Computer-navigated Iliosacral Screw Insertion Reduces Malposition Rate and Radiation Exposure

Abstract

Insertion of percutaneous iliosacral screws with fluoroscopic guidance is associated with a relatively high screw malposition rate and long radiation exposure. We asked whether radiation exposure was reduced and screw position improved in patients having percutaneous iliosacral screw insertion using computer-assisted navigation compared with patients having conventional fluoroscopic screw placement. We inserted 26 screws in 24 patients using the navigation system and 35 screws in 32 patients using the conventional fluoroscopic technique. Two subgroups were analyzed, one in which only one iliosacral screw was placed and another with additional use of an external fixator. We determined screw positions by computed tomography and compared operation time, radiation exposure, and screw position. We observed no difference in operative times. Radiation exposure was reduced for the patients and operating room personnel with computer assistance. The postoperative computed tomography scan showed better screw position and fewer malpositioned screws in the three-dimensional navigated groups. Computer navigation reduced malposition rate and radiation exposure. Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Percutaneous iliosacral screw fixation in S1 and S2 for posterior pelvic ring injuries: technique and perioperative complications

“…This is consistent with our data, even though the distribution of fracture severity was diVerent or could not be identiWed due to diVerent applied classiWcation systems. Although various techniques for CT-guided or computer-navigated screw insertion have been described [1,2,13,17,20,27], their use in the treatment of trauma patients is controversial. While higher precision of screw placement was described for computer-assisted surgery [2,20,27] others found no diVerence between navigated or CT-guided and conventional screw placement [1,17,20].…”

“…With the advent of standardized intraoperative imaging algorithms [3,5,15], percutaneous screw placement has gained popularity allowing for minimally invasive early deWnitive Wxation of fractures and disruptions of the posterior pelvic ring. In order to increase precision of screw positioning, various techniques for CT-guided/computer-navigated screw positioning were described [13,27]. Yet, in the emergency room (ER) with patients in urgent need for early primary care, these time-consuming techniques are unsuitable.…”

Accuracy of a 3D fluoroscopic navigation system using a flat-panel detector-equipped C-arm

“…Three-dimensional (3D) fluoroscopic navigation systems using Iso-C3D, a mobile 3D C-arm equipped with an image intensifier, have been successfully validated for surgeries of the cervical [1][2][3][4][5][6], thoracic [3,[6][7][8][9] and lumbar [3,6,[10][11][12] spine, sacrum [6,[13][14][15], pelvis [16] and lower extremities [17][18][19]. The quality of imaging is a crucial factor for safe performance of image-based navigation.…”

MRI-guided Navigation Surgery with Temporary Implantable Bone Markers in Limb Salvage for Sarcoma

“…Computer-assisted navigation surgery has been widely used for patients with trauma [3,8,18] or those having joint arthroplasty [9,11] or spine surgery [14]. Navigation also has been used for patients with malignant bone tumors for precise tumor resection and planned reconstruction presuming it will reduce local recurrence rates and enhance functional outcomes by saving adjacent joint and major neurovascular structures [1,6,7,10,[15][16][17].…”

“…Therefore, MRI is essential for computer-assisted navigation surgery in patients with malignant bone tumors, combined with the CT images using the software provided with the navigation system. Three or four corresponding anatomic bone landmarks of the patients then can be established on the fused CT-MR images [16][17][18].…”