Spinal Navigation: An Accepted Standard of Care?

Schröder, J.; Wassmann, H.

doi:10.1055/s-2006-942146

Cited by 10 publications

(4 citation statements)

References 26 publications

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“…In recent years, 3-dimensional image intensifiers, intraoperative CT and navigation systems have been established and several authors have reported reduced rates of malpositioned pedicle screws when employing these systems. While these technologies are disputed, they appear to be the method of choice in our opinion, at least in the long-term perspective [4,8].…”

Section: Discussionmentioning

confidence: 90%

Delayed perforation of the aorta by a thoracic pedicle screw

et al. 2008

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Pedicle screw instrumentation has become increasingly popular during the past 20 years and a vast selection of products is available on the market. With rising implantation rates, reports about specific complications also have increased. The main reason for these complications is the fact that the course of the pedicle and in turn the positioning of the pedicle screw cannot be adequately controlled visually. Based on the anatomy of the surrounding structures, complications caused by malpositioning can be divided into three main groups: mechanical, neurological and vascular. Beyond mechanical limitations of spinal motion, nerve injury can lead to neurological problems while injuries to vascular structures usually cause hemorrhage. These typical problems in general become apparent intraoperatively or in the immediate postoperative course. We report on a rare delayed complication and analyze the factors that led to it. In addition, we outline our treatment strategy. The goal has to be to avoid such problems in the future by using suitable navigational aids. MaterialA 69-year-old female patient was first seen by her general practitioner for back pain, which had been present for a period of 4 weeks. She was referred to our department, where clinical examination showed strong pain at the thoracolumbar junction without any peripheral neurological deficit. Plain radiographs showed osteolytic destruction of the 9th thoracic vertebra (Fig. 1). The subsequent diagnostic work-up consisted of a CT of the chest and abdomen, an MRI of the spine, and a 3-phase technetium bone scan and resulted in the diagnosis of a renal cell carcinoma with a solitary metastasis to the 9th thoracic vertebra. The metastasis had penetrated into the spinal canal with beginning compression of the spinal cord (Fig. 2, 3). The operative treatment consisted of dorsal decompression by means of an expanded costotransversectomy, bilateral laminectomy, tumor debulking and posterior pedicle screw instrumentation using the USS I-system (Synthes, Umkirch, Germany, Fig. 4) after preoperative tumor embolization. Surgery was followed by local radiation, a nephrectomy and a systemic immunochemotherapy. One year after the procedure, the patient presented again with renewed back pain. She was also experiencing intermittent and pulsating epigastric pain, symptoms which had already been observed immediately after the original surgery, but which had gotten much worse during recent days. In addition, there was left-sided pelvic pain, which could be explained by a new metastasis in the left pubic bone. The epigastric pain did not follow any dermatomal pattern and a CT of the chest and the abdomen was performed. This study showed a suspected penetration of the left-sided T 11-pedicle screw into the descending thoracic aorta (Fig. 5), subsequently confirmed by aortography. We performed a left-sided thoracotomy and the intraoperative findings confirmed screw penetration into the aorta. Brief proximal and distal cross clamping of the aorta allowed for pulling the ...

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Section: Discussionmentioning

confidence: 90%

Delayed perforation of the aorta by a thoracic pedicle screw

et al. 2008

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“…Difference of opinion is expected amongst neurosurgeons versus orthopedic surgeons as to what constitutes surgical excellence [26]. Schroder and Wassman [27] point to a range of opinion amongst German neurosurgical departments about navigation technology for insertion of pedical screws ranging from "not useful at all" to "malpractice if not using it". They also found that opinion was divided on the safety benefits of using neuro-navigation for spinal surgery with 49% responding that it enhances safety whereas 37% reported that it did not and 14% were unsure.…”

Section: Review Of Success Criteramentioning

confidence: 99%

User requirements for image-guided navigation in spinal surgery

2013

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Abstract-Advances in image-guided technology have resulted in a number of technologies to support surgeons in the identification of tissue and the tracking and navigation of surgical instruments in spinal surgery. There are various existing and proposed systems to support registration and intraoperative image guidance based on fluoroscopy, Computerized Tomography (CT), Magnetic Resonance Imaging (MRI) and ultrasound (US) or combinations of imaging modalities. However, the user requirements for the design of such systems are complex, dependent on medical specialty in addition to the range of instrumented and non-instrumented treatments offered in the orthopedic and neurological domains. This paper presents a review and study of user requirements for intraoperative navigation in spinal surgery. The numerous outcomes measures for successful operations are outlined, that provide a basis for understanding the needs of surgeons. A hierarchy of needs is then presented that can be used to inform an Analytic Hierarchy Process for elicitation of detailed user requirements.

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“…15,16 However, CAN is used routinely by only 10-15% of spinal surgeons. [17][18][19] A worldwide survey of spinal surgeons, representing predominantly Europe, Asia, and Latin America, revealed multiple barriers to CAN adoption, principally cost, lack of training, workflow disruption, and unproven clinical benefit. 17 The potential benefit of intra-operative CAN for trainee education is also poorly represented in assessments of spinal CAN utility.…”

Section: Introductionmentioning

confidence: 99%

Utilization of Spinal Intra-operative Three-dimensional Navigation by Canadian Surgeons and Trainees: A Population-based Time Trend Study

Guha

Moghaddamjou

Jiwani

et al. 2019

Can. J. Neurol. Sci.

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BackgroundComputer-assisted navigation (CAN) improves the accuracy of spinal instrumentation in vertebral fractures and degenerative spine disease; however, it is not widely adopted because of lack of training, high capital costs, workflow hindrances, and accuracy concerns. We characterize shifts in the use of spinal CAN over time and across disciplines in a single-payer health system, and assess the impact of intra-operative CAN on trainee proficiency across Canada.MethodsA prospectively maintained Ontario database of patients undergoing spinal instrumentation from 2005 to 2014 was reviewed retrospectively. Data were collected on treated pathology, spine region, surgical approach, institution type, and surgeon specialty. Trainee proficiency with CAN was assessed using an electronic questionnaire distributed across 15 Canadian orthopedic surgical and neurosurgical programs.ResultsIn our provincial cohort, 16.8% of instrumented fusions were CAN-guided. Navigation was used more frequently in academic institutions (15.9% vs. 12.3%, p<0.001) and by neurosurgeons than orthopedic surgeons (21.0% vs. 12.4%, p<0.001). Of residents and fellows 34.1% were fully comfortable using spinal CAN, greater for neurosurgical than orthopedic surgical trainees (48.1% vs. 11.8%, p=0.008). The use of CAN increased self-reported proficiency in thoracic instrumentation for all trainees by 11.0% (p=0.036), and in atlantoaxial instrumentation for orthopedic trainees by 18.0% (p=0.014).ConclusionsSpinal CAN is used most frequently by neurosurgeons and in academic centers. Most spine surgical trainees are not fully comfortable with the use of CAN, but report an increase in technical comfort with CAN guidance particularly for thoracic instrumentation. Increased education in spinal CAN for trainees, particularly at the fellowship stage and, specifically, for orthopedic surgery, may improve adoption.

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Spinal Navigation: An Accepted Standard of Care?

Cited by 10 publications

References 26 publications

Delayed perforation of the aorta by a thoracic pedicle screw

Delayed perforation of the aorta by a thoracic pedicle screw

User requirements for image-guided navigation in spinal surgery

Utilization of Spinal Intra-operative Three-dimensional Navigation by Canadian Surgeons and Trainees: A Population-based Time Trend Study

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