Does Computer-Assisted Spine Surgery Reduce Intraoperative Radiation Doses?

Gebhard, Florian; Kraus, M.; Schneider, Eugen; Liener, U. C.; Kinzl, L.; Arand, M.

doi:10.1097/01.brs.0000229250.69369.ac

Cited by 137 publications

(84 citation statements)

References 17 publications

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“…CT-navigation reduces radiation exposure for the patient when the first computed tomography after trauma can be used for planning [10]. The radiation dose increases considerably when an additive CT scan for navigation planning is required.…”

Section: Discussionmentioning

confidence: 99%

Benefit and accuracy of intraoperative 3D-imaging after pedicle screw placement: a prospective study in stabilizing thoracolumbar fractures

et al. 2009

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Internal fixation is the established dorsal standard procedure for the treatment of thoracolumbar fractures. The main problem of the procedure is the false positioning of the pedicle screws. The exact determination of pedicle screws has up to now only been possible through postoperative computed tomography. This study was intended to clarify the diagnostic value of intraoperative 3D scans after pedicle screw implantation in thoracolumbar spine surgery. The direct intraoperative consequences of the 3D scans are reported and the results of the 3D scans are compared with the postoperative computed tomography images. Intraoperative 3D scans were prospectively carried out from June 2006 to October 2008 on 95 patients with fractures of the thoracolumbar spine that have been treated with internal fixation. Screws positions were categorised intraoperatively, screws in relevant malposition were repositioned immediately. A computed tomography of the involved spinal section was carried out postoperatively for all patients. The positions of the pedicle screws were determined and compared in the axial reconstructions of both procedures. Four hundred and fourteen pedicles with enclosed screws were evaluated by the 3D scans. The time needed for carrying out the 3D scan amounts to an average of 8.2 min. Eleven screws (2.7%) in ten patients were primarily intraoperatively repositioned on the basis of the 3D scan evaluation. Two of 95 patients had to have false positions of the screws revised secondarily following evaluation of the computed tomographies. The secondary postoperative revision rate of the patients amounts to 2.1%. In relation to the number of screws, this is a revision rate of 0.5%. The postoperative computed tomographies showed 323 pedicles without cortical penetration by the screws (78.0%). Ninety-one screws penetrated the pedicle wall (22%). It was possible to postoperatively compare the position classifications of 406 pedicle screws. The CT showed 378 correct screw positions, while 28 screws were positioned falsely. On the basis of the 3D scans, 376 of 378 correct positions were correctly assessed. Twenty-one of 28 false positions could be correctly classified. The sensitivity of all 3D scans reached 91.3% and the specificity 98.2%. The position of 97.8% of the pedicle screws was correctly recognised by the intraoperative 3D scan. Nine screws were classified falsely (2.2%). The comparison of the classification results showed significantly higher error findings by the 3D scan in the spinal section T1-10 (P = 0.014). The image quality of the 3D scan correlates significantly with the width of the scanned pedicle, with the body mass index, the scanned spinal section and the extent of the fixation assembly. 3D scans showed a high accuracy in predicting pedicle screw position. Primary false placement of screws and primary neurovascular damage cannot be avoided. But intraoperative evaluation of the 3D scans resulted in a primary revision rate of 2.7% of the pedicle screws and we could lower the secondary revis...

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Section: Discussionmentioning

confidence: 99%

Benefit and accuracy of intraoperative 3D-imaging after pedicle screw placement: a prospective study in stabilizing thoracolumbar fractures

et al. 2009

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“…Surgeon radiation exposure was less with the mini-C-arm. Gebhard et al [6] performed a prospective study of patients who underwent cervical, thoracic, or lumbar spine fracture fixation with pedicle screws through CT computerassisted navigation, Iso C-arm computer-assisted navigation, or standard C-arm placement. Radiation exposure to the patient was decreased with the use of Iso C-arm computer-assisted surgery.…”

Section: Use Of the Standard C-arm Fluoroscopy Compared With Fluoroscmentioning

confidence: 99%

“…Gebhard [6] Cadaveric comparison study hard to characterize and may always represent an area of uncertainty in studies on this topic. We found that radiation exposure was higher during procedures using less invasive spine approaches than an open approach.…”

Section: Cadaveric Studymentioning

confidence: 99%

Does Less Invasive Spine Surgery Result in Increased Radiation Exposure? A Systematic Review

Khan

2014

Clinical Orthopaedics &Amp; Related Research

104

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“…The radiation exposure of the patients mainly depends on the CT protocol [59][60][61]. By analyzing the radiation of three different CT protocols-based navigation system, Slomczykowski et al [59] noted that when CTNav was to be used, the spiral mode of CT scanning was recommended.…”

Section: Other Perioperative Findingsmentioning

confidence: 99%

Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies

et al. 2010

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Studies revealed that navigation systems that provided intraoperative assistance might improve pedicle screw insertion accuracy, and also implied that different systems provided different pedicle screw insertion accuracy. A systematic review and meta-analysis was conducted to focus on the pedicle screw insertion accuracy with or without the assistance of image-guided system, and the variance among the different navigation systems. Comparative studies were searched on pedicle screw insertion accuracy between conventional and navigated method, and among different navigation systems. A total of 43 papers, including 28 clinical, 14 cadaveric and 1 model studies, were included in the current study. For clinical articles, there were 3 randomized clinical trials, 4 prospective comparative studies and 21 retrospective comparative studies. The incidence of pedicle violation among computer tomography-based navigation method group was statistically significantly less than that observed among the conventional group (OR 95% CI, in vivo: 0.32-0.60; in vitro: 0.24-0.75 P \ 0.01). Two-dimensional fluoroscopybased navigation system (OR 95% CI, in vivo: 0.27-0.48; in vitro: 0.43-0.88 P \ 0.01) and three-dimension fluoroscopy-based navigation system (OR 95% CI, in vivo: 0.09-0.38; in vitro: 0.09-0.36 P \ 0.01) also obtained significant reduced screw deviation rate over traditional methods. Between navigated approaches, statistically insignificant individual and pooled RR values were observed for all in vivo subgroups. Pooled estimate of in vitro studies show that computer tomography-based and three-dimension fluoroscopy-based navigation system provided more accurate pedicle screw insertion over two-dimension fluoroscopy-based navigation system. Our review showed that navigation provided a higher accuracy in the placement of pedicle screws compared with conventional methods. The superiority of navigation systems was obvious when they were applied to abnormal spinal structure. Although no strong in vivo evidence has detected significantly different pedicle screw placement accuracy among the three major navigation systems, meta-analysis revealed the variance in pedicle screw insertion accuracy with different navigation methods.

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Does Computer-Assisted Spine Surgery Reduce Intraoperative Radiation Doses?

Abstract: These findings are important for the operating room personnel, which is exposed daily to radiation intraoperatively, as well as the patients, when using CAS procedures.

Cited by 137 publications

References 17 publications

Benefit and accuracy of intraoperative 3D-imaging after pedicle screw placement: a prospective study in stabilizing thoracolumbar fractures

Benefit and accuracy of intraoperative 3D-imaging after pedicle screw placement: a prospective study in stabilizing thoracolumbar fractures

Does Less Invasive Spine Surgery Result in Increased Radiation Exposure? A Systematic Review

Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies

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