Reliability and consequences of intraoperative 3D imaging to control positions of thoracic pedicle screws

Abstract Background Correct positioning of pedicle screws can be challenging. Intraoperative imaging may be helpful. The purpose of this study was to evaluate the use of intraoperative 3D imaging with a cone-beam CT. The hypotheses were that intraoperative 3D imaging (1) will lead to an intraoperative revision of pedicle screws and (2) may diminish the rate of perforated screws on postoperative imaging. Methods Totally, 351 patients (age 60.9 ± 20.3 a (15–96); m/f 203/148) underwent dorsal instrumentation with intraoperative 3D imaging with 2215 pedicle screws at a trauma center level one. This study first evaluates intraoperative imaging. After this, 501 screws in 73 patients (age 62.5 ± 19.7 a; m/f 47/26) of this collective were included in the study group (SG) and their postoperative computed tomography was evaluated with regard to screw position. Then, 500 screws in 82 patients (age 64.8 ± 14.4 a; m/f 51/31) as control group (CG), who received the screws with conventional 2D fluoroscopy but without 3D imaging, were evaluated with regard to screw position. Results During the placement of the 2215 pedicle screws, 158 (7.0%) intraoperative revisions occurred as a result of 3D imaging. Postoperative computed tomography of the SG showed 445 (88.8%) screws without relevant perforation (type A + B), of which 410 (81.8%) could be classified as type A and 35 (7.0%) could be classified as type B. Fifty-six (11.2%) screws in SG showed relevant perforation (type C–E). In contrast, 384 (76.8%) screws in the CG were without relevant perforation (type A + B), of which 282 (56.4%) could be classified as type A and 102 (20.4%) as type B. One hundred and sixteen (23.2%) screws in the CG showed relevant perforation (type C–E). Conclusion This study shows that correct placement of pedicle screws in spine surgery with conventional 2D fluoroscopy is challenging. Misplacement of screws cannot always be prevented. Intraoperative 3D imaging with a CBCT can be helpful to detect and revise misplaced pedicle screws intraoperatively. The use of intraoperative 3D imaging will probably minimize the number of revision procedures due to perforating pedicle screws.

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Intraoperative 3D Imaging with Cone-Beam Computed Tomography Leads to Revision of Pedicle Screws in Dorsal Instrumentation – A Retrospective Analysis.

10.21203/rs.3.rs-927270/v1 ◽

2021 ◽

Author(s):

Felix Zimmermann ◽

Katharina Kohl ◽

Maxim Privalov ◽

Jochen Franke ◽

Sven Yves Vetter

Keyword(s):

Computed Tomography ◽

3D Imaging ◽

Intraoperative Imaging ◽

Pedicle Screws ◽

Type A ◽

Cone Beam ◽

Type B ◽

Intraoperative 3D Imaging ◽

Screw Position ◽

Type C

Abstract Background: Correct positioning of pedicle screws can be challenging. Intraoperative imaging may be helpful. The purpose of this study was to evaluate the use of intraoperative 3D imaging with a cone-beam CT. The hypotheses were that intraoperative 3D imaging (1) will lead to an intraoperative revision of pedicle screws and (2) may diminish the rate of perforated screws on postoperative imaging.Methods: 351 patients (age 60.9 ± 20.3 a (15-96); m/f 203/148) underwent dorsal instrumentation with intraoperative 3D imaging with 2215 pedicle screws at a trauma center level one. This study first evaluates the intraoperative imaging. After this, 501 screws in 73 patients (age 62.5 ± 19.7 a; m/f 47/26) of this collective were included in the study group (SG) and their postoperative computed tomography was evaluated with regard to screw position. Then 500 screws in 82 patients (age 64.8 ± 14.4 a; m/f 51/31) as control group (CG), who received the screws with conventional 2D fluoroscopy but without 3D imaging, were evaluated with regard to screw position. Results: During the placement of the 2215 pedicle screws 158 (7.0%) intraoperative revisions occurred as a result of 3D imaging. Postoperative computed tomography of the SG showed 445 (88.8%) screws without relevant perforation (type A+B), of which 410 (81.8%) could be classified as type A and 35 (7.0%) could be classified as type B. 56 (11.2%) screws in SG showed relevant perforation (type C-E). In contrast, 384 (76.8%) screws in the CG were without relevant perforation (type A+B), of which 282 (56.4%) could be classified as type A and 102 (20.4%) as type B. 116 (23.2%) screws in the CG showed relevant perforation (type C-E).Conclusion: This study shows that correct placement of pedicle screws in spine surgery with conventional 2D fluoroscopy is challenging. Misplacement of screws cannot always be prevented. Intraoperative 3D imaging with a CBCT can be helpful to detect and revise misplaced pedicle screws intraoperatively. The use of intraoperative 3D imaging will probably minimize the number of revision procedures due to perforating pedicle screws.

