Computer Navigation of Parapedicular Screw Fixation in the Thoracic Spine

Kothe, Ralph; Strauss, Jan Matthias; Deuretzbacher, G.; Hemmi, Tanja; Lorenzen, M; Wiesner, L.

doi:10.1097/00007632-200111010-00019

Cited by 29 publications

(22 citation statements)

References 21 publications

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“…We found good accuracy of screw insertion using a virtual fluoroscopy system as compared to the overall accuracy reported for 3-D image-guided systems (Schwarzenbach et al 1997, Merloz et al 1998, Amiot et al 2000, Kothe et al 2001, Youkilis et al 2001). …”

Section: Discussionmentioning

confidence: 57%

“…The difference in sagittal screw angle (SSA) between the planned virtual images and the postoperative lateral plain radiographs was determined. The SSA was determined between a line parallel to the inferior vertebral end-plate and a line through the center of the screw (Kothe et al 2001).…”

Section: Evaluation Of Screwsmentioning

confidence: 99%

“…Image-guided systems (IGS) have been documented to improve the accuracy of pedicle screw insertion and reduce exposure to radiation (Schwarzenbach et al 1997, Merloz et al 1998, Amiot et al 2000, Kothe et al 2001, Youkilis et al 2001. Such methods have not been widely accepted due to the steep learning curve, the cost of preoperative computed tomography (CT), and the extra surgical time required for patient registration, data acquisition, and transfer.…”

mentioning

confidence: 99%

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Computer-assisted fluoroscopic navigation of pedicle screw insertion An in vivo feasibility study

Chen

Wong

et al. 2004

Acta Orthopaedica Scandinavica

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Background Accurate placement of pedicle screws is difficult.Patients and methods We evaluated the feasibility and accuracy of pedicle screw insertion assisted by a real-time, 2-dimensional (2D) image-guided navigation system in 12 patients who underwent thoraco-lumbar and/or lumbar stabilization. 66 pedicle screws were inserted either by senior spine surgeons or residents. The accuracy of positioning of the screws was evaluated using postoperative plain radiographs and thin-cut CT.Results 61 of the 66 screws were inserted successfully. 5 screw insertions showed structural violations: 4 on the medial and 1 on the lateral pedicle wall. The accuracy was higher in the sagittal plane than in the axial plain. There was no difference between the surgical error rates caused by the senior surgeons and the residents.Interpretation Using computer-assisted 2D fluoroscopic image navigation, it is possible to achieve reliable and accurate pedicle screw insertion during low thoracic and lumbar spinal surgery.

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Section: Discussionmentioning

confidence: 57%

Section: Evaluation Of Screwsmentioning

confidence: 99%

mentioning

confidence: 99%

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Computer-assisted fluoroscopic navigation of pedicle screw insertion An in vivo feasibility study

Chen

Wong

et al. 2004

Acta Orthopaedica Scandinavica

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“…However, these methods have shortcomings that have led to the use of computer-assisted instrumentation [9,12,13,25]. Imageguided techniques provide detailed views of hidden spinal anatomy that can be used for surgical planning and navigation.…”

Section: Discussionmentioning

confidence: 99%

A novel computer-assisted drill guide template for placement of C2 laminar screws

Zhang

et al. 2009

Eur Spine J

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The present method of C2 laminar screw placement relies on anatomical landmarks for screw placement. Placement of C2 laminar screws using drill template has not been described in the literature. The authors reported on their experience with placement of C2 laminar screws using a novel computer-assisted drill guide template in nine patients undergoing posterior occipitocervical fusion. CT scan of C2 vertebrae was performed. 3D model of C2 vertebrae was reconstructed by software MIMICS 10.01. The 3D vertebral model was then exported in STL format, and opened in a workstation running software UG imageware12.0 for determining the optimal laminar screw size and orientation. A virtual navigational template was established according to the laminar anatomic trait. The physical vertebrae and navigational template were manufactured using rapid prototyping. The navigational template was sterilized and used intraoperative to assist the placement of laminar screw. Overall, 19 C2 laminar screws were placed and the accuracy of screw placement was confirmed with postoperative X-ray and CT scanning. There were not complications of related screws insertion. Average follow-up was 9 months (range 4-13 months), 77.8% of the patients exhibited improvement in their myelopathic symptoms; in 22.2% the symptoms were unchanged. Postoperative computed tomographic (CT) scanning was available for allowing the evaluation of placement of thirteen C2 laminar screws, all of which were in good position with no spinal canal violation. This study shows a patient-specific template technique that is easy to use, can simplify the surgical act and generates highly accurate C2 laminar screw placement. Advantages of this technology over traditional techniques include planning of the screw trajectory is done completely in the presurgical period as well as the ability to size the screw to the patient's anatomy.

