Comparison of intraoperative O-arm- and conventional fluoroscopy (C-arm)-assisted insertion of pedicle screws in the treatment of fracture of thoracic vertebrae

Liu, Hao; Wang, Yimeng; Pi, Bin; Zhou, Qian; Zhu, Xiaoyu; Yang, Huilin

doi:10.1177/2309499016684090

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…Liu et al compared pedicle screw placement for fractures in the thoracic spine either using fluoroscopy or 3D-Scan via O-arm to control K-wire position. A significantly higher rate of satisfactory positioned pedicle screws (grade 0 and I) was observed in the O-arm control group [11]. The rate of perforations with less than 2 mm was with 96.6% comparable to the 98.3% in our study underlining the importance of a K-wire control after fluoroscopy guided pedicle screw placement.…”

Section: Discussionsupporting

confidence: 66%

Spine surgery in a state-of-the-art hybrid operating room: an experience of 1745 implanted pedicle screws in the thoracolumbar spine

et al. 2023

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Hybrid-operating rooms (hybrid-OR) combine high-resolution 2D images and 3D-scans with the possibility of 3D-navigation and allow minimal invasive pedicle screw placement even in the upper thoracic spine. The disadvantage of high cost and increased radiation needs to be compensated with high accuracy and safety. The hybrid operating room consists of a floor-based flat-panel robotic C-arm with 3D-scan capability (Artis Zeego, Siemens; Germany) combined with navigation (BrainLAB Curve, BrainLAB; Germany). Through a minimally invasive incision, a Jamshidi needle was advanced through the pedicle and a K-wire was placed. If 2D image quality did not allow safe placement 3D-navigation was used to place the K-wire. Position was controlled through a 3D-Scan and corrected if necessary before screw placement. Postoperative CTs evaluated screw perforation grade with grade I when completely within the pedicle, II < 2 mm, III 2–4 mm, and IV > 4 mm outside the pedicle. Overall, 354 screws were placed in T1–T6, 746 in the lower thoracic spine T7–T12 and 645 in the L1-L5. Navigation was mainly used in upper thoracic spine cases (31 of 57). In 63 out of 326 cases K-wire was corrected after the 3D-Scan. Overall, 99.1% of the screws showed perforation less than 2 mm. Mean radiation was 13.3 ± 11.7 mSv and significantly higher in the upper thoracic spine and in navigated procedures. Despite higher costs and radiation, the hybrid-OR allows highest accuracy and therefore patient safety in minimal invasive pedicle screw placement in the thoracic and lumbar spine.

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Section: Discussionsupporting

confidence: 66%

Spine surgery in a state-of-the-art hybrid operating room: an experience of 1745 implanted pedicle screws in the thoracolumbar spine

et al. 2023

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“…Navigation technology that has emerged in recent years can significantly improve the accuracy of screw placement during spinal deformity surgery 3 . Based on the intraoperative use of an O‐arm‐based navigation system, the convenience and accuracy of pedicle screw placement under navigation is further improved, and many studies have reported that O‐arm navigation has increased the accuracy of intraoperative pedicle screw placement compared with traditional C‐arm fluoroscopy navigation 4–7 . However, we found that patients with spinal deformity showed abnormal vertebral body development, even when the pedicle screws were implanted with the aid of O‐arm navigation, which is not satisfactory.…”

Section: Introductionmentioning

confidence: 93%

“… 3 Based on the intraoperative use of an O‐arm‐based navigation system, the convenience and accuracy of pedicle screw placement under navigation is further improved, and many studies have reported that O‐arm navigation has increased the accuracy of intraoperative pedicle screw placement compared with traditional C‐arm fluoroscopy navigation. 4 , 5 , 6 , 7 However, we found that patients with spinal deformity showed abnormal vertebral body development, even when the pedicle screws were implanted with the aid of O‐arm navigation, which is not satisfactory. After excluding systematic errors and misuse, we named the phenomenon where the pedicle screw deviates from the guide line during O‐arm navigation‐assisted pedicle screw placement the drift phenomenon.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for the Drift Phenomenon in O‐arm Navigation‐Assisted Pedicle Screw Placement during Spinal Deformity Surgery

