Radiation dose reduction in thoracic and lumbar spine instrumentation using navigation based on an intraoperative cone beam CT imaging system: a prospective randomized clinical trial

Pireau, Nathalie; Cordemans, Virginie; Banse, Xavier; Irda, Nadia; Lichtherte, S.; Kaminski, Ludovic

doi:10.1007/s00586-017-5229-x

Cited by 23 publications

(10 citation statements)

References 35 publications

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“…Next, intraoperative medical procedure exposure to X-rays remains a problem. Intraoperative CT combined with a navigation system may be useful in improving the efficiency of the surgery and reducing the exposure of medical workers (22,23). In our experience, some key points should be considered in performing Endo-TLIF.…”

Section: Discussionmentioning

confidence: 93%

A Modified Endoscopic Transforaminal Lumbar Interbody Fusion Technique: Preliminary Clinical Results of 96 Cases

et al. 2021

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Background: As a newly emerging technique, endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) has become an increasingly popular procedure of interest. The purpose of this study was to introduce a modified Endo-TLIF system and share our preliminary clinical experiences and outcomes in treating lumbar degenerative disease with this procedure.Methods: Ninety-six patients (thirty-seven men and fifty-nine women; mean age 55.85 ± 11.03 years) with lumbar degenerative diseases who underwent Endo-TLIF in our hospital were enrolled. The surgical time, volume of intraoperative blood loss, postoperative hospitalization time and postoperative drainage were documented. Clinical outcomes were evaluated by visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, and modified MacNab criteria. Bone fusion was identified through computerized tomography (CT) scans or X-ray during the follow-up period.Results: All patients were followed up for at least 12 months, and the average follow-up time was 17.03 ± 3.27 months. The mean operative time was 136.79 ± 30.14 minutes, and the mean intraoperative blood loss was 53.06 ± 28.89 ml. The mean VAS scores of low back pain and leg pain were 5.05 ± 1.37 and 6.25 ± 1.03, respectively, before surgery, which improved to 2.27 ± 0.66 and 2.22 ± 0.55, respectively, after the operation (P < 0.05). The final VAS scores of low back pain and leg pain were 0.66 ± 0.60 and 0.73 ± 0.66, respectively (P < 0.05). The preoperative ODI score (49.06 ± 6.66) also improved significantly at the 3-month follow-up (13.00 ± 7.37; P < 0.05). The final ODI score was 8.03 ± 6.13 (P < 0.05). There were 10 cases of non-fusion (nine women and one man) at the 12-month follow-up, but no cases of non-union were identified by imaging at the final follow-up.Conclusions: The present study demonstrated satisfactory clinical and radiologic results among patients who received Endo-TLIF treatment from our institution. This indicates that Endo-TLIF is efficient and safe for select patients.

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Section: Discussionmentioning

confidence: 93%

A Modified Endoscopic Transforaminal Lumbar Interbody Fusion Technique: Preliminary Clinical Results of 96 Cases

et al. 2021

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“…It should be noted though that low-dose, ALARA protocols have been shown to be able to reduce the amount of radiation by up to a factor of 5 when compared to normal, high-dose protocols [14], and therefore are viable options in facilities where image enhancement is not available.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Intraoperative Fluoroscopic Radiation Emission Using ALARA Methods Versus Image-Enhancement Technology in Single-Position Lateral Lumbar Surgery

