An intraoperative fluoroscopic method to accurately measure the post-implantation position of pedicle screws

Newell, Robyn; Esfandiari, Hooman; Anglin, Carolyn; Bernard, Renee; Street, John; Hodgson, Antony J.

doi:10.1007/s11548-018-1732-8

Cited by 15 publications

(15 citation statements)

References 32 publications

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“…Implants of the wrong size can ultimately lead to unstable fixation 10 or may lead to pedicle fracture or damage to the nerves and vessels. 7,11,15 For osteoporotic fractures, which are commonly stabilized using cement augmentation, pedicle fractures may lead to cement leaks into the spinal canal. Furthermore, the surgeon should be aware preoperatively of whether sufficient implant material of the correct length and diameter for a stable osteosynthesis is in stock.…”

Section: Discussionmentioning

confidence: 99%

“…10,11,13 Despite disagreements in an ideal trajectory angle, there is consensus that the main focus should be in placing the pedicle screw within the safe corridor to prevent nerve root or spinal cord injury. 10,15 Aside from the trajectory angle, the diameter of the screw seems to be more important than the depth of the screw for improving pullout strength. 10,11,14 Further pullout resistance is achieved by implanting the screws parallel to the cover plate of the vertebra, 12,13,16 but the definitive size of the right screw finally depends on the anatomy of the patient and on the availability of the specific screw sizes.…”

Section: Introductionmentioning

confidence: 99%

“…10 Considering these conditions, preoperative planning and measurement of size and direction of the pedicle is highly recommended. 11,15 To date, the gold standard imaging modality for the preoperative Copyright 2020 by International Society for the Advancement of Spine Surgery.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Preoperative Pedicle Screw Measurement Between Computed Tomography and Magnet Resonance Imaging

et al. 2020

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Background: Pedicle screw fixation is commonly used in the treatment of spinal pathologies. While the biomechanical factors that affect bone fixation have been frequently described, questions remain as to which imaging modality is the ideal medium for preoperative planning. Due to its perceived superiority in assessing bony changes, computed tomography (CT) scan is assumed to be the gold standard for preparative planning, and we hypothesize that magnetic resonance imaging (MRI) is sufficiently accurate to predict screw length and diameter compared to CT. Methods: We retrospectively measured the length and diameter of vertebral bodies in the lumbar region in both MRI and CT and tested for differences between the modalities as well as for confounding effects of age, sex, and the presence of spondyloarthrosis. Results: We found a significant difference in pedicle screw length between CT and MRI measurements for both sides. For the left pedicle, the mean difference was 1.89 mm (95% confidence interval [CI] À3.03 to À0.75; P , .002), while for the right pedicle, the mean difference was 2.05 mm (95% CI À3.27 to À0.84; P ¼ .001). We also found a significant difference in diameter measurements between CT and MRI for the left pedicle (0.53 mm; 95% CI 0.13 to 0.93; P ¼ .011) but not for the right pedicle (0.36 mm; 95% CI À0.06 to 0.78; P ¼ .094). We identified no significant effect of sex, age or spondyloarthrosis on the results (P. .05). Conclusions: Pedicle screw planning measurements were more accurate using CT images compared to MRI images. CT scan remains the gold standard for pedicle screw planning in trauma surgery. When using MRI images, the surgeon should be aware of the differences in screw length and diameter compared to CT in order to avoid intra-and postoperative risks.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of Preoperative Pedicle Screw Measurement Between Computed Tomography and Magnet Resonance Imaging

et al. 2020

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“…This may require additional fluoroscopy images, leading to prolonged surgery and increased surgeon fatigue. Moreover, the rod cannot be forced in to engage with the screw heads as this will increase the risk of screw pull out [13-15].…”

Section: Discussionmentioning

confidence: 99%

Utilization of Spinal Navigation to Facilitate Hassle-Free Rod Placement during Minimally-Invasive Long-Construct Posterior Instrumentation

Kaliya-Perumal

Limthongkul

2019

Asian Spine J

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During minimally-invasive long-construct posterior instrumentation, it may be challenging to contour and place the rod as the screw heads are not visualized. To overcome this, we utilized the image data merging (IDM) facility of our spinal navigation system to visualize a coherent whole image of the construct throughout the procedure. Here, we describe this technique that was used for a patient in whom L1–L5 posterior instrumentation was performed. Using an IDM facility, screws are color coded and after placement, the final image is saved. Saved images of all previous screws are displayed and observed while placing the subsequent screws. Therefore, the entry point, depth, and mediolateral alignment of subsequent screws can be adjusted to fall in line with previous screws such that the rod can be placed without hassle. Moreover, final adjustments to the construct are kept to a minimum. The possibility of screw pullout due to force engaging the rod on poorly aligned screws is thus avoided.

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“…To ensure clinical adoption of such a system, there should be minimal interference with the existing surgical workflow, minimal user interaction and little or no additional hardware or imaging modalities required. In a recent work, we have described such an approach that relied on registration of preoperative CTs and intraoperative C‐arm X‐rays 14 . This method requires X‐rays to be acquired post‐implantation in order to estimate the pose of each implant using a deep‐learning algorithm 15 as well as to register the anatomy using an intensity‐based 2D‐3D registration method.…”

Section: Introductionmentioning

confidence: 99%

Deep learning‐based X‐ray inpainting for improving spinal 2D‐3D registration

Esfandiari

Weidert

Kövesházi

et al. 2021

Robotics Computer Surgery

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Background Two‐dimensional (2D)‐3D registration is challenging in the presence of implant projections on intraoperative images, which can limit the registration capture range. Here, we investigate the use of deep‐learning‐based inpainting for removing implant projections from the X‐rays to improve the registration performance. Methods We trained deep‐learning‐based inpainting models that can fill in the implant projections on X‐rays. Clinical datasets were collected to evaluate the inpainting based on six image similarity measures. The effect of X‐ray inpainting on capture range of 2D‐3D registration was also evaluated. Results The X‐ray inpainting significantly improved the similarity between the inpainted images and the ground truth. When applying inpainting before the 2D‐3D registration process, we demonstrated significant recovery of the capture range by up to 85%. Conclusion Applying deep‐learning‐based inpainting on X‐ray images masked by implants can markedly improve the capture range of the associated 2D‐3D registration task.

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An intraoperative fluoroscopic method to accurately measure the post-implantation position of pedicle screws

Cited by 15 publications

References 32 publications

Comparison of Preoperative Pedicle Screw Measurement Between Computed Tomography and Magnet Resonance Imaging

Comparison of Preoperative Pedicle Screw Measurement Between Computed Tomography and Magnet Resonance Imaging

Utilization of Spinal Navigation to Facilitate Hassle-Free Rod Placement during Minimally-Invasive Long-Construct Posterior Instrumentation

Deep learning‐based X‐ray inpainting for improving spinal 2D‐3D registration

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