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Gorgy G, Avrumova F, Paschal PK, Paschal GK, Carrino JA, Lebl DR. Assessing intraoperative pedicle screw placement accuracy using biplanar radiographs compared to three-dimensional imaging. J Robot Surg 2024; 18:68. [PMID: 38329623 DOI: 10.1007/s11701-023-01760-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/10/2023] [Indexed: 02/09/2024]
Abstract
To date, biplanar imaging (2D) has been the method of choice for pedicle screw (PS) positioning and verified for the anteroposterior view and (spinal midline) M-line method. In recent years, the use of intraoperative three-dimensional (3D) imaging has become available with the Gertzbein-Robbins system (GRS) to assess PS breach and positioning confirmation. The aim is to determine if 2D imaging is sufficient to assess PS position in comparison to advanced 3D imaging.Retrospective review of prospectively collected data from 204 consecutive adult patients who underwent posterior thoracic and lumbar instrumented fusion for degenerative spinal surgery by a single surgeon (2019-2022).Of the 204 patients, 187 (91.6%) had intraoperative images available for analysis. A total of 1044 PS implants were used; 922 (88.3%) were robotically placed. Postoperative CT scans were verified with M-line/GRS findings. Among 103 patients (50.5%) with a total of 362 screws, (34.7%) had postoperative CT, intraoperative 3D scan, and intraoperative 2D scan for analysis. Postoperative CT findings were consistent with all GRS findings, validating that 3D imaging was accurate. Screws (1%) were falsely verified by the M-line as 3D imaging confirmed false negative or positive findings.In our series, intraoperative 3D scan was as accurate as postoperative CT scan in assessing PS breach. A significant number of PS may be falsely read as accurate on 2D imaging, that is in fact inaccurate when assessed on 3D imaging. An intraoperative post-instrumentation 3D scan may be preferable to prevent postoperative recognition of a falsely verified screw on biplanar imaging.
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Affiliation(s)
- George Gorgy
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Fedan Avrumova
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Philip K Paschal
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Gregory K Paschal
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - John A Carrino
- Department of Radiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Darren R Lebl
- Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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Avrumova F, Goldman SN, Altorfer F, Paschal GK, Lebl DR. Anterior cervical osteotomy of diffuse idiopathic skeletal hyperostosis lesions with computer-assisted navigation surgery: A case report. Clin Case Rep 2024; 12:e8427. [PMID: 38197064 PMCID: PMC10774538 DOI: 10.1002/ccr3.8427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/24/2023] [Accepted: 12/14/2023] [Indexed: 01/11/2024] Open
Abstract
Key Clinical Message Diffuse idiopathic skeletal hyperostosis (DISH) involves spine ligament ossification. Computer-assisted navigation (CAN) effectively aids complex surgeries, such as anterior cervical osteotomy, to alleviate progressive DISH-related dysphagia. Abstract We describe a 68-year-old man with sudden onset dysphagia to both solids and liquids. Radiographic Imaging revealed DISH lesions from C2 down to the thoracic spine. The patient was successfully treated with CAN anterior osteotomy and resection of DISH lesions from C3-C6 and had complete symptom relief within 2 weeks post-operatively.
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Affiliation(s)
- Fedan Avrumova
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Samuel N. Goldman
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Franziska Altorfer
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Gregory K. Paschal
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Darren R. Lebl
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
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