Clinical Accuracy of Fluoroscopic Computer-Assisted Pedicle Screw Fixation: A CT Analysis

Rampersaud, Y. Raja; Pik, Justin; Salonen, David; Farooq, Samina

doi:10.1097/01.brs.0000157490.65706.38

Cited by 149 publications

(98 citation statements)

References 43 publications

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“…At review, 48 papers were excluded as they did not meet the inclusion criteria (Table 1). Thus, 23 publications [5,6,8,9,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] were analysed in this paper (Table 2; 2 randomised controlled trials, 12 case-control studies and 9 case series). Three studies were in German language and remaining 20 studies were in English.…”

Section: Resultsmentioning

confidence: 99%

“…The reported pedicle screw misplacement in historical spinal literature can be as high as [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39].8% [1][2][3], but only a small number leads to complications (neurological, vascular or visceral injuries). But these complications can be potentially life and limb threatening.…”

Section: Introductionmentioning

confidence: 99%

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Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws

et al. 2010

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A number of studies have shown increased accuracy of pedicle screw placement in spine with the help of computer-assisted navigation. The literature is lacking in regard to functional benefit derived from this technique. The aim of this systematic review was to look at the functional outcomes following computer-assisted pedicle screw placement in spine. A 'Dialog Datastar' search was used using optimized search strategy covering the period from 1950 to July 2009; 23 papers were finally included which met our inclusion criteria. We report on a total of 1,288 patients with 5,992 pedicle screws. The comparison of neurological complications in two groups demonstrated an odds ratio of 0.25 (95% CI 0.06, 1.14) in favour of using navigation for pedicle screw insertion (p = 0.07). Comparative trials demonstrated a significant advantage in terms of accuracy of navigation over conventional pedicle screw insertion with a relative risk of 1.12 (95% CI 1.09, 1.15) (p \ 0.00001). Navigation does not show statistically significant benefit in reducing neurological complications and there was insufficient data in the literature to infer a conclusion in terms of fusion rate, pain relief and health outcome scores.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws

et al. 2010

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“…Lastly, all included studies involved independent blinded investigators to assess pedicle screw position using post-operative fine-cut CT. Unfortunately the metric tools used to satisfactorily determine screw placement varied widely including the Gertzbein and Robbins scale, Rampersaud scale, and Wiesner and Schizas scale [6,15,19,28]. In the instance when the same scale was shared, criteria for a satisfactory position varied; for example, while the Schizas et al and Lieberman et al studies both adopted the Rampersaud scale, the former considered positions A and B adequate (completely in pedicle, or \2 mm breach), while the latter considered only position A acceptable (completely in pedicle only).…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted and fluoroscopy-guided pedicle screw placement: a systematic review

et al. 2013

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Purpose At present, most spinal surgeons undertake pedicle screw implantation using either anatomical landmarks or C-arm fluoroscopy. Reported rates of screw malposition using these techniques vary considerably, though the evidence generally favors the use of imageguidance systems. A miniature spine-mounted robot has recently been developed to further improve the accuracy of pedicle screw placement. In this systematic review, we critically appraise the perceived benefits of robot-assisted pedicle screw placement compared to conventional fluoroscopy-guided technique. Methods The Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases were searched between January 2006 and January 2013 to identify relevant publications that (1) featured placement of pedicle screws, (2) compared robot-assisted and fluoroscopy-guided surgery, (3) assessed outcome in terms of pedicle screw position, and (4) present sufficient data in each arm to enable meaningful comparison ([10 pedicle screws in each study group). Results A total of 246 articles were retrieved, of which 5 articles met inclusion criteria, collectively reporting placement of 1,308 pedicle screws (729 robot-assisted, 579 fluoroscopy-guided). The findings of these studies are mixed, with limited higher level of evidence data favoring fluoroscopy-guided procedures, and remaining comparative studies supporting robot-assisted pedicle screw placement. Conclusions There is insufficient evidence to unequivocally recommend one surgical technique over the other. Given the high cost of robotic systems, and the high risk of spinal surgery, further high quality studies are required to address unresolved clinical equipoise in this field.

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“…Pedicle screw insertion in the lumbosacral region of the spine has been extensively studied and is widely performed today. The relative ease of implantation is mainly due to the larger size of both the vertebral body and the pedicle diameters, as compared to the mid and upper thoracic vertebral anatomy [20]. Interest in thoracic pedicle screw use has gained momentum recently, especially in the lower thoracic spine, as it presents an alternative to the use of hook and wire fixation [14,15].…”

Section: Introductionmentioning

confidence: 99%

“…It is therefore important to study optimal placement of thoracic pedicle screws in order to evaluate safety of their use. The goal is to improve methods for avoiding screw misplacement [9,20].…”

Section: Introductionmentioning

confidence: 99%

Inserting pedicle screws in the upper thoracic spine without the use of fluoroscopy or image guidance. Is it safe?

2006

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Several studies have looked at accuracy of thoracic pedicle screw placement using fluoroscopy, image guidance, and anatomical landmarks. To our knowledge the upper thoracic spine (T1-T6) has not been specifically studied in the context of screw insertion and placement accuracy without the use of either image guidance or fluoroscopy. Our objective was to study the accuracy of upper thoracic screw placement without the use of fluoroscopy or image guidance, and report on implant related complications. A single surgeon inserted 60 screws in 13 consecutive non-scoliotic spine patients. These were the first 60 screws placed in the high thoracic spine in our institution. The most common diagnosis in our patient population was trauma. All screws were inserted using a modified RoyCamille technique. Post-operative axial computed tomography (CT) images were obtained for each patient and analyzed by an independent senior radiologist for placement accuracy. Implant related complications were prospectively noted. No pedicle screw misplacement was found in 61.5% of the patients. In the remaining 38.5% of patients some misplacements were noted. Fifty-three screws out of the total 60 implanted were placed correctly within all the pedicle margins. The overall pedicle screw placement accuracy was 88.3% using our modified Roy-Camille technique. Five medial and two lateral violations were noted in the seven misplaced screws. One of the seven misplaced screws was considered to be questionable in terms of pedicle perforation. No implant related complications were noted. We found that inserting pedicle screws in the upper thoracic spine based solely on anatomical landmarks was safe with an accuracy comparable to that of published studies using imageguided navigation at the thoracic level.

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Clinical Accuracy of Fluoroscopic Computer-Assisted Pedicle Screw Fixation: A CT Analysis

Abstract: The clinical pedicle breach rate in this study is comparable to those reported using conventional techniques with or without fluoroscopic assistance. FluoroNav appears to be a safe adjunct for the placement of thoracic and LS pedicle screws.

Cited by 149 publications

References 43 publications

Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws

Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws

Robot-assisted and fluoroscopy-guided pedicle screw placement: a systematic review

Inserting pedicle screws in the upper thoracic spine without the use of fluoroscopy or image guidance. Is it safe?

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