Präzisionsanalyse navigationsgestützt implantierter thorakaler und lumbaler Pedikelschrauben

Abstract

A prospective clinical trial was performed to study the accuracy of pedicle screw placement of consecutive computer-aided and conventional techniques. Concerning the clinical performance of the navigation system, the average time of matching has been 8.4 minutes per vertebrae. For evaluation of the results, only complete intraosseous placement of the pedicle screw has been defined as correct position. Any medial or lateral perforation of the cortical structure of the pedicle was recorded as malplacement. In the CT-controlled patients complete intrapedicular placement of the screw was obtained in 36 of 45 thoracic (80%) and in 22 of 27 navigated lumbar (81%) pedicles. In the conventional cohort group 27 of 34 (79%) thoracal and 43 of 52 (83%) lumbar screws were completely in. No radicular neurologic damage, caused by a malplaced transpedicular screw has been observed in both groups. In the presented study is shown, that the application of the computer-assisted freehand navigation can improve results concerning the precision of spinal screw placement. Although, the spinal navigator has to consider a learning curve for the clinical inauguration of the system and the qualification of the implant system for computer-assisted application.

Camera Augmented Mobile C-Arm (CAMC): Calibration, Accuracy Study, and Clinical Applications

“…Within the other two experiments the access path showed medial perforation (classification group B and C) according to Arand et al [53]). The observation of the videos recorded by our workflow analysis tool of these two experiments showed an undetected motion of the phantom.…”

“…Within our experiments three out of five needles were perfectly positioned, i.e., in central position through the pedicle of the L1 (classification group A according to Arand et al [53]). Within the other two experiments the access path showed medial perforation (classification group B and C) according to Arand et al [53]).…”

Computernavigierte Implantation transpedikulärer Schrauben in die Lendenwirbelsäule

“…Abschließend bleibt festzuhalten, dass der Einsatz der computernavigierten Implantation transpedikulä-rer Schrauben in der LWS -wie auch in anderen Wirbelsäulenabschnitten [2,5,[14][15][16]19] -mit hinreichender Sicherheit möglich ist. Der Operateur sollte sich nicht nur mit der Arbeitsweise der CAS auskennen, sondern auch bei einem technischen Versagen imstande sein, einen Eingriff unter Durchleuchtungskontrolle fortzuführen.…”

“…We would also like to mention that the pedicle screw insertion under CT navigation cannot only be used for the lumbar spine but also for other spine segments [2,5,[14][15][16]19]. The goal of reduction of surgical risks has certainly been reached with the use of CAS and has proven its place in clinical practice.…”

Navigation an der Brust- und Lendenwirbelsäule mit dem 3D-Bildwandler

“…Trotzdem sind die beschriebenen Raten an Fehlplatzierungen mit bis zu % immer noch relativ hoch [3,34]. Ein Problem ist die unterschiedliche Definition von Fehllagen.…”