Clinical efficiency of operating room-based sliding gantry CT as compared to mobile cone-beam CT-based navigated pedicle screw placement in 853 patients and 6733 screws

Ille, Sebastian; Baumgart, Lea; Obermueller, Thomas; Meyer, Bernhard; Krieg, Sandro M.

doi:10.1007/s00586-021-06981-3

Cited by 8 publications

(9 citation statements)

References 26 publications

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“…Regarding the accuracy of pedicle screw placement in our study, two patients (7.4%) were reported with pedicle screw revision in this study, resulting in a total screw revision rate of 4.0%, which is comparable to previous studies in patient positioning in prone position (35,36).…”

Section: -Degree Semi-prone Patient Positioningsupporting

confidence: 84%

The one-stop-shop approach: Navigating lumbar 360-degree instrumentation in a single position

et al. 2023

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ObjectiveTreatment strategies of patients suffering from pyogenic spondylodiscitis are a controverse topic. Percutaneous dorsal instrumentation followed by surgical debridement and fusion of the infectious vertebral disc spaces is a common approach for surgical treatment. Technical advances enable spinal navigation for dorsal and lateral instrumentation. This report investigates combined navigated dorsal and lateral instrumentation in a single surgery and positioning for lumbar spondylodiscitis in a pilot series.MethodsPatients diagnosed with 1- or 2-level discitis were prospectively enrolled. To enable posterior navigated pedicle screw placement and lateral interbody fusion (LLIF) patients were positioned semi-prone in 45-degree fashion. For spinal referencing, a registration array was attached to the pelvic or spinal process. 3D scans were acquired intraoperatively for registration and implant control.Results27 patients suffering from 1- or 2-level spondylodiscitis with a median ASA of 3 (1–4) and a mean BMI of 27.9 ± 4.9 kg/m2 were included. Mean duration of surgery was 146 ± 49 min. Mean blood loss was 367 ± 307 ml. A median of 4 (4–8) pedicle screws were placed for dorsal percutaneous instrumentation with an intraoperative revision rate of 4.0%. LLIF was performed on 31 levels with an intraoperative cage revision rate of 9.7%.ConclusionsNavigated lumbar dorsal and lateral instrumentation in a single operation and positioning is feasible and safe. It enables rapid 360-degree instrumentation in these critically ill patients and potentially reduces overall intraoperative radiation exposure for patient and staff. Compared to purely dorsal approaches it allows for optimal discectomy and fusion while overall incisions and wound size are minimized. Compared to prone LLIF procedures, semi-prone in 45-degree positioning allows for a steep learning curve due to minor changes of familiar anatomy.

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Section: -Degree Semi-prone Patient Positioningsupporting

confidence: 84%

The one-stop-shop approach: Navigating lumbar 360-degree instrumentation in a single position

et al. 2023

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“…The comparison of time effort in other research is difficult, since the methods for the measurement of time required for pedicle screw placement is inconsistent. Only trends within studies can be compared, but validity is limited due to the wide variation in data collection [ 6 , 31 – 33 ]. For example, in this study, time required for the preoperative “set-up” was not considered because artificial partial spine models were studied.…”

Section: Discussionmentioning

confidence: 99%

“…3D navigation can be based on different intraoperative imaging modalities, that differ in various aspects such as image quality and field of view. Modalities available include cone beam computed tomography (CBCT) or intraoperative computed tomography (iCT) [ 3 – 6 ]. Advantages of the iCT compared to the CBCT are higher image resolution and a lager field of view [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Radiation exposure for pedicle screw placement with three different navigation system and imaging combinations in a sawbone model

