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Xia W, Wu Z, Zuo R, Wu J, Ling J, Mo L, Shi Z, Zhou Y, Li C, Zheng W, Zhang C. Feasibility and accuracy evaluation of novel 2D instant navigation system on spinal surgery - a preclinical study. BMC Musculoskelet Disord 2025; 26:510. [PMID: 40410739 PMCID: PMC12100916 DOI: 10.1186/s12891-025-08769-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Accepted: 05/15/2025] [Indexed: 05/25/2025] Open
Abstract
BACKGROUND Intraoperative navigation has significantly facilitated spinal surgery and enhanced surgical accuracy. Nevertheless, it is often encumbered by the need for expensive equipment, a complex workflow, and frequently exhibits inefficiencies. Leveraging permanent calibration technology, we have developed a novel two-dimensional fluoroscopic image navigation system with the aim of streamlining and expediting the navigation process. In this study, we comprehensively evaluated its feasibility and accuracy. METHODS The accuracy of the 2D-navigation system was rigorously assessed using a standardized high-precision mold. To validate the feasibility and accuracy of the novel navigation system for spinal surgery, the bare-bones of the pig lumbar spine are employed for evaluation. Subsequently, 2D navigation-assisted pedicle penetrations were meticulously carried out on the spine (L1-L5) of live animals. The navigation accuracy was quantified by comparing the visualized position of the surgical tool in the actual fluoroscopic image with the virtual position pre-planned by the navigation system. RESULTS During the experimental process, an excellent correlation between the virtual fluoroscopic images and actual fluoroscopic images was prominently observed. The navigation positioning accuracy, as evaluated by the standardized high-precision mold, was determined to be 0.54±0.16mm (AP view) and 0.57±0.14mm (lateral view). Specifically, in the bare-bones of the pig lumbar spine, the average distance errors between the virtual and actual fluoroscopic images under anteroposterior and lateral views were 0.99±0.48mm and 0.87±0.60mm, respectively. Meanwhile, the average angle errors were 0.41±0.29∘ and 0.37±0.11∘ , respectively. In the surgical procedure on normal adult pigs (L1-L5), the average distance errors were 1.14±0.58mm(95% CI [0.50-0.59]) and 1.54±0.79mm(95% CI [0.11-0.12]), respectively. The corresponding average angle errors were 0.61±0.49∘ (95% CI [0.33-0.35]) and 0.40±0.31∘ (95% CI [0.33-0.47]), respectively. Throughout a single navigation registration and the entire surgical procedure, the navigation accuracy across the L1 to L5 segments remained consistently high, with no statistically significant differences detected among the segments (p>0.05). CONCLUSION The two-dimensional fluoroscopic image navigation system based on permanent calibration technology is characterized by a rapid and convenient workflow. It demonstrates high-level navigation accuracy, thereby meeting the stringent requirements for spinal navigation in live surgical procedures.
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Affiliation(s)
- Wen Xia
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University (Army Medical University), No.183, Xinqiao Main Street, Shapingba District, Chongqing, 400038, China
- Chongqing Municipal Health Commission Key Laboratory of Precise Orthopedics, No.183, Xinqiao Main Street, Shapingba District, Chongqing, 400038, China
| | - Zhengyang Wu
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University (Army Medical University), No.183, Xinqiao Main Street, Shapingba District, Chongqing, 400038, China
- Chongqing Municipal Health Commission Key Laboratory of Precise Orthopedics, No.183, Xinqiao Main Street, Shapingba District, Chongqing, 400038, China
| | - Rui Zuo
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University (Army Medical University), No.183, Xinqiao Main Street, Shapingba District, Chongqing, 400038, China
- Chongqing Municipal Health Commission Key Laboratory of Precise Orthopedics, No.183, Xinqiao Main Street, Shapingba District, Chongqing, 400038, China
| | - Jiang Wu
- R & D Center, Chongqing Boshikang Technology Co., Ltd., No.78, Fenghe Road, Beibei District, Chongqing, 400722, China
| | - Jing Ling
- R & D Center, Chongqing Boshikang Technology Co., Ltd., No.78, Fenghe Road, Beibei District, Chongqing, 400722, China
| | - Linfeng Mo
- R & D Center, Chongqing Boshikang Technology Co., Ltd., No.78, Fenghe Road, Beibei District, Chongqing, 400722, China
| | - Zegang Shi
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University (Army Medical University), No.183, Xinqiao Main Street, Shapingba District, Chongqing, 400038, China
- Chongqing Municipal Health Commission Key Laboratory of Precise Orthopedics, No.183, Xinqiao Main Street, Shapingba District, Chongqing, 400038, China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University (Army Medical University), No.183, Xinqiao Main Street, Shapingba District, Chongqing, 400038, China
- Chongqing Municipal Health Commission Key Laboratory of Precise Orthopedics, No.183, Xinqiao Main Street, Shapingba District, Chongqing, 400038, China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University (Army Medical University), No.183, Xinqiao Main Street, Shapingba District, Chongqing, 400038, China
- Chongqing Municipal Health Commission Key Laboratory of Precise Orthopedics, No.183, Xinqiao Main Street, Shapingba District, Chongqing, 400038, China
- State Key Laboratory of Trauma and Chemical Poisoning, No.183, Xinqiao Main Street, Shapingba District, Chongqing, 400038, China
| | - Wenjie Zheng
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University (Army Medical University), No.183, Xinqiao Main Street, Shapingba District, Chongqing, 400038, China.
- Chongqing Municipal Health Commission Key Laboratory of Precise Orthopedics, No.183, Xinqiao Main Street, Shapingba District, Chongqing, 400038, China.
| | - Chao Zhang
- Department of Orthopedics, Xinqiao Hospital, Third Military Medical University (Army Medical University), No.183, Xinqiao Main Street, Shapingba District, Chongqing, 400038, China.
- Chongqing Municipal Health Commission Key Laboratory of Precise Orthopedics, No.183, Xinqiao Main Street, Shapingba District, Chongqing, 400038, China.
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Haida DM, Wagenblast I, Huber-Wagner S. [Robotically assisted placement of a pubic ramus screw and an SI-S1 screw]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2025:10.1007/s00113-025-01580-z. [PMID: 40327092 DOI: 10.1007/s00113-025-01580-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/04/2025] [Indexed: 05/07/2025]
Abstract
OBJECTIVE OF SURGERY The aim of this operation is to stabilize the anterior pelvic ring fractures on both sides and the sacral fracture on the right using robotically assisted screw osteosynthesis and to restore the mobility of the patient. INDICATIONS The indications arise from the patient's very severe pain, resulting immobility under conservative treatment measures and a fragility fracture of the pelvis grade II (FFP II). CONTRAINDICATIONS Typical contraindications for this type of operation are the same as for conventional techniques (mainly infection and swelling). SURGICAL TECHNIQUE Performed in the 3D navigation hybrid operating theatre Robotic Suite with the following components: navigation unit "Curve Navigation System", movable robotic 3D cone beam computed tomography (CBCT) "Loop‑X", robotic arm "Cirq Arm System" and wall monitor "BUZZ" (Brainlab, Munich, Germany). The individual surgical steps are explained in the video online (English). FOLLOW-UP TREATMENT Full weight bearing, pain medication according to the World Health Organization (WHO) stage scheme, physiotherapy after the first postoperative day. EVIDENCE Navigated and robotically assisted techniques are mainly used on the spine. These techniques are also increasingly being used on the pelvis, whereby very high levels of accuracy can also be achieved.
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Affiliation(s)
- Dominik M Haida
- Klinikum rechts der Isar, Klinik für Unfallchirurgie, Technische Universität München, München, Deutschland
- Klinik für Unfallchirurgie, Wirbelsäulenchirurgie und Alterstraumatologie, DIAK Klinikum Schwäbisch Hall, Diakoniestraße 10, 74523, Schwäbisch Hall, Deutschland
| | - Iris Wagenblast
- Klinik für Unfallchirurgie, Wirbelsäulenchirurgie und Alterstraumatologie, DIAK Klinikum Schwäbisch Hall, Diakoniestraße 10, 74523, Schwäbisch Hall, Deutschland
| | - Stefan Huber-Wagner
- Klinikum rechts der Isar, Klinik für Unfallchirurgie, Technische Universität München, München, Deutschland.
- Klinik für Unfallchirurgie, Wirbelsäulenchirurgie und Alterstraumatologie, DIAK Klinikum Schwäbisch Hall, Diakoniestraße 10, 74523, Schwäbisch Hall, Deutschland.
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Liu P, Hu J, Zhang W, Wang F, Tang L, Zhou W, Lin S. Robot-assisted versus fluoroscopy-assisted kyphoplasty in treatment of severe osteoporotic vertebral compression fractures in the old patients: a retrospective study : Robot-assisted in treatment of severe OVCF. BMC Musculoskelet Disord 2025; 26:322. [PMID: 40176005 PMCID: PMC11963701 DOI: 10.1186/s12891-025-08564-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 03/20/2025] [Indexed: 04/04/2025] Open
Abstract
BACKGROUND Although percutaneous kyphoplasty (PKP) is used to treat severe osteoporotic vertebral compression fractures (OVCF), the unsatisfactory effect of bone cement reduction and leakage is a concern. In recent years, the application of surgical robots in the field of orthopaedics has shown promising prospects. Since 2017, our hospital has used surgical robot-assisted PKP to treat severe OVCF. METHODS One hundred and fifty-five old patients with severe OVCF who had undergone PKP were retrospectively analyzed and stratified into two groups: robot-assisted (n = 88) and fluoroscopy-assisted (n = 67). The surgical time, intraoperative radiation dose, surgical efficacy (analgesic effect and limb function), imaging evaluation (accuracy of puncture, distribution of bone cement, reduction of vertebral height, and rectification of Cobb angle), and leakage of bone cement were analyzed to evaluate the potential advantages of robot-assisted PKP in the treatment of severe OVCF. RESULTS There were significant differences in surgical time (P < 0.001), intraoperative radiation dose (P < 0.001), analgesic effect (P = 0.001), accuracy of puncture (P = 0.008), distribution (P = 0.013), and leakage of bone cement (P = 0.019) between the two groups. However, postoperative limb function (P = 0.612), reduction in vertebral height (P = 0.068), and rectification of the Cobb angle (P = 0.243) were similar in both groups. CONCLUSIONS The application of robot-assisted PKP for treating severe OVCF (Genant Grade III) can slightly shorten surgery time and significantly reduce intraoperative total radiation exposure for both patients and clinicians. Additionally, it improves puncture accuracy and reduces the cement leakage rate, ultimately achieving satisfactory pain relief. However, in terms of functional recovery, no significant differences were observed between the two approaches.
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Affiliation(s)
- Peng Liu
- Department of Orthopedic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, 610072, Chengdu, China
| | - Jiang Hu
- Department of Orthopedic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, 610072, Chengdu, China
| | - Wei Zhang
- Department of Orthopedic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, 610072, Chengdu, China
| | - Fei Wang
- Department of Orthopedic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, 610072, Chengdu, China
| | - Liuyi Tang
- Department of Orthopedic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, 610072, Chengdu, China
| | - Weijun Zhou
- Department of Orthopedic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, 610072, Chengdu, China
| | - Shu Lin
- Department of Orthopedic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 32 West Second Section, First Ring Road, 610072, Chengdu, China.
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Suter D, Massalimova A, Laux CJ, Leoty L, Spirig JM, Liebmann F, Carrillo F, Fürnstahl P, Farshad M. A new method of accurate pedicle screw navigation. Sci Rep 2025; 15:8615. [PMID: 40075159 PMCID: PMC11904219 DOI: 10.1038/s41598-025-91945-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Accepted: 02/24/2025] [Indexed: 03/14/2025] Open
Abstract
One of the most established approaches to navigate pedicle screws is the planning and alignment (PA) method. Thereby a trajectory and associated entry point (EP) is planned and navigated after referencing to patient anatomy. However, deviations from the planned EP potentially lead to an altered screw position. The aim of this study was to investigate the influence of these EP deviations and to examine possible alternative methods. The merits of two new points of reference (screw tip point STP and midpoint MP) were therefore analyzed. STP represents the point on the optimal screw tip, MP the point at the center/midportion of the pedicle at its narrowest portion. The adapted screw trajectory was defined as the directional vector from any chosen EP to the STP or MP. First, computer simulations were used to evaluate the performance of these new approaches. Subsequently, the navigation technique yielding more acceptable screws in case of an EP deviation was analyzed on phantom-sawbone models. Both new methods showed a significantly larger number of possible screw trajectories in the simulations (p < 0.01). Even with a deliberate deviation of 4.5 mm (IQR 3.3) from the optimal EP, a perforation-free screw diameter of 4.9 mm (IQR 5.7 mm) could be achieved using the new navigation techniques. The simulated perforations were mainly located laterally with a median of 8.45 mm (IQR 3.95) distance to the medial pedicle wall. The PA method seems to be susceptible to EP deviations. The STP and MP methods are possible improvement mechanisms to overcome this disadvantage.
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Affiliation(s)
- Daniel Suter
- Research in Orthopedic Computer Science, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland.
