Image-guided insertion of transpedicular screws. A laboratory set-up

Nolte, L.-P.; Zamorano, Lucía; Jiang, Zhang; Wang, Q.; Langlotz, Frank; Berlemann, U.

doi:10.1016/j.esas.2010.10.001

Cited by 20 publications

(23 citation statements)

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“…In 1995, image guidance technologies were first used to perform spine surgery-by Pollack in the cervicomedullary junction 103 and by Nolte for the placement of pedicle screws. 91 The first spinal instrumentation procedure is credited to Hadra, who used wires to repair a spinous process fracture in 1891. 45 The concept of bone augmentation and arthrodesis for the treatment of lumbar degenerative disc disease dates back to 1911, and successful fusions are documented in independent reports by Albee 2 and Hibbs.…”

Section: Degenerative Disease Of the Lumbar Spinementioning

confidence: 99%

Minimally invasive spine technology and minimally invasive spine surgery: a historical review

Oppenheimer

DeCastro

McDonnell

2009

FOC

193

128

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The trend of using smaller operative corridors is seen in various surgical specialties. Neurosurgery has also recently embraced minimal access spine technique, and it has rapidly evolved over the past 2 decades. There has been a progression from needle access, small incisions with adaptation of the microscope, and automated percutaneous procedures to endoscopically and laparoscopically assisted procedures. More recently, new muscle-sparing technology has come into use with tubular access. This has now been adapted to the percutaneous placement of spinal instrumentation, including intervertebral spacers, rods, pedicle screws, facet screws, nucleus replacement devices, and artificial discs. New technologies involving hybrid procedures for the treatment of complex spine trauma are now on the horizon. Surgical corridors have been developed utilizing the interspinous space for X-STOP placement to treat lumbar stenosis in a minimally invasive fashion. The direct lateral retroperitoneal corridor has allowed for minimally invasive access to the anterior spine. In this report the authors present a chronological, historical perspective of minimal access spine technique and minimally invasive technologies in the lumbar, thoracic, and cervical spine from 1967 through 2009. Due to a low rate of complications, minimal soft tissue trauma, and reduced blood loss, more spine procedures are being performed in this manner. Spine surgery now entails shorter hospital stays and often is carried out on an outpatient basis. With education, training, and further research, more of our traditional open surgical management will be augmented or replaced by these technologies and approaches in the future.

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Section: Degenerative Disease Of the Lumbar Spinementioning

confidence: 99%

Minimally invasive spine technology and minimally invasive spine surgery: a historical review

Oppenheimer

DeCastro

McDonnell

2009

FOC

193

128

View full text Add to dashboard Cite

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“…Spinal navigation based on CT scans is now recognized as a valuable tool for improving the accuracy and safety of screw placement. 3,5,22,26 Cervical spinal navigation based on preoperative 3D-CT scans can effectively assist in reducing the risks of VA, spinal cord, and nerve root injuries, especially in the C1-2 region. 8,25 However, while the patient is prone during surgery, the anatomical relationships may not match those depicted on preoperative CT scans obtained while the patient was supine.…”

mentioning

confidence: 99%

Management of C1–2 traumatic fractures using an intraoperative 3D imaging–based navigation system

Costa¹,

Ortolina²,

Attuati³

et al. 2015

SPI

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OBJECT Fractures of C-1 and C-2 are complex and surgical management may be difficult and challenging due to the anatomical relationship sbetween the vertebrae and neurovascular structures. The aim of this study was to evaluate the role, reliability, and accuracy of cervical fixation using the O-arm intraoperative 3D image–based navigation system. METHODS The authors evaluated patients who underwent a navigation system–based surgery for stabilization of a fracture of C-1 and/or C-2 from August 2011 to August 2013. All of the fixation screws were intraoperatively checked and their position was graded. RESULTS The patient population comprised 17 patients whose median age was 47.6 years. The surgical procedures were as follows: anterior dens screw fixation in 2 cases, transarticular fixation of C-1 and C-2 in 1 case, fixation using the Harms technique in 12 cases, and occipitocervical fixation in 2 cases. A total of 67 screws were placed. The control intraoperative CT scan revealed 62 screws (92.6%) correctly placed, 4 (5.9%) with a minor cortical violation (< 2 mm), and only 1 screw (1.5%) that was judged to be incorrectly placed and that was immediately corrected. No vascular injury of the vertebral artery was observed either during exposition or during screw placement. No implant failure was observed. CONCLUSIONS The use of a navigation system based on an intraoperative CT allows a real-time visualization of the vertebrae, reducing the risks of screw misplacement and consequent complications.

