Reliability and Usefulness of Intraoperative 3-Dimensional Imaging by Mobile C-Arm With Flat-Panel Detector

Fujimori, Takahito; Iwasaki, Motoki; Nagamoto, Yukitaka; Kashii, Masafumi; Takao, Masaki; Sugiura, Tetsuro; Yoshikawa, Hiroyuki

doi:10.1097/bsd.0b013e3182a357ad

Cited by 10 publications

(6 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The Cohen's Kappa and the AUC are indicators of the strength of agreement and diagnosis comparisons respectively. The strength of agreement was superior to the study performed with a mobile CBCT by Fujimori et al 27 and comparable to the study performed with CBCT in a hybrid OR28. The study by Cordemans et al is the only study from which the AUC could be derived for comparison of diagnostic strength28.…”

Section: Discussionsupporting

confidence: 48%

See 1 more Smart Citation

Intraoperative cone beam CT in hybrid operating room set-up as an alternative to postoperative CT for pedicle screw breach detection

Peh

Pfarr

Schäfer

et al. 2021

Preprint

View full text Add to dashboard Cite

Background CT is considered the gold standard for detecting pedicle breach. However, CBCT may be a viable and low radiation dose alternative, to provide intraoperative feedback to surgeons to permit in-room revisions of misplaced screws Methods To assess the ability and reliability of intraoperative cone-beam CT (CBCT) from a robotic C-arm in a hybrid operating room (OR) two hundred forty-one pedicle screws were inserted in cervical, thoracic and lumbar spine of 7 cadavers, followed by CBCT and CT imaging. The CT images served as the standard of reference. Agreement on screw placement between both imaging systems was assessed using Cohen’s Kappa coefficient (κ). Sensitivity, Specificity, Receiver operating characteristic (ROC), area under the empirical and fitted ROC curves (AUC) were computed to assess CBCT as a diagnostic tool compared to CT. The patient effective radiation dose (ED) was calculated for comparison. A systematic literature review was performed to provide perspective to the obtained results. Results Almost perfect agreement in assessing pedicle screw grading between CBCT and CT was observed (κ = 0.84). The sensitivity and specificity of CBCT were 0.84 and 0.98, respectively. The AUC derived from the empirical and fitted ROC curves were 0.95 and 0.96, respectively. Conclusion Intraoperative CBCT by C-arm in a hybrid OR is highly reliable in identification of screw placement at significant dose reduction.

show abstract

Section: Discussionsupporting

confidence: 48%

“…4). Two studies were cadaveric work comparing intraoperative CBCT vs macroscopic dissection 25,26 from which one compared to CT as well 26 ; and 2 clinical studies compared CBCT vs CT 27,28 . Details of these studies are in Table 3 with sensitivity, speci city, and AUC where applicable.…”

Section: Literature Review and Comparisonmentioning

confidence: 99%

Intraoperative cone beam CT in hybrid operating room set-up as an alternative to postoperative CT for pedicle screw breach detection

Peh

Pfarr

Schäfer

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Among the most- known ones of these methods, intraoperative Iso-C 3-dimensional navigation and CT navigation have been demonstrated to decrease perforation rates. [ 11 , 12 ] However, these systems increase the duration of surgery and are unavailable in most medical centers. Also, studies showed that even though they are superior to the freehand technique, these methods are not perfect; screws might be used incorrectly even with these systems.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the accuracy of the cannulated pedicle screw and the classical pedicle screw in the treatment of Scheuermann’s kyphosis: A retrospective study

