Computer-assisted screw insertion into the first sacral vertebra using a three-dimensional image intensifier: results of a controlled experimental investigation

Briem, D.; Linhart, Wolfgang E.; Lehmann, Wolfgang; Begemann, Philipp G. C.; Adam, Gerhard; Schumacher, Udo; Cullinane, Dennis M.; Rueger, Johannes M.; Windolf, Joachim

doi:10.1007/s00586-005-0992-5

Cited by 31 publications

(18 citation statements)

References 34 publications

(23 reference statements)

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“…An additional ilioiliac tension band plate or, technically more demanding, a second screw into S2 are the treatment alternatives of choice in our centre to achieve sufficient fracture stabilisation and early mobilisation. Recent studies propose computer-assisted procedures in pelvic surgery to reduce the risk of screw misplacement based on previous experiences in spinal surgery [5,7]. Our study data suggest that the use of navigation is associated with a lower screw misplacement rate compared to the standard procedure.…”

Section: Malpositionmentioning

confidence: 59%

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Factors influencing the accuracy of iliosacral screw placement in trauma patients

Großterlinden

Rueger

Catalá-Lehnen

et al. 2010

International Orthopaedics (SICOT)

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Correct placement of iliosacral screws remains a surgical challenge. The aim of this retrospective study was to identify parameters which impact the accuracy of this technically demanding procedure. Eighty-two patients with vertically unstable pelvic injuries treated with a total of 147 iliosacral screws were included. Assessment of postoperative CT scans revealed screw misplacement in 13 cases (8%), of which six occurred following insertion of two unilateral screws into S1. Six screw misplacements occurred in patients with dislocation injuries of the posterior pelvis. Comparison of a navigated and the standard technique revealed a decreased screw misplacement rate in the navigated group (15% standard vs. 3% navigation, p<0.05). In addition, the malposition rate was influenced by the surgeon's individual experience (20% for low vs. 3.9% for high volume surgeons, p<0.05). Overall, the accuracy of iliosacral screw placement depends on the number of screws inserted into S1 and the extent of dislocation. In experienced hands, the use of navigation represents a helpful tool to improve the placement accuracy.

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Section: Malpositionmentioning

confidence: 59%

“…More recently, a number of reports also proposed navigated procedures for fixation of unstable pelvic ring injuries, predominantly of the posterior pelvis [5][6][7]. The current standard for treatment of those injuries is the percutaneous iliosacral screw fixation using fluoroscopic techniques according to Matta and Saucedo [8].…”

Section: Introductionmentioning

confidence: 99%

Factors influencing the accuracy of iliosacral screw placement in trauma patients

Großterlinden

Rueger

Catalá-Lehnen

et al. 2010

International Orthopaedics (SICOT)

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“…In orthopedic surgery, it is used in spine and pelvic surgery in particular, and has grown considerably in popularity [7][8][9]. Therapy for fractures of the scaphoid is an interesting indication for CAS, although it also involves some potential difficulties.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 2D and 3D navigation techniques for percutaneous screw insertion into the scaphoid: Results of an experimental cadaver study

Catalá-Lehnen

Nüchtern

Briem

et al. 2011

Computer Aided Surgery

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“…The clinical relevance of this information may be of particular importance when considered in conjunction with other potential sources of error. While the clinical relevance of these factors has been found to be less critical when using navigation for spine or pelvic surgery [6,14], an awareness of these potential sources of error will allow the surgeon to address and reduce these problems [13,15]. Metallic artifacts were not found to significantly affect the precision of registration with fluoroscopybased navigation.…”

Section: Discussionmentioning

confidence: 99%

“…This is what allows the navigation system to generate the position and orientation of the 3D data set in space. The value of this device has been demonstrated in several procedures, including the drilling of osteochondral lesions in the talus [4], the placement of pedicle screws for spine surgery [5], sacroiliac screw placement in the pelvis [6], and tumor surgery [7]. As with most navigation systems, registration and data acquisition are important steps in Iso-C 3D -based navigation, and are subject to several potential sources of error.…”

Section: Introductionmentioning

confidence: 99%

The influence of metal artifacts on navigation and the reduction of artifacts by the use of polyether-ether-ketone

Citak

Kendoff

Wanich

et al. 2008

Computer Aided Surgery

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Registration is a crucial step in navigation assisted surgery. When performing anatomical pair-point registration, there are several potential sources of error, including inadequate data acquisition, improper segmentation, and distortion resulting from metal artifacts. The aim of this study was to evaluate the influence of metal artifacts on the precision of Iso-C 3D and fluoroscopy-based navigation, and to assess any changes in precision from the use of a newly developed Schanz screw composed of polyether-ether-ketone (PEEK OPTIMA Õ ). A T-shaped test specimen was manufactured from synthetic bone material. It was then scanned with a Siremobil Õ Iso-C 3D while different types of implant were present in the specimen. Five Iso-C 3D scans were acquired: one with a steel Schanz screw in the specimen, one with a titanium screw, one with a PEEK screw, one with a 5-hole plate, and one with no screw or plate present. The registration was analyzed by ''reverse verification'' with a pointer in a purpose-built, manipulable 3D holder. All experiments were then repeated using fluoroscopy-based navigation.Increasing presence of metal in the scan area resulted in an increase in mean error (0.55 mm with the steel Schanz screw, 0.7 mm with the 5-hole plate). Artifacts resulting from the titanium Schanz screw were less than those caused by the stainless steel Schanz screw. While this study demonstrates that metallic artifacts do have an influence on the precision of Iso-C 3D navigation, such artifacts were not found to be a factor when performing fluoroscopy-based navigation.

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Computer-assisted screw insertion into the first sacral vertebra using a three-dimensional image intensifier: results of a controlled experimental investigation

Cited by 31 publications

References 34 publications

Factors influencing the accuracy of iliosacral screw placement in trauma patients

Factors influencing the accuracy of iliosacral screw placement in trauma patients

Comparison of 2D and 3D navigation techniques for percutaneous screw insertion into the scaphoid: Results of an experimental cadaver study

The influence of metal artifacts on navigation and the reduction of artifacts by the use of polyether-ether-ketone

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