- Spine Division, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland.
| | - Aidana Massalimova
- Research in Orthopedic Computer Science, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Christoph Johannes Laux
- Spine Division, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Laura Leoty
- Research in Orthopedic Computer Science, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland
| | - José Miguel Spirig
- Spine Division, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Florentin Liebmann
- Research in Orthopedic Computer Science, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Fabio Carrillo
- Research in Orthopedic Computer Science, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science, University Hospital Balgrist, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Mazda Farshad
- Spine Division, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich, 8008, Switzerland
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Newman WC, Bilsky MH, Barzilai O. Role of Minimally Invasive Spine Surgery in Spine Oncology. Neurosurgery 2025; 96:S119-S128. [PMID: 39950792 DOI: 10.1227/neu.0000000000003340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 10/19/2024] [Indexed: 05/09/2025] Open
Abstract
The application of minimally invasive spine surgery (MISS) in degenerative spine disease and deformity has seen rapid growth in the past 20 years. Building on this experience, such methods have been adopted into spine oncology in the past decade, particularly for metastatic disease. The impetus for this growth stems from the benefits of surgical decompression combined with radiation treatment in patients with metastatic disease in conjunction with the need for less morbid interventions in a patient population with limited life expectancy. The result of these two realizations was the application of minimally invasive techniques for the treatment of spine tumors including re-establishment of spinal stability, decompression of the spinal cord or nerve roots, and restoration of spinal alignment. Technological advancement and improvement in biomaterials have allowed for durable stabilization with short constructs even for patients with poor bone quality. The implementation of navigation and robotic capabilities has transformed MISS by streamlining surgery and further reducing the surgical footprint while laser ablation, endoscopy, and robotic surgery hold the potential to minimize the surgical footprint even further. MISS for intradural tumors is commonly performed, while the role for other primary tumors has yet to be defined. In this article, we describe the evolution of and indications for MISS in spine oncology through a retrospective literature review.
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Affiliation(s)
- W Christopher Newman
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Dada A, Saggi S, Ambati VS, Patel A, Mummaneni PV. Evolution of the Minimally Invasive Surgery Transforaminal Lumbar Interbody Fusion: Where Are We Now? Neurosurgery 2025; 96:S33-S41. [PMID: 39950782 DOI: 10.1227/neu.0000000000003336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 10/11/2024] [Indexed: 05/09/2025] Open
Abstract
The transforaminal lumbar interbody fusion (TLIF) technique, pioneered by Harms and Rolinger in 1982 and further refined in the early 2000s by Rosenberg and Mummaneni and later by Foley and Lefkowitz, uses Kambin triangle to access the disc space, thecal sac, and nerve roots. The minimally invasive surgery (MIS) approach to TLIF minimizes soft tissue disruption and spinal segment destabilization, offering benefits such as reduced operative times, blood loss, complications, and postoperative opiate use, with comparable fusion rates to open techniques. Despite these advantages, MIS interbody selection poses challenges, with the MIS TLIF preferred for L4-5 fusions when lordosis restoration is not needed. Key to the MIS TLIF technique is the use of expandable retractors, image-guided pedicle screw placement, and innovations like the expandable TLIF, which improves disc space lordosis. Navigation technologies, including 3-dimensional navigation, augmented reality, and robotics, may enhance surgical accuracy and visualization and may allow more precise screw and cage placement and reducing operative time and complications. Awake MIS TLIF, incorporating conscious sedation and local anesthesia, offers additional benefits of faster discharge and reduced postoperative pain. Some authors have also started using endoscopic techniques as well to further minimize tissue trauma. The integration of these advanced techniques and technologies in MIS TLIF continues to improve surgical outcomes and expands the applicability of this minimally invasive approach, making it a valuable tool in spine surgery.
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Affiliation(s)
- Abraham Dada
- Department of Neurological Surgery, School of Medicine, University of California, San Francisco, San Francisco, California, USA
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Quinones C, Wilson JP, Kumbhare D, Guthikonda B, Hoang S. Optimizing Single-Position Prone Lateral Lumbar Interbody Fusion with Exoscopic Technology: A Review of Key Innovations. J Clin Med 2025; 14:1132. [PMID: 40004663 PMCID: PMC11856252 DOI: 10.3390/jcm14041132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Revised: 02/01/2025] [Accepted: 02/05/2025] [Indexed: 02/27/2025] Open
Abstract
Minimally invasive spine surgery has advanced significantly over the past decade, integrating technologies such as intraoperative navigation, robotics, and artificial intelligence with innovative techniques such as single-position prone lateral transpsoas lumbar interbody fusion (proLIF). While proLIF offers excellent clinical outcomes for a wide range of lumbar pathologies, the lateral approach to lumbar spine presents technical and ergonomic challenges, including an increased need for soft-tissue dissection and unfavorable ergonomics for surgeons. This review details how the combination of emerging technologies has been applied in minimally invasive lumbar spine surgery. It also describes the novel application of an exoscope during navigation-guided proLIF. The benefits offered by the exoscope included high-resolution, three-dimensional visualization, enhanced maneuverability, and improved surgeon ergonomics. By combining emerging technologies with novel surgical approaches, this review demonstrates the recent advancements in minimally invasive spine surgery and underscores the exoscope's potential to enhance visualization and optimize ergonomics for surgeons.
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Affiliation(s)
| | | | | | | | - Stanley Hoang
- Department of Neurosurgery, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA (J.P.W.)
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Haida DM, Möhlig T, Huber-Wagner S. [Navigated and minimally invasive screw osteosynthesis of a talus fracture]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2025; 128:64-68. [PMID: 39690263 PMCID: PMC11735484 DOI: 10.1007/s00113-024-01513-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/18/2024] [Indexed: 12/19/2024]
Abstract
OBJECTIVE OF SURGERY The aim of this surgery is to safeguard the multifragmentary and nondisplaced talus fracture (body and neck) against secondary dislocation in a navigated and minimally invasive manner using screw osteosynthesis. INDICATIONS Due to the young age of the patient in the presented case and the risk of a possible secondary dislocation, the decision was made in favor of surgical treatment. CONTRAINDICATIONS Soft tissue swelling, wound infections and allergies to the osteosynthesis material. SURGICAL TECHNIQUE The video is available online (in English) and shows the individual surgical steps in detail. Preoperative computed tomography (CT) imaging and screw planning. Attachment of the reference array. 1) Cone beam CT (CBCT) scan, image fusion and fusion control. Planning of the minimally invasive skin incisions. Skin incision, navigated drilling and insertion of the K‑wires. 2) CBCT scan and position check of the K‑wires, fine adjustment if necessary. Insertion of the screws. 3) CBCT scan with subsequent position check of the screws, retightening of the screws if necessary. Performed in the Robotic Suite (Brainlab, Munich, Germany) using the following elements: navigation unit curve navigation system, movable robotic 3D CBCT, "Loop-X" and wall monitor "BUZZ". FOLLOW-UP Postoperative X‑ray and CT to control the position of the implants. Partial weight-bearing of the foot with 10 kg sole contact for 6 weeks. Physiotherapy with active and passive joint mobilization. Thrombosis prophylaxis with enoxaparin sodium. Optional implant removal after approximately 1 year. EVIDENCE Navigated operations are routine, so far mainly in the area of the spine. This article shows that navigated extremity surgery can be successfully performed in hybrid operating theaters.
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Affiliation(s)
- Dominik M Haida
- Klinik für Unfallchirurgie, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Deutschland
- Klinik für Unfallchirurgie, Wirbelsäulenchirurgie und Alterstraumatologie, Diakonie-Klinikum Schwäbisch Hall, Diakoniestraße 10, 74523, Schwäbisch Hall, Deutschland
| | - Thorsten Möhlig
- Klinik für Unfallchirurgie, Wirbelsäulenchirurgie und Alterstraumatologie, Diakonie-Klinikum Schwäbisch Hall, Diakoniestraße 10, 74523, Schwäbisch Hall, Deutschland
| | - Stefan Huber-Wagner
- Klinik für Unfallchirurgie, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Deutschland.
- Klinik für Unfallchirurgie, Wirbelsäulenchirurgie und Alterstraumatologie, Diakonie-Klinikum Schwäbisch Hall, Diakoniestraße 10, 74523, Schwäbisch Hall, Deutschland.
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Wu K, Yun Z, Suvithayasiri S, Liang Y, Setiawan DR, Kotheeranurak V, Jitpakdee K, Giordan E, Liu Q, Kim JS. Evolving Paradigms in Spinal Surgery: A Systematic Review of the Learning Curves in Minimally Invasive Spine Techniques. Neurospine 2024; 21:1251-1275. [PMID: 39765270 PMCID: PMC11744536 DOI: 10.14245/ns.2448838.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 09/22/2024] [Accepted: 10/01/2024] [Indexed: 01/23/2025] Open
Abstract
Our research examines the learning curves of various minimally invasive lumbar surgeries to determine the benefits and challenges they pose to both surgeons and patients. The advent of microsurgical techniques since the 1960s, including advances in fluoroscopic navigation and intraoperative computed tomography, has significantly shifted spinal surgery from open to minimally invasive methods. This study critically evaluates surgical duration, intraoperative conversions to open surgery, and complications as primary parameters to gauge these learning curves. Through a comprehensive literature search up to March 2024, involving databases PubMed, Cochrane Library, and Web of Science, this paper identifies a steep learning curve associated with these surgeries. Despite their proven advantages in reducing recovery time and surgical trauma, these procedures require surgeons to master advanced technology and equipment, which can directly impact patient outcomes. The study underscores the need for well-defined learning curves to facilitate efficient training and enhance surgical proficiency, especially for novice surgeons. Moreover, it addresses the implications of technology on surgical accuracy and the subsequent effects on complication rates, providing insights into the complex dynamics of adopting new surgical innovations in spinal health care.
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Affiliation(s)
- Kun Wu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Zhihe Yun
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Siravich Suvithayasiri
- Department of Orthopedics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
- Bone and Joint Excellence Center, Thonburi Hospital, Bangkok, Thailand
| | - Yihao Liang
- Department of Orthopedics, The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | | | - Vit Kotheeranurak
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Khanathip Jitpakdee
- Department of Orthopedics, Thai Red Cross Society, Queen Savang Vadhana Memorial Hospital, Sriracha, Thailand
| | - Enrico Giordan
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Treviso, Italy
| | - Qinyi Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Regmi M, Liu W, Liu S, Dai Y, Xiong Y, Yang J, Yang C. The evolution and integration of technology in spinal neurosurgery: A scoping review. J Clin Neurosci 2024; 129:110853. [PMID: 39348790 DOI: 10.1016/j.jocn.2024.110853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 09/19/2024] [Accepted: 09/24/2024] [Indexed: 10/02/2024]
Abstract
Spinal disorders pose a significant global health challenge, affecting nearly 5% of the population and incurring substantial socioeconomic costs. Over time, spinal neurosurgery has evolved from basic 19th-century techniques to today's minimally invasive procedures. The recent integration of technologies such as robotic assistance and advanced imaging has not only improved precision but also reshaped treatment paradigms. This review explores key innovations in imaging, biomaterials, and emerging fields such as AI, examining how they address long-standing challenges in spinal care, including enhancing surgical accuracy and promoting tissue regeneration. Are we at the threshold of a new era in healthcare technology, or are these innovations merely enhancements that may not fundamentally advance clinical care? We aim to answer this question by offering a concise introduction to each technology and discussing in depth its status and challenges, providing readers with a clearer understanding of its actual potential to revolutionize surgical practices.
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Affiliation(s)
- Moksada Regmi
- State Key Laboratory of Vascular Homeostasis and Remodeling, Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing 100191, China; Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing 100191, China; Peking University Health Science Center, Beijing 100191, China; Henan Academy of Innovations in Medical Science (AIMS), Zhengzhou 450003, China
| | - Weihai Liu
- State Key Laboratory of Vascular Homeostasis and Remodeling, Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing 100191, China; Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing 100191, China
| | - Shikun Liu
- State Key Laboratory of Vascular Homeostasis and Remodeling, Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing 100191, China; Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing 100191, China
| | - Yuwei Dai
- State Key Laboratory of Vascular Homeostasis and Remodeling, Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing 100191, China; Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing 100191, China
| | - Ying Xiong
- State Key Laboratory of Vascular Homeostasis and Remodeling, Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing 100191, China; Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing 100191, China
| | - Jun Yang
- State Key Laboratory of Vascular Homeostasis and Remodeling, Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing 100191, China; Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing 100191, China
| | - Chenlong Yang
- State Key Laboratory of Vascular Homeostasis and Remodeling, Department of Neurosurgery, Peking University Third Hospital, Peking University, Beijing 100191, China; Center for Precision Neurosurgery and Oncology of Peking University Health Science Center, Peking University, Beijing 100191, China; Henan Academy of Innovations in Medical Science (AIMS), Zhengzhou 450003, China.
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11
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Zellner AA, Prangenberg C, Roos J, Amar SB, Babasiz T, Wahlers C, Eysel P, Oppermann J. A computed tomography-based morphometric analysis of thoracic pedicles in a European population. J Orthop Surg Res 2024; 19:668. [PMID: 39420350 PMCID: PMC11483982 DOI: 10.1186/s13018-024-05171-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 10/13/2024] [Indexed: 10/19/2024] Open
Abstract
PURPOSE The goal of this retrospective study was to perform a CT imaging assessment of thoracic pedicles to provide a representative understanding of pedicle morphology for pedicle-based fixation systems commonly used in orthopedics, trauma and neurosurgery. This study aimed to better understand the morphology of the spine and give spine surgeons a better understanding of thoracic spine anatomy. METHODS In this study, we retrospectively measured the thoracic spine pedicles of a total of 16 males and 16 females, totaling in 768 individual pedicles. For the measurements, we used standardized planes in computed tomography imaging with a maximum slice thickness of 1 mm. RESULTS In brief, we identified significant differences in various measurements of male and female pedicle morphology. The medial cortical wall of the pedicles was significantly thicker than the lateral wall, and, in both sexes, the thoracic vertebral body number four was the vertebra with the least amount of cortical bone in the pedicle. CONCLUSIONS Surgeons performing operations involving pedicle screw placement should be aware of the sex-specific differences in thoracic spine pedicle morphology noted in this research.