Zhao

Zhuge

Gao

et al. 2022

Orthopaedic Surgery

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Objective Intraoperative O‐arm navigation systems improve the accuracy of spinal instrumentation placement. However, deviation of the pedicle screw from the guide line might occur. The aim of the present study was to explore the causes of and countermeasures for the drift phenomenon during pedicle screw implantation with the aid of an O‐arm three‐dimensional navigation system in spinal deformity surgery. Methods This was a retrospective analysis of 341 patients with spinal deformity who underwent O‐arm navigation system‐assisted pedicle screw placement from July 2015 to June 2019. The patient's general condition, Cobb angle, apical vertebra position, softness index, spinal release status, fixed reference frame position, and distance between the navigation vertebral body and the reference frame were collected and compared by independent‐samples t test or Pearson's chi‐square analysis. The potential risk factors for the drift phenomenon were identified using binary logistic regression analysis. Results The drift phenomenon occurred in 57 patients during the first navigation‐assisted pedicle screw placement, for an incidence of 16.7% (57/341). There were significant differences in factors such as the apical vertebra position, softness index, spinal release status, and distance between the vertebral body and the reference frame when the drift phenomenon occurred (P < 0.05). Binary logistic regression analysis showed that the softness index, spinal release status, and distance between the vertebral body and the reference frame when drifting occurred were independent risk factors for the drift phenomenon during O‐arm navigation‐assisted pedicle screw placement. Conclusion During the use of an O‐arm navigation system to assist with pedicle screw placement, pedicle screws should not be placed away from the reference frame, and spinal osteotomy and release should be performed after pedicle screw placement. In addition, the accuracy of O‐arm navigation‐assisted pedicle screw placement will be affected more in those with larger softness indices.

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“…[ 1 ] Here, in 64 patients with thoracic or lumbar fractures undergoing instrumented fusions, we compared the accuracy of utilizing intraoperative lateral fluoroscopy with postoperative CT 3D navigation. [ 8 ]…”

Section: Introductionmentioning

confidence: 99%

Comparison of the accuracy of intraoperative lateral fluoroscopy versus postoperative computed tomography in spinal fusions

Altaf¹,

Rehman²,

Javeed³

et al. 2023

Surgical Neurology International

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Background: This study compared the accuracy of intraoperative lateral fluoroscopic images versus postoperative computed tomography (CT) 3D studies in the treatment of thoracolumbar spinal fusions. Methods: In a tertiary care hospital (study duration 6 months), we compared the use of lateral fluoroscopic images with the postoperative CT scans in 64 patients with thoracic or lumbar fractures undergoing spinal fusions. Results: Out of the 64 patients, 61% were lumbar followed by 39% thoracic fractures. In the lumbar spine, the accuracy of screw placement utilizing lateral fluoroscopy versus postoperative CT 3D was 97.4%, while in thoracic spine, accuracy was reduced to 84.4%. Of the 64 patients, just 4 (6.2%) patients demonstrated lateral pedicle cortex penetration, 1 (1.5%) patient had a medial pedicle cortex breach, while none exhibited anterior vertebral body cortex penetration. Conclusion: This study documented the efficacy of lateral fluoroscopy in intraoperative thoracic and lumbar spinal fixation as confirmed by postoperative CT 3D studies. These findings support the continued use of fluoroscopy rather than CT intraoperatively to lower the risk of radiation exposure to both patients and surgeons.

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Comparison of intraoperative O-arm- and conventional fluoroscopy (C-arm)-assisted insertion of pedicle screws in the treatment of fracture of thoracic vertebrae

Cited by 8 publications

References 27 publications

Spine surgery in a state-of-the-art hybrid operating room: an experience of 1745 implanted pedicle screws in the thoracolumbar spine

Spine surgery in a state-of-the-art hybrid operating room: an experience of 1745 implanted pedicle screws in the thoracolumbar spine

Risk Factors for the Drift Phenomenon in O‐arm Navigation‐Assisted Pedicle Screw Placement during Spinal Deformity Surgery

Comparison of the accuracy of intraoperative lateral fluoroscopy versus postoperative computed tomography in spinal fusions

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