Reduction in radiation (fluoroscopy) while maintaining safe placement of pedicle screws during lumbar spine fusion

Abstract

Objective: The purpose of this study is to report the results using PediGuard (electrical conductivity device) to reduce radiation exposure while drilling the pilot hole for pedicle screw placement. Method: Eighteen patients diagnosed with a degenerative lumbar spine, that required a posterior spinal fusion. Average age of the patients were 55 ± 12 years. Patients received postoperative CT scans of all screws. Scans were reviewed by an independent reviewer grading 'in' < 2 mm of breach , or 'out' > 2 mm of breach. In a randomized fashion, the surgeon created pilot holes with either his standard technique or by using the PediGuard. Fluoroscopy was used for each drilling as necessary. Once the pilot hole was created, the surgeon inserted titanium screws into the pedicle pilot holes. A total of 78 screws (39 standard probe and 39 PediGuard ) were analyzed. Results: 78 screws (39 standard probe and 39 PediGuard were analyzed. No significant difference in breach rate > 2mm by either method (p=1.000), with one screw out in each group. Fluoroscopy shots averaged 5.2 (range, 0 to 15), average decrease of 2.3 (30%) per screw in the PediGuard group vs. 7.5 (range, 2 to 17) in the standard group (p< .001). Conclusion: This trial to assess pedicle probe location within the pedicle and vertebral body showed the number of fluoroscopy shots were reduced by 30%, compared to a standard probe while maintaining a 97.5% screw placement accuracy.

Does Three-Dimensional Printed Patient-Specific Templates Add Benefit in Revision Surgeries for Complex Pediatric Kyphoscoliosis Deformity with Sublaminar Wires in Situ? A Clinical Study

“…To address this problem, various techniques of safe pedicle screw placement have been described in the literature, including intraoperative fluoroscopy, computer-assisted navigation based on the preoperative CT scan, O-armbased navigation, robotic-assisted pedicle screw placement, use of a PediGuard, and use of 3D printed templates [17][18][19][20][21][22].…”

Radiation Safety in Image-guided Spinal Injections

“…66 In this prospective, randomized trial of a pedicle drilling device that uses electrical conductivity differentiation at the tip for assessing bone versus soft tissue, the number of fluoro shots was reduced by 30% compared with a standard drilling probe while maintaining a 97.5% accurate and safe screw placement. The results of using the PediGuard (SpineGuard Inc., San Francisco, CA), a local electrical conductivity measurement device, to reduce radiation exposure while drilling the pilot hole for pedicle screw placement has been reported recently.…”

Does the Use of Dynamic Surgical Guidance Assist Accurate Pedicle Screw Placement in Patients With Osteoporosis or Osteopenia?

“…5 Fluoroscopy is the most common technique used to assist pedicle screw insertion due to its capacity to present real time images and produce a higher rate of accurate screw placement than with the freehand technique. 5,6 However, the surgeon's exposure to radiation during a fluoroscopic assisted thoracolumbar pedicle screw surgery is 10-12 times greater compared to other non-spinal procedures assisted by the fluoroscopic technique. 6,7 Improved instrumentation, as well as novel image-guided and navigation techniques, were developed to improve pedicle screw placement and accuracy.…”

“…5,6 However, the surgeon's exposure to radiation during a fluoroscopic assisted thoracolumbar pedicle screw surgery is 10-12 times greater compared to other non-spinal procedures assisted by the fluoroscopic technique. 6,7 Improved instrumentation, as well as novel image-guided and navigation techniques, were developed to improve pedicle screw placement and accuracy. A pedicle probe was developed, called the PediGuard® probe, which is capable of identifying different tissue types by measuring electrical conductivity.…”