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

Sagi, H. Claude; Manos, Richard E.; Park, S.-C.; Jako, Ron von; Ordway, Nathaniel R.; Connolly, Patrick J.

doi:10.1097/01.brs.0000086822.76638.76

Cited by 45 publications

(35 citation statements)

References 15 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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“…3,4 More recently, Sagi et al, in a cadaveric study comparing electromagnetic fi eld-based (EM) image guidance to conventional anatomical/fl uoroscopic guidance, found similar rates of screw misplacement in the thoracic spine. 5 EM tracking, as an alternative to optical tracking, signifi cantly reduced mean screw insertion time per screw (179 versus 261 seconds, P = .007) and mean total fl uoroscopy time (162 versus 261 seconds, P = .045). 5 Thus, EM tracking technology, which, unlike optical imaging, does not depend on continuous line-ofsight registration, represents an important development in the advance of image-guided complex spine surgery.…”

Section: Minimally Invasive Surgerymentioning

confidence: 99%

Electromagnetic Navigation in Minimally Invasive Spine Surgery: Results of a Cadaveric Study to Evaluate Percutaneous Pedicle Screw Insertion

Fraser¹,

Jako²,

Carrino³

et al. 2008

SAS Journal

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BackgroundTh is cadaveric study compared effi cacy and safety of an electromagnetic (EM) guidance system versus conventional fl uoroscopy for percutaneous pedicle screw fi xation. As percutaneous pedicle screw fi xation becomes increasingly common in spinal surgery, intraoperative imaging systems that maximize effi ciency while minimizing radiation exposure and inaccurate trajectories will be progressively more important. Published studies have validated the safety of percutaneous screw fi xation using conventional fl uoroscopic guidance and frameless optical stereotaxy, though EM guidance systems have not been evaluated for percutaneous placement in the lumbosacral spine. Th e aim of the study was to evaluate the clinical applicability of an EM system for minimally invasive spine fusion in the lumbosacral spine. MethodsFive human cadaveric specimens underwent bilateral lumbosacral percutaneous screw fi xation from L1 to S1 using conventional anteroposterior (AP) and lateral fl uoroscopic techniques on one side and 2-dimesional (2D) EM guidance on each matching side. Intraoperative effi ciency was evaluated, and pedicle, vertebral, and critical breach rates were assessed on postoperative computed tomography (CT). ResultsOverall mean fl uoroscopy time per screw was 58.9 ± 44.7 seconds for conventional fl uoroscopy compared to 27.4 ± 13.5 seconds for electromagnetic guidance (P = .0003). Pedicle, vertebral, and critical breach rates for the L1-S1 were 32.1%, 10.7%, and 25.0% for conventional fl uoroscopy and 42.8%, 10.7%, and 14.1% for electromagnetic guidance (diff erence not statistically signifi cant [ns]). In comparing critical breaches in the lumbar spine (L1-L5), there was a signifi cant diff erence between 2-D EM guidance (0) and CF guidance (6) (P = .02). ConclusionsTwo-dimensional EM navigation provides a modality for lumbosacral percutaneous pedicle screw fi xation that is more effi cient and safer than conventional fl uoroscopy. Th is data provides a foundation for further clinical trials of this technology. Level of EvidenceLevel 5 -Bench Research Key Words: Minimally invasive spine fusion, percutaneous pedicle screw fi xation, electromagnetic guidance.

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“…Previous studies evaluating thoracic placement have focused mostly in the lower thoracic region [1,4,12,16,17,19,26,29]. Furthermore, accuracy of thoracic pedicle screw instrumentation has been reported in several cadaveric populations [5,7,21,22,25,28,29,31,32], and with the use of assisted-navigation techniques [2,5,6,8,25]. While there is data on thoracic screw placement accuracy in the literature, we found little information specifically reporting on upper thoracic screws inserted in vivo on nondeformed spines.…”

Section: Discussionmentioning

confidence: 89%

Inserting pedicle screws in the upper thoracic spine without the use of fluoroscopy or image guidance. Is it safe?

2006

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Several studies have looked at accuracy of thoracic pedicle screw placement using fluoroscopy, image guidance, and anatomical landmarks. To our knowledge the upper thoracic spine (T1-T6) has not been specifically studied in the context of screw insertion and placement accuracy without the use of either image guidance or fluoroscopy. Our objective was to study the accuracy of upper thoracic screw placement without the use of fluoroscopy or image guidance, and report on implant related complications. A single surgeon inserted 60 screws in 13 consecutive non-scoliotic spine patients. These were the first 60 screws placed in the high thoracic spine in our institution. The most common diagnosis in our patient population was trauma. All screws were inserted using a modified RoyCamille technique. Post-operative axial computed tomography (CT) images were obtained for each patient and analyzed by an independent senior radiologist for placement accuracy. Implant related complications were prospectively noted. No pedicle screw misplacement was found in 61.5% of the patients. In the remaining 38.5% of patients some misplacements were noted. Fifty-three screws out of the total 60 implanted were placed correctly within all the pedicle margins. The overall pedicle screw placement accuracy was 88.3% using our modified Roy-Camille technique. Five medial and two lateral violations were noted in the seven misplaced screws. One of the seven misplaced screws was considered to be questionable in terms of pedicle perforation. No implant related complications were noted. We found that inserting pedicle screws in the upper thoracic spine based solely on anatomical landmarks was safe with an accuracy comparable to that of published studies using imageguided navigation at the thoracic level.

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

Cited by 45 publications

References 15 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

Electromagnetic Navigation in Minimally Invasive Spine Surgery: Results of a Cadaveric Study to Evaluate Percutaneous Pedicle Screw Insertion

Inserting pedicle screws in the upper thoracic spine without the use of fluoroscopy or image guidance. Is it safe?

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