Effective dose of radiation per screw in surgery of adolescent idiopathic scoliosis: Matched pair analysis of 293 pedicle screws inserted using three different techniques

Abstract

Purpose Reports on heterogenous groups of patients have indicated that pedicle screw insertion guided by navigation (PIN) leads to, for the patient, higher doses of radiation compared with pedicle screw insertion guided by fluoroscopy (PIF). This would be a major concern, especially in paediatric deformity correction. Methods After a power analysis (aiming at > 0.8) 293 pedicle screws which were inserted in patients with adolescent idiopathic scoliosis were analyzed by comparing effective dose and fluoroscopy time per screw for three different techniques. Groups 2 and 3 were matched to Group 1 by Lenke type of scoliosis. Group 1 were prospectively enrolled consecutive patients that have been operated on by PIN with image acquisition by preoperative CT scan (CTS). Group 2 were consecutive retrospectively matched patients who have been operated on by PIN with image acquisition by an intraoperative 3D scan (3DS). Group 3 were consecutive retrospectively matched patients who have been operated on by PIF. Results Mean dose of radiation per screw was 1.0 mSv (sd 0.8) per screw in CTS patients, 0.025 mSv (sd 0.001) per screw in 3DS patients and 0.781 mSv (sd 0.12) per screw in PIF patients. The difference was significant (p < 0.0001). Conclusion When we compared different techniques of navigation, navigation by image acquisition with CTS showed a significantly higher (by 97.5%) dose of radiation per screw for the patient than navigation by image acquisition by a 3DS. Navigation by 3DS showed significantly lower effective dose per screw for the adolescent patients than the fluoroscopic technique. Level of Evidence: II

Medical Multimedia Image Analysis of Scoliosis in Children Aged 3–7 Years Based on Adaptive Multiobjective Differential Evolution Algorithm

“…In the adaptive multiobjective differential evolution stage, each submultimedia image is treated as a slice/ adaptive multiobjective differential evolution technology of H.265/HEVC [8][9][10]. As shown in Figure 1, each submultimedia image is treated as a slice/adaptive multiobjective differential evolution technology of H.265/HEVC.…”

Modification to the placement of the navigation reference frame in posterior corrective fusion of spinal deformity with myelomeningocele: a series of 6 cases

“…The accuracy of PS placement based on navigation system has been reported in pediatric spinal deformities [11,14]. The accuracy of PS placement has been reported not only in adolescent idiopathic scoliosis but also in neuromuscular scoliosis.…”

“…Pedicle screws (PS) and iliac screws (IS) have been extensively used in pediatric spinal deformities to improve correction of the deformity and obtain rigid fixation [5][6][7][8]. In recent years, there have been many reports on the effective use of preoperative computed tomography (CT) navigation (pCTN) and intraoperative CT navigation (iCTN) for PS and IS placement, owing to their its safety and low radiation exposure [6,7,[9][10][11][12][13][14]. On the other hand, there are reports of posterior corrective fusion to the pelvis using PS and IS for spinal deformity associated with myelomeningocele [2,3], however, there are no reports regarding placement of PS, conventional IS, subcrestal IS, or sacral alar IS (SAIS) using a navigation system.…”

May bending radiographs be replaced by recumbent CT scans in patients with adolescent idiopathic scoliosis?

“…Since some of our patients were operated by navigation based on a preoperative CTS, we used these CTS images as recumbent imaging technique in this investigation and found that CTS may be applied to classify scoliotic minor curves as structural or non-structural. We presently avoid performing any more pedicle screw insertions guided by navigation (PIN) with preoperative CTS in AIS patients because of the higher exposure to radiation of the patients, but applying navigation by an intraoperative 3D scan [18]. For the same reason, we now aspire to apply different recumbent imaging techniques, i.e., MRI or intraoperative images, as "replacement" for BR.…”