Intra-operative cone-beam CT (O-arm) and stereotactic navigation in acute spinal trauma surgery

Schouten, Rowan; Lee, Robert; Boyd, Michael; Paquette, Scott; Dvorak, Marcel F.; Kwon, Brian K.; Fisher, Charles G.; Street, John

doi:10.1016/j.jocn.2012.01.020

Cited by 61 publications

(56 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In fact, using a conventional technique, Kotani et al 15 reported a perforation rate of 6.7% (45 of 664 screws) and 2 of 45 screws that caused radiculopathy. The rate of cortical violation decreases when an IGS is used, 1,4,[13][14][15]23,25 with a total rate ranging from 2% to 2.8% (graded as cortex violation > 2 mm). Our experience using the O-arm system is in line with these results, with a significant cortical violation (Grade II) observed with 1 screw (1.5%), which was changed intraoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…However, even though an error may occur with these navigation devices (such as Iso-C3D and O-arm systems), it is possible to perform intraoperative 3D imaging so as to gain immediate control and make any correction of a misplaced screw that is necessary, 23 thus avoiding the need for revision surgery. In our series, for example, the positioning of one misplaced screw was corrected intraoperatively, and the final position of the screw was shown to be correct on a third CT scan.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Management of C1–2 traumatic fractures using an intraoperative 3D imaging–based navigation system

Costa¹,

Ortolina²,

Attuati³

et al. 2015

SPI

View full text Add to dashboard Cite

OBJECT Fractures of C-1 and C-2 are complex and surgical management may be difficult and challenging due to the anatomical relationship sbetween the vertebrae and neurovascular structures. The aim of this study was to evaluate the role, reliability, and accuracy of cervical fixation using the O-arm intraoperative 3D image–based navigation system. METHODS The authors evaluated patients who underwent a navigation system–based surgery for stabilization of a fracture of C-1 and/or C-2 from August 2011 to August 2013. All of the fixation screws were intraoperatively checked and their position was graded. RESULTS The patient population comprised 17 patients whose median age was 47.6 years. The surgical procedures were as follows: anterior dens screw fixation in 2 cases, transarticular fixation of C-1 and C-2 in 1 case, fixation using the Harms technique in 12 cases, and occipitocervical fixation in 2 cases. A total of 67 screws were placed. The control intraoperative CT scan revealed 62 screws (92.6%) correctly placed, 4 (5.9%) with a minor cortical violation (< 2 mm), and only 1 screw (1.5%) that was judged to be incorrectly placed and that was immediately corrected. No vascular injury of the vertebral artery was observed either during exposition or during screw placement. No implant failure was observed. CONCLUSIONS The use of a navigation system based on an intraoperative CT allows a real-time visualization of the vertebrae, reducing the risks of screw misplacement and consequent complications.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of C1–2 traumatic fractures using an intraoperative 3D imaging–based navigation system

Costa¹,

Ortolina²,

Attuati³

et al. 2015

SPI

View full text Add to dashboard Cite

show abstract

“…16,25,28 A higher accuracy of intraoperative than preoperative CT-based navigation was revealed in our meta-analysis results. The main reason may be the position changes (from supine to prone) of the patients.…”

Section: Discussionmentioning

confidence: 55%

Accuracy of pedicle screw placement based on preoperative computed tomography versus intraoperative data set acquisition for spinal navigation system

Líu

Chen

Liu

et al. 2017

J Orthop Surg (Hong Kong)