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Intraoperative 3D imaging control during subthalamic Deep Brain Stimulation procedures using O-arm® technology: Experience in 15 patients

Neurochirurgie ◽

10.1016/j.neuchi.2014.05.005 ◽

2014 ◽

Vol 60 (6) ◽

pp. 276-282 ◽

Cited By ~ 6

Author(s):

F. Caire ◽

D. Guehl ◽

P. Burbaud ◽

A. Benazzouz ◽

E. Cuny

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

3D Imaging ◽

Intraoperative 3D Imaging ◽

Technology Experience ◽

Deep Brain

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Usefulness of the Nutrient Foramen of Lamina for Insertion of Thoracic Pedicle Screws

Journal of Spinal Disorders & Techniques ◽

10.1097/bsd.0b013e3180ca70ff ◽

2008 ◽

Vol 21 (3) ◽

pp. 205-208 ◽

Cited By ~ 7

Author(s):

Jun-Young Yang ◽

Lawrence G. Lenke

Keyword(s):

Pedicle Screws ◽

Nutrient Foramen ◽

Thoracic Pedicle Screws

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Comparison of FlouroNav and standard fluoroscopy for placement of thoracic pedicle screws

The Spine Journal ◽

10.1016/s1529-9430(01)00249-2 ◽

2002 ◽

Vol 2 (2) ◽

pp. 30 ◽

Cited By ~ 1

Keyword(s):

Pedicle Screws ◽

Thoracic Pedicle Screws

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The evaluation of long-term screw pull-out rates following posterior thoracolumbar fusion surgery with short and thin pedicle screws

Romanian Neurosurgery ◽

10.33962/roneuro-2019-033 ◽

2019 ◽

pp. 178-182

Author(s):

Umit Kocaman ◽

Hakan Yilmaz

Keyword(s):

Pedicle Screws ◽

Fusion Surgery ◽

Pull Out ◽

Transpedicular Screw ◽

Thoracic Pedicle Screws ◽

Pedicle Length ◽

Neurocentral Junction ◽

Male Patients ◽

Lumbar Pedicle

Background. The aim of this study was to evaluate screw pull-out rates after fusion operations with short and thin pedicle screws.Methods. A total of 200 posterior lumbar and thoracolumbar fusion operations performed at our clinic with short and thin pedicle screws (5.5x35 mm) were retrospectively evaluated. The patients were assessed with computed tomography postoperatively on the day of surgery and at the 6th month. Single groove retraction of the transpedicular screw was evaluated as pull-out. The results were evaluated by the 'number of pull-out cases / total number of cases' and also the 'total number of pull-out screws / total number of screws used' ratios. Results. There were 112 (56%) female and 88 (44%) male patients with a mean age of 58 years. The total number of screws used in the 200 cases was 1188. There were 88 (7.4%) thoracic pedicle screws, 1056 (88.9%) lumbar pedicle screws and 44 (3.7%) sacral pedicle screws used. No pull-out was found in the control CTs taken postoperatively. Left side T11 and T12 pull-out was observed in one case and left L4 pull-out was observed in another case in the control CTs taken at the postoperative 6th month. Pull-out was observed in 2 (1%) of the 200 cases and 3 (0.25%) of the 1188 screws.Conclusions. All the short and thin pedicle screws used had passed the pedicle length and neurocentral junction. The use of a 5.5x35 mm screws in fusion operations is less invasive than using longer and thicker screws while the pull-out rates may be similar.

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