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Affiliation(s)
- Alberto Alfieri Zellner
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland.
| | - Christian Prangenberg
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - Jonas Roos
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - Soufian Ben Amar
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - Tamara Babasiz
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische-Ästhetische Chirurgie, Uniklinik Köln, Joseph-Stelzmann-Str. 24, 50931, Köln, Deutschland
| | - Christopher Wahlers
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische-Ästhetische Chirurgie, Uniklinik Köln, Joseph-Stelzmann-Str. 24, 50931, Köln, Deutschland
| | - Peer Eysel
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische-Ästhetische Chirurgie, Uniklinik Köln, Joseph-Stelzmann-Str. 24, 50931, Köln, Deutschland
| | - Johannes Oppermann
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische-Ästhetische Chirurgie, Uniklinik Köln, Joseph-Stelzmann-Str. 24, 50931, Köln, Deutschland
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12
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Hadgaonkar S, Tomer D, Adhye B, Shyam A, Sancheti P. O-arm navigation without apnoea in thoracolumbar and lumbar spine surgery: Outcomes and considerations in a prospective study. J Clin Orthop Trauma 2024; 57:102551. [PMID: 39439437 PMCID: PMC11492603 DOI: 10.1016/j.jcot.2024.102551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 08/12/2024] [Accepted: 09/27/2024] [Indexed: 10/25/2024] Open
Abstract
Background Intra operative three dimensional navigation-assisted pedicle screw insertion typically requires apnoea for reliable image production. However this carries potential risks to the physiologically compromised patients such as patients having COPD, obesity, cardiac illnesses, and anaemia. In such patients' safe apnoea time may be as low as 1 min, and can cause life threatening complications. Therefore, this study was done to evaluate the accuracy of thoracolumbar and lumbar pedicle screw insertion using O-arm without using apnoea during imaging, to prevent such possible complications. Methods This is a single centre prospective study of 238 patients treated with pedicle screw implantation under O-arm guidance, without using apnoea while imaging. The pedicle breach rate during screw insertion was graded on Gertzbein classification. Also, two senior spine surgeons independently evaluated motion artifacts in the intra operative images and rated them as 'Significant' or 'Non-Significant' for the procedure. Values of p < 0.05 were considered statistically significant. Results Despite not using apnoea in 238 patients with 1120 screws, there were nil screw related complications. Only in one paediatric case of dorsal spine deformity, there were blurred and inaccurate images because of chest expansion, without apnoea. Hence he was given apnoea to render the image reliable for pedicle screw insertion. The screw placement in the pedicles was checked intraoperatively and graded for breach. Grade 2 breach were seen in only 2 cases (n = 3 screws) which were revised intra operatively. The interobserver agreement on motion artifacts was good (κ = 0.565, p < 0.001). Conclusions The results of pedicular screw insertion performed without induced apnea are comparable to those achieved with apnea when using O-arm imaging. This technique has proven to be a safe and reliable method for pedicle screw insertion in the thoracolumbar and lumbar spine, potentially mitigating physiological complications. Nonetheless, even minor motion artifacts, on the order of a few millimeters, can significantly impact outcomes in the cervical and upper thoracic spine. Therefore, further research is warranted to evaluate the efficacy and safety of this approach in these regions of the spine.
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Affiliation(s)
- Shailesh Hadgaonkar
- Head-Spine & Neuroscience Unit, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Divya Tomer
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Bharati Adhye
- Head- Department of Anaesthesiology, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Ashok Shyam
- Department of Spine Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
| | - Parag Sancheti
- Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India
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13
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Haida DM, Mohr P, Won SY, Möhlig T, Holl M, Enk T, Hanschen M, Huber-Wagner S. Hybrid-3D robotic suite in spine and trauma surgery - experiences in 210 patients. J Orthop Surg Res 2024; 19:565. [PMID: 39272126 PMCID: PMC11401291 DOI: 10.1186/s13018-024-05044-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 08/31/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND In modern Hybrid ORs, the synergies of navigation and robotics are assumed to contribute to the optimisation of the treatment in trauma, orthopaedic and spine surgery. Despite promising evidence in the area of navigation and robotics, previous publications have not definitively proven the potential benefits. Therefore, the aim of this retrospective study was to evaluate the potential benefit and clinical outcome of patients treated in a fully equipped 3D-Navigation Hybrid OR. METHODS Prospective data was collected (March 2022- March 2024) after implementation of a fully equipped 3D-Navigation Hybrid OR ("Robotic Suite") in the authors level 1 trauma centre. The OR includes a navigation unit, a cone beam CT (CBCT), a robotic arm and mixed reality glasses. Surgeries with different indications of the spine, the pelvis (pelvic ring and acetabulum) and the extremities were performed. Spinal and non-spinal screws were inserted. The collected data was analysed retrospectively. Pedicle screw accuracy was graded according to the Gertzbein and Robbins (GR) classification. RESULTS A total of n = 210 patients (118 m:92f) were treated in our 3D-Navigation Hybrid OR, with 1171 screws inserted. Among these patients, 23 patients (11.0%) arrived at the hospital via the trauma room with an average Injury Severity Score (ISS) of 25.7. There were 1035 (88.4%) spinal screws inserted at an accuracy rate of 98.7% (CI95%: 98.1-99.4%; 911 GR-A & 111 GR-B screws). The number of non-spinal screws were 136 (11.6%) with an accuracy rate of 99.3% (CI95%: 97.8-100.0%; 135 correctly placed screws). This resulted in an overall accuracy rate of 98.8% (CI95%: 98.2-99.4%). The robotic arm was used in 152 cases (72.4%), minimally invasive surgery (MIS) was performed in 139 cases (66.2%) and wound infection occurred in 4 cases (1,9%). Overall, no revisions were needed. CONCLUSION By extending the scope of application, this study showed that interventions in a fully equipped 3D-Navigation Hybrid OR can be successfully performed not only on the spine, but also on the pelvis and extremities. In trauma, orthopaedics and spinal surgery, navigation and robotics can be used to perform operations with a high degree of precision, increased safety, reduced radiation exposure for the OR-team and a very low complication rate.
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Affiliation(s)
- Dominik M Haida
- Department of Trauma Surgery, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
- Department of Trauma Surgery, Diakonie-Klinikum Schwäbisch Hall, Diakoniestraße 10, 74523, Schwäbisch Hall, Germany
| | - Peter Mohr
- Radiation Protection, Diakonie-Klinikum Schwäbisch Hall, Diakoniestraße 10, 74523, Schwäbisch Hall, Germany
| | - Sae-Yeon Won
- Department of Neurosurgery, Rostock University Medical Center, Schillingallee 35, 18057, Rostock, Germany
| | - Thorsten Möhlig
- Department of Trauma Surgery, Diakonie-Klinikum Schwäbisch Hall, Diakoniestraße 10, 74523, Schwäbisch Hall, Germany
| | - Mike Holl
- Department of Trauma Surgery, Diakonie-Klinikum Schwäbisch Hall, Diakoniestraße 10, 74523, Schwäbisch Hall, Germany
| | - Thorsten Enk
- Department of Neurosurgery, Diakonie-Klinikum Schwäbisch Hall, Diakoniestraße 10, 74523, Schwäbisch Hall, Germany
| | - Marc Hanschen
- Department of Trauma Surgery, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Stefan Huber-Wagner
- Department of Trauma Surgery, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany.
- Department of Trauma Surgery, Diakonie-Klinikum Schwäbisch Hall, Diakoniestraße 10, 74523, Schwäbisch Hall, Germany.
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Bielecki M, Boadi BI, Xie Y, Ikwuegbuenyi CA, Farooq M, Berger J, Hernández-Hernández A, Hussain I, Härtl R. High Accuracy of Three-Dimensional Navigated Kirschner-Wire-Less Single-Step Pedicle Screw System (SSPSS) in Lumbar Fusions: Comparison of Intraoperatively Planned versus Final Screw Position. Brain Sci 2024; 14:873. [PMID: 39335369 PMCID: PMC11430722 DOI: 10.3390/brainsci14090873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 09/30/2024] Open
Abstract
(1) Background: Our team has previously introduced the Single-Step Pedicle Screw System (SSPSS), which eliminates the need for K-wires, as a safe and effective method for percutaneous minimally invasive spine (MIS) pedicle screw placement. Despite this, there are ongoing concerns about the reliability and accuracy of screw placement in MIS procedures without traditional tools like K-wires and Jamshidi needles. To address these concerns, we evaluated the accuracy of the SSPSS workflow by comparing the planned intraoperative screw trajectories with the final screw positions. Traditionally, screw placement accuracy has been assessed by grading the final screw position using postoperative CT scans. (2) Methods: We conducted a retrospective review of patients who underwent lumbar interbody fusion, using intraoperative 3D navigation for screw placement. The planned screw trajectories were saved in the navigation system during each procedure, and postoperative CT scans were used to evaluate the implanted screws. Accuracy was assessed by comparing the Gertzbein and Robbins classification scores of the planned trajectories and the final screw positions. Accuracy was defined as a final screw position matching the classification of the planned trajectory. (3) Results: Out of 206 screws, 196 (95%) were accurately placed, with no recorded complications. (4) Conclusions: The SSPSS workflow, even without K-wires and other traditional instruments, facilitates accurate and reliable pedicle screw placement.
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Affiliation(s)
- Mateusz Bielecki
- Weill Cornell Medicine-Department of Neurosurgery, NewYork-Presbyterian Och Spine Hospital, New York, NY 10034, USA
| | - Blake I Boadi
- Weill Cornell Medicine-Department of Neurosurgery, NewYork-Presbyterian Och Spine Hospital, New York, NY 10034, USA
| | - Yizhou Xie
- Weill Cornell Medicine-Department of Neurosurgery, NewYork-Presbyterian Och Spine Hospital, New York, NY 10034, USA
| | - Chibuikem A Ikwuegbuenyi
- Weill Cornell Medicine-Department of Neurosurgery, NewYork-Presbyterian Och Spine Hospital, New York, NY 10034, USA
| | - Minaam Farooq
- Weill Cornell Medicine-Department of Neurosurgery, NewYork-Presbyterian Och Spine Hospital, New York, NY 10034, USA
| | - Jessica Berger
- Weill Cornell Medicine-Department of Neurosurgery, NewYork-Presbyterian Och Spine Hospital, New York, NY 10034, USA
| | - Alan Hernández-Hernández
- Weill Cornell Medicine-Department of Neurosurgery, NewYork-Presbyterian Och Spine Hospital, New York, NY 10034, USA
| | - Ibrahim Hussain
- Weill Cornell Medicine-Department of Neurosurgery, NewYork-Presbyterian Och Spine Hospital, New York, NY 10034, USA
| | - Roger Härtl
- Weill Cornell Medicine-Department of Neurosurgery, NewYork-Presbyterian Och Spine Hospital, New York, NY 10034, USA
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15
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Liu C, Xu C, Liang J, Xie B. Surgical Innovation: Comparative Efficacy of Navigation-Assisted Modified Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) and Traditional MIS-TLIF in Treating Low-Grade Isthmic Spondylolisthesis in the Elderly. World Neurosurg 2024:S1878-8750(24)01456-6. [PMID: 39181238 DOI: 10.1016/j.wneu.2024.08.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 08/18/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE To compare the efficacy of navigation-assisted modified minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and MIS-TLIF in the treatment of low-grade isthmic spondylolisthesis in the elderly. METHODS We retrospectively included elderly patients with low-grade isthmic spondylolisthesis who underwent surgical treatment at our hospital from January 2019 to January 2022. Based on the surgical method chosen according to the patient's personal preference, the patients were divided into the modified MIS-TLIF group and the MIS-TLIF group. The modified MIS-TLIF group underwent navigation-assisted MIS-TLIF, while the MIS-TLIF group underwent conventional MIS-TLIF. A total of 54 patients (34 males and 20 females) were included in this study, with 26 cases in the modified MIS-TLIF group and 28 cases in the MIS-TLIF group. Relevant data for this study were collected by an independent observer. The demographic characteristics, including age, gender, body mass index, comorbidities, surgical level, Meyerding grade, and duration of symptoms before admission, were recorded and compared between the 2 groups. Perioperative parameters, such as operative time, intraoperative blood loss, postoperative drainage volume, bed rest time, and hospital stay, were also recorded and compared. The lumbar pain visual analog scale, Oswestry Disability Index, and lumbar Japanese Orthopaedic Association scores were recorded preoperatively and at 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively to evaluate functional recovery in both groups. At 12 months postoperatively, patient satisfaction was assessed using the Macnab criteria (with satisfaction defined as the number of excellent and good outcomes divided by the total number in the group × 100%). The rate of vertebral slippage was recorded preoperatively, 1 week postoperatively, and 12 months postoperatively. The accuracy of screw placement was evaluated by CT scan at 1 week postoperatively, and interbody fusion was assessed by CT scan at 12 months postoperatively. Surgical complications were recorded, and their incidence was calculated. RESULTS The intraoperative blood loss, postoperative drainage volume, bed rest time, and hospital stay in the modified MIS-TLIF group were less than those in the MIS-TLIF group (P < 0.05). The back pain visual analog scale, Oswestry Disability Index, and Japanese Orthopaedic Association modified MIS-TLIF groups improved significantly compared with the MIS-TLIF group at 1 week, 1 month, 3 months, and 6 months after surgery, and the differences between groups were statistically significant (P < 0.05). The excellent and good rate of modified MIS-TLIF group was higher than that of MIS-TLIF group, and the difference had statistical significance (P < 0.05). The accuracy of screw placement in the modified MIS-TLIF group was higher than that in the MIS-TLIF group, and the difference was statistically significant (P < 0.05). The fusion rate in the modified MIS-TLIF group was higher than that in the MIS-TLIF group at 12 months after surgery, and the difference was statistically significant (P < 0.05). There was no statistical difference in the incidence rate of complications between the 2 groups. CONCLUSIONS Compared with MIS-TLIF, navigation-assisted modified MIS-TLIF has the advantages of less trauma, rapid recovery, accurate screw placement, high fusion rate, high surgical satisfaction, and good safety.
