Accuracy of pedicle screw placement in the thoracic and lumbosacral spines using O-arm-based navigation versus conventional freehand technique

Jing, Linyuan; Wang, Zhenze; Sun, Zhenxing; Zhang, Huifang; Wang, James; Wang, Guihuai

doi:10.1186/s41016-019-0154-y

Cited by 19 publications

(31 citation statements)

References 19 publications

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“…A comparative study of 318 pedicle screws placed in 60 patients with a workstation/O-arm (n = 183 subjects) versus freehand placement (n = 135 subjects) demonstrated that guided placement was superior ( P = 0.034) to freehand work. Using the GRS, 95.8% and 90.0% of guided and freehand screws respectively were safely inserted (grades A–B) 11 . Yet, accuracy of the freehand technique can vary widely in practice and has been reported as low as 83.6% (GRS) in a recent study 12 .…”

Section: Discussionmentioning

confidence: 99%

Augmented Reality Spine Surgery Navigation

Felix

Kalatar

Moatz

et al. 2022

Spine

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Study Design. Collectively, seven cadavers were instrumented with 124 thoracolumbar pedicle screws using VisAR augmented reality/guidance. Sixty-five screws were inserted into four donors using open dissection spine surgery. Fifty-nine screws were positioned in three donors with a minimally invasive spine surgery (MISS) procedure. For both open and MISS, VisAR was used exclusively for pedicle screw navigation.Objective. The objective of this study was to determine the accuracy of pedicle screw placement using VisAR for open spine and MISS procedures. Summary of Background Data. Pedicle screw placement can be challenging depending on anatomical location and a surgeon's experience. AR may minimize fluoroscopy use and speed screw insertion. Methods. Prior to computed tomography (CT) a series of four image visible April Tag optical fiducials were attached to the backs' of the donors. Resulting images were used preoperatively for planned virtual pedicle screw pathways including entry point, trajectory, and depth. The study link was encrypted on a quick response (QR) code, printed, and viewed in the operating room (OR) by the surgeon using VisAR (HoloLens 2 headset). Viewing the code wirelessly uploads and launches the study, converting the DICOM data to holographic images which register to the fiducials on the donor's back. The annotated pathways for each pedicle were called up by voice command and the surgeon positioned each screw by aligning with the virtual guidance hologram. Results. Overall, 124 pedicle screws were inserted with VisAR navigation with 96% accuracy (Gertzbein-Robbins grades A and B). The combined angle of error was 2.48 and the distance error was 1.9 mm. Conclusion. Augmented reality is a highly accurate, emerging technology for navigating both open and minimally invasive spine surgery techniques with off-the-shelf headset hardware.

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Section: Discussionmentioning

confidence: 99%

Augmented Reality Spine Surgery Navigation

Felix

Kalatar

Moatz

et al. 2022

Spine

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“…Accuracy of pedicle screw placement Studies from surgeries using O-arm imaging with StealthStation navigation have reported increased accuracy of screw placement compared to other techniques. A retrospective review of 191 screws showed 95.81% accuracy in placement [11]. Kleck et al showed 97% accuracy [21].…”

Section: Discussionmentioning

confidence: 99%

“…The intraoperative O-arm images were evaluated by two independent reviewers. If the cortical layer was breached by the pedicle screw, the breaches were assessed in the axial, sagittal, and coronal planes using the Gertzbein-Robbins classi cation system [11]. Speci cally, pedicles that did not breach the cortical layer were de ned as grade A, breaches < 2 mm as grade B, breaches < 4 mm as grade C, breaches < 6 mm as grade D, and breaches ≥ 6 mm as grade E [Fig.…”

Section: Evaluation Of Screw Placementmentioning

confidence: 99%

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Accuracy of Screw Placement and Fusion Rate after Transforaminal Lumbar Interbody Fusion with O-arm Navigation: A Review of 475 Patients

Kuansongtham¹,

Wasinpongwanich²,

Lwin³

et al. 2021

Preprint

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Purpose To evaluate the accuracy of screw placement and fusion rate after the minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) technique under O-arm navigation. Methods In 475 consecutive patients at a single-center, the accuracy of screw placement was evaluated on intraoperative O-arm imaging. Misplaced screws were investigated to identify the direction of deviation and associated clinical outcomes. The fusion rate was evaluated on postoperative computed tomography scan at 1 and 2 year(s). The assessment of screw placement and fusion level was analyzed for inter-rater reliability and reported as a kappa value. Accuracy of screw placement (Gertzbein-Robbins Classification), extent of fusion (Bridwell Interbody Fusion Grading System), and complications were considered as outcome measures. Results A retrospective data analysis from 2,098 pedicle screws in 475 patients. The mean age of participants was 56.61 ± 12.30 years, and 45.26% were female. Their ethnicities were as follows: Asian (58.74%), Caucasian (20.21%), Middle-eastern (14.32%), and African (6.74%). The final fusion levels were single (80.63%), two (18.11%), three (1.05%), and four (0.21%). There were L4/L5 as the most prevalent placement (55.35%), followed by L5/S1 (36.29%), L3/L4 (5.22%), L2/L3 (2.35%), L1/L2 (0.52%), and S1/S2 (0.26%). Seven out of 2,098 screws were breaches. None of screw needed immediate revision. In total, 99.66% of the screws were grade A (no breach), 0.19% were grade B (breach < 2 mm) and 0.14% were grade C (breach < 4mm). Conclusion The accuracy of pedicle screw insertion was 99.66%, with a fusion rate of 95.45% after MIS-TLIF under O-arm navigation. Breaches were not associated with poor clinical outcomes or fusion rates.

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“…The consequences of inaccurate pedicle screw placement can be disastrous – ranging from decreased pull-out strength owing to compromised purchase in the bone to iatrogenic injury to critical neurovascular structures. Conventional, free-hand technique of pedicle screw insertion relies on anatomical landmarks and experience of the surgeon – the element of skill that this involves had led to variable rates of pedicle screw accuracy across medical literature, with rates of pedicle screw perforation ranging from 10%-40% [ 2 , 3 ].…”

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confidence: 99%