Navigated pedicle screw placement: Experimental comparison between CT- and 3D fluoroscopy-based techniques

Geerling, J.; Gösling, Thomas; Gösling, Anna; Ortega, Gil; Kendoff, Daniel; Citak, Mustafa; Krettek, Christian; Hüfner, T.

doi:10.1080/10929080802102110

Cited by 5 publications

(9 citation statements)

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“…Insertion inaccuracy and radiation exposure (for the patient, the surgical team, or both) remain drawbacks of this method. 4,12,13 Breach rates reported in the literature are as high as 40% overall and 55% in the thoracic spine. [1][2][3][4]9 The incidence of neurological complications has been reported as up to 5%.…”

Section: Discussionmentioning

confidence: 99%

“…4,12,13 Breach rates reported in the literature are as high as 40% overall and 55% in the thoracic spine. [1][2][3][4]9 The incidence of neurological complications has been reported as up to 5%. 4 Computer-assisted imaging-based navigation techniques are reported to increase accuracy and reduce radiation exposure, but require expensive equipment and are complicated, with a steep learning curve.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, lateral and superior breaches may result in weak fixation. 4,8,10,13 Several techniques have been introduced to improve accuracy of PS placement. The conventional method, relying upon anatomical landmarks with liberal use of fluoroscopy, is the most commonly used technique around the world.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4]9 The incidence of neurological complications has been reported as up to 5%. 4 Computer-assisted imaging-based navigation techniques are reported to increase accuracy and reduce radiation exposure, but require expensive equipment and are complicated, with a steep learning curve. 3,6,7,9,13 Perforation rates for the overall spine have been reported to be as high as 11% using merged CT-and fluoroscopy-based navigation 4 and 17% using fluoroscopy-based navigation; 1 a perforation rate of 31.6% has been reported for fluoroscopy-based navigation in thoracic vertebra.…”

Section: Discussionmentioning

confidence: 99%

“…2 The use of combined CT-and fluoroscopic image-guided navigation has also been reported to improve accuracy but is expensive and complex. 4,12,13 The authors evaluate these 3 methods and a fourth technique using standard cervical distractor screws as markers.…”

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confidence: 99%

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Pedicle screw insertion in the thoracolumbar spine: comparison of 4 guidance techniques in the intact cadaveric spine

Al-Habib¹,

Nataraj²,

‏Khashab³

et al. 2011

SPI

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Object Pedicle screw fixation is a mainstay of thoracolumbar stabilization. Screw insertion using anatomical landmarks and fluoroscopy is common but can be technically challenging and generally involves substantial exposure to ionizing radiation. Computerized navigation has been reported to improve accuracy but is expensive and complex. The authors undertook this study to evaluate these 3 methods in comparison with a fourth technique using standard cervical distractor screws to mark the entry point and trajectory. Methods Four cadaveric human spines were used for this study. After an initial CT scan, 34 pedicle screws were inserted in each intact spine from T-1 to L-5 using the following 4 screw insertion guidance techniques (1 technique per specimen): use of anatomical landmarks, use of cervical distractor screws and spot fluoroscopy, fluoroscopy-based navigation, and fluoroscopy- and CT-based navigation (using merged imaging data). Postprocedural CT and anatomical dissection were then performed to evaluate screw position for site and degree of breach. Results The cervical distractor screw method had a breach rate of 5.9% versus 29.4%, 32.4%, and 20.6% for use of anatomical landmarks, fluoroscopic navigation, and fluoroscopic-CT navigation, respectively (p < 0.05). There is also a significant association between degree of medial and distal breach and the method of screw insertion (p < 0.05). Conclusions Cervical distractor screws as pedicle markers offer favorable insertion accuracy and reduction of radiation exposure compared with the other 3 methods used in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Pedicle screw insertion in the thoracolumbar spine: comparison of 4 guidance techniques in the intact cadaveric spine