Beisemann,

Gierse,

Mandelka

et al. 2023

BMC Musculoskelet Disord

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Background Studies have shown that pedicle screw placement using navigation can potentially reduce radiation exposure of surgical personnel compared to conventional methods. Spinal navigation is based on an interaction of a navigation software and 3D imaging. The 3D image data can be acquired using different imaging modalities such as iCT and CBCT. These imaging modalities vary regarding acquisition technique and field of view. The current literature varies greatly in study design, in form of dose registration, as well as navigation systems and imaging modalities analyzed. Therefore, the aim of this study was a standardized comparison of three navigation and imaging system combinations in an experimental setting in an artificial spine model. Methods In this experimental study dorsal instrumentation of the thoracolumbar spine was performed using three imaging/navigation system combinations. The system combinations applied were the iCT/Curve, cCBCT/Pulse and oCBCT/StealthStation. Referencing scans were obtained with each imaging modality and served as basis for the respective navigation system. In each group 10 artificial spine models received bilateral dorsal instrumentation from T11-S1. 2 referencing and control scans were acquired with the CBCTs, since their field of view could only depict up to five vertebrae in one scan. The field of view of the iCT enabled the depiction of T11-S1 in one scan. After instrumentation the region of interest was scanned again for evaluation of the screw position, therefore only one referencing and one control scan were obtained. Two dose meters were installed in a spine bed ventral of L1 and S1. The dose measurements in each location and in total were analyzed for each system combination. Time demand regarding screw placement was also assessed for all system combinations. Results The mean radiation dose in the iCT group measured 1,6 ± 1,1 mGy. In the cCBCT group the mean was 3,6 ± 0,3 mGy and in the oCBCT group 10,3 ± 5,7 mGy were measured. The analysis of variance (ANOVA) showed a significant (p < 0.0001) difference between the three groups. The multiple comparisions by the Kruskall-Wallis test showed no significant difference for the comparison of iCT and cCBCT (p1 = 0,13). Significant differences were found for the direct comparison of iCT and oCBCT (p2 < 0,0001), as well as cCBCT and oCBCT (p3 = 0,02). Statistical analysis showed that significantly (iCT vs. oCBCT p = 0,0434; cCBCT vs. oCBCT p = 0,0083) less time was needed for oCBCT based navigated pedicle screw placement compared to the other system combinations (iCT vs. cCBCT p = 0,871). Conclusion Under standardized conditions oCBCT navigation demanded twice as much radiation as the cCBCT for the same number of scans, while the radiation exposure measured for the iCT and cCBCT for one scan was comparable. Yet, time effort was significantly less for oCBCT based navigation. However, for transferability into clinical practice additional studies should follow evaluating parameters regarding feasibility and clinical outcome under standardized conditions.

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“…We retrospectively analyzed prospectively the collected data of consecutive patients being operated on using a CFR-PEEK pedicle screw system for posterior stabilization (Icotec, Altstätten, Switzerland) because of spinal metastases or primary bone tumors of the thoracic or lumbar spine. Pedicle screw placement was performed and navigated using an operating room-based sliding gantry CT (Brilliance CT Big Bore, Philipps, Amsterdam, The Netherlands), a mobile cone-beam CT (O-arm II, Medtronic, Minneapolis, MN, USA) [ 21 ] or a C-arm with 3-dimensional scanning (Arcadis Orbic, Siemens, München, Germany). Cement augmentation was used, depending on the quality of the cancellous bone.…”

Section: Methodsmentioning

confidence: 99%

CFR-PEEK Pedicle Screw Instrumentation for Spinal Neoplasms: A Single Center Experience on Safety and Efficacy

Joerger

Seitz

Lange

et al. 2022

Cancers

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(1) Background: Surgery for spinal metastases has gained a decisive role in modern oncological treatment. Recently, carbon-fiber-reinforced (CFR) polyethyl-ether-ether-ketone (PEEK) pedicle screw systems were introduced, reducing artifacts on imaging and showing less perturbation effects on photon radiation. Preliminary clinical experience with CFR-PEEK implants for spinal metastases exists. The aim of this monocentric study is to report on the safety and efficacy of CFR-PEEK pedicle screw systems for spinal neoplasms in a large cohort of consecutive patients. (2) Methods: We retrospectively analyzed prospectively the collected data of consecutive patients being operated on from 1 August 2015 to 31 October 2021 using a CFR-PEEK pedicle screw system for posterior stabilization because of spinal metastases or primary bone tumors of the spine. (3) Results: We included 321 patients of a mean age of 65 ± 13 years. On average, 5 ± 2 levels were instrumented. Anterior reconstruction was performed in 121 (37.7%) patients. Intraoperative complications were documented in 30 (9.3%) patients. Revision surgery for postoperative complications was necessary in 55 (17.1%) patients. Implant-related complications, such as intraoperative screw breakage (3.4%) and screw loosening (2.2%), were rare. (4) Conclusions: CFR-PEEK is a safe and efficient alternative to titanium for oncological spinal instrumentation, with low complication and revision rates in routine use and with the advantage of its radiolucency.

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Clinical efficiency of operating room-based sliding gantry CT as compared to mobile cone-beam CT-based navigated pedicle screw placement in 853 patients and 6733 screws

Cited by 8 publications

References 26 publications

The one-stop-shop approach: Navigating lumbar 360-degree instrumentation in a single position

The one-stop-shop approach: Navigating lumbar 360-degree instrumentation in a single position

Radiation exposure for pedicle screw placement with three different navigation system and imaging combinations in a sawbone model

CFR-PEEK Pedicle Screw Instrumentation for Spinal Neoplasms: A Single Center Experience on Safety and Efficacy

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