Electromagnetic Real Time Navigation in the Region of the Posterior Pelvic Ring: An Experimental In-Vitro Feasibility Study and Comparison of Image Guided Techniques

Pishnamaz, Miguel; Wilkmann, Christoph; Na, Hong-Sik; Pfeffer, Joachim; Hänisch, Christoph; Janssen, Max; Bruners, Philipp; Kobbe, Philipp; Hildebrand, Frank; Schmitz‐Rode, Thomas; Pape, Hans-Christian

doi:10.1371/journal.pone.0148199

Cited by 7 publications

(4 citation statements)

References 31 publications

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“…As such, improving the accuracy of placement of the guide wires using the conventional method increases both intra-operative time and radiation exposure, which limits the use of this iterative approach for accurate guide wire placement in clinical practice. Different assistive tools have been used to improve the accuracy and efficiency in placing guide wires, including the use of multidimensional fluoroscopy [ 20 ], an internal template [ 8 , 9 ], thermoplastic membrane navigation [ 21 ], and computer-assisted navigation [ 5 , 6 , 17 , 22 ]. Our external template is distinctive from these assistive approaches, with greater pre-operative time taken to design and print the navigation template, which avoids the need for repeated fluoroscopy during the surgery and reduces the overall operative time.…”

Section: Discussionmentioning

confidence: 99%

A novel patient-specific three-dimensional-printed external template to guide iliosacral screw insertion: a retrospective study

Yang

Yao

Chen

et al. 2018

BMC Musculoskelet Disord

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BackgroundIliosacral screw fixation is a popular method for the management of posterior pelvic ring fractures or dislocations, providing adequate biomechanical stability. Our aim in this study was to describe the use of a new patient-specific external template to guide the insertion of iliosacral screws and to evaluate the efficacy and safety of this technique compared with the conventional fluoroscopy-guided technique.MethodsThis was a retrospective study of patients with incomplete or complete posterior pelvic ring disruptions who required iliosacral screw fixation. For analysis, patients were divided into two groups: the external template group (37 screws in 22 patients) and the conventional group (28 screws in 18 patients). The operative time per screw, radiation exposure time and the rate of screw perforation (accuracy) were compared between groups. In the external template group, the difference between the actual and planned iliosacral screw position was also compared.ResultsIn the conventional group, the average operative time per screw was 39.7 ± 10.6 min, with an average radiation exposure dose of 1904.0 ± 844.5 cGy/cm2, with 4 cases of screw perforation. In the external template group, the average operative time per screw was 17.9 ± 4.7 min, with an average radiation exposure dose of 742.8 ± 230.6 cGy/cm2 and 1 case of screw perforation. In the template group, the mean deviation distance between the actual and planned screw position was 2.75 ± 1.0 mm at the tip, 1.83 ± 0.67 mm in the nerve root tunnel zone and 1.52 ± 0.48 mm at the entry point, with a mean deviation angle of 1.73 ± 0.80°.ConclusionsThe external template provides an accurate and safe navigation tool for percutaneous iliosacral screw insertion that could decrease the operative time and radiation exposure.

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Section: Discussionmentioning

confidence: 99%

A novel patient-specific three-dimensional-printed external template to guide iliosacral screw insertion: a retrospective study

Yang

Yao

Chen

et al. 2018

BMC Musculoskelet Disord

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“…Actually, its safety and accuracy is always doubted by experienced Chinese doctors who are good at free-hand screw insertion, have great confidence in their ability to perform this technique, or just dislike complicated procedures. However, some high-level clinical studies [ 8 – 10 ] have reported that previous tools all have adequate safety and accuracy for spine surgery, such as conductivity measurement devices that detect cortical defects in the screw trajectory, and been improved [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Accuracy of Pedicle Screw Insertion Among 4 Guided Technologies in Spine Surgery

et al. 2017

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BackgroundAs an available new tool for spinal surgery, robotic technology holds great potential and has been demonstrated to have better clinical outcomes compared with traditional techniques. However, it has not been compared with other assisted tools for the treatment of lumbar degenerative disease. This article focused on studying such variances.Material/MethodsA total of 176 pedicle screws were inserted in 39 patients using a spine robot (group 1), 134 screws were implanted in 28 patients using navigational template (group 2), 234 screws were implanted in 51 patients by O-arm-based navigation (group 3), and 346 screws were implanted in 72 patients by fluoroscopy-guided assistance (group 4). The screw position was evaluated using postoperative scans according to Rampersaud A to D classification, and other secondary data were also collected.Results“Perfect” pedicle screw insertion (Grade A) was 90.34%, 91.79%, 84.19%, and 65.03% of groups 1–4, respectively. “Clinically acceptable” screw implantation (Grade A+B) was 94.32%, 95.52, 90.60%, and 78.03% in groups 1–4, respectively. Deviation sagittal (°) respectively was 3±9, 2±10, 4±7, and 10±8° in groups 1–4, respectively. Deviation transversal (°) screw insertion was 3±8, 3±7, 4±9, and 8±13° in groups 1–4, respectively. Statistical analysis showed group 1 had no significant difference in the accuracy of “Perfect and Clinical acceptable” as well as deviation sagittal or transversal, respectively, compared with groups 2 and 3 but not group 4.ConclusionsRobotic-assistance technology no clear advantage in terms of accuracy compared to the navigation template or O-arm systems for screw implantation, but it significantly reduced adverse events, fluoroscopy time per screw, postoperative stay, and blood loss.

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“…Navigated fixation is currently regarded as a research tool and cannot yet be judged as a routine method [14].…”

Section: Current Surgical Techniquesmentioning

confidence: 99%

Sacral nonunion following acute major fractures: how to heal the holy bone? Results from a systematic literature review

Kalbas

Kumabe

Pape

2021

Injury

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Electromagnetic Real Time Navigation in the Region of the Posterior Pelvic Ring: An Experimental In-Vitro Feasibility Study and Comparison of Image Guided Techniques

Cited by 7 publications

References 31 publications

A novel patient-specific three-dimensional-printed external template to guide iliosacral screw insertion: a retrospective study

A novel patient-specific three-dimensional-printed external template to guide iliosacral screw insertion: a retrospective study

Comparison of Accuracy of Pedicle Screw Insertion Among 4 Guided Technologies in Spine Surgery

Sacral nonunion following acute major fractures: how to heal the holy bone? Results from a systematic literature review

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