDY DESIGN Retrospective clinical study. OBJECTIVES The aim of this study was to compare intraoperative conditions and clinical results of patients undergoing pre-psoas oblique lateral interbody fusion (OLIF) using navigation or conventional fluoroscopy (C-ARM) techniques. METHODS Forty-two patients (22 patients by navigation and 20 by fluoroscopy) underwent the OLIF procedure at 2 medical centers, and records were reviewed. Clinical data was collected and compared between the 2 groups. Patients were followed-up with a range of 6 to 24 months. RESULTS There were no significant differences on demographic data between groups. The navigation group had zero radiation exposure (RE) to the surgeon and radiation time compared to the C-ARM group, with total RE of 44.59 ± 26.65 mGy and radiation time of 88.30 ± 58.28 seconds (P < .05). The RE to the patient was significantly lower in the O-ARM group (9.38 mGy) compared to the C-ARM group (44.59 ± 26.65 mGy). Operating room time was slightly longer in the navigation group (2.49 ± 1.35 hours) compared to the C-ARM group (2.30 ± 1.17 hours; P > .05), although not statistically significant. No differences were found in estimated blood loss, length of hospitalization, surgery-related complications, and outcome scores with an average of 8-month follow-up. CONCLUSIONS Compared with C-ARM techniques, using navigation can eliminate RE to surgeon and decrease RE to the patient, and it had no significant effect on operating time, estimated blood loss, length of hospitalization, or perioperative complications in the patients with OLIF procedure. This study shows that navigation is a safe alternative to fluoroscopy during the OLIF procedure in the treatment of degenerative lumbar conditions.
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Affiliation(s)
- Yue-Hui Zhang
- University of California San Francisco, CA, USA,Xin Hua Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ian White
- Goodman Campbell Brain and Spine, Indianapolis, IN, USA
| | - Eric Potts
- Goodman Campbell Brain and Spine, Indianapolis, IN, USA
| | | | - Dean Chou
- University of California San Francisco, CA, USA,Dean Chou, 505 Parnassus Ave, Box 0112, San Francisco, CA 94143, USA.
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40
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Abstract
Spinal instrumentation often involves placing implants without direct visualization of their trajectory or proximity to adjacent neurovascular structures. Two-dimensional fluoroscopy is commonly used to navigate implant placement, but with the advent of computed tomography, followed by the invention of a mobile scanner with an open gantry, three-dimensional (3D) navigation is now widely used. This article critically appraises the available literature to assess the influence of 3D navigation on radiation exposure, accuracy of instrumentation, operative time, and patient outcomes. Also explored is the latest technological advance in 3D neuronavigation: the manufacturing of, via 3D printers, patient-specific templates that direct implant placement.
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Liu X, Joseph JR, Smith BW, Saadeh Y, Park P. Analysis of Intraoperative Cone-Beam Computed Tomography Combined With Image Guidance for Lateral Lumbar Interbody Fusion. Oper Neurosurg (Hagerstown) 2017; 14:620-626. [DOI: 10.1093/ons/opx176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/13/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Minimally invasive lateral lumbar interbody fusion (LLIF) is traditionally performed with biplanar fluoroscopy. Recent literature demonstrates that intraoperative cone-beam computed tomography combined with spinal navigation can be safely utilized for localization and cage placement in LLIF.
OBJECTIVE
To evaluate the accuracy and safety of cage placement using spinal navigation in LLIF, as well as to evaluate the radiation exposure to surgeon and staff during the procedure.
METHODS
The authors performed a retrospective analysis of a prospectively acquired database of patients undergoing LLIF with image-based navigation performed from April 2014 to July 2016 at a single institution. The medical records were reviewed, and data on clinical outcomes, cage accuracy, complications, and radiation exposure were recorded. All patients underwent a minimum 30-d clinical follow-up to assess intraoperative and short-term complications associated with their LLIF.
RESULTS
Sixty-three patients comprising 117 spinal levels were included in the study. There were 36 (57.1%) female and 27 (42.9%) male patients. Mean age was 62.7 yr (range 24-79 yr). A mean 1.9 (range 1-4) levels per patient were treated. Cages were placed in the anterior or middle of 115 (98.3%) disc spaces. Image-guided cage trajectory was accurate in 116/117 levels (99.1%). In a subgroup analysis of 18 patients, mean fluoroscopy time was 11.7 ± 9.7 s per level. Sixteen (25.4%) patients experienced a complication related to approach.