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Affiliation(s)
- Chenqi Liu
- Second Department of Spinal Surgery, Weihaiwei People's Hospital, Weihai, Shandong, China
| | - Chuanyong Xu
- Second Department of Spinal Surgery, Weihaiwei People's Hospital, Weihai, Shandong, China
| | - Junyang Liang
- Second Department of Spinal Surgery, Weihaiwei People's Hospital, Weihai, Shandong, China
| | - Bin Xie
- Second Department of Spinal Surgery, Weihaiwei People's Hospital, Weihai, Shandong, China.
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González-González F, Aguilar-Chávez F, Martínez-Loya C, Marín-Castañeda LA, Arellanes-Chavez CA, Lee Á. Top 100 Most Cited Articles on Intraoperative Image-Guided Navigation in Spine Surgery. Cureus 2024; 16:e67950. [PMID: 39328685 PMCID: PMC11426548 DOI: 10.7759/cureus.67950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2024] [Indexed: 09/28/2024] Open
Abstract
Navigation technologies have become essential in spine surgery over the last decade, offering precise procedures and minimizing risks. To the best of our knowledge, this is the first bibliometric analysis on this topic, providing insights and trends on topics, authors, and journals. The study identifies and analyzes the 100 most cited articles related to navigation in spine surgery. A systematic search was performed in Scopus and Google Scholar to identify all articles related to navigation in spine surgery (38,057 articles). The 100 most cited were analyzed for citations, titles, abstracts, authors, affiliations, keywords, country and institute of origin, year of publication, and level of evidence. The search was conducted in October 2023. The 100 most cited articles were published between 1995 and 2019, with 2010 to 2019 being the most prolific decade (46%). The most cited article had 733 citations, and the paper with the most citations per year averaged 59.27 citations/year. The Spine Journal had the most articles (34%). The United States contributed the most articles (39%). Most publications were clinical research and reviews (94%), with an overall evidence grade of IV-V (63%). A positive trend was noted in the last decade for incorporating augmented reality. This bibliometric analysis offers valuable insights and trends in spine surgery navigation literature. The findings indicate that technological advancements have led to more articles with higher levels of evidence. These pivotal articles shape evidence-based medicine, future surgeons, and industry improvements in navigated spine surgery.
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Affiliation(s)
| | - Felipe Aguilar-Chávez
- Cisne Spine Academy, Star Medica Hospital, Autonomous University of Chihuahua, Chihuahua, MEX
| | - Carolina Martínez-Loya
- Research, Faculty of Medicine and Biomedical Sciences, Autonomous University of Chihuahua, Chihuahua, MEX
| | | | | | - Ángel Lee
- Research, Dr. Manuel Gea González General Hospital, Mexico City, MEX
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17
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Kow CY, Castle-Kirszbaum M, Kam JK, Goldschlager T. Advances in Surgery for Metastatic Disease of the Spine: An Update for Oncologists. Global Spine J 2024:21925682231155847. [PMID: 39069655 DOI: 10.1177/21925682231155847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE Metastatic spine disease is an increasingly common clinical challenge that requires individualised multidisciplinary care from spine surgeons and oncologists. In this article, the authors describe the recent surgical advances in patients presenting with spinal metastases. METHODS We present an overview of the presentation, assessment, and management of spinal metastases from the perspective of the spine surgeon, highlighting advances in surgical technology and techniques, to facilitate multidisciplinary care for this complex patient group. Neither institutional review board approval nor patient consent was needed for this review. RESULTS Advances in radiotherapy delivery and systemic therapy (including immunotherapy and targeted therapy) have refined operative indications for decompression of neural structures and spinal stabilisation, while advances in surgical technology and technique enable these goals to be achieved with reduced morbidity. Formulating individualised management strategies that optimise outcome, while meeting patient goals and expectations, requires a comprehensive understanding of the factors important to patient management. CONCLUSION Spinal metastases require prompt diagnosis and expert management by a multidisciplinary team. Improvements in systemic, radiation, and surgical therapies have broadened operative indications and increased operative candidacy, and future advances are likely to continue this trend.
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Affiliation(s)
- Chien Yew Kow
- Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand
| | - Mendel Castle-Kirszbaum
- Department of Neurosurgery, Monash Health, Melbourne, AU-VIC, Australia
- Department of Surgery, Monash University, Melbourne, AU-VIC, Australia
| | - Jeremy Kt Kam
- Department of Neurosurgery, Monash Health, Melbourne, AU-VIC, Australia
- Department of Surgery, Monash University, Melbourne, AU-VIC, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, AU-VIC, Australia
- Department of Surgery, Monash University, Melbourne, AU-VIC, Australia
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18
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Striano BM, Crawford AM, Verhofste BP, Hresko AM, Hedequist DJ, Schoenfeld AJ, Simpson AK. Intraoperative navigation increases the projected lifetime cancer risk in patients undergoing surgery for adolescent idiopathic scoliosis. Spine J 2024; 24:1087-1094. [PMID: 38262498 DOI: 10.1016/j.spinee.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND CONTEXT Adolescent idiopathic scoliosis (AIS) is a common condition, often requiring surgical correction. Computed tomography (CT) based navigation technologies, which rely on ionizing radiation, are increasingly being utilized for surgical treatment. Although this population is highly vulnerable to radiation, given their age and female predominance, there is little available information elucidating modeled iatrogenic cancer risk. PURPOSE To model lifetime cancer risk associated with the use of intraoperative CT-based navigation for surgical treatment of AIS. STUDY DESIGN/SETTING This retrospective cross-sectional study took place in a quaternary care academic pediatric hospital in the United States. PATIENT SAMPLE Adolescents aged 10-18 who underwent posterior spinal fusion for a diagnosis of AIS between July 2014 and December 2019. OUTCOMES MEASURES Effective radiation dose and projected lifetime cancer risk associated with intraoperative doses of ionizing radiation. METHODS Clinical and radiographic parameters were abstracted, including total radiation dose during surgery from flat plate radiographs, fluoroscopy, and intraoperative CT scans. Multivariable regression analysis was used to assess differences in radiation exposure between patients treated with conventional radiography versus intraoperative navigation. Radiation exposure was translated into lifetime cancer risk using well-established algorithms. RESULTS In total, 245 patients were included, 119 of whom were treated with navigation. The cohort was 82.9% female and 14.4 years of age. The median radiation exposure (in millisieverts, mSv) for fluoroscopy, radiography, and navigation was 0.05, 4.14, and 8.19 mSv, respectively. When accounting for clinical and radiographic differences, patients treated with intraoperative navigation received 8.18 mSv more radiation (95%CI: 7.22-9.15, p<.001). This increase in radiation projects to 0.90 iatrogenic malignancies per 1,000 patients (95%CI 0.79-1.01). CONCLUSIONS Ours is the first work to define cancer risk in the setting of radiation exposure for navigated AIS surgery. We project that intraoperative navigation will generate approximately one iatrogenic malignancy for every 1,000 patients treated. Given that spine surgery for AIS is common and occurs in the context of a multitude of other radiation sources, these data highlight the need for radiation budgeting protocols and continued development of lower radiation dose technologies. LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Brendan M Striano
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Alexander M Crawford
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Bram P Verhofste
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Andrew M Hresko
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Daniel J Hedequist
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Jitpakdee K, Boadi B, Härtl R. Image-Guided Spine Surgery. Neurosurg Clin N Am 2024; 35:173-190. [PMID: 38423733 DOI: 10.1016/j.nec.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The realm of spine surgery is undergoing a transformative shift, thanks to the integration of image-guided navigation technology. This innovative system seamlessly blends real-time imaging data with precise location tracking. While the indispensable expertise of experienced spine surgeons remains irreplaceable, navigation systems bring a host of valuable advantages to the operating room. By offering a comprehensive view of the surgical anatomy, these systems empower surgeons to conduct procedures with accuracy, while minimizing radiation exposure for both patients and medical professionals. Moreover, image-guided navigation paves the way for integration of other state-of-the-art technologies, such as augmented reality and robotics. These innovations promise to further revolutionize the field, providing greater precision and expanding the horizons of what is possible in the world of spinal procedures. This article explores the evolution, classification, and impact of image-guided spine surgery, underscoring its pivotal role in enhancing efficacy and safety while setting the stage for the incorporation of future technological advancements.
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Affiliation(s)
- Khanathip Jitpakdee
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Thai Red Cross Society, 290 Jermjompol, Si Racha, Chonburi 20110, Thailand
| | - Blake Boadi
- Department of Neurosurgery, Weill Cornell Medicine, New York-Presbyterian - Och Spine, 525 East 68th Street, Box 99, New York, NY 10021, USA
| | - Roger Härtl
- Department of Neurosurgery, Weill Cornell Medicine, New York-Presbyterian - Och Spine, 525 East 68th Street, Box 99, New York, NY 10021, USA.
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20
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Wilson JP, Fontenot L, Stewart C, Kumbhare D, Guthikonda B, Hoang S. Image-Guided Navigation in Spine Surgery: From Historical Developments to Future Perspectives. J Clin Med 2024; 13:2036. [PMID: 38610801 PMCID: PMC11012660 DOI: 10.3390/jcm13072036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/08/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Intraoperative navigation is critical during spine surgery to ensure accurate instrumentation placement. From the early era of fluoroscopy to the current advancement in robotics, spinal navigation has continued to evolve. By understanding the variations in system protocols and their respective usage in the operating room, the surgeon can use and maximize the potential of various image guidance options more effectively. At the same time, maintaining navigation accuracy throughout the procedure is of the utmost importance, which can be confirmed intraoperatively by using an internal fiducial marker, as demonstrated herein. This technology can reduce the need for revision surgeries, minimize postoperative complications, and enhance the overall efficiency of operating rooms.
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Affiliation(s)
| | | | | | | | | | - Stanley Hoang
- Department of Neurosurgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71103, USA; (J.P.W.J.); (L.F.); (C.S.); (D.K.); (B.G.)
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21
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Jankowski PP, Chan JP. Advances in Imaging (Intraop Cone-Beam Computed Tomography, Synthetic Computed Tomography, Bone Scan, Low-Dose Protocols). Neurosurg Clin N Am 2024; 35:161-172. [PMID: 38423732 DOI: 10.1016/j.nec.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Spine surgery has seen a rapid advance in the refinement and development of 3-dimensional and nuclear imaging modalities in recent years. Cone-beam CT has proven to be a valuable tool for improving the accuracy of pedicle screw placement. The use of synthetic CT and low-dose CT have also emerged as modalities which allow for little to no radiation while streamlining imaging workflows. Bone scans also serve to provide functional information about bone metabolism in both the preoperative and postoperative monitoring phases.
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Affiliation(s)
- Pawel P Jankowski
- Hoag Spine Center, 520 Superior Avenue, #300, Newport Beach, CA 92663, USA.
| | - Justin P Chan
- University of California, Irvine, 101 The City Drive South, Orange, CA 92868, USA
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22
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Lee YS, Cho DC, Kim KT. Navigation-Guided/Robot-Assisted Spinal Surgery: A Review Article. Neurospine 2024; 21:8-17. [PMID: 38569627 PMCID: PMC10992634 DOI: 10.14245/ns.2347184.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 04/05/2024] Open
Abstract
The development of minimally invasive spinal surgery utilizing navigation and robotics has significantly improved the feasibility, accuracy, and efficiency of this surgery. In particular, these methods provide improved accuracy of pedicle screw placement, reduced radiation exposure, and shortened learning curves for surgeons. However, research on the clinical outcomes and cost-effectiveness of navigation and robot-assisted spinal surgery is still in its infancy. Therefore, there is limited available evidence and this makes it difficult to draw definitive conclusions regarding the long-term benefits of these technologies. In this review article, we provide a summary of the current navigation and robotic spinal surgery systems. We concluded that despite the progress that has been made in recent years, and the clear advantages these methods can provide in terms of clinical outcomes and shortened learning curves, cost-effectiveness remains an issue. Therefore, future studies are required to consider training costs, variable initial expenses, maintenance and service fees, and operating costs of these advanced platforms so that they are feasible for implementation in standard clinical practice.
