Iso-C3D navigation assisted pedicle screw placement in deformities of the cervical and thoracic spine

Rajan, Vinod V; Kamath, Vijay; Shetty, Ajoy Prasad; Rajasekaran, Shanmuganathan

doi:10.4103/0019-5413.62083

Cited by 26 publications

(7 citation statements)

References 40 publications

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“…Different navigation systems were used, including StealthStation [ 12 , 17 ], VectorVision [ 18 , 19 ] and intraoperative CT [ 10 , 20 ]; both were included. The trials involving templates used Mimics Software to design the template from pre-operative scans.…”

Section: Resultsmentioning

confidence: 99%

“…Pre-operative registration navigation was previously held back by prolonged intraoperative registration that had to be performed for each vertebrae, extending intraoperative times. Rajan reported on over 340 pedicle screws and showed that average insertion time was 2.37 min, whilst the registration time was 24.6 min [ 18 ]. Yang compared 210 pre-operatively registered and navigated pedicle screws with 152 fluoroscopic lumbar spine pedicle screws and noted 3.65 min per screw in the navigated group and 4.43 min in the fluoroscopy.…”

Section: Discussionmentioning

confidence: 99%

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Cervical Spine Pedicle Screw Accuracy in Fluoroscopic, Navigated and Template Guided Systems—A Systematic Review

et al. 2021

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Background: Pedicle screws provide excellent fixation for a wide range of indications. However, their adoption in the cervical spine has been slower than in the thoracic and lumbar spine, which is largely due to the smaller pedicle sizes and the proximity to the neurovascular structures in the neck. In recent years, technology has been developed to improve the accuracy and thereby the safety of cervical pedicle screw placement over traditional fluoroscopic techniques, including intraoperative 3D navigation, computer-assisted Systems and 3D template moulds. We have performed a systematic review into the accuracy rates of the various systems. Methods: The PubMed and Cochrane Library databases were searched for eligible papers; 9 valid papers involving 1427 screws were found. Results: fluoroscopic methods achieved an 80.6% accuracy and navigation methods produced 91.4% and 96.7% accuracy for templates. Conclusion: Navigation methods are significantly more accurate than fluoroscopy, they reduce radiation exposure to the surgical team, and improvements in technology are speeding up operating times. Significantly superior results for templates over fluoroscopy and navigation are complemented by reduced radiation exposure to patient and surgeon; however, the technology requires a more invasive approach, prolonged pre-operative planning and the development of an infrastructure to allow for their rapid production and delivery. We affirm the superiority of navigation over other methods for providing the most accurate and the safest cervical pedicle screw instrumentation, as it is more accurate than fluoroscopy and lacks the limitations of templates.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cervical Spine Pedicle Screw Accuracy in Fluoroscopic, Navigated and Template Guided Systems—A Systematic Review

et al. 2021

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“…Several studies documented pedicle screw breach rates ranging from 10% to 15% using free-hand or fluoroscopic techniques [Table 3]. [2,4,6,7] Literature also shows significant pedicle breach with navigation aid; i.e., Schwarzenbach et al [8] and Rajan et al [5] showed 11% pedicular breach rates. Rampersaud et al [7] showed a 15% pedicular breach rate, while Merloz et al [4] showed a 10% of pedicular breach rate.…”

Section: Discussionmentioning

confidence: 99%

“Critical pedicle wall” breaches analysis in complex spinal deformity using O-arm navigation