View full text Add to dashboard Cite

Aim: To investigate the accuracy of pedicle screw placement based on preoperative computed tomography in comparison with intraoperative data set acquisition for spinal navigation system. Methods: The PubMed (MEDLINE), EMBASE, and Web of Science were systematically searched for the literature published up to September 2015. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Statistical analysis was performed using the Review Manager 5.3. The dichotomous data for the pedicle violation rate was summarized using relative risk (RR) and 95% confidence intervals (CIs) with the fixed-effects model. The level of significance was set at p < 0.05. Results: For this meta-analysis, seven studies used a total of 579 patients and 2981 screws. The results revealed that the accuracy of intraoperative data set acquisition method is significantly higher than preoperative one using 2 mm grading criteria (RR: 1.82, 95% CI: 1.09, 3.04, I 2 ¼ 0%, p ¼ 0.02). However, there was no significant difference between two kinds of methods at the 0 mm grading criteria (RR: 1.13, 95% CI: 0.88, 1.46, I 2 ¼ 17%, p ¼ 0.34). Using the 2-mm grading criteria, there was a higher accuracy of pedicle screw insertion in O-arm-assisted navigation than CT-based navigation method (RR: 1.96, 95% CI: 1.05, 3.64, I 2 ¼ 0%, p ¼ 0.03). The accuracy between CT-based navigation and two-dimensional-based navigation showed no significant difference (RR: 1.02, 95% CI: 0.35-3.03, I 2 ¼ 0%, p ¼ 0.97). Conclusions: The intraoperative data set acquisition method may decrease the incidence of perforated screws over 2 mm but not increase the number of screws fully contained within the pedicle compared to preoperative CT-based navigation system. A significantly higher accuracy of intraoperative (O-arm) than preoperative CT-based navigation was revealed using 2 mm grading criteria.

show abstract

“…4 Its role in the cervical spine, however, has been limited, both for anterior cervical surgery and posterior cervical fusion. 9,15,18 The 4 cases presented in this paper illustrate new applications in the use of the O-arm for image guidance in the upper cervical spine.…”

Section: Discussionmentioning

confidence: 93%

“…In patients with scoliosis, degenerative spine disease, or ankylosing spondylitis and in very obese patients or in treating areas of the cervicothoracic junction and upper thoracic spine where fluoroscopy has poor resolution, CT guidance is very useful with reduction in radiation exposure. 5,18 This is especially true in revision cervical spine surgery where the normal anatomical landmarks are obscured. Seichi et al 19 used a frameless stereotactic image-guidance system with simultaneous fluoroscopy in 10 patients who required revision of previous cervical spine surgery.…”

Section: Revision Cervical Spine Surgery Using Image Guidancementioning

confidence: 99%

The use of intraoperative navigation for complex upper cervical spine surgery

Guppy

Chakrabarti²,

Banerjee³

2014

FOC

View full text Add to dashboard Cite

Imaging guidance using intraoperative CT (O-arm surgical imaging system) combined with a navigation system has been shown to increase accuracy in the placement of spinal instrumentation. The authors describe 4 complex upper cervical spine cases in which the O-arm combined with the StealthStation surgical navigation system was used to accurately place occipital screws, C-1 screws anteriorly and posteriorly, C-2 lateral mass screws, and pedicle screws in C-6. This combination was also used to navigate through complex bony anatomy altered by tumor growth and bony overgrowth. The 4 cases presented are: 1) a developmental deformity case in which the C-1 lateral mass was in the center of the cervical canal causing cord compression; 2) a case of odontoid compression of the spinal cord requiring an odontoidectomy in a patient with cerebral palsy; 3) a case of an en bloc resection of a C2–3 chordoma with instrumentation from the occiput to C-6 and placement of C-1 lateral mass screws anteriorly and posteriorly; and 4) a case of repeat surgery for a non-union at C1–2 with distortion of the anatomy and overgrowth of the bony structure at C-2.

show abstract

Intra-operative cone-beam CT (O-arm) and stereotactic navigation in acute spinal trauma surgery

Cited by 61 publications

References 29 publications

Management of C1–2 traumatic fractures using an intraoperative 3D imaging–based navigation system

Management of C1–2 traumatic fractures using an intraoperative 3D imaging–based navigation system

Accuracy of pedicle screw placement based on preoperative computed tomography versus intraoperative data set acquisition for spinal navigation system

The use of intraoperative navigation for complex upper cervical spine surgery

Contact Info

Product

Resources

About