Does intraoperative navigation improve the accuracy of pedicle screw placement in the apical region of dystrophic scoliosis secondary to neurofibromatosis type I: comparison between O-arm navigation and free-hand technique

Jin, Mengran; Liu, Zhen; Liu, Xingyong; Huang, Yan; Han, Xiao; Qiu, Yong; Zhu, Zezhang

doi:10.1007/s00586-015-4012-0

Cited by 79 publications

(61 citation statements)

References 27 publications

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“…5,6,17–21 In this context, it should be noted that in our study, the screw placement grading was more rigorous than in comparable studies. We used three different views (axial, coronal, and sagittal) to identify any potential breach in any direction and were thus more likely to identify a subtle breach not visible on axial views only (cf.…”

Section: Discussionmentioning

confidence: 73%

Surgical Navigation Technology Based on Augmented Reality and Integrated 3D Intraoperative Imaging

Elmi-Terander

Skúlason

Söderman

et al. 2016

Spine

136

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Study Design.A cadaveric laboratory study.Objective.The aim of this study was to assess the feasibility and accuracy of thoracic pedicle screw placement using augmented reality surgical navigation (ARSN).Summary of Background Data.Recent advances in spinal navigation have shown improved accuracy in lumbosacral pedicle screw placement but limited benefits in the thoracic spine. 3D intraoperative imaging and instrument navigation may allow improved accuracy in pedicle screw placement, without the use of x-ray fluoroscopy, and thus opens the route to image-guided minimally invasive therapy in the thoracic spine.Methods.ARSN encompasses a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D capabilities, integrated optical cameras for augmented reality navigation, and noninvasive patient motion tracking. Two neurosurgeons placed 94 pedicle screws in the thoracic spine of four cadavers using ARSN on one side of the spine (47 screws) and free-hand technique on the contralateral side. X-ray fluoroscopy was not used for either technique. Four independent reviewers assessed the postoperative scans, using the Gertzbein grading. Morphometric measurements of the pedicles axial and sagittal widths and angles, as well as the vertebrae axial and sagittal rotations were performed to identify risk factors for breaches.Results.ARSN was feasible and superior to free-hand technique with respect to overall accuracy (85% vs. 64%, P < 0.05), specifically significant increases of perfectly placed screws (51% vs. 30%, P < 0.05) and reductions in breaches beyond 4 mm (2% vs. 25%, P < 0.05). All morphometric dimensions, except for vertebral body axial rotation, were risk factors for larger breaches when performed with the free-hand method.Conclusion.ARSN without fluoroscopy was feasible and demonstrated higher accuracy than free-hand technique for thoracic pedicle screw placement.Level of Evidence: N/A

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Section: Discussionmentioning

confidence: 73%

Surgical Navigation Technology Based on Augmented Reality and Integrated 3D Intraoperative Imaging

Elmi-Terander

Skúlason

Söderman

et al. 2016

Spine

136

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“…By a navigated screwdriver, the pedicle screw was placed to a proper depth. The position and screw trajectory were displayed on the monitor [36] (Fig 1…”