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“…Segundo a literatura as taxas de violação pedicular nas deformidades vertebrais variam entre 1,8% a 11,4% quando colocados com auxilio da navegação, dependendo da margem de erro captada pelo navegador no momento da instrumentação, tornando-se necessário uma precisão de erro do navegador menor que 1,5 mm 25 . O sistema de navegação possibilita aquisição de dados e trans- fere automaticamente para a interface do programa de navegação.…”

Section: Discussionunclassified

“…O uso da navegação apresentou bons resultados in vivo e em estudos laboratoriais com cadáver anteriormente [26][27][28] . Melhores resultados foram observados de maneira uniforme com o uso de navegação 22,25,27,[29][30] . Porém o software do navegador depende de dados da TC pré-operatória, podendo ter variação no posicionamento da coluna no intra-operatório, logo há necessidade de calibragem da superfície de cada vértebra para aumentar a acurácia do método.…”

Section: Discussionunclassified

Estudo de acurácia em cirurgia assistida por navegação na revisão cirúrgica de deformidade vertebral

Jacob¹,

Galves²,

Santos³

et al. 2011

Coluna/Columna

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RESUMOObjetivo: Avaliar as vantagens da cirurgia com navegação na revisão cirúrgica de deformidades vertebrais, verificando a acurácia deste método. Método: Foram revisados cincos pacientes com deformidades vertebrais que tiveram intercorrências na primeira cirurgia. Esses pacientes foram submetidos a um estudo de tomografia computadorizada (TC) com cortes de 2mm da coluna vertebral antes da segunda cirurgia. Nos cinco pacientes submetidos a reabordagem cirúrgica procedeu-se a instrumentação posterior com auxílio da navegação. Foram 84 parafusos pediculares implantados, sendo que 33 destes parafusos foram assistidos por computação. A navegação foi empregada nos níveis da deformidade vertebral onde a anatomia apresentava-se alterada inviabilizando o correto uso dos parâmetros anatômicos para inserção de parafusos pediculares. Nos demais níveis onde era possível a correta identificação desses parâmetros anatômicos foi utilizada a técnica padrão. A TC pós-operatória foi realizada para aferição do posicionamento dos parafusos pediculares. Avaliamos os resultados obtidos no posicionamento com e sem o uso da navegação. O tempo de fluoroscopia e o tempo da cirurgia também foram comparados com o padrão ouro da literatura. Resultados: Dos 33 parafusos implantados com navegação observou-se uma acurácia de 94%, com uma taxa de violação pedicular de 6%. Conclusões: O uso da navegação é importante nas revisões cirúrgicas das deformidades vertebrais com anatomia alterada, influenciando no bom resultado final da cirurgia.Descritores: Cirurgia assistida por computação; Reoperação; Escoliose. RESUMENObjetivo: Evaluar las ventajas de la cirugía con navegación en reoperación por deformidades vertebrales, verificando la precisión de este método. Método: Fueron revisados cinco pacientes con deformidades vertebrales que tuvieron complicaciones en la primera cirugía. Esos pacientes fueron sometidos a un estudio de tomografía computada (TC) con cortes de 2 mm de la columna vertebral antes de la segunda cirugía. En los 5 pacientes sometidos al reabordaje quirúrgico se procedió a instrumentación posterior con auxilio de la navegación. Fueron 84 tornillos pediculares implantados, siendo que 33 de éstos fueron asistidos por computación. La navegación fue empleada en los niveles de la deformidad vertebral en donde la anatomía se presentaba alterada impidiendo el uso correcto de los parámetros anatómicos para inserción de tornillos pediculares. En los demás niveles en donde era posible la correcta identificación de esos parámetros anatómicos se utilizó la técnica estándar. La TC postoperatoria fue realizada para medición del posicionamiento de los tornillos pediculares. Evaluamos los resultados obtenidos en el posicionamiento con y sin el uso de la navegación. El tiempo de fluoroscopía y el tiempo de la cirugía también fueron comparados con la regla áurea de la literatura. Resultados. De los 33 tornillos implantados con navegación se observó una precisión de 94%, con una tasa de violación pedicular del 6%. Conclusiones: El uso de la navegac...

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Image-guided insertion of transpedicular screws. A laboratory set-up

Cited by 20 publications

References 0 publications

Minimally invasive spine technology and minimally invasive spine surgery: a historical review

Minimally invasive spine technology and minimally invasive spine surgery: a historical review

Management of C1–2 traumatic fractures using an intraoperative 3D imaging–based navigation system

Estudo de acurácia em cirurgia assistida por navegação na revisão cirúrgica de deformidade vertebral

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