Accuracy of pedicle screw placement using neuronavigation based on intraoperative 3D rotational fluoroscopy in the thoracic and lumbar spine

Conrads, Nora; Grunz, Jan-Peter; Huflage, Henner; Luetkens, Karsten Sebastian; Feldle, Philipp; Grunz, Katharina; Köhler, Stefan; Westermaier, Thomas

doi:10.1007/s00402-022-04514-1

Cited by 3 publications

(1 citation statement)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Intraoperative (IO) image guidance using 3-dimensional (3D) fluoroscopic navigation such as O-arm technology has improved both precision and reliability of pedicle screw placement in instrumented spine surgery. [1][2][3][4][5] These technologies are routinely used in many spine centers worldwide. IO and postoperative (PO) evaluation and verification of implant position on radiological images are an important and decisive step during and after surgery to ensure surgical safety and avoid complications due to implant misplacement.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Navigated Pedicle Screws From Intraoperative Imaging: A Prospective Study of Accuracy and Agreement

Åkerstedt,

Berglund,

Kolakowski

et al. 2023

Int J Spine Surg

View full text Add to dashboard Cite

Background: Intraoperative (IO) image guidance surgery using 3-dimensional fluoroscopic navigation methods, such as the O-arm system, has improved the accuracy of pedicle screw placement in instrumented spine surgery. IO and postoperative (PO) validation of the implant's correct position from radiological images is a decisive step to ensure patient safety and avoidance of complications related to implant misplacement. In this prospective single-center study, the authors investigated the accuracy and agreement of assessment of pedicle screws from IO O-arm images in comparison to PO computed tomography images. This study aimed to determine whether final evaluation of pedicle screws can safely be conducted from IO images that supersedes the PO computed tomography control.Methods: A prospective single-center study was carried out at the Spine Unit in the Department of Orthopedics at Umeå University Hospital between 2019 and 2021. All patients enrolled in the study underwent instrumented thoracolumbar spine surgery using navigation. Imaging data were obtained from IO and PO examinations. Four reviewers-2 attending senior spine surgeons, 1 final year resident in orthopedics, and 1 attending neuroradiologist-classified pedicle screws using the Gertzbein and Robbins classification system. Agreement and accuracy of the reviewers were studied to evaluate the assessment of pedicle screws from IO and PO images.Results: A total of 70 patients (422 screws) were included in the study. There was high accuracy among surgeons both on IO and PO images (0.96-0.97, 95% CI [0.94-0.99] and 0.97, 95% CI [0.94-0.99], respectively), and the overall agreement between all raters was 92% to 98% (95% CI [0.90, 1.00]). The discrepancy in assessment between optimal (Group 1) and suboptimal (Group 2) screws between IO and PO images was as low as 1% to 1.7%, which indicates that very few suboptimal screws are missed in the assessment of IO images.Conclusions: The assessment of navigated pedicle screws using IO images is safe and reliable and may replace the need for further assessment using PO imaging.

show abstract

Section: Introductionmentioning

confidence: 99%

Assessment of Navigated Pedicle Screws From Intraoperative Imaging: A Prospective Study of Accuracy and Agreement

Åkerstedt,

Berglund,

Kolakowski

et al. 2023

Int J Spine Surg

View full text Add to dashboard Cite

show abstract

SafeRPlan: Safe deep reinforcement learning for intraoperative planning of pedicle screw placement

Ao,

Esfandiari,

Carrillo

et al. 2025

Medical Image Analysis

View full text Add to dashboard Cite

Freehand Juxtapedicular Screws Placed in the Apical Concavity of Adult Idiopathic Scoliosis Patients: Technique, Computed Tomography Confirmation, and Radiographic Results

et al. 2022

View full text Add to dashboard Cite

Objective: The purpose of this study is to highlight our technique for freehand placement of juxtapedicular screws along with intraoperative computed tomography (CT) and radiographic results.Methods: Consecutive patients with adult idiopathic scoliosis undergoing primary surgery by the senior author were identified. All type D (absent/slit like channel) pedicles were identified on preoperative CT. Three-dimensional visualization software was used to measure screw angulation and purchase. Radiographs were measured by a fellowship trained spine surgeon. The freehand technique was used to place all screws in a juxtapedicular fashion without any fluoroscopic, radiographic, navigational or robotic assistance.Results: Seventy-three juxtapedicular screws were analyzed. The most common level was T7 (9 screws) on the left and T5 (12 screws) on the right. The average medial angulation was 20.7° (range, 7.1°–36.3°), lateral vertebral body purchase was 13.4 mm (range, 0–28.9 mm), and medial vertebral body purchase was 21.1 mm (range, 8.9–31.8 mm). More than half (53.4%) of the screws had bicortical purchase. Two screws were lateral on CT scan, defined by the screw axis lateral to the lateral vertebral body cortex. No screws were medial. There was a difference in medial angulation between screws with (n = 58) and without (n = 15) lateral body purchase (22.0 ± 4.9 vs. 15.5 ± 4.5, p < 0.001). Three of 73 screws were repositioned after intraoperative CT. There were no neurovascular complications. The mean coronal cobb corrections for main thoracic and lumbar curves were 83.0% and 80.5%, respectively, at an average of 17.5 months postoperative.Conclusion: Freehand juxtapedicular screw placement is a safe technique for type D pedicles in adult idiopathic scoliosis patients.

show abstract

Accuracy of pedicle screw placement using neuronavigation based on intraoperative 3D rotational fluoroscopy in the thoracic and lumbar spine

Cited by 3 publications

References 26 publications

Assessment of Navigated Pedicle Screws From Intraoperative Imaging: A Prospective Study of Accuracy and Agreement

Assessment of Navigated Pedicle Screws From Intraoperative Imaging: A Prospective Study of Accuracy and Agreement

SafeRPlan: Safe deep reinforcement learning for intraoperative planning of pedicle screw placement

Freehand Juxtapedicular Screws Placed in the Apical Concavity of Adult Idiopathic Scoliosis Patients: Technique, Computed Tomography Confirmation, and Radiographic Results

Contact Info

Product

Resources

About