Section: Methodsmentioning

confidence: 99%

Accuracy of pedicle screw placement in patients with Marfan syndrome

Qiao

Zhu

et al. 2017

BMC Musculoskelet Disord

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BackgroundThere is no study concerning safety and accuracy of pedicle screw placement in Marfan syndrome. The objective of this study is to investigate accuracy and safety of pedicle screw placement in scoliosis associated with Marfan syndrome.MethodsCT scanning was performed to analyze accuracy of pedicle screw placement. Pedicle perforations were classified as medial, lateral or anterior and categorized to four grades: ≤ 2 mm as Grade 1, 2.1–4.0 mm as Grade 2, 4.1–6.0 mm as Grade 3, ≥6.1 mm as Grade 4. Fully contained screws or with medial wall perforation ≤ 2 mm or with lateral wall perforation ≤ 6 mm and without injury of visceral organs were considered acceptable, otherwise were unacceptable.Results976 pedicle screws were placed, 713 screws (73.1%) were fully contained within the cortical boundaries of the pedicle. 924 (94.7%) screws were considered as acceptable, and 52 (5.3%) as unacceptable. The perforation rate was higher using free-hand technique than O-arm navigation technique (30.8% VS. 11.4%, P < 0.05), higher in lumbar region than in thoracic region (34.1% VS. 22.3%, P < 0.05) and higher in concave side than in convex side (33.5% VS. 21.9%, P < 0.05). No injury of visceral organs especially aorta erosion was noted in the series. 7 cases of dural tear caused by misplaced screws occurred, and 4 cases developed cerebro-spinal fluid leak. Drainage and pressure dressings were applied for these patients, and no infection was observed. Leg pain was observed in 7 cases, and 2 cases simultaneously complained of leg weakness. Revision surgery was conducted to remove the misplaced screws for these 2 patients. Conservative treatment was applied for the 5 patients without leg weakness. Symptoms of leg weakness and pain resolved in all patients.ConclusionPlacement of pedicle screw in Marfan syndrome is accuracy and safe. O-arm navigation was an effective modality to ensure the safety and accuracy of screw placement. Special attention should be paid when screws were placed at the lumber spine and the concave side of spine deformity to avoid the higher rate of complications.

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“…7 The O-arm navigation, one of the latest intraoperative imaging platforms, has been well acknowledged for its superiorities in surgeries for trauma or degenerative spinal diseases. [8][9][10] Shin et al have reported a decrease in pedicle perforation rates from 15% in nonnavigated screws to 6% in navigated pedicle screw insertions. 11 However, the intraoperative navigation pitfalls could eventually cause a loss of operative time, prolonged anesthesia, blood loss, intraoperative pedicle screw errors, and inadvertent neurological complications.…”

Section: Introductionmentioning

confidence: 99%

Comparison of intraoperative O-arm- and conventional fluoroscopy (C-arm)-assisted insertion of pedicle screws in the treatment of fracture of thoracic vertebrae

Liu

Wang

et al. 2017

J Orthop Surg (Hong Kong)

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Purpose: To introduce the intraoperative O-arm-assisted pedicle screw insertion without any navigation system in the treatment of thoracic vertebrae fracture and compare it to conventional fluoroscopy (C-arm)-assisted pedicle screw insertion technique. Methods: About 156 pedicle screws were inserted in 23 patients (C-arm group), and 208 pedicle screws were inserted in 30 patients (O-arm group). The postoperative computed tomography images were analyzed for pedicle violation based on Gertzbein classification. The total surgery time, the average time required for inserting a screw, the mean action times of adjusting guide probe and pedicle screw, and the hospitalization time were compared in both groups, respectively. The American Spinal Injury Association (ASIA) was used for evaluating the health outcomes pre-and postoperatively. Results: There are the higher accuracy rate of satisfactory pedicle screw placement (grades 0 and 1) and the less incidence of medial perforation in the O-arm group compared to the C-arm group (p < 0.05). The average time required for inserting a screw, the action times of adjusting the guide probe and pedicle screw, and the hospitalization time in the O-arm group are less than the respective ones in the C-arm group (p < 0.05). There was no significant difference for the total surgery time between both groups. No further damage of the nerve function postoperatively is found according to the ASIA grade. Conclusion: The O-arm-assisted pedicle screw insertion without navigation we described provides higher accuracy of pedicle screw placement and better clinical efficacy compared to conventional fluoroscopy (C-arm) technique.

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Does intraoperative navigation improve the accuracy of pedicle screw placement in the apical region of dystrophic scoliosis secondary to neurofibromatosis type I: comparison between O-arm navigation and free-hand technique

Cited by 79 publications

References 27 publications

Surgical Navigation Technology Based on Augmented Reality and Integrated 3D Intraoperative Imaging

Surgical Navigation Technology Based on Augmented Reality and Integrated 3D Intraoperative Imaging

Accuracy of pedicle screw placement in patients with Marfan syndrome

Comparison of intraoperative O-arm- and conventional fluoroscopy (C-arm)-assisted insertion of pedicle screws in the treatment of fracture of thoracic vertebrae

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