CONCLUSION
Use of intraoperative cone-beam computed tomography combined with spinal navigation for LLIF results in accurate and safe cage placement as well as significantly decreased surgeon and staff radiation exposure.
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Affiliation(s)
- Xilin Liu
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Jacob R Joseph
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Brandon W Smith
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Yamaan Saadeh
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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42
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Costa F, Ortolina A, Cardia A, Riva M, Revay M, Pecchioli G, Anania CD, Asteggiano F, Fornari M. Preoperative Magnetic Resonance and Intraoperative Computed Tomography Fusion for Real-Time Neuronavigation in Intramedullary Lesion Surgery. Oper Neurosurg (Hagerstown) 2017; 13:188-195. [PMID: 28927206 DOI: 10.1093/ons/opw005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/18/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Image-guided surgery techniques in spinal surgery are usually based upon fluoroscopy or computed tomography (CT) scan, which allow for a real-time navigation of bony structures, though not of neural structures and soft tissue remains. OBJECTIVE To verify the effectiveness and efficacy of a novel technique of imaging merging between preoperative magnetic resonance imaging (MRI) and intraoperative CT scan during removal of intramedullary lesions. METHODS Ten consecutive patients were treated for intramedullary lesions using a navigation system aid. Preoperative contrast-enhanced MRI was merged in the navigation software, with an intraoperative CT acquisition, performed using the O-arm TM system (Medtronic Sofamor Danek, Minneapolis, Minnesota). Dosimetric and timing data were also acquired for each patient. RESULTS The fusion process was achieved in all cases and was uneventful. The merged imaging information was useful in all cases for defining the exact area of laminectomy, dural opening, and the eventual extension of cordotomy, without requiring exposition corrections. The radiation dose for the patients was 0.78 mSv. Using the authors' protocol, it was possible to merge a preoperative MRI with navigation based on intraoperative CT scanning in all cases. Information gained with this technique was useful during the different surgical steps. However, there were some drawbacks, such as the merging process, which still remains partially manual. CONCLUSION In this initial experience, MRI and CT merging and its feasibility were tested, and we appreciated its safety, precision, and ease.
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Affiliation(s)
- Francesco Costa
- Departments of Neurosurgery, Humani-tas Clinical and Research Center, Rozzano (MI), Italy
| | - Alessandro Ortolina
- Departments of Neurosurgery, Humani-tas Clinical and Research Center, Rozzano (MI), Italy
| | - Andrea Cardia
- Departments of Neurosurgery, Humani-tas Clinical and Research Center, Rozzano (MI), Italy
| | - Marco Riva
- Departments of Neurosurgery, Humani-tas Clinical and Research Center, Rozzano (MI), Italy
| | - Martina Revay
- Departments of Neurosurgery, Humani-tas Clinical and Research Center, Rozzano (MI), Italy
| | - Guido Pecchioli
- Departments of Neurosurgery, Humani-tas Clinical and Research Center, Rozzano (MI), Italy
| | - Carla Daniela Anania
- Departments of Neurosurgery, Humani-tas Clinical and Research Center, Rozzano (MI), Italy
| | - Francesco Asteggiano
- Departments of Radiology, Humanitas Clinical and Research Center, Rozzano (MI), Italy
| | - Maurizio Fornari
- Departments of Neurosurgery, Humani-tas Clinical and Research Center, Rozzano (MI), Italy
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43
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Chang CC, Fay LY, Wu JC, Chang PY, Tu TH, Cheng H, Huang WC. Letter to the Editor: Strategic use of cone-beam CT in modern spine surgery. J Neurosurg Spine 2017; 26:544-545. [PMID: 28084932 DOI: 10.3171/2016.9.spine161054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Chih-Chang Chang
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Yu Fay
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jau-Ching Wu
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Peng-Yuan Chang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Tsung-Hsi Tu
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Taiwan International Graduate Program in Molecular Medicine, National Yang-Ming University and Academia Sinica, Taipei, Taiwan
| | - Henrich Cheng
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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44
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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
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