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“…The computer-assisted computed tomography imageguided system (CTGS) is clinically proven to increase accuracy of pedicle screw insertion and reduce radiation exposure during surgery [1,8,9,15,17]. This technique offers the advantages of three-dimensional (3D) images of the spine, which can reveal structures beneath the surface and also provides a real-time image-interactive means of navigation for pedicle screw insertion.…”

Section: Introductionmentioning

confidence: 99%

Pedicle screw insertion: computed tomography versus fluoroscopic image guidance

Wong

Tsai

et al. 2007

International Orthopaedics (SICO

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Computed tomography image-guided surgery (CTGS) clearly improves the accuracy of pedicle screw insertion. Recent reports claim that a fluoroscopy-guided system (FGS) offered high accuracy and easy application. However, the superiority of either technique remains unclear in clinical application. This study compares the accuracy of pedicle screws installed using CTGS with that of screws installed using FGS. Seventy-four screws inserted using FGS in 13 patients and 76 screws inserted using CTGS in 11 patients were compared. The study population included ten cases of vertebral fracture, five cases of degenerative spondylolisthesis, three cases of spondylolytic spondylolisthesis, two cases of tuberculous spondylitis, two cases of failed earlier back surgery and two case of ankylosing spondylitis with pseudarthrosis. The installed vertebral levels ranged from T8 to S1. Screw positions were assessed with postoperative radiographs and computed tomography. Sixty-nine (93.2%) screws were correctly placed in the FGS group, and seventy-three (96.1%) screws were correctly placed in the CTGS group (P=0.491). The results indicated that both image-guided systems offer high accuracy. However, the fluoroscope image-guided system could be considered the primary tool for lower thoracic and lumbosacral pedicle placement because it enables real-time navigation and does not require a preoperative CT scan.Résumé La chirurgie assistée par imagerie (CTGS) permet d'avoir une meilleure sécurité lors de l'implantation de vis pediculaires. Des articles récents montrent que le système avec amplificateur de brillance (fluoroscopie FGS) permet également cette implantation. Cependant, la supériorité d'une technique ou d'une autre n'apparaît pas clairement. Le but de cette étude est de comparer la bonne implantation des vis pediculaires en utilisant les deux systèmes. 74 vis ont été insérées avec le système FGS chez 13 patients et 66 vis avec le système CTGS chez 11 patients. Ces deux séries ont été comparées. Cette étude inclut 10 cas de fractures vertébrales, 5 cas de spondylolisthésis dégénératifs, 3 cas de spondylolisthésis avec spondylolyse, à 2 cas d'atteintes tuberculeuses, 2 cas d'échec de chirurgie par voie postérieure et 2 cas de spondylarthrite ankylosante avec pseudarthrose. Les niveaux d'instrumentation se sont échelonnés de T8 à S1. 69 (93.2%) vis ont été correctement mises en place dans le groupe FGS et, 73 (96.1%) avec le groupe CTGS (P=0.491). Les résultats montrent que le système d'images guidées CTGS offre beaucoup plus de sécurité dans l'implantation des vis tant au niveau lombaire qu'au niveau thoracique ou lombosacré ceci ne nécessite pas par ailleurs un scanner pré opératoire.

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Computer Navigation of Parapedicular Screw Fixation in the Thoracic Spine

Cited by 29 publications

References 21 publications

Computer-assisted fluoroscopic navigation of pedicle screw insertion An in vivo feasibility study

Computer-assisted fluoroscopic navigation of pedicle screw insertion An in vivo feasibility study

A novel computer-assisted drill guide template for placement of C2 laminar screws

Pedicle screw insertion: computed tomography versus fluoroscopic image guidance

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