Risk-benefit analysis of navigation techniques for vertebral transpedicular instrumentation: a prospective study

Noriega, David; Hernández-Ramajo, Rubén; Milano, Fiona Rodríguez-Monsalve; Sánchez-Lite, Israel; Toribio, Borja; Ardura, Francisco; Torres, Ricardo; Corredera, Raul; Krüger, Antonio

doi:10.1016/j.spinee.2016.08.004

Cited by 33 publications

(16 citation statements)

References 19 publications

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“…The findings show that implantation of PSs at the L4-L5-S1 level using 3DFL results in significantly greater A B C D accuracy and involves less risk than FL, with a perfect position achieved in 95% of the cases and clinically acceptable positioning (displacement <2 mm) with 99.3% accuracy in the 3DFL group compared to 85% and 96% in the FL group, respectively. Several clinical (11,12,(15)(16)(17) and experimental (8,18) studies have shown that the positioning accuracy of PSs is significantly better with a navigation system than with FL. In 2013, Waschke et al (11) retrospectively analysed the data of 1,006 patients: in the lumbar spine, the placement accuracy was 96.4% for 2,422 CT-navigated screws and 93.9% for 2,002 PSs placed under fluoroscopy (P=0.001).…”

Section: Discussionmentioning

confidence: 99%

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Three-dimensional fluoroscopic navigation versus fluoroscopy-guided placement of pedicle screws in L4-L5-S1 fixation: single-centre experience of pedicular accuracy and S1 cortical fixation of 810 screws

García-Fantini¹,

Casas²

2018

J Spine Surg

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Background: Three-dimensional (3D) navigation techniques can theoretically provide higher accuracy rates and increased safety for pedicle screw (PS) placement than traditional fluoroscopy (FL) guided methods. In this study, we compare the pedicular accuracy of 3D isocentric fluoroscopic navigation (3DFL) versus FL guidance in PS L4-L5-S1 fixation and evaluate the differential cortical purchase and safety of fixation of the S1 PS. Methods: This is a single-centre retrospective study of 810 PSs placed in open L4-L5-S1 fixation between 2012 and 2017 in 39 patients using standard FL and in 96 patients under 3DFL. Pedicular screw accuracy was determined by postoperative computed tomography (CT) and graded on a 4-tiered classification system according to Gertzbein and Robbins. In addition, sacral screws were evaluated depending on the degree of cortical fixation: monocortical, bicortical or tricortical, and the degree of safety with respect to retroperitoneal structures. Results: Grade 0 perfect pedicular screw placement was 95% for 3DFL screws compared to 85% for screws placed under fluoroscopy (P<0.05). The number of grade 0 versus grade 1 and higher (breached screws) was statistically significant (P<0.05). Higher S1 cortical screw accuracy [77% versus 51% (P<0.05)] for bi-and tricortical fixation and a lower percentage of "at risk" PSs (P<0.05) were achieved with placement under 3DFL versus FL. Conclusions: 3DFL enhances the accuracy and safety of PS placement in L4-L5-S1 fixation, reducing the rate of misplaced screws and improving S1 cortical fixation.

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Section: Discussionmentioning

confidence: 99%

“…The malpositioning of a PS may not only affect the stability of fixation but also result in clinical repercussions or even necessitate surgical revision (3,7,15,17,(21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional fluoroscopic navigation versus fluoroscopy-guided placement of pedicle screws in L4-L5-S1 fixation: single-centre experience of pedicular accuracy and S1 cortical fixation of 810 screws

García-Fantini¹,

Casas²

2018

J Spine Surg

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“…The Brainlab Curve navigation system (Brainlab AG, Munich, Germany) 104,109,110 appeared three times in papers. Medtronic Stealth S7 (Medtronic, Inc, Littleton, Massachusetts), 111,112 StealthStation TREON Plus (Medtronic Navigation, Louisville, Kentucky), 113,114 and the BrainLAB system 115,116 and Renaissance system (Mazor Robotics, Ltd, Caesarea, Israel) 76,100 appeared twice. Stealth StationVR Navigation (MedtronicVR Medtronics, Inc, Minneapolis, Minnesota), 117 StealthStation ION Fluoroscopic Navigation System (Medtronic SNT, Louisville, Colorado), 118 Vector Vision Spine (BrainLAB, Munich, Germany), 119 VectorVision Compact (Brain LAB, Germany), 120 DRA (Spine & Trauma iCT, BrainLab, Feldkirchen, Germany), 121 Praxim‐Medivision‐La Tronche (France), 122 the PACS system, 123 GE Healthcare (Salt Lake City, Utah), 124 and Mazor X (Mazor Robotics, Ltd, Caesarea, Israel) 78 each appeared once.…”

Section: Computer‐assisted Orthopaedic Surgery Navigation Systemsmentioning

confidence: 99%

“…Fraser et al 118 found that the use of surgery navigation systems can improve learning curves for minimally invasive spinal surgery. In terms of the rate of revision surgery for spinal surgery, navigation surgery can reduce the rate of revision 66,111,138 . Fichtner et al 120 pointed out that compared with manual placement of pedicle screws, the use of 3D fluoroscopic navigation significantly reduced the rate of revision surgery after posterior spinal fixation.…”

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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“…The trajectory of screws can then be calculated using the computer system, with potentially better accuracy and less radiation exposure than conventional pedicle screw techniques. 48,49…”

Section: Advances In Spine Navigation and Robotic Guidancementioning

confidence: 99%

Spine Oncology—Metastatic Spine Tumors

et al. 2017

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Surgery for spinal metastases remains the mainstay treatment for pain, instability, and neurological deterioration due to tumor infiltration of the spine. However, several new therapies are emerging which may improve outcomes further, and in some cases even replace the need for surgery. We now have a better understanding of which factors influence survival and quality of life after surgery, and this underpins the development and application of new treatments, and assessment of outcome.Depending on genetic subtyping of tumors, novel immunotherapies and chemotherapies may be very effective in prolonging quality of life. New surgical techniques allow smaller, quicker, and safer operations with less blood loss, pain, and quicker recovery after surgery. Radiation treatments have also leapt forward with the greater accuracy and higher doses possible from intensity-modulated photon radiation, stereotactic body radiation treatment, proton beam therapy, or carbon ion treatment. Combined with more advanced materials for vertebral body stabilization, computer navigation systems, and robotics, more can be done at earlier or later stages of the spinal disease than was previously possible, resulting in more options and improved outcomes for patients.

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Risk-benefit analysis of navigation techniques for vertebral transpedicular instrumentation: a prospective study

Cited by 33 publications

References 19 publications

Three-dimensional fluoroscopic navigation versus fluoroscopy-guided placement of pedicle screws in L4-L5-S1 fixation: single-centre experience of pedicular accuracy and S1 cortical fixation of 810 screws

Three-dimensional fluoroscopic navigation versus fluoroscopy-guided placement of pedicle screws in L4-L5-S1 fixation: single-centre experience of pedicular accuracy and S1 cortical fixation of 810 screws

A review of computer‐assisted orthopaedic surgery systems

Spine Oncology—Metastatic Spine Tumors

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