Improved accuracy of screw implantation could decrease the incidence of post-operative hydrothorax? O-arm navigation vs. free-hand in thoracic spinal deformity correction surgery

Zhao, Zhihui; Liu, Zhen; Hu, Zongshan; Tseng, Changchun; Li, Jie; Pan, Wei Ren; Qiu, Yong; Zhu, Zezhang

doi:10.1007/s00264-018-3889-8

Cited by 9 publications

(4 citation statements)

References 25 publications

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“…This study shows that the O-arm navigation aid technology can effectively improve the accuracy of screw placement. [ 5 ] Given the rapid rehabilitation and minimally invasive surgery concepts, the Wiltse approach can not only reduce tissue damage, but also play a positive role in reducing blood loss and increasing quality of life. [ 14 , 15 ] Here, a retrospective case-control study of 32 patients with AS combined with thoraco-lumbar fracture showed that pedicle screw reduction with O-arm navigation assisted by the Wiltse approach could significantly shorten operation time, reduce the amount of intraoperative bleeding volume, and improve the accuracy of pedicle screw placement.…”

Section: Discussionmentioning

confidence: 99%

“…With the development of modern technology and the concept of minimally invasive surgery, the O-arm is used more and more often during orthopedic surgery, since it facilitates intraoperative three-dimensional CT imaging and intraoperative real-time navigation, both of which greatly improve the accuracy of the screwing procedure. [ 5 – 7 ] However, to date there are few reports on O-arm navigation-assisted pedicle screw placement for AS combined with thoracolumbar vertebral fractures. The purpose of this study was therefore to examine the efficacy of an O-arm navigation-assisted Wiltse approach relative to a freehand posterior pedicle screw combined osteotomy in cases of AS combined with thoracolumbar fracture.…”

Section: Introductionmentioning

confidence: 99%

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Case series: O-arm navigation assisted by the Wiltse approach improves the accuracy of pedicle screw placement in ankylosing spondylitis combined with thoracolumbar fractures

Li,

Zhao,

et al. 2023

Medicine

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Here we assessed the accuracy of O-arm navigation assisted by Wiltse approach to improve based pedicle screw insertion in ankylosing spondylitis combined with thoracolumbar fractures. We then compared it with the freehand pedicle screw insertion technique. The study sample included 32 patients with ankylosing spondylitis combined with thoracolumbar fractures. Pedicle screw reduction and internal fixation was performed under an O-arm navigation system assisted by a Wiltse approach-combined osteotomy (“navigation group,” n = 17) and posterior pedicle screw reduction and internal fixation was performed using freehand technique combined osteotomy (“freehand group,” n = 15). We then compared the operation time and bleeding volume between the 2 groups. The visual analog scale (VAS) and Oswestry disability index (ODI) were then used to evaluate the clinical efficacy and the kyphosis Cobb angle was used to evaluate the radiological efficacy before operation, 3 days after operation and after the last follow-up. All complications were noted when detected. Finally, classification of screw positions as proposed by Neo et al was used to evaluate the relationship of the position between the screw, the bone cortex, and the incidence of screw penetration. All patients were followed up for 18 to 36 months (i.e., 24.2 ± 3.5 months). The operation time and intraoperative bleeding volume of the navigation group were significantly shorter (lower) than those of the freehand group (P < .05). In addition, Both groups showed significantly decreased VAS, ODI, and Cobb angle 3 days after the operation and at the last follow-up when compared to values recorded pre-operation. However, we found no significant difference in VAS, ODI, and Cobb angle between the 2 groups (P > .05). We identified no complications (e.g., infection, VTE/PE, or nerve injury). Moreover, the pedicle screw placement position of the navigation group was better than that of the freehand group (P < .05), and the screw cortical penetration rate was lower than the freehand group (P < .05). During the process of posterior pedicle screw placement, O-arm navigation assisted by the Wiltse approach can significantly reduce operation time, minimize the amount of bleeding volume, and enhance the accuracy of pedicle screw implantation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Case series: O-arm navigation assisted by the Wiltse approach improves the accuracy of pedicle screw placement in ankylosing spondylitis combined with thoracolumbar fractures

Li,

Zhao,

et al. 2023

Medicine

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“…As reported in a previous study, the nerve injury risk and clinical complications could be decreased through this technique [ 24 ]. Zhao et al [ 25 ] compared the occurrence of postoperative hydrothorax between O-arm navigation and free-hand in spinal deformity surgery. They found that the volume of postoperative hydrothorax could be significantly reduced using the O-arm navigation, and this was ascribed to the improvement in screw implantation accuracy.…”

