Electromagnetic Field-Based Image-Guided Spine Surgery Part One: Results of a Cadaveric Study Evaluating Lumbar Pedicle Screw Placement

Sagi, H. Claude; Manos, Richard E.; Benz, R.; Ordway, Nathaniel R.; Connolly, Patrick J.

doi:10.1097/01.brs.0000087851.51547.00

Cited by 60 publications

(53 citation statements)

References 40 publications

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“…Five in vitro papers also revealed that 2D FluoroNav obtained a lesser, but insignificant, perforation risk compared with the conventional methods (Fig. 1) [39,[41][42][43]54].…”

Section: Two-dimension Fluoroscopy-based Navigation Systemmentioning

confidence: 99%

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Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies

et al. 2010

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Studies revealed that navigation systems that provided intraoperative assistance might improve pedicle screw insertion accuracy, and also implied that different systems provided different pedicle screw insertion accuracy. A systematic review and meta-analysis was conducted to focus on the pedicle screw insertion accuracy with or without the assistance of image-guided system, and the variance among the different navigation systems. Comparative studies were searched on pedicle screw insertion accuracy between conventional and navigated method, and among different navigation systems. A total of 43 papers, including 28 clinical, 14 cadaveric and 1 model studies, were included in the current study. For clinical articles, there were 3 randomized clinical trials, 4 prospective comparative studies and 21 retrospective comparative studies. The incidence of pedicle violation among computer tomography-based navigation method group was statistically significantly less than that observed among the conventional group (OR 95% CI, in vivo: 0.32-0.60; in vitro: 0.24-0.75 P \ 0.01). Two-dimensional fluoroscopybased navigation system (OR 95% CI, in vivo: 0.27-0.48; in vitro: 0.43-0.88 P \ 0.01) and three-dimension fluoroscopy-based navigation system (OR 95% CI, in vivo: 0.09-0.38; in vitro: 0.09-0.36 P \ 0.01) also obtained significant reduced screw deviation rate over traditional methods. Between navigated approaches, statistically insignificant individual and pooled RR values were observed for all in vivo subgroups. Pooled estimate of in vitro studies show that computer tomography-based and three-dimension fluoroscopy-based navigation system provided more accurate pedicle screw insertion over two-dimension fluoroscopy-based navigation system. Our review showed that navigation provided a higher accuracy in the placement of pedicle screws compared with conventional methods. The superiority of navigation systems was obvious when they were applied to abnormal spinal structure. Although no strong in vivo evidence has detected significantly different pedicle screw placement accuracy among the three major navigation systems, meta-analysis revealed the variance in pedicle screw insertion accuracy with different navigation methods.

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“…Five in vitro papers also revealed that 2D FluoroNav obtained a lesser, but insignificant, perforation risk compared with the conventional methods (Fig. 1) [39,[41][42][43]54].…”

Section: Two-dimension Fluoroscopy-based Navigation Systemmentioning

confidence: 99%

“…FluoroNav that does not require registration might reduce surgical time. However, some authors pointed out that extra time was needed for the setup of the system, placing the transmitter and acquiring suitable images for navigation, which would not significantly reduce the total insertion time per screw [15,17,[41][42][43].…”

Section: Other Perioperative Findingsmentioning

confidence: 99%

Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies

et al. 2010

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“…The use of pedicle screws for fixation is not without complications, however, with reported rates of breach ranging from 15% to 54%. 2,3,12,13 Perforations can further lead to complications such as dural tear, nerve root injury, spinal cord injury, vascular injury, or vertebral fractures.The accuracy with which such instrumentation can be placed has been and continues to be the topic of much investigation. Much of the variation in perforation rates in the literature depends on the method used to determine the perforation.…”

mentioning

confidence: 99%

Independent assessment of a new pedicle probe and its ability to detect pedicle breach: a cadaveric study