Al-Habib¹,

Nataraj²,

‏Khashab³

et al. 2011

SPI

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Comparison of Three-Dimensional Fluoroscopy versus Postoperative Computed Tomography for the Assessment of Accurate Screw Placement after Instrumented Spine Surgery

Garber

Bisson

Schmidt

2012

Global Spine Journal

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While intraoperative three-dimensional fluoroscopy does not possess the resolution and image quality of computed tomography (CT), it may provide adequate information about screw placement to guide intra- and postoperative decision making. We compared the accuracy of intraoperative three-dimensional fluoroscopy visualization of proper screw placement with that of postoperative CT. We retrospectively reviewed spinal instrumentation procedures done using the O-arm (Medtronic, Minneapolis, MN, USA) that also had postoperative CT. All screws were assessed for placement accuracy on O-arm and CT images on a 4-point scale. In this study, 20 cases met the inclusion criteria. Thirteen breaches (11 grade 1 and 2 grade 2) were identified on O-arm images, and 14 breaches (10 grade 1, 3 grade 2, and 1 grade 3) were identified on CT. Sensitivity, specificity, and positive and negative predictive values were 93, 99, 99, and 98%, respectively. The Kappa value (0.96) suggested a very high degree of agreement between three-dimensional fluoroscopy and CT in determining accuracy of screw placement. These findings may allow less frequent use of postoperative CT scans, improving cost effectiveness in patients who require spinal instrumentation procedures and potentially decreasing the number of patients who require replacement of an inappropriately positioned screw.

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Minimally Invasive Fluoro-Navigation Screw Fixation for the Treatment of Pelvic Ring Injuries

Gao

Luo

et al. 2011

Surg Innov

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Intensive use of intraoperative fluoroscopy is mandatory to achieve good accuracy and avoid neural or vascular injury and may prolong surgical time and increase exposure-related hazards. New methods of percutaneous treatment in conjunction with innovative fluoroscopy-based computerized navigation have evolved in an attempt to overcome the existing difficulties. This report described our experience in applying fluoroscopic surgical navigation technique and evaluated its clinical application to pelvic ring injuries, including its feasibility, merits and limitations. Twenty-two patients with pelvic ring injuries were treated with percutaneous pubic ramus screw and sacroiliac screw techniques under the guidance of a fluoroscopy-based navigation system. A total of forty-four screws were inserted, including twenty-seven pubic ramus screws and seventeen sacroiliac screws. The average operation time and the average fluoroscopy time per screw were 23.6 minutes and 22.2 seconds respectively. Compared to the final position of the screw, the average deviated distance of wire tip was 2.8 mm and the average trajectory difference was 2.6°. A ventral cortex perforation of the sacrum was found in one sacroiliac screw without any clinical symptoms. No superficial or deep infection occurred. No patient sustained recognized neurologic, vascular, or urologic injury as a result of percutaneous screw fixation of pubic ramus fractures, sacroiliac disruptions, or sacral fractures. Our results showed that fluoroscopy-based navigation technique for the pelvic ring injuries could become a safe and effective alterative method for the treatment of pelvic ring injuries in some selected patients.

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Navigated pedicle screw placement: Experimental comparison between CT- and 3D fluoroscopy-based techniques

Abstract: The overall image-to-reality accuracy for CT- and Iso-C-based navigation was assessed in the described experimental setup. An apparent tendency towards higher accuracy with Iso-C-based navigation was evaluated; however, the differences were not significant.

Cited by 5 publications

References 0 publications

Pedicle screw insertion in the thoracolumbar spine: comparison of 4 guidance techniques in the intact cadaveric spine

Pedicle screw insertion in the thoracolumbar spine: comparison of 4 guidance techniques in the intact cadaveric spine

Comparison of Three-Dimensional Fluoroscopy versus Postoperative Computed Tomography for the Assessment of Accurate Screw Placement after Instrumented Spine Surgery

Minimally Invasive Fluoro-Navigation Screw Fixation for the Treatment of Pelvic Ring Injuries

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