scholarly journals Clinical efficiency of operating room-based sliding gantry CT as compared to mobile cone-beam CT-based navigated pedicle screw placement. An observational cohort study on 853 patients and 6733 screws

2021 ◽  
Vol 1 ◽  
pp. 100178
Author(s):  
Sebastian Ille ◽  
Lea Baumgart ◽  
Bernhard Meyer ◽  
sandro krieg
Keyword(s):  
Cohort Study ◽  
Pedicle Screw ◽  
Operating Room ◽  
Cone Beam Ct ◽  
Observational Cohort Study ◽  
Cone Beam ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Clinical Efficiency ◽  
Observational Cohort

scholarly journals Clinical efficiency of operating room-based sliding gantry CT as compared to mobile cone-beam CT-based navigated pedicle screw placement in 853 patients and 6733 screws

2021 ◽  
Author(s):  
Sebastian Ille ◽  
Lea Baumgart ◽  
Thomas Obermueller ◽  
Bernhard Meyer ◽  
Sandro M. Krieg
Keyword(s):  
Pedicle Screw ◽  
Operating Room ◽  
Cone Beam Ct ◽  
Spinal Instrumentation ◽  
High Volume ◽  
Cone Beam ◽  
Screw Placement ◽  
Daily Routine ◽  
Pedicle Screw Placement ◽  
Mean Time

Abstract Purpose Multiple solutions for navigation-guided pedicle screw placement are available. However, the efficiency with regard to clinical and resource implications has not yet been analyzed. The present study’s aim was to analyze whether an operating room sliding gantry CT (ORCT)-based approach for spinal instrumentation is more efficient than a mobile cone-beam CT (CBCT)-based approach. Methods This cohort study included a random sample of 853 patients who underwent spinal instrumentation using ORCT-based or CBCT-based pedicle screw placement due to tumor, degenerative, trauma, infection, or deformity disorders between November 2015 and January 2020. Results More screws had to be revised intraoperatively in the CBCT group due to insufficient placement (ORCT: 98, 2.8% vs. CBCT: 128, 4.0%; p = 0.0081). The mean time of patients inside the OR (Interval 5 Entry–Exit) was significantly shorter for the ORCT group (ORCT: mean, [95% CI] 256.0, [247.8, 264.3] min, CBCT: 283.0, [274.4, 291.5] min; p < 0.0001) based on shorter times for Interval 2 Positioning—Incision (ORCT: 18.8, [18.1, 19.9] min, CBCT: 33.6, [32.2, 35.5] min; p < 0.0001) and Interval 4 Suture—Exit (ORCT: 24.3, [23.6, 26.1] min, CBCT: 29.3, [27.5, 30.7] min; p < 0.0001). Conclusions The choice of imaging technology for navigated pedicle screw placement has significant impact on standard spine procedures even in a high-volume spine center with daily routine in such devices. Particularly with regard to the duration of surgeries, the shorter time needed for preparation and de-positioning in the ORCT group made the main difference, while the accuracy was even higher for the ORCT.

scholarly journals A Case-Controlled Study Evaluating the Effect of Cone Beam CT (O-