Advantages and Disadvantages of Multi-axis Intraoperative Angiography Unit for Percutaneous Pedicle Screw Placement in the Lumbar Spine

Abstract

We analyzed clinical usefulness of the high resolution imaging system in a hybrid operation room (OR) for posterior lumbar interbody fusion. A total of 17 patients with lumbar spondylolisthesis between February 2014 and August 2016 were included. Multi-axis imaging system in a hybrid OR was used in 12 patients (hybrid OR group); the conventional C-arm fluoroscopy, in 5 patients (C-arm group). The time to confirm the first percutaneous pedicle screw (PPS) angle (hybrid OR, 80 vs C-arm, 249 s; P = 0.0026) and the second to the last PPS angle (77 vs 90 s; P = 0.040) were shorter in the hybrid OR group. Placement accuracy was higher in the hybrid OR group (88.0 vs 59.1%; P = 0.010). Irradiation dose was significantly lower in the C-arm group (462 vs 102 mGy; P = 0.0013). This study suggested that the accuracy of PPS placement and time to confirm the PPS angle are the advantages in a hybrid OR.

Accuracy of Pedicle Screw Placement Comparing an Electronic Conductivity Device and a Multi-axis Angiography Unit with C-arm Fluoroscopy in Lumbar Fixation Surgery for Safety

“…Although the MAU in our institution is not coupled to a navigation system, image resolution of the MAU is markedly higher than that of the C-arm, allowing clear visualization of the shape or margin of the pedicle and the tip of the guidewire, facilitating more accurate screw insertion than that achieved with the C-arm. 15) In the present study, we found that the accuracy of screw insertion in the MAU+ECD group (98.0%) was higher than that in the C-arm group (92.4%). Richter et al reported a high accuracy by combining the MAU and a navigation system during surgery for orthopedic diseases, including spinal disorders.…”

“…In the present study, we used two different types of information-guided intraoperative supporting devices: a multi-axis angiography unit (MAU) (Artis Zeego, VC21-B, Siemens Healthineers) that can capture wide-range, high-resolution, fluoroscopic images and 3D images (which allows creation of CT-like images intraoperatively), 14 , 15) and an electronic conductivity device (ECD) with a cannulated Jamshidi needle (PediGuard; Spine Guard, Paris, France). 16 – 18) ( Fig.…”

Usefulness of a New Electronic Conductivity Device with a Pedicle Probe and a Multi-axis Angiography Unit for Inserting a C1 Lateral Mass Screw Safely and Tightly: A Technical Note

“…The CT-like imaging, that is obtained by the multi-axis angiography unit, further enables intraoperative confirmation of the screw position immediately after screwing. 19) Here, we combined these two pieces of equipment and succeeded in obtaining good results.…”

Curved periacetabular osteotomy using intraoperative real-time 3-dimensional computed tomography with a robotic C-arm system

“…Results have been reported that the placement accuracy was higher in the Artis zeego group, and the irradiation dose was significantly lower in the C-arm group (462 mGy vs 102 mGy; P = .0013). [20] Approximately 2 times the irradiation dose was indicated in the Artis zeego group. On the contrary, Kageyama et al also compared the irradiation dose and time between the initial 6 cases and the later 6 cases.…”

“…Irradiation time and dose gradually decreased, indicating a learning curve. [20] Additionally, Kraus et al proposed the low-dose radiation exposure protocol for the spinal surgery with Artis zeego. The reduced dosage protocol can be drastically reduced the irradiation dose in comparison to routine CT and high-dose protocol with Artis zeego, and produced good image quality in the cadaveric study.…”