Kothari,

Katkade,

Bhilare

et al. 2023

Surgical Neurology International

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Background: Free-hand and fluoroscopic-guided pedicle screw placement has been associated with higher rates of pedicle breaches (frequency range 15–40% especially in deformed pedicles). Neurological complications are more “critical” (i.e., frequent and significant) with medial and inferior pedicle-wall breaches due to the proximity of the neural elements. Here, we analyzed the effectiveness of O-arm navigation in minimizing “critical” pedicle wall breaches and their complications in 21 complex spinal deformity cases. Methods: Twenty-one complex spinal deformity cases were prospectively managed with O-arm-navigated posterior-instrumented fusions. Preoperative assessment included; evaluation of the type of scoliosis, the magnitude of the deformity, and the anatomy of the pedicles – (i.e., classified using Watanabe et al.). The O-arm was used to confirm and grade both the intraoperative and postoperative location of screws. Other variables analyzed included; duration of surgery, estimated blood loss, complications, and radiation exposure. Results: In 21 patients, 259 (63.45%) of 384 pedicles were instrumented; we observed 22 of 259 pedicle screw breaches. Significant (>2 mm) breaches were observed in two medial and one inferior wall cases that required revision; the overall biomechanically significant screw breach rate was (3/259) 1.2% with an accuracy rate of 98.8%. Pedicle screw placement resulted in another 14 nonsignificant (<2 mm) breaches; ten were medial and four involved the inferior wall. As anterior, lateral, and “in-out-in” trajectory pedicle screws beaches were nonsignificant, they were not included in our analysis. Conclusion: O-arm navigation decreased the incidence of medial and inferior (i.e., >2 mm “critical”) pedicle screw breaches applied in 21 patients with deformed pedicles due to scoliosis. Further, the O-arm minimized the operating time, decreased the estimated blood loss, and reduced the incidence of complications.

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“…Three-dimensional fluoroscopy and navigation systems improve the accuracy of pedicle screw insertion [20]. Cone-beam type CT is also being increasingly used for difficult procedures, such as cervical pedicle screw placement [21].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative evaluation using mobile computed tomography in anterior cervical decompression with floating method for massive ossification of the posterior longitudinal ligament

et al. 2017

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BackgroundAn anterior decompression and fusion (ADF) with the floating method is an effective procedure for treating ossification of the posterior longitudinal ligament (OPLL), allowing a direct decompressive effect on the spinal cord. However, the procedure is skill-intensive, particularly in cases of OPLL with a high canal-occupying ratio. In such cases, there are potential risks for insufficient decompression due to the incomplete floating of the OPLL. Here, we introduce an anterior decompression procedure for massive OPLL, using an intraoperative computed tomography (CT) with a mobile scanner gantry for the intraoperative evaluation of the decompression. We further evaluated the outcomes of ADF using mobile CT in comparison with a historical control of ADF without intraoperative CT evaluation.MethodsFifty OPLL patients who underwent ADF with the floating method were evaluated in this study: 25 patients with intraoperative CT (CT group) and 25 patients without CT (non-CT group). In the CT group, intraoperative CT scanning was performed before freeing the ossification from the surrounding bone tissues. The reconstructed images were reviewed to evaluate the extent of bone decompression and thinning of the OPLL. After review of the images, further thinning of the OPLL or removal of surrounding bone was performed as deemed necessary, to complete the floating of the OPLL.ResultsPatients’ background was similar between the CT and non-CT group. Operating time tended to be shorter for the CT group. On the postoperative CT, incomplete OPLL floating due to “impingement” between the OPLL and the medial aspect of the pedicle or uncovertebral joint was observed for four patients (16.0%) in the non-CT group, whereas insufficient decompression was not observed in the CT group.ConclusionsIntraoperative CT imaging was effective to avoid insufficient decompression following ADF with the floating method for massive OPLL. We also consider that the intraoperative three-dimensional imaging is helpful for providing informative feedback to surgeons to improve performance in skill-intensive surgeries such as ADF with the floating method.

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Iso-C3D navigation assisted pedicle screw placement in deformities of the cervical and thoracic spine

Cited by 26 publications

References 40 publications

Cervical Spine Pedicle Screw Accuracy in Fluoroscopic, Navigated and Template Guided Systems—A Systematic Review

Cervical Spine Pedicle Screw Accuracy in Fluoroscopic, Navigated and Template Guided Systems—A Systematic Review

“Critical pedicle wall” breaches analysis in complex spinal deformity using O-arm navigation

Intraoperative evaluation using mobile computed tomography in anterior cervical decompression with floating method for massive ossification of the posterior longitudinal ligament

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