Guillen¹,

Knopper

Kroger

et al. 2014

SPI

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Object The authors undertook an independent, non–industry funded cadaveric study to evaluate the efficacy of a pedicle-probing device, which uses impedance measurement to warn of impending and actual pedicle screw breach. Methods A previously validated fresh-frozen cadaver model (saline-soaked spine) was used. Individuals at 3 levels of training (attending spine surgeon, orthopedic surgery resident, and medical student) used a cannulated pedicle-probing device to cannulate each of the levels between T-2 and S-1. Each pedicle was cannulated freehand using 2 approaches: 1) a standard trajectory through the middle of the pedicle, and 2) a medial trajectory aimed to breach the medial wall of the pedicle. A 16-slice helical CT scanner was used. The images were interpreted and analyzed by 2 orthopedic spine surgeons and a neuroradiologist. Results The sensitivity of the pedicle probe to detect impending breach or breach of 4 mm or less was 90.06%. The sensitivity in detecting medial wall breach was 95.8%. The positive predictive value was 87.1%. The device detected medial breach more often than lateral breach. Conclusions This study showed that this pedicle-probing device could reasonably be used to detect impending breach and actual breach of 4 mm or less. Medial breach was detected better than lateral breach. Use of the pedicle probe may improve patient safety.

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“…Accordingly, 3.4-66 seconds of fluoroscopy time per screw is the range reported in the literature. 8,15,[18][19][20] Disadvantages to the surgeon in using active fluoroscopy for pedicle screw placement include wearing a lead apron and the ergonomic challenge of working around the fluoroscope. 4 In addition, spinal surgeons can sustain a 10-to 12-fold increase in radiation exposure as compared with surgeons using fluoroscopy for nonspinal procedures.…”

Section: Discussionmentioning

confidence: 99%

Operating room radiation exposure in cone beam computed tomography–based, image-guided spinal surgery

Nottmeier¹,

Pirris²,

Edwards³

et al. 2013

SPI

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Object Surgeon and operating room (OR) staff radiation exposure during spinal surgery is a concern, especially with the increasing use of multiplanar fluoroscopy in minimally invasive spinal surgery procedures. Cone beam computed tomography (cbCT)–based, 3D image guidance does not involve the use of active fluoroscopy during instrumentation placement and therefore decreases radiation exposure for the surgeon and OR staff during spinal fusion procedures. However, the radiation scatter of a cbCT device can be similar to that of a standard 64-slice CT scanner and thus could expose the surgeon and OR staff to radiation during image acquisition. The purpose of the present study was to measure radiation exposure at several unshielded locations in the OR when using cbCT in conjunction with 3D image-guided spinal surgery in 25 spinal surgery cases. Methods Five unshielded badge dosimeters were placed at set locations in the OR during 25 spinal surgery cases in which cbCT-based, 3D image guidance was used. The cbCT device (O-ARM) was used in conjunction with the Stealth S7 image-guided platform. The radiology department analyzed the badge dosimeters after completion of the last case. Results Fifty high-definition O-ARM spins were performed in 25 patients for spinal registration and to check instrumentation placement. Image-guided placement of 124 screws from C-2 to the ileum was accomplished without complication. Badge dosimetry analysis revealed minimal radiation exposure for the badges 6 feet from the gantry in the area of the anesthesiology equipment, as well as for the badges located 10–13 feet from the gantry on each side of the room (mean 0.7–3.6 mrem/spin). The greatest radiation exposure occurred on the badge attached to the OR table within the gantry (mean 176.9 mrem/spin), as well as on the control panel adjacent to the gantry (mean 128.0 mrem/spin). Conclusions Radiation scatter from the O-ARM was minimal at various distances outside of and not adjacent to the gantry. Although the average radiation exposure at these locations was low, an earlier study, undertaken in a similar fashion, revealed no radiation exposure when the surgeon stood behind a lead shield. This simple precaution can eliminate the small amount of radiation exposure to OR staff in cases in which the O-ARM is used.

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Electromagnetic Field-Based Image-Guided Spine Surgery Part One: Results of a Cadaveric Study Evaluating Lumbar Pedicle Screw Placement

Cited by 60 publications

References 40 publications

Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies

Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies

Independent assessment of a new pedicle probe and its ability to detect pedicle breach: a cadaveric study

Operating room radiation exposure in cone beam computed tomography–based, image-guided spinal surgery

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