Computer Assisted Spine Surgery

Merloz, P.; Tonetti, Jérôme; Eid, Ahmad; Faure, Claude; Lavallée, Stéphane; Troccaz, Jocelyne; Sautot, P.; Hamadeh, Ali; Cinquin, Philippe

doi:10.1097/00003086-199704000-00011

Cited by 111 publications

(34 citation statements)

References 21 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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“…Our percutaneous technique takes advantage of some previously developed method for spine surgery [12,13,14] because of the decreasing of wound complications. It has been validated successfully on 4 cadaver specimens, which encourages us to start clinical validation.…”

Section: Resultsmentioning

confidence: 99%

Treatment of pelvic ring fractures: Percutaneous computer assisted iliosacral screwing

Carrat

Tonetti

Lavallée

et al. 1998

Medical Image Computing and Computer-Assisted Intervention — MICCAI’98

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Abstract. This paper describes the development and preliminary testing of an image-guided system for the placement of iliosacral screws to stabilize pelvic ring fractures percutaneously, with the aim of decreasing the incidence of surgical complications and increasing the accuracy of screw placement. Pre-operative planning of screw trajectories is performed on a 3D model of the pelvis constructed from CT scans. During surgery, a 6D optical localizer is used to track the positions and orientations of an ultrasound probe, a surgical drill and a reference frame fixed to the posterior iliac crest. Registration of the pre-operative model with curves segmented from the ultrasound scans is performed using a surface-based algorithm. The drill tip and axis are displayed relative to the desired screw trajectories in real time. The accuracy of the system has been verified in four cadaver specimens by comparing actual screw trajectories to the desired trajectories and by measuring the distance from each screw to important anatomical landmarks on post-operative CT scans. All screws were considered to be in correct position.

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“…Furthermore, not all navigation methods are equal, with some offering an unacceptable rate of misplacement [18]. Previous studies evaluating thoracic placement have focused mostly in the lower thoracic region [1,4,12,16,17,19,26,29]. Furthermore, accuracy of thoracic pedicle screw instrumentation has been reported in several cadaveric populations [5,7,21,22,25,28,29,31,32], and with the use of assisted-navigation techniques [2,5,6,8,25].…”

Section: Discussionmentioning

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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Computer Assisted Spine Surgery

Cited by 111 publications

References 21 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

Treatment of pelvic ring fractures: Percutaneous computer assisted iliosacral screwing

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

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