Surgeon radiation exposure in cone beam computed tomography‐based, image‐guided spinal surgery

Nottmeier, Eric W.; Bowman, Cammi; Nelson, Kevin L.

doi:10.1002/rcs.450

Cited by 37 publications

(23 citation statements)

References 28 publications

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“…It has been well studied for posterior approaches, with noted benefits in decreasing both operator and staff radiation exposure, as well as increasing accuracy. 4,9,10,15 The technical details and nuances of using an IGNS for LLIF have previously been reported. 3,12 Here, we present the results of a cohort of 31 consecutive patients who underwent LLIF using iCBCT and IGNS.…”

Section: Discussionmentioning

confidence: 99%

Use of 3D CT-based navigation in minimally invasive lateral lumbar interbody fusion

Joseph¹,

Smith²,

Patel

et al. 2016

SPI

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OBJECTIVE Lateral lumbar interbody fusion (LLIF) is an increasingly popular technique used to treat degenerative lumbar disease. The technique of using an intraoperative cone-beam CT (iCBCT) and an image-guided navigation system (IGNS) for LLIF cage placement has been previously described. However, other than a small feasibility study, there has been no clinical study evaluating its accuracy or safety. Therefore, the purpose of this study was to evaluate the accuracy and safety of image-guided spinal navigation in LLIF. METHODS An analysis of a prospectively acquired database was performed. Thirty-one consecutive patients were identified. Accuracy was initially determined by comparison of the planned trajectory of the IGNS with post–cage placement intraoperative fluoroscopy. Accuracy was subsequently confirmed by postprocedural CT and/or radiography. Cage placement was graded based on a previously described system separating the disc space into quarters. RESULTS The mean patient age was 63.9 years. A total of 66 spinal levels were treated, with a mean of 2.1 levels (range 1–4) treated per patient. Cage placement was noted to be accurate using IGNS in each case, as confirmed with intraoperative fluoroscopy and postoperative imaging. Sixty-four (97%) cages were placed within Quarters 1 to 2 or 2 to 3, indicating placement of the cage in the anterior or middle portions of the disc space. There were no instances of misguidance by IGNS. There was 1 significant approach-related complication (psoas muscle abscess) that required intervention, and 8 patients with transient, mild thigh paresthesias or weakness. CONCLUSIONS LLIF can be safely and accurately performed utilizing iCBCT and IGNS. Accuracy is acceptable for multilevel procedures.

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Section: Discussionmentioning

confidence: 99%

Use of 3D CT-based navigation in minimally invasive lateral lumbar interbody fusion

Joseph¹,

Smith²,

Patel

et al. 2016

SPI

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“…Radiation times in kyphoplasty and vertebroplasty must be reduced by using intermittent fluoroscopy [66]. In addition, new techniques, such as CAOS can reduce the total fluoroscopy time [32,50,51].…”

Section: Discussionmentioning

confidence: 99%

The Great Unknown—A systematic literature review about risk associated with intraoperative imaging during orthopaedic surgeries

Matityahu

Duffy

Goldhahn

et al. 2017

Injury

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“…Computed tomography-based IGSS offers several advantages to the spine surgeon including greater accu racy of pedicle screw placement, 4,6,21,[24][25][26][27] minimal to no radiation exposure, 12,15,21,22 and potentially a short regis tration time. 5,[12][13][14] As with any new technology, CT-guid ed spinal surgery is prone to growing pains, which may force novice surgeons to abandon this technology early.…”

Section: Discussionmentioning

confidence: 99%

“…5,[12][13][14] As with any new technology, CT-guid ed spinal surgery is prone to growing pains, which may force novice surgeons to abandon this technology early.…”

Section: Discussionmentioning

confidence: 99%

Thoracolumbar instrumentation with CT-guided navigation (O-arm) in 270 consecutive patients: accuracy rates and lessons learned

Rivkin¹,

Yocom²

2014

FOC

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Object Thoracolumbar instrumentation has experienced a dramatic increase in utilization over the last 2 decades. However, pedicle screw fixation remains a challenging undertaking, with suboptimal placement contributing to postoperative pain, neurological deficit, vascular complications, and return to the operating suite. Image-guided spinal surgery has substantially improved the accuracy rates for these procedures. However, it is not without technical challenges and a learning curve for novice operators. The authors present their experience with the O-arm intraoperative imaging system and share the lessons they learned over nearly 5 years. Methods The authors performed a retrospective chart review of 270 consecutive patients who underwent thoracolumbar pedicle screw fixation utilizing the O-arm imaging system in conjunction with StealthStation navigation between April 2009 and September 2013 at a single tertiary care center; 266 of the patients underwent CT scanning on postoperative Day 1 to evaluate hardware placement. The CT scans were interpreted prospectively by 3 neuroradiologists as part of standard work flow and retrospectively by 2 neurosurgeons and a senior resident. Pedicle screws were evaluated for breaches according to the 3-tier classification proposed by Mirza et al. Results Of 270 patients, 266 (98.5%) were included in the final analysis based on the presence of a postoperative CT scan. Overall, 1651 pedicle screws were placed in 266 patients and yielded a 5.3% breach rate; 213 thoracic and 1438 lumbosacral pedicle screws were inserted with 6.6% and 5.1% breach rates, respectively. Of the 87 suboptimally placed screws, there were 13 Grade 1, 16 Grade 2, and 12 Grade 3 misses as well as 46 anterolateral or “tip-out” perforations at L-5. Four patients (1.5%) required a return to the operating room for pedicle screw revision, 2 of whom experienced transient radicular symptoms and 2 remained asymptomatic. Interestingly, the pedicle breach rate was higher than anticipated at 13.21% for the 30 patients over the initial 6-month period with the O-arm. After certain modifications to the authors' technique, the subsequent 30 patients experienced a statistically significant decrease in breach rate at 5.6% (p = 0.014). Conclusions Image-guided spinal surgery can be a great option in the operating room and provides high pedicle screw accuracy rates. With numerous systems commercially available, it is important to develop a systematic approach regardless of the technology in question. There is a learning curve for surgeons unfamiliar with image guidance that should be recognized and appreciated when transitioning to navigation-assisted spinal surgery. In fact, the authors' experience with a large patient cohort suggests that this learning curve may be more significant than previously reported.

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Surgeon radiation exposure in cone beam computed tomography‐based, image‐guided spinal surgery

Cited by 37 publications

References 28 publications

Use of 3D CT-based navigation in minimally invasive lateral lumbar interbody fusion

Use of 3D CT-based navigation in minimally invasive lateral lumbar interbody fusion

The Great Unknown—A systematic literature review about risk associated with intraoperative imaging during orthopaedic surgeries

Thoracolumbar instrumentation with CT-guided navigation (O-arm) in 270 consecutive patients: accuracy rates and lessons learned

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