Braly¹,

Mason²,

Lange

et al. 2021

OPROJ

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Background: Expanded interest in minimally invasive spine techniques has led to increased reliance on intraoperative imaging to guide surgical decision making. Attempts to minimize the amount of radiation by using the dosage 'as low as reasonably achievable' (ALARA) has proven acceptable in decreasing the risk to the surgeons and staff to a certain extent, though the reciprocal nature of radiation reduction and image usability (quality) challenge further expansion of ALARA in this setting. Emerging technologies propose to reduce the radiation requirements even further without compromising image quality. In this study, radiation emission and fluoroscopy time were evaluated when image-enhancing technology was applied to minimally invasive single-position lumbar surgery to further our understanding of how imageenhancement technology performs in comparison to established ALARA protocols. Methods: This was a retrospective case-control study which in radiation emission and intra-operative fluoroscopy time was measured in patients undergoing lateral based, single-position surgery. From Oct 2018 through July 2019, 68 patients underwent one-or two-level single-position, lateral-based lumbar fusions by the same surgeon and operative team (including radiation technologist) at one of two hospitals. Both hospitals utilize an ALARA protocol in the operating rooms. One institution has acquired image-enhancing technology which aims to further reduce radiation emission and exposure while the other uses standard ALARA techniques. Intraoperative radiation data were retrospectively reviewed for comparison.Results: Image-enhancing technology allowed for further reduction of radiation emission from the fluoroscope by 36% when compared to the current low-dose ALARA protocols. Operative workflow features within the image-enhancing system allowed for a reduction of overall fluoroscopic time requirements by 34%, which aided in the overall 36% reduction in radiation emission. Conclusion:Emerging image-enhancement technology allows for further reduction of radiation emission in the operating room by 36% when compared to current, low-dose protocols established by ALARA.

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“…The planning information gives the orthopaedic doctor operation examination prompts. Two systems 80,127 have achieved a breakthrough in preoperative planning for THR surgery and can design prostheses for specific patients. In terms of preoperative planning for THA, the advantage of one system 92 is that it can automatically determine the key space parameters for the acetabulum before the operation so that it is more convenient to design the acetabulum prosthesis for special patients.…”

Section: Discussionmentioning

confidence: 99%

“…It has also been found that the combination of spinal navigation and an intraoperative 3D perspective may overcome this shortcoming. 135,110,116,126,127 Villard et al 108 compared the radiation exposure of orthopaedic surgeons and 21 patients who underwent posterior lumbar internal fixation (10 cases with navigation and 11 hands‐on procedures). The plastic surgeon performing the PSP received 9.96 times the radiation received during an operation with a navigational system.…”

Section: Computer‐assisted Orthopaedic Surgery Navigation Systemsmentioning

confidence: 99%

A review of computer‐assisted orthopaedic surgery systems

Wang

Shang

et al. 2020

Robotics Computer Surgery

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Background: Computer-assisted orthopaedic surgery systems have great potential, but no review has focused on computer-assisted surgery systems for the spine, hip, and knee. Methods: A systematic search was performed in Web of Science and PubMed. We searched the literature on computer-assisted orthopaedic surgery systems from 2008 to the present and focused on three aspects of systems: training, planning, and intraoperative navigation. Results and discussion: In this review study, we reviewed 34 surgical training systems, 31 surgical planning systems, and 41 surgical navigation systems. The functions and characteristics of the surgical systems were compared and analysed, and the current concerns about and the impact of the surgical systems on doctors and surgery were clarified. Conclusion: Computer-assisted orthopaedic surgery systems are still in the development stage. Future surgical training systems should include synthetic models with patient anatomy. Surgical planning systems with automatic planning should be developed, and surgical navigation systems with multimodal fusion, robotic assistance and imaging should be developed.

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Radiation dose reduction in thoracic and lumbar spine instrumentation using navigation based on an intraoperative cone beam CT imaging system: a prospective randomized clinical trial

Abstract: This study emphasizes the paramount importance of using low-dose protocols for intraoperative cone beam CT imaging coupled with the navigation system, as it at least does not affect the accuracy of pedicle screw placement and irradiates drastically less.

Cited by 23 publications

References 35 publications

A Modified Endoscopic Transforaminal Lumbar Interbody Fusion Technique: Preliminary Clinical Results of 96 Cases

A Modified Endoscopic Transforaminal Lumbar Interbody Fusion Technique: Preliminary Clinical Results of 96 Cases

A Comparison of Intraoperative Fluoroscopic Radiation Emission Using ALARA Methods Versus Image-Enhancement Technology in Single-Position Lateral Lumbar Surgery

A review of computer‐assisted orthopaedic surgery systems

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