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Affiliation(s)
- Young-Seok Lee
- Department of Neurosurgery, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Dae-Chul Cho
- Department of Neurosurgery, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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Frisk H, Burström G, Persson O, El-Hajj VG, Coronado L, Hager S, Edström E, Elmi-Terander A. Automatic image registration on intraoperative CBCT compared to Surface Matching registration on preoperative CT for spinal navigation: accuracy and workflow. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03076-4. [PMID: 38378987 DOI: 10.1007/s11548-024-03076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/09/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Spinal navigation solutions have been slower to develop compared to cranial ones. To facilitate greater adoption and use of spinal navigation, the relatively cumbersome registration processes need to be improved upon. This study aims to validate a new solution for automatic image registration and compare it to a traditional Surface Matching method. METHOD Adult patients undergoing spinal surgery requiring navigation were enrolled after providing consent. A registration matrix-Universal AIR (= Automatic Image Registration)-was placed in the surgical field and used for automatic registration based on intraoperative 3D imaging. A standard Surface Matching method was used for comparison. Accuracy measurements were obtained by comparing planned and acquired coordinates on the vertebrae. RESULTS Thirty-nine patients with 42 datasets were included. The mean accuracy of Universal AIR registration was 1.20 ± 0.42 mm, while the mean accuracy of Surface Matching registration was 1.94 ± 0.64 mm. Universal AIR registration was non-inferior to Surface Matching registration. Post hoc analysis showed a significantly greater accuracy for Universal AIR registration. In Surface Matching, but not automatic registration, user-related errors such as incorrect identification of the vertebral level were seen. CONCLUSION Automatic image registration for spinal navigation using Universal AIR and intraoperative 3D imaging provided improved accuracy compared to Surface Matching registration. In addition, it minimizes user errors and offers a standardized workflow, making it a reliable registration method for navigated spinal procedures.
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Affiliation(s)
- Henrik Frisk
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Gustav Burström
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Oscar Persson
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | | | | | | | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands-Väsby, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands-Väsby, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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24
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Khalilullah T, Mignucci-Jiménez G, Huffman H, Karthikeyan H, Hanif Z, Ariwodo O, Panchal RR. Surgical Management of Primary Thoracic Epidural Melanoma. Cureus 2024; 16:e54536. [PMID: 38516457 PMCID: PMC10956551 DOI: 10.7759/cureus.54536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
In this study, we reported one of the first cases where a rare robotic-assisted platform with neuronavigation technology and carbon-fiber-polyetheretherketone (CF/PEEK) screws is employed to surgically treat multilevel thoracic primary spinal epidural melanoma. A 67-year-old male presented with left upper thoracic pain. His magnetic resonance imaging (MRI) of the thoracic spine revealed a dumbbell-shaped left epidural mass at the T2-3 level. Partial resection was performed due to tumor growth into the vertebral bodies and patient discretion for minimal surgery. The patient's neurological conditions improved postoperatively, with reduced reported symptoms of pain and numbness. Postoperative imaging showed evidence of appropriate spinal stabilization. Patient underwent stereotactic body radiation therapy (SBRT), and no adverse events were reported. This case reflects one of the first examples of treating thoracic epidural melanoma with the use of robotic-assisted navigation. Further prospective studies are needed to determine the efficacy of robot-assisted navigation for patients with primary spinal malignant melanoma which may open the possibility of surgery to once presumed non-operative patients.
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Affiliation(s)
| | - Giancarlo Mignucci-Jiménez
- Neurosurgery, Loyal and Edith Davis Neurosurgical Research Laboratory, Barrow Neurological Institute, Phoenix, USA
| | | | | | - Zaheer Hanif
- Neurosurgery, University of Texas Medical Branch, Galveston, USA
| | - Ogechukwu Ariwodo
- Neurosurgery, Philadelphia College of Osteopathic Medicine South Georgia, Moultrie, USA
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25
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Guevara F, Foss KD, Harper TAM, Moran CA, Hague DW, Hamel PES, Schaeffer DJ, McCoy AM. Ex vivo comparison of pin placement with patient-specific drill guides or freehand technique in canine cadaveric spines. Vet Surg 2024; 53:254-263. [PMID: 37822110 DOI: 10.1111/vsu.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE To compare vertebral implant placement in the canine thoracolumbar spine between 3D-printed patient-specific drill guides (3DPG) and the conventional freehand technique (FH). STUDY DESIGN Ex vivo study. ANIMALS Cadaveric canine spines (n = 24). METHODS Implant trajectories were established for the left and right sides of the T10 through L6 vertebrae based on computed tomography (CT) imaging. Customized drill guides were created for each vertebra of interest. Each cadaver was randomly assigned to one of six veterinarians with varying levels of experience placing vertebral implants. Vertebrae were randomly assigned a surgical order and technique (3DPG or FH) for both sides. Postoperative CT images were acquired. A single, blinded observer assessed pin placement using a modified Zdichavsky classification. RESULTS A total of 480 implants were placed in 240 vertebrae. Three sites were excluded from the analysis; therefore, a total of 238 implants were evaluated using the FH technique and 239 implants using 3DPG. When evaluating implant placement, 152/239 (63.6%) of 3DPG implants were considered to have an acceptable placement in comparison with 115/248 (48.32%) with FH. Overall, pin placement using 3DPG was more likely to provide acceptable pin placement (p < .001) in comparison with the FH technique for surgeons at all levels of experience. CONCLUSION The use of 3DPG was shown to be better than the conventional freehand technique regarding acceptable placement of implants in the thoracolumbar spine of canine cadavers. CLINICAL SIGNIFICANCE Utilizing 3DPG can be considered better than the traditional FH technique when placing implants in the canine thoracolumbar spine.
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Affiliation(s)
- Francisco Guevara
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Kari D Foss
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Tisha A M Harper
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Clara A Moran
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Devon W Hague
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Philip E S Hamel
- Boundary Bay Veterinary Specialty Hospital, Langley, British Columbia, Canada
| | - David J Schaeffer
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
| | - Annette M McCoy
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, Illinois, USA
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26
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Mallepally AR, Marathe N, Menon S, Das K. Misplaced S1 screw causing L5 radiculopathy, rare and unusual presentation: a report of 2 cases. Br J Neurosurg 2024; 38:131-135. [PMID: 34396884 DOI: 10.1080/02688697.2021.1967286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Many spine surgeons are not optimally acquainted with anatomy anterior to sacrum. Screw malposition injuring these structures can lead to unwanted lethal consequences. We report unusual cases of acute radiculopathy due to misplaced bicortical sacral screw causing L5 nerve root impingement on anterior sacrum. A 39/M patient complained of severe rest pain (VAS 9/10) post TLIF in region of L5 dermatome with sensory deficit along the right lateral leg and straight leg raise less than 30°. X-ray revealed S1 screw protruding beyond the second cortex with a straight trajectory. CT scan revealed a protrusion of 11.4mm beyond anterior cortex. The patient was taken for re-surgery and the trajectory and length of screw was revised. Sciatic pain completely disappeared immediately after surgery. A 61/M patient operated elsewhere with instrumented decompression and fusion with screws passed at L4, L5 and S1 level for lumbar canal stenosis, post-surgery patient developed new onset radicular symptoms in right lower limb. Patient was managed conservatively in the form of L5 selective nerve root block. Pain and numbness improved. Bicortical purchase of S1 screw though improves pull out strength, is associated with a risk of neurovascular complications. Surgeons should be alerted to the misplacement of S1 pedicle screws to avoid involvement not only anterior to the anteromedial neurovascular tissue, but also anterolateral to the arrangement of the L5 nerve root.
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Affiliation(s)
| | - Nandan Marathe
- Department of spine services, Indian Spinal Injuries Centre, New Delhi, India
| | - Sreejith Menon
- Department of spine services, Indian Spinal Injuries Centre, New Delhi, India
| | - Kalidutta Das
- Department of spine services, Indian Spinal Injuries Centre, New Delhi, India
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Ghenbot Y, Ahmad HS, Chauhan D, Wathen C, Arena J, Turlip R, Parr R, Gibby W, Yoon JW. Effects of Augmented Reality on Thoracolumbar Pedicle Screw Instrumentation Across Different Levels of Surgical Experience. World Neurosurg 2024; 182:e284-e291. [PMID: 38008167 DOI: 10.1016/j.wneu.2023.11.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE Augmented reality (AR) is an emerging technology that may accelerate skill acquisition and improve accuracy of thoracolumbar pedicle screw placements. We aimed to quantify the relative assistance of AR compared with freehand (FH) pedicle screw accuracy across different surgical experience levels. METHODS A spine fellowship-trained and board-certified attending neurosurgeon, postgraduate year 4 neurosurgery resident, and second-year medical student placed 32 FH and 32 AR-assisted thoracolumbar pedicle screws in 3 cadavers. A cableless, voice-activated AR system was paired with a headset. Accuracy was assessed using χ2 analysis and the Gertzbein-Robbins scale. Angular error, distance error, and time per pedicle screw were collected and compared. RESULTS The attending neurosurgeon had 91.6% (11/12) clinically acceptable (Gertzbein-Robbins scale A or B) insertion in both FH and AR groups; the resident neurosurgeon had 100% (9/9) FH and AR in both cases; the medical student had 72.3% (8/11) FH accuracy and 81.8% (9/11) AR accuracy. The medical student displayed significantly lower ideal (Gertzbein-Robbins scale A) FH accuracy compared with the resident neurosurgeon (P = 0.017) and attending neurosurgeon (P = 0.005), but no difference when using AR. FH screw placement was faster by both the attending neurosurgeon (median 46 seconds vs. 94.5 seconds, P = 0.0047) and the neurosurgery resident neurosurgeon (median 144 seconds vs. 140 seconds, P = 0.05). Total clinically acceptable AR and FH accuracy was 90.6% (29/32) and 87.5% (28/32), respectively (P = 0.69). CONCLUSIONS AR screw placement allowed an inexperienced medical student to double their accuracy in 1 training session. With subsequent iterations, this promising technology could serve as an important tool for surgical training.
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Affiliation(s)
- Yohannes Ghenbot
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hasan S Ahmad
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daksh Chauhan
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Connor Wathen
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Arena
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Turlip
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ryan Parr
- Novarad Corporation, Provo, Utah, USA
| | - Wendell Gibby
- Novarad Corporation, Provo, Utah, USA; Department of Radiology, University of California San Diego School of Medicine, San Diego, California, USA
| | - Jang W Yoon
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Avrumova F, Goldman SN, Altorfer F, Paschal GK, Lebl DR. Anterior cervical osteotomy of diffuse idiopathic skeletal hyperostosis lesions with computer-assisted navigation surgery: A case report. Clin Case Rep 2024; 12:e8427. [PMID: 38197064 PMCID: PMC10774538 DOI: 10.1002/ccr3.8427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/24/2023] [Accepted: 12/14/2023] [Indexed: 01/11/2024] Open
Abstract
Key Clinical Message Diffuse idiopathic skeletal hyperostosis (DISH) involves spine ligament ossification. Computer-assisted navigation (CAN) effectively aids complex surgeries, such as anterior cervical osteotomy, to alleviate progressive DISH-related dysphagia. Abstract We describe a 68-year-old man with sudden onset dysphagia to both solids and liquids. Radiographic Imaging revealed DISH lesions from C2 down to the thoracic spine. The patient was successfully treated with CAN anterior osteotomy and resection of DISH lesions from C3-C6 and had complete symptom relief within 2 weeks post-operatively.
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Affiliation(s)
- Fedan Avrumova
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Samuel N. Goldman
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Franziska Altorfer
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Gregory K. Paschal
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Darren R. Lebl
- Department of Spine SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
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Keshavarzi S, Spardy J, Ramchandran S, George S. Use of navigation for anterior and posterior instrumentation in the surgical management of pediatric pathologic lumbosacral deformity. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:114-117. [PMID: 38644920 PMCID: PMC11029110 DOI: 10.4103/jcvjs.jcvjs_144_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/31/2023] [Indexed: 04/23/2024] Open
Abstract
We report the use of computerized tomography (CT)-guided navigation for complex spinal deformity correction (anterior and posterior) in an 8-year-old patient with neurofibromatosis complicated by dystrophic pedicles, dural ectasia, and extensive vertebral scalloping. A retrospective review was conducted of the patient's medical records for the past 3 years, including the patient's office visit notes, operative reports, pre- and 2-year postoperative imaging studies. The patient successfully underwent anterior lumbar interbody fusion from L3-S1 using CT-guided navigation to negotiate the challenges posed by dural ectasia and vertebral body scalloping. One week after the anterior procedure, she underwent navigation-guided T10-to-pelvis posterior instrumented fusion. There were no perioperative or postoperative complications at 2 years. In patients with complex deformities of the spine, including dural ectasia, scalloped vertebral bodies, and decreased pedicle integrity, the use of intraoperative CT-guided navigation can benefit surgeons by facilitating the safe placement of interbody spacers and pedicle screws.
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Affiliation(s)
- Sassan Keshavarzi
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA
| | - Jeffrey Spardy
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | | | - Stephen George
- Department of Orthopedic Surgery, Nicklaus Children’ s Hospital, Miami, FL, USA
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30
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Schwendner M, Ille S, Wostrack M, Meyer B. Evaluating a cutting-edge augmented reality-supported navigation system for spinal instrumentation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:282-288. [PMID: 37962688 DOI: 10.1007/s00586-023-08011-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/27/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE Dorsal instrumentation using pedicle screws is a standard treatment for multiple spinal pathologies, such as trauma, infection, or degenerative indications. Intraoperative three-dimensional (3D) imaging and navigated pedicle screw placement are used at multiple centers. For the present study, we evaluated a new navigation system enabling augmented reality (AR)-supported pedicle screw placement while integrating navigation cameras into the reference array and drill guide. The present study aimed to evaluate its clinical application regarding safety, efficacy, and accuracy. METHODS A total of 20 patients were operated on between 06/2021 and 01/2022 using the new technique for intraoperative navigation. Intraoperative data with a focus on accuracy and patient safety, including patient outcome, were analyzed. The accuracy of pedicle screw placement was evaluated by intraoperative CT imaging. RESULTS A median of 8 (4-18) pedicle screws were placed in each case. Percutaneous instrumentation was performed in 14 patients (70%). The duration of pedicle screw placement (duration scan-scan) was 56 ± 26 (30-107) min. Intraoperative screw revision was necessary for 3 of 180 pedicle screws (1.7%). Intraoperatively, no major complications occurred-one case of delay due to software issues and one case of difficult screw placement were reported. CONCLUSION The current study's results could confirm the use of the present AR-supported system for navigated pedicle screw placement for dorsal instrumentation in clinical routine. It provides a reliable and safe tool for 3D imaging-based pedicle screw placement, only requires a minimal intraoperative setup, and provides new opportunities by integrating AR.