Section: Discussionmentioning

confidence: 99%

Radiation Dose Reduction and Surgical Efficiency Improvement in Endoscopic Transforaminal Lumbar Interbody Fusion Assisted by Intraoperative O-arm Navigation: A Retrospective Observational Study

et al. 2022

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Objective: Endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) has gained increasing popularity among spine surgeons. However, with the use of fluoroscopy, intraoperative radiation exposure remains a major concern. Here, we aim to introduce Endo-TLIF assisted by O-arm-based navigation and compare the results between O-arm navigation and fluoroscopy groups.Methods: Sixty-four patients were retrospectively analyzed from May 2019 to September 2020; the nonnavigation group comprised 34 patients, and the navigation group comprised 30 patients. Data on radiation dose, blood loss, postoperative drains, surgery time, complications, and length of hospital stay (LOS) were collected. Clinical outcomes were evaluated from postoperative data such as fusion rate, Oswestry Disability Index (ODI), and visual analogue scale (VAS). Radiation dose and surgery time were selected as primary outcomes; the others were second outcomes.Results: All patients were followed up for at least 12 months. No significant differences were detected in intraoperative hemorrhage, postoperative drains, hospital LOS, or complications between the 2 groups. The radiation dose was significantly lower in the navigation group compared with the nonnavigation group. The time of cannula placement and pedicle screw fixation was significantly reduced in the navigation group. No significant differences were detected between the clinical outcomes in the 2 groups (VAS and ODI scores).Conclusion: The present study demonstrates that O-arm-assisted Endo-TLIF is efficient and safe. Compared with fluoroscopy, O-arm navigation could reduce the radiation exposure and surgical time in Endo-TLIF surgery, with similar clinical outcomes. However, the higher doses exposed to patients remains a negative effect of this technology.

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“…There was a trend towards shorter length of hospital stay and lower blood loss in the navigation group in this study; although not statistically significant. Studies which have compared length of hospital stay and blood loss have shown as well non-significant trends towards a decrease compared to free-hand [28][29][30] . Our sample size is too small to detect any such differences in these secondary endpoints.…”

Section: Figurementioning

confidence: 99%

Augmented reality navigation with intraoperative 3D imaging vs fluoroscopy-assisted free-hand surgery for spine fixation surgery: a matched-control study comparing accuracy

Elmi-Terander

Burström

Nachabé

et al. 2020

Sci Rep

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This study aimed to compare screw placement accuracy and clinical aspects between Augmented Reality Surgical Navigation (ARSN) and free-hand (FH) technique. Twenty patients underwent spine surgery with screw placement using ARSN and were matched retrospectively to a cohort of 20 FH technique cases for comparison. All ARSN and FH cases were performed by the same surgeon. Matching was based on clinical diagnosis and similar proportions of screws placed in the thoracic and lumbosacral vertebrae in both groups. Accuracy of screw placement was assessed on postoperative scans according to the Gertzbein scale and grades 0 and 1 were considered accurate. Procedure time, blood loss and length of hospital stay, were collected as secondary endpoints. A total of 262 and 288 screws were assessed in the ARSN and FH groups, respectively. The share of clinically accurate screws was significantly higher in the ARSN vs FH group (93.9% vs 89.6%, p < 0.05). The proportion of screws placed without a cortical breach was twice as high in the ARSN group compared to the FH group (63.4% vs 30.6%, p < 0.0001). No statistical difference was observed for the secondary endpoints between both groups. This matched-control study demonstrated that ARSN provided higher screw placement accuracy compared to free-hand.Compared to conventional free-hand (FH) surgical technique, computer-assisted navigation using intraoperative 3D imaging has been shown to improve screw placement accuracy and reduce complications due to screw misplacements 1 . Moreover, improved accuracy has also been shown in more challenging conditions, such as scoliosis surgery, where it may be of even greater importance 2 . Consequently, navigation also reduces the frequency of postoperative revision surgery compared to FH surgery 3 .Although several studies have compared intraoperative image guidance to free-hand (FH) technique, the evidence in favor of navigation is still limited. In a recent systematic review, Chan et al., found only four studies comparing computed tomography (CT) guidance with free-hand methods head-to-head, including one small (10 patients in each group, 169 screws in total) randomized study 4 . Overall, the reviewers found only moderate level evidence showing that CT guidance has lower breach rates than FH, while screw-related complication rates were conflicting at 0% in CT navigation compared with 0%-1.7% in FH groups 5 . In a more recent retrospective study comparing O-arm navigation to FH, Wang et al. demonstrated higher pedicle screw accuracy and lower total

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Improved accuracy of screw implantation could decrease the incidence of post-operative hydrothorax? O-arm navigation vs. free-hand in thoracic spinal deformity correction surgery

Abstract: The volume of PE after correction surgery can be significantly decreased by application of O-arm navigation system as compared to conventional free-hand technique. We ascribed the improvement to the accuracy of screw implantation navigated by O-arm.

Cited by 9 publications

References 25 publications

Case series: O-arm navigation assisted by the Wiltse approach improves the accuracy of pedicle screw placement in ankylosing spondylitis combined with thoracolumbar fractures

Case series: O-arm navigation assisted by the Wiltse approach improves the accuracy of pedicle screw placement in ankylosing spondylitis combined with thoracolumbar fractures

Radiation Dose Reduction and Surgical Efficiency Improvement in Endoscopic Transforaminal Lumbar Interbody Fusion Assisted by Intraoperative O-arm Navigation: A Retrospective Observational Study

Augmented reality navigation with intraoperative 3D imaging vs fluoroscopy-assisted free-hand surgery for spine fixation surgery: a matched-control study comparing accuracy

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