Yilar

Zeynal

Toy³

et al. 2020

Jt Dis Relat Surg

View full text Add to dashboard Cite

Scheuermann's kyphosis (SK) is a spinal deformity characterized by anterior angulation of more than 5 degrees in three successive vertebra, stenosis in the disc interval, irregularity, and Schmorl nodes in lateral radiography (Figure 1c, 2c). The incidence of this disease, which was first designated by Scheuermann [1] in 1921, varies between 4 to 8%. [2] As the pedicles are usually sclerotic and rotated or too narrow in adolescent spinal deformities, it is considerably challenging to place pedicle screws in these patients. [3,4] For this reason, methods that facilitate screw placement were developed to reduce complications that might develop following potentially incorrect screw placement. Cannulated pedicle screws (CPSs) are increasingly preferred by many spinal surgeons to increase the accuracy of the screws. [5,6] Cannulated pedicle screws had been previously used in adolescent idiopathic scoliosis (AIS) patients, and their effectiveness was proven. Although CPS is frequently preferred in SK and we opine that it Objectives: This study aims to investigate if use of cannulated pedicle screw (CPS) in the dysplastic pedicles in Scheuermann's kyphosis (SK) increases the accuracy rate of the screw and reduces screw-related complications. Patients and methods: This retrospective study included 21 patients (11 males, 10 females; mean age 19.1 years; range, 13 to 22 years) (550 screws) who received correction with pedicle screws due to SK deformity between May 2015 and January 2019. Between 2017 and 2018, classical pedicle screws were used in addition to CPSs in the upper thoracic region (T2, T3, T4) and thin pedicles (group 1). However, during the years 2015 to 2016, only classical pedicle screws were used for the patients who underwent posterior instrumentation for SK (group 2). Computed tomography scanning was used to investigate the accuracy of the screws. Results: There were 12 patients (316 screws) in group 1 and nine patients (234 screws) in group 2. Seventy-four (13.4%) of all screws were inserted incorrectly. Incorrect screw rate in group 1 was significantly lower than group 2; 21 (6.6%) and 53 (22.6%), respectively (p<0.001). There were no complications related to the use of CPSs after a mean follow-up of two-and-a-half years. Conclusion: The use of CPS in the surgical treatment of SK does not increase the complication rate; instead it increases the accuracy of the screw. For this reason, we believe that CPS may be an effective and reliable option in the treatment of SK.

show abstract

“…Die intraoperative 3-D-Darstellung bei Becken- und Wirbelsäulenverletzungen wurde in verschiedenen Studien als nützliches Hilfsmittel zur Beurteilung des Operationsergebnisses evaluiert 13 , 14 , 15 . Im Einsatz des mobilen intraoperativen CTs konzentrierte man sich auf die Anwendung in den oben beschriebenen Stammverletzungen.…”

Section: Diskussionunclassified

Intraoperative Computed Tomography in Orthopaedic Trauma Surgery

et al. 2021

View full text Add to dashboard Cite

Background When using mobile 3D C-arms, impairments in image quality occur due to artefacts caused by metal implants as well as to the limited field of view. To avoid these restrictions, special computed tomography devices were designed, in order to improve image quality and to meet requirements for intraoperative usage. Objectives To analyse practicability and benefits of a mobile intraoperative CT device (Airo, Brainlab, Munich, Germany) on the basis of several parameters that were obtained during a 40-month period. Materials and Methods All procedures that were performed with usage of intraoperative CT between January 2017 and April 2020 were analysed with respect to anatomical region, count of scans, duration of scans, consequences drawn from the scans and use of navigation. Results 354 CT-scans were performed in 171 patients (mean 2.07 [1 – 6] scans per procedure). 47.81% of the procedures were spinal, 52.19% affected the pelvis. 83% of the procedures were navigated. In 22% of patients, improvement in implant placement or reduction was achieved; in most patients (55%), a guidewire for pedicle screws was corrected. The mean scan duration was 10.33 s (3.54 – 21.72). Conclusions Use of intraoperative CT was reliable and helpful. Integration in OR standards requires more effort than mobile 3D C-arms. Image quality was outstanding for intraoperative conditions and allowed proper assessment of implant placement and reduction in all cases. Due to the high financial outlay of the system and the good image quality of 3D C-arms in the extremities, we assume that this procedure can be applied in intraoperative CT in traumatological cases in spinal and pelvic surgery in high-level trauma centres.

show abstract

Reliability and Usefulness of Intraoperative 3-Dimensional Imaging by Mobile C-Arm With Flat-Panel Detector

Abstract: Intraoperative imaging with a 3D C-arm was reliable for detecting screw misplacement and helpful in decreasing the rate of revision surgery for screw misplacement.

Cited by 10 publications

References 37 publications

Intraoperative cone beam CT in hybrid operating room set-up as an alternative to postoperative CT for pedicle screw breach detection

Intraoperative cone beam CT in hybrid operating room set-up as an alternative to postoperative CT for pedicle screw breach detection

Comparison of the accuracy of the cannulated pedicle screw and the classical pedicle screw in the treatment of Scheuermann’s kyphosis: A retrospective study

Intraoperative Computed Tomography in Orthopaedic Trauma Surgery

Contact Info

Product

Resources

About