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Affiliation(s)
- Maximilian Schwendner
- Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Ille
- Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
- TUM Neuroimaging Center, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Maria Wostrack
- Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
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31
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Kim SI, Mittal S, Ko YI, Ko MS, Kim YH. The Role of Intraoperative Navigation in Guiding Spine Tumor Resection for Achieving an Adequate Surgical Margin: An Institutional Case Series. JOURNAL OF KOREAN SOCIETY OF SPINE SURGERY 2024; 31:10. [DOI: 10.4184/jkss.2024.31.1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/06/2023] [Accepted: 01/17/2024] [Indexed: 10/17/2024]
Affiliation(s)
- Sang-Il Kim
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Samarth Mittal
- Department of Ortho-Spine Surgery, BLK-MAX SuperSpeciality Hospital, New Delhi, India
| | - Young-Il Ko
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myung-Sup Ko
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Hoon Kim
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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32
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Watrinet J, Wenzel L, Fürmetz J, Augat P, Blum P, Neidlein C, Bormann M, Stuby F, von Rüden C. [Possibilities and limits of intraoperative 2D imaging in trauma surgery]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:935-941. [PMID: 37870559 DOI: 10.1007/s00113-023-01381-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND The two-dimensional (2D) imaging represents an essential and cost-effective component of intraoperative position control in fracture stabilization, even in the era of new three-dimensional (3D) imaging capabilities. OBJECTIVE The aim of the present study, in addition to a current literature review, was to examine whether the intraoperative use of 2D images leads to a quality of fracture reduction comparable to postoperative computed tomographic (CT) analysis including 3D reconstructions. MATERIAL AND METHODS A comparative retrospective analysis of intraoperative 2D and postoperative 3D image data was performed on 21 acetabular fractures stabilized via a pararectus approach according to an established protocol using the Matta criteria. RESULTS The assessment of fracture reduction in intraoperative fluoroscopy compared with postoperative CT revealed a difference only in one case with respect to the categorization of the joint step reduction in the main loading zone. CONCLUSION In the intraoperative use of 2D imaging for fracture treatment it is important to select the correct adjustment planes taking the anatomical conditions into account in order to achieve optimum assessability. In this way, the reduction result can be adequately displayed in fluoroscopy and is also comparable to the postoperative CT control. In addition, depending on the findings, optional intraoperative dynamic fluoroscopic assessment can have a direct influence on the further surgical procedure.
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Affiliation(s)
- Julius Watrinet
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Murnau, Deutschland
| | - Lisa Wenzel
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Murnau, Deutschland
| | - Julian Fürmetz
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Murnau, Deutschland
| | - Peter Augat
- Universitätsinstitut für Biomechanik, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
- Institut für Biomechanik, BG Unfallklinik Murnau, Murnau, Deutschland
| | - Philipp Blum
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Murnau, Deutschland
| | - Claas Neidlein
- Muskuloskelettales Universitätszentrum München, Ludwig-Maximilians-Universität München (LMU), München, Deutschland
| | - Markus Bormann
- Muskuloskelettales Universitätszentrum München, Ludwig-Maximilians-Universität München (LMU), München, Deutschland
| | - Fabian Stuby
- Abteilung Unfallchirurgie, BG Unfallklinik Murnau, Murnau, Deutschland
| | - Christian von Rüden
- Universitätsinstitut für Biomechanik, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Weiden, Weiden in der Oberpfalz, Deutschland.
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Schwendner M, Liang R, Butenschöen VM, Krieg SM, Ille S, Meyer B. Spinal Navigation for Lateral Instrumentation of the Thoracolumbar Spine. Oper Neurosurg (Hagerstown) 2023; 25:303-310. [PMID: 37441800 DOI: 10.1227/ons.0000000000000803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/29/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Three-dimensional imaging-based navigation in spine surgery is mostly applied for pedicle screw placement. However, its potential reaches beyond. In this study, we analyzed the incorporation of spinal navigation for lateral instrumentation of the thoracolumbar spine in clinical routine at a high-volume spine center. METHODS Patients scheduled for lateral instrumentation were prospectively enrolled. A reference array was attached to the pelvis, and a computed tomography scan was acquired intraoperatively. A control computed tomography scan was routinely performed after final cage placement, replacing conventional 2-dimensional X-ray imaging. RESULTS 145 cases were enrolled from April to October 2021 with a median of 1 (1-4) level being instrumented. Indications for surgery were trauma (35.9%), spinal infection (31.7%), primary and secondary tumors of the spine (17.2%), and degenerative spine disease (15.2%). The duration of surgery after the first scan was 98 ± 41 (20-342) minutes. In total, 190 cages were implanted (94 expandable cages for vertebral body replacement (49.5%) and 96 cages for interbody fusion [50.5%]). Navigation was successfully performed in 139 cases (95.9%). The intraoperative mental load was rated on a scale from 0 to 150 (maximal effort) by the surgeons, showing a moderate effort (median 30 [10-120]). CONCLUSION Three-dimensional imaging-based spinal navigation can easily be incorporated in clinical routine and serves as a reliable tool to achieve precise implant placement in lateral instrumentation of the spine. It helps to minimize radiation exposure to the surgical staff.
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Affiliation(s)
- Maximilian Schwendner
- Department of Neurosurgery, Technical University of Munich, Germany, School of Medicine, Klinikum rechts der Isar, Munich, Germany
- TUM-Neuroimaging Center, Technical University of Munich, Munich, Germany
| | - Raimunde Liang
- Department of Neurosurgery, Technical University of Munich, Germany, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Vicki M Butenschöen
- Department of Neurosurgery, Technical University of Munich, Germany, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University of Munich, Germany, School of Medicine, Klinikum rechts der Isar, Munich, Germany
- TUM-Neuroimaging Center, Technical University of Munich, Munich, Germany
| | - Sebastian Ille
- Department of Neurosurgery, Technical University of Munich, Germany, School of Medicine, Klinikum rechts der Isar, Munich, Germany
- TUM-Neuroimaging Center, Technical University of Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University of Munich, Germany, School of Medicine, Klinikum rechts der Isar, Munich, Germany
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Bertram U, Köveshazi I, Michaelis M, Weidert S, Schmidt TP, Blume C, Zastrow FSV, Müller CA, Szabo S. Man versus machine: Automatic pedicle screw planning using registration-based techniques compared with manual screw planning for thoracolumbar fusion surgeries. Int J Med Robot 2023:e2570. [PMID: 37690099 DOI: 10.1002/rcs.2570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE This study evaluates the precision of a commercially available spine planning software in automatic spine labelling and screw-trajectory proposal. METHODS The software uses automatic segmentation and registration of the vertebra to generate screw proposals. 877 trajectories were compared. Four neurosurgeons assessed suggested trajectories, performed corrections, and manually planned pedicle screws. Additionally, automatic identification/labelling was evaluated. RESULTS Automatic labelling was correct in 89% of the cases. 92.9% of automatically planned trajectories were in accordance with G&R grade A + B. Automatic mode reduced the time spent planning screw trajectories by 7 s per screw to 20 s per vertebra. Manual mode yielded differences in screw-length between surgeons (largest distribution peak: 5 mm), automatic in contrast at 0 mm. The size of suggested pedicle screws was significantly smaller (largest peaks in difference between 0.5 and 3 mm) than the surgeon's choice. CONCLUSION Automatic identification of vertebrae works in most cases and suggested pedicle screw trajectories are acceptable. So far, it does not substitute for an experienced surgeon's assessment.
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Affiliation(s)
- Ulf Bertram
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - Istvan Köveshazi
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
- M3i Industry-in-Clinic-Platform GmbH, Munich, Germany
| | | | - Simon Weidert
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
- M3i Industry-in-Clinic-Platform GmbH, Munich, Germany
| | | | - Christian Blume
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - Felix Swamy V Zastrow
- M3i Industry-in-Clinic-Platform GmbH, Munich, Germany
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | | | - Szilard Szabo
- M3i Industry-in-Clinic-Platform GmbH, Munich, Germany
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Bonello JP, Koucheki R, Abbas A, Lex J, Nucci N, Yee A, Ahn H, Finkelstein J, Lewis S, Larouche J, Toor J. Comparison of major spine navigation platforms based on key performance metrics: a meta-analysis of 16,040 screws. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2937-2948. [PMID: 37474627 DOI: 10.1007/s00586-023-07865-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/28/2023] [Accepted: 07/09/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE The objective of this meta-analysis is to compare available computer-assisted navigation platforms by key performance metrics including pedicle screw placement accuracy, operative time, neurological complications, and blood loss. METHODS A systematic review was conducted using major databases for articles comparing pedicle screw accuracy of computer-assisted navigation to conventional (freehand or fluoroscopy) controls via post-operative computed tomography. Outcome data were extracted and pooled by random-effects model for analysis. RESULTS All navigation platforms demonstrated significant reduction in risk of breach, with Stryker demonstrating the highest accuracy compared to controls (OR 0.16 95% CI 0.06 to 0.41, P < 0.00001, I2 = 0%) followed by Medtronic. There were no significant differences in accuracy or most surgical outcome measures between platforms; however, BrainLab demonstrated significantly faster operative time compared to Medtronic by 30 min (95% CI - 63.27 to - 2.47, P = 0.03, I2 = 74%). Together, there was significantly lower risk of major breach in the navigation group compared to controls (OR 0.42, 95% CI 0.27-0.63, P < 0.0001, I2 = 56%). CONCLUSIONS When comparing between platforms, Stryker demonstrated the highest accuracy, and Brainlab the shortest operative time, both followed by Medtronic. No significant difference was found between platforms regarding neurologic complications or blood loss. Overall, our results demonstrated a 60% reduction in risk of major breach utilizing computer-assisted navigation, coinciding with previous studies, and supporting its validity. This study is the first to directly compare available navigation platforms offering insight for further investigation and aiding in the institutional procurement of platforms. LEVEL 3 EVIDENCE: Meta-analysis of Level 3 studies.
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Affiliation(s)
- John-Peter Bonello
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
| | - Robert Koucheki
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Aazad Abbas
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Johnathan Lex
- Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
| | - Nicholas Nucci
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Canada
| | - Albert Yee
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Department of Orthopaedic Surgery, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Henry Ahn
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Canada
| | - Joel Finkelstein
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Department of Orthopaedic Surgery, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Stephen Lewis
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Department of Orthopaedic Surgery, Toronto Western Hospital, Toronto, Canada
| | - Jeremie Larouche
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
- Department of Orthopaedic Surgery, Sunnybrook Health Sciences Center, Toronto, Canada
| | - Jay Toor
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Canada
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Mollica C, Guatta R, Scarone P. Augmented Reality Surgical Navigation in Hybrid Operating Room for Minimally Invasive Lumbar Fusion: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e107. [PMID: 37166196 DOI: 10.1227/ons.0000000000000753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/14/2023] [Indexed: 05/12/2023] Open
Affiliation(s)
- Caterina Mollica
- Neurosurgical Service, Neurocenter of Southern Switzerland, Lugano, Switzerland
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Mandelka E, Gierse J, Zimmermann F, Gruetzner PA, Franke J, Vetter SY. Implications of navigation in thoracolumbar pedicle screw placement on screw accuracy and screw diameter/pedicle width ratio. BRAIN & SPINE 2023; 3:101780. [PMID: 38020982 PMCID: PMC10668071 DOI: 10.1016/j.bas.2023.101780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/22/2023] [Accepted: 07/10/2023] [Indexed: 12/01/2023]
Abstract
Introduction There is ample evidence that higher accuracy can be achieved in thoracolumbar pedicle screw placement by using spinal navigation. Still, to date, the evidence regarding the influence of the use of navigation on the screw diameter to pedicle width ratio remains limited. Research question The aim of this study was to investigate the implications of navigation in thoracolumbar pedicle screw placement not only on screw accuracy, but on the screw diameter to pedicle width ratio as well. Material and methods In this single-center single-surgeon study, 45 Patients undergoing navigated thoracolumbar pedicle screw placement were prospectively included. The results were compared with a matched comparison group of patients in which screw placement was performed under fluoroscopic guidance. The screw accuracy and the screw diameter to pedicle width ratio of every screw were compared between the groups. Results Screw accuracy was significantly higher in the navigation group compared to the fluoroscopic guidance group, alongside with a significant increase of the screw diameter to pedicle width ratio by approximately 10%. In addition, both the intraoperative radiation dose and the operating time tended to be lower in the study group. Conclusion This study was able to show that navigated thoracolumbar pedicle screw placement not only increases the accuracy of screw placement but also facilitates the selection of the adequate screw sizes, which according to the literature has positive effects on fixation strength. Meanwhile, the use of navigation did not negatively affect the time needed for surgery or the patient's intraoperative exposure to radiation.
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Affiliation(s)
- Eric Mandelka
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Jula Gierse
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Felix Zimmermann
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Paul A. Gruetzner
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Sven Y. Vetter
- Research group Medical Imaging and Navigation in Trauma and Orthopedic Surgery (MINTOS), Department of Orthopedics and Trauma Surgery, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
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Chatelain LS, Kourilsky A, Lot G, Rogers A. Airo® navigation versus freehand fluoroscopy technique: A comparative study of accuracy and radiological exposure for thoracolumbar screws placement. Neurochirurgie 2023; 69:101437. [PMID: 36967084 DOI: 10.1016/j.neuchi.2023.101437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE The aim was to compare the accuracy of freehand fluoroscopy and CT based navigation on thoracolumbar screws placement and their respective effects on radiological exposure to the patient. No previous study directly compared the Airo® navigation system to freehand technique. METHODS In this monocentric retrospective study, 156 consecutive patients who underwent thoracolumbar spine surgery were included. Epidemiological data and surgical indications were noted. Heary classification was used for thoracic screws and Gertzbein-Robbins classification for lumbar screws. Radiological exposure was collected for each surgery. RESULTS A total of 918 screws were implanted. We analyzed 725 lumbar screws (Airo® 287; freehand fluoroscopy 438) and 193 thoracic screws (Airo® 49; freehand fluoroscopy 144). Overall, lumbar screws accuracy (Gertzbein-Robbins grade A and B) was good in both groups (freehand fluoroscopy 91.3%; Airo® 97.6%; P<0.05). We found significantly less Grade B and C in the Airo® group. Thoracic accuracy was also good in both groups (Heary 1 and 2; freehand fluoroscopy 77.8%; Airo® 93.9%), without reaching statistical significance. Radiological exposure was significantly higher in the Airo® group with a mean effective dose of 9.69 mSv versus 0.71mSv for freehand fluoroscopy. CONCLUSION Our study confirmed that the use of Airo® navigation yielded good accuracy. It however exposed the patient to higher radiological exposure compared with freehand fluoroscopy technique. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- L S Chatelain
- Fondation Rothschild, Department of Neurosurgery, 25-29, rue Manin, 75019 Paris, France.
| | - A Kourilsky
- Fondation Rothschild, Department of Neurosurgery, 25-29, rue Manin, 75019 Paris, France
| | - G Lot
- Fondation Rothschild, Department of Neurosurgery, 25-29, rue Manin, 75019 Paris, France
| | - A Rogers
- Fondation Rothschild, Department of Neurosurgery, 25-29, rue Manin, 75019 Paris, France; American Hospital of Paris, 55, boulevard du Château, 92200 Neuilly-sur-Seine, France
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Schwendner M, Liang R, Butenschön VM, Meyer B, Ille S, Krieg SM. The one-stop-shop approach: Navigating lumbar 360-degree instrumentation in a single position. Front Surg 2023; 10:1152316. [PMID: 37009623 PMCID: PMC10060549 DOI: 10.3389/fsurg.2023.1152316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectiveTreatment strategies of patients suffering from pyogenic spondylodiscitis are a controverse topic. Percutaneous dorsal instrumentation followed by surgical debridement and fusion of the infectious vertebral disc spaces is a common approach for surgical treatment. Technical advances enable spinal navigation for dorsal and lateral instrumentation. This report investigates combined navigated dorsal and lateral instrumentation in a single surgery and positioning for lumbar spondylodiscitis in a pilot series.MethodsPatients diagnosed with 1- or 2-level discitis were prospectively enrolled. To enable posterior navigated pedicle screw placement and lateral interbody fusion (LLIF) patients were positioned semi-prone in 45-degree fashion. For spinal referencing, a registration array was attached to the pelvic or spinal process. 3D scans were acquired intraoperatively for registration and implant control.Results27 patients suffering from 1- or 2-level spondylodiscitis with a median ASA of 3 (1–4) and a mean BMI of 27.9 ± 4.9 kg/m2 were included. Mean duration of surgery was 146 ± 49 min. Mean blood loss was 367 ± 307 ml. A median of 4 (4–8) pedicle screws were placed for dorsal percutaneous instrumentation with an intraoperative revision rate of 4.0%. LLIF was performed on 31 levels with an intraoperative cage revision rate of 9.7%.ConclusionsNavigated lumbar dorsal and lateral instrumentation in a single operation and positioning is feasible and safe. It enables rapid 360-degree instrumentation in these critically ill patients and potentially reduces overall intraoperative radiation exposure for patient and staff. Compared to purely dorsal approaches it allows for optimal discectomy and fusion while overall incisions and wound size are minimized. Compared to prone LLIF procedures, semi-prone in 45-degree positioning allows for a steep learning curve due to minor changes of familiar anatomy.
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Affiliation(s)
- Maximilian Schwendner
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- TUM Neuroimaging Center, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Raimunde Liang
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Vicki M. Butenschön
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Sebastian Ille
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- TUM Neuroimaging Center, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Sandro M. Krieg
- Department of Neurosurgery, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- TUM Neuroimaging Center, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
- Correspondence: Sandro M. Krieg
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Croci DM, Nguyen S, Streitmatter SW, Sherrod BA, Hardy J, Cole KL, Gamblin AS, Bisson EF, Mazur MD, Dailey AT. O-Arm Accuracy and Radiation Exposure in Adult Deformity Surgery. World Neurosurg 2023; 171:e440-e446. [PMID: 36528322 DOI: 10.1016/j.wneu.2022.12.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE In long thoracolumbar deformity surgery, accurate screw positioning is critical for spinal stability. We assessed pedicle and pelvic screw accuracy and radiation exposure in patients undergoing long thoracolumbar deformity fusion surgery (≥4 levels) involving 3-dimensional fluoroscopy (O-Arm/Stealth) navigation. METHODS In this retrospective single-center cohort study, all patients aged >18 years who underwent fusion in 2016-2018 were reviewed. O-Arm images were assessed for screw accuracy. Effective radiation doses were calculated. The primary outcome was pedicle screw accuracy (Heary grade). Secondary outcomes were pelvic fixation screw accuracy, radiation exposure, and screw-related perioperative and postoperative complications or revision surgery within 3 years. RESULTS Of 1477 pedicle screws placed in 91 patients (mean 16.41 ± 5.6 screws/patient), 1208 pedicle screws (81.8%) could be evaluated by 3-dimensional imaging after placement. Heary Grade I placement was achieved in 1150 screws (95.2%), Grade II in 47 (3.9%), Grade III in 10 (0.82%), Grade IV in 1 (0.08%), and Grade V in 0; Grade III-V were replaced intraoperatively. One of 60 (1.6%) sacroiliac screws placed showed medial cortical breach and was replaced. The average O-Arm-related effective dose was 29.54 ± 14.29 mSv and effective dose/spin was 8.25 ± 2.65 mSv. No postoperative neurological worsening, vascular injuries, or revision surgeries for screw misplacement were recorded. CONCLUSIONS With effective radiation doses similar to those in interventional neuroendovascular procedures, the use of O-Arm in multilevel complex deformity surgery resulted in high screw accuracy, no need for surgical revision because of screw malposition, less additional imaging, and no radiation exposure for the surgical team.
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Affiliation(s)
- Davide Marco Croci
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Sarah Nguyen
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Seth W Streitmatter
- Medical Imaging Physics and Radiation Safety, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Brandon A Sherrod
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Jeremy Hardy
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Kyril L Cole
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Austin S Gamblin
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Erica F Bisson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Marcus D Mazur
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Andrew T Dailey
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
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Schwendner M, Meyer B, Krieg SM. [Robot-assisted pedicle screw placement]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023; 35:37-42. [PMID: 36459194 DOI: 10.1007/s00064-022-00792-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/29/2022] [Accepted: 07/10/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Pedicle screw-based posterior instrumentation of the spine. INDICATIONS Instability of the spine due to trauma, infection, degenerative spinal disease or tumor. CONTRAINDICATIONS None. SURGICAL TECHNIQUE Robot-assisted navigated pedicle screw placement. POSTOPERATIVE MANAGEMENT Early functional mobilization starting on the first postoperative day. RESULTS A study by Lee et al. analyzed the clinical application of the system Mazor X Stealth Edition (Medtronic Navigation, Louisville, CO, USA; Medtronic Spine, Memphis, TN, USA) in 186 cases with a total of 1445 pedicle screws [1]. Correct screw positioning was achieved in 1432 pedicle screws (99.1%); six pedicle screws (0.4%) were revised intraoperatively. The mean duration of pedicle screw placement was 6.1 ± 2.3 min. Pojskić et al. published a case series regarding the application of the system Cirq (Brainlab, Munich, Germany) in 13 cases with a total number of 70 pedicle screws implanted [2]. Intraoperative imaging showed screw positioning according to the Gertzbein Robbins classification (GR) category A in 65 screws (92.9%) and GR B in one screw (1.4%). Screw positioning GR D with intraoperative revision was reported in two screws (2.9%). Mean duration of pedicle screw placement was 08:27 ± 06:54 min.
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Affiliation(s)
- Maximilian Schwendner
- Klinik und Poliklinik für Neurochirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Bernhard Meyer
- Klinik und Poliklinik für Neurochirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Sandro M Krieg
- Klinik und Poliklinik für Neurochirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
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[Application of navigation in the fractured spine]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023; 35:29-36. [PMID: 36441223 DOI: 10.1007/s00064-022-00790-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Computer navigation is used in patients with spine fractures to optimize the accuracy of pedicle screws and thereby reduce intra- and postoperative complications, such as injuries to vessels, nerves and accompanying structures. In addition, the ideal screw length and diameter for each pedicle can be detected to ensure optimal stability. INDICATIONS Intraoperative navigation is suitable for the treatment of spine fractures, which require dorsal stabilization or fusion. It is primarily used for dorsal procedures ranging from the cervical to lumbar/sacral spine. CONTRAINDICATIONS Computer navigation relies on rigid fixation of the dynamic reference base (DRB) at the spinous process. Failure of DRB fixation is the major contraindication for navigation in the spine. SURGICAL TECHNIQUE After acquisition of an intraoperative three-dimensional (3D) scan, a digital relation between the anatomy and the 3D scan is established with the navigation system and its infrared camera. Pedicle screws are planned percutaneously with a calibrated pointer. In the next step K‑wires (or screws) are implanted after the pedicles are drilled with a calibrated drill guide. After implantation, an additional 3D scan is performed to verify accurate K‑wire placement. POSTOPERATIVE MANAGEMENT Postoperative management does not differ compared to nonnavigated procedures. RESULTS Intraoperative navigation in combination with modern imaging systems leads to very high accuracy for pedicle screws. Immediate intraoperative control of K‑wires as well as screws and fracture reduction can avoid revision surgery. Image guidance can reduce radiation exposure for the surgical team.
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Richter M. [Spinal navigation with preoperative computed tomography]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023; 35:3-16. [PMID: 36446936 DOI: 10.1007/s00064-022-00791-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/13/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Safe placement of posterior cervical-sacral pedicle screws, S2-Ala-iliac screws, iliac screws, transarticular screws C1/2, translaminar screws C2 or cervical lateral mass screws under the guidance of spinal navigation. INDICATIONS All posterior spinal instrumentations with screws: instabilities and deformities of rheumatic, traumatic, neoplastic, infectious, iatrogenic or congenital origin; multilevel cervical spinal stenosis with degenerative instability or kyphosis of the affected spinal segment. CONTRAINDICATIONS There are no absolute contraindications for spinal navigation. SURGICAL TECHNIQUE Cervical spine: Prone position on a gel mattress, rigid head fixation, e.g., with Mayfield tongs; if appropriate, closed reduction under lateral image intensification; thoracic + lumbar spine: prone position on a cushioned frame; midline posterior surgical approach at the level of the segments to be instrumented; if necessary, open reduction; insertion of the cervical/upper thoracic screws under the guidance of spinal navigation; if necessary, posterior decompression; instrumentation longitudinal rods; if fusion is to be obtained, decortication of the posterior bone elements with a high-speed burr and onlay of cancellous bone or bone substitutes. POSTOPERATIVE MANAGEMENT In stable instrumentations, no postoperative immobilization with orthosis is necessary, removal of drains (if used) 2-3 days postoperatively (postop), removal of the sutures 14 days postop, clinical and x‑ray controls 3 and 12 months postop or in case of clinical or neurological deterioration. RESULTS Numerous studies showed that the use of spinal navigation significantly reduces implant malplacement rates, complications, and revision surgery. Furthermore, intraoperative radiation exposure to the operation team can be reduced by up to 90%.
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Affiliation(s)
- Marcus Richter
- Wirbelsäulenzentrum, St. Josefs-Hospital GmbH, Beethovenstr. 20, 65189, Wiesbaden, Deutschland.
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Shiber M, Kimchi G, Knoller N, Harel R. The Evolution of Minimally Invasive Spine Tumor Resection and Stabilization: From K-Wires to Navigated One-Step Screws. J Clin Med 2023; 12:jcm12020536. [PMID: 36675466 PMCID: PMC9865379 DOI: 10.3390/jcm12020536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/03/2023] [Accepted: 01/07/2023] [Indexed: 01/11/2023] Open
Abstract
Minimization of the surgical approaches to spinal extradural metastases resection and stabilization was advocated by the 2012 Oncological Guidelines for Spinal Metastases Management. Minimally invasive approaches to spine oncology surgery (MISS) are continually advancing. This paper will describe the evolution of minimally invasive surgical techniques for the resection of metastatic spinal lesions and stabilization in a single institute. A retrospective analysis of patients who underwent minimally invasive extradural spinal metastases resection during the years 2013-2019 by a single surgeon was performed. Medical records, imaging studies, operative reports, rates of screw misplacement, operative time and estimated blood loss were reviewed. Detailed description of the surgical technique is provided. Of 138 patients operated for extradural spinal tumors during the study years, 19 patients were treated in a minimally invasive approach and met the inclusion criteria for this study. The mortality rate was significantly improved over the years with accordance of improve selection criteria to better prognosis patients. The surgical technique has evolved over the study years from fluoroscopy to intraoperative 3D imaging and navigation guidance and from k-wire screw insertion technique to one-step screws. Minimally invasive spinal tumor surgery is an evolving technique. The adoption of assistive devices such as intraoperative 3D imaging and one-step screw insertion systems was safe and efficient. Oncologic patients may particularly benefit from the minimization of surgical decompression and fusion in light of the frailty of this population and the mitigated postoperative outcomes associated with MIS oncological procedures.
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Affiliation(s)
- Mai Shiber
- Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Medical School, Tel-Aviv University, Tel Aviv 69978, Israel
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Gil Kimchi
- Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Medical School, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Nachshon Knoller
- Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Medical School, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Ran Harel
- Department of Neurological Surgery, Sheba Medical Center, Ramat Gan 52621, Israel
- Sackler Medical School, Tel-Aviv University, Tel Aviv 69978, Israel
- Correspondence: ; Tel.: +972-3-5302650
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Ivanov M, Radatz M. Role of Navigation in the Surgery of Spine Tumours. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:173-178. [PMID: 38153467 DOI: 10.1007/978-3-031-36084-8_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Computer-assisted navigation has emerged in neurosurgery as an approach to improve intraoperative orientation and achieve better surgical results with lower complication rates. While the initial use was focused around precise identification of the surgical target, the current applications are much wider and continue to rapidly expand.Here we report our review of the main applications of navigation in spine surgery with a focus on the surgery of spine tumours operated in Sheffield Teaching Hospitals in the past 10 years (2010-2020). In our unit, intraoperative navigation became a helpful and routine adjunct to the modern armamentarium of a spinal surgeon and is currently used not just for accurate placement of the implants but also for precise demarcation of the tumour margins, as well as for identification of important anatomical structures that must be preserved.Conclusion: Intraoperative navigation is a technology that helped us to improve intraoperative orientation to the unexposed anatomy and reduce the risk of iatrogenic complications; achieve better tumour resection; improve the spinal biomechanical construction; provide a safer learning environment for the spinal surgical trainees; minimise radiation exposure of the surgical team and shorten the operating time. In our opinion, it was helpful not only to reduce the risk of complications but also to perform procedures, which without navigation would have been considered inoperable or very high risk.
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Durrani S, Onyedimma C, Jarrah R, Bhatti A, Nathani KR, Bhandarkar AR, Mualem W, Ghaith AK, Zamanian C, Michalopoulos GD, Alexander AY, Jean W, Bydon M. The Virtual Vision of Neurosurgery: How Augmented Reality and Virtual Reality are Transforming the Neurosurgical Operating Room. World Neurosurg 2022; 168:190-201. [DOI: 10.1016/j.wneu.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 11/22/2022]
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Zhao J, Jiang H, Zhuge Y, Gao R, Wang C, Ma J, Zhou X. Risk Factors for the Drift Phenomenon in O-arm Navigation-Assisted Pedicle Screw Placement during Spinal Deformity Surgery. Orthop Surg 2022; 15:118-123. [PMID: 36394161 PMCID: PMC9837212 DOI: 10.1111/os.13557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 09/10/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Intraoperative O-arm navigation systems improve the accuracy of spinal instrumentation placement. However, deviation of the pedicle screw from the guide line might occur. The aim of the present study was to explore the causes of and countermeasures for the drift phenomenon during pedicle screw implantation with the aid of an O-arm three-dimensional navigation system in spinal deformity surgery. METHODS This was a retrospective analysis of 341 patients with spinal deformity who underwent O-arm navigation system-assisted pedicle screw placement from July 2015 to June 2019. The patient's general condition, Cobb angle, apical vertebra position, softness index, spinal release status, fixed reference frame position, and distance between the navigation vertebral body and the reference frame were collected and compared by independent-samples t test or Pearson's chi-square analysis. The potential risk factors for the drift phenomenon were identified using binary logistic regression analysis. RESULTS The drift phenomenon occurred in 57 patients during the first navigation-assisted pedicle screw placement, for an incidence of 16.7% (57/341). There were significant differences in factors such as the apical vertebra position, softness index, spinal release status, and distance between the vertebral body and the reference frame when the drift phenomenon occurred (P < 0.05). Binary logistic regression analysis showed that the softness index, spinal release status, and distance between the vertebral body and the reference frame when drifting occurred were independent risk factors for the drift phenomenon during O-arm navigation-assisted pedicle screw placement. CONCLUSION During the use of an O-arm navigation system to assist with pedicle screw placement, pedicle screws should not be placed away from the reference frame, and spinal osteotomy and release should be performed after pedicle screw placement. In addition, the accuracy of O-arm navigation-assisted pedicle screw placement will be affected more in those with larger softness indices.
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Affiliation(s)
- Jianquan Zhao
- Present address:
Department of Orthopaedic Surgery, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
| | - Heng Jiang
- Present address:
Department of Orthopaedic Surgery, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
| | - Yingjie Zhuge
- Present address:
Department of Orthopaedic Surgery, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina,Department of Orthopaedic SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong UniversityShanghaiChina
| | - Rui Gao
- Present address:
Department of Orthopaedic Surgery, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
| | - Ce Wang
- Present address:
Department of Orthopaedic Surgery, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
| | - Jun Ma
- Present address:
Department of Orthopaedic Surgery, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
| | - Xuhui Zhou
- Present address:
Department of Orthopaedic Surgery, Shanghai Changzheng HospitalSecond Military Medical UniversityShanghaiChina
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He J, Luo F, Wang H, Xu J, Zhang Z. SAP Principle Guided Free Hand Technique: A Secret for T1 to S1 Pedicle Screw Placement. Orthop Surg 2022; 14:2995-3002. [PMID: 36208012 DOI: 10.1111/os.13513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/31/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Existing freehand techniques of screw placement mainly emphasized on various entry points and complex trajectory reference. The aim of this study is to illustrate a standardized and reliable freehand technique of pedicle screw insertion for open pedicle screw fixation with a universal entry point and a stereoscopic trajectory reference system and report the results from a single surgeon's clinical experience with the technique. METHOD In this study, the author respectively reviewed a total of 200 consecutive patients who had undergone open freehand pedicle screw fixation with Superior Articular Process (SAP) technique from January 2019 to May 2020. For accuracy and safety, all 200 cases had undergone postoperative X-ray while 33 cases including spinal deformity, infection, and tumor had received additional CT-scan. Screw accuracy was analyzed via a CT-based classification system with Student's t test. RESULTS A total of 1126 screws had been placed from T1-S1 with SAP-guided freehand technique and the majority had been confirmed safe in X-ray without the need of CT scan. A total of 316 screws in deformity or infectious or tumor cases had undergone additional CT scan with 95.5% (189 of 198 screws) accuracy in thoracic group and 94.9% (112 of 118 screws) in lumbar group. The accuracy had been 90.5% (114 of 126 screws) in deformity group and 95.8% (182 of 190 screws) in non-deformity group. All perforation cases had been rated Grade B (<2 mm) without significant difference between the medial and the lateral (p < 0.05). No cases had been detected with significant neurological deficiencies. The mean intraoperative X-ray shots were 0.73 per screw. CONCLUSION SAP-guidance is a reliable freehand technique for thoracic and lumbar pedicle screw instrument. It allows accurate and safe screw insertion in both non-deformity and deformity cases with less radiation exposure.
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Affiliation(s)
- Jinyue He
- Department of Orthopedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Fei Luo
- Department of Orthopedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Hao Wang
- Department of Orthopedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Jianzhong Xu
- Department of Orthopedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - ZeHua Zhang
- Department of Orthopedics, Southwest Hospital, Army Medical University, Chongqing, China
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Coskun E, Wellington IJ, Bellas N, Singh H, Mallozzi SS, Cote MP, Moss IL. Determination of a neurologic safe zone for bicortical S1 pedicle screw placement. Spine J 2022; 22:1708-1715. [PMID: 35504567 DOI: 10.1016/j.spinee.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/24/2022] [Accepted: 04/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbosacral fixation is commonly used for the management of lumbosacral instability. As the sacrum mainly consists of cancellous bone, bicortical fixation, in which the pedicle screw penetrates the anterior sacral cortex, can help increase the strength of fixation. However, this method carries a risk to the L5 nerves which lie anterior to the sacrum at this level. PURPOSE The goal of this study is to determine a safe zone for the placement of S1 pedicle screws to decrease the likelihood of L5 nerve injury. STUDY DESIGN Retrospective imaging review. PATIENT SAMPLE This study evaluated imaging data of patients who underwent lumbar spine magnetic resonance imaging (MRI) at our institute between September 1, 2020 and September 1, 2021. OUTCOME MEASURES T1-weighted axial MRIs were measured at the level of S1 pedicle screw placement. The space medial and lateral to the L5 nerve root on the anterior sacrum were measured and defined as safe zones. Additionally, the nerve width and sacral lengths were measured at this level. METHODS The distribution of the measurements were evaluated to determine a medial and lateral safe zone, as well as the average nerve width at the level of S1 pedicle screw placement. Correlation analysis was performed to determine a relationship between safe zone sizes and sacral size. RESULTS A total of 400 MRIs were analyzed. The average medial safe zone measured was 32.8 mm (95% CI: 32.2-33.4) with no nerves lying within 22.3 mm of the midline sacrum. The average lateral safe zone measured was 17.7 mm (95% CI: 17.1-18.2), with no nerves within 5.3 mm of the lateral border of the sacrum. The average nerve root width was 6.2 mm (95% CI: 6.13-6.34). An increased sacral length was associated with a larger medial (p<.001) and lateral (p<.001) safe zone. CONCLUSIONS Our study revealed lateral and medial safe zones for the placement of S1 pedicle screws to avoid iatrogenic nerve injury in a retrospective cohort of 400 patients. There were no L5 nerve roots found within 22.3 mm of the sacrum's mid-axis or within 5.3 mm of the sacrum's anterolateral border. These defined safe zones can be used during pedicle screw planning and placement to decrease the risk of injury to the L5 nerve root.
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Affiliation(s)
- Ergin Coskun
- University of Connecticut, Department of Orthopedics, 120 Dowling Way, Farmington, CT 06032, USA
| | - Ian J Wellington
- University of Connecticut, Department of Orthopedics, 120 Dowling Way, Farmington, CT 06032, USA.
| | - Nicholas Bellas
- University of Connecticut, Department of Orthopedics, 120 Dowling Way, Farmington, CT 06032, USA
| | - Hardeep Singh
- University of Connecticut, Department of Orthopedics, 120 Dowling Way, Farmington, CT 06032, USA
| | - Scott S Mallozzi
- University of Connecticut, Department of Orthopedics, 120 Dowling Way, Farmington, CT 06032, USA
| | - Mark P Cote
- University of Connecticut, Department of Orthopedics, 120 Dowling Way, Farmington, CT 06032, USA
| | - Isaac L Moss
- University of Connecticut, Department of Orthopedics, 120 Dowling Way, Farmington, CT 06032, USA
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Niu G, Cheng J, Liu L, Li C, Zhou G, Chen H, Liu T, Nie H, Sun Z, Jiang W, Zhou Q, Zhao B, Zhu J, Yu R, Guo Y, Yang Y, Bai J. Individualized 3D printed navigation template-assisted atlantoaxial pedicle screws vs. free-hand screws for the treatment of upper cervical fractures. Front Surg 2022; 9:932296. [PMID: 36225218 PMCID: PMC9549244 DOI: 10.3389/fsurg.2022.932296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aims to compare the efficacy and safety of freehand atlantoaxial pedicle screws against custom 3D printed navigation template screws in the treatment of upper cervical fractures. Methods In our institution from 2010 to 2020, a retrospective cohort analysis of 23 patients with upper cervical fractures was done. These patients were separated into two groups: group A (N = 12), which received customized 3D printed navigation template-assisted screws with virtual reality techniques, and group B (N = 11), which received freehand screws assisted by intraoperative fluoroscopy. Every patient was monitored for more than 1 year. The two groups were contrasted in terms of screw implant accuracy, cervical spine Japanese Orthopaedic Association (JOA) score, American Spinal Injury Association (ASIA) score, visual analogue scale (VAS) score, surgical time, fluoroscopy times, and intraoperative blood loss. Results A total of 88 atlantoaxial pedicle screws in all, 46 in group A and 42 in group B, were implanted. In group A, the screw insertion accuracy rate was 95.7%, compared to 80.0% in group B (P < 0.05). When compared to group B, group A had shorter surgery times, less blood loss, fewer fluoroscopies, a higher short-term JOA score, and overt pain reduction (P < 0.05). However, there was no discernible difference between the two groups' VAS scores, long-term JOA scores, or ASIA scores (sensory and motor), at the most recent follow-up. Conclusion Individualized 3D printed guide leads to significant improvement in the screw safety, efficacy, and accuracy, which may be a promising strategy for the treatment of upper cervical fractures.
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Affiliation(s)
- Guoqi Niu
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
- Correspondence: Guoqi Niu Jianzhong Bai
| | - Jiawei Cheng
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Lutan Liu
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Chao Li
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Gong Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Hui Chen
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Tao Liu
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Hu Nie
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Zheng Sun
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Weili Jiang
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Qiankun Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Baoyin Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Jun Zhu
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Ruochen Yu
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Yalong Guo
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Yi Yang
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
| | - Jianzhong Bai
- Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Digital Orthopedics Technology R/D and Application Innovation Team
- Correspondence: Guoqi Niu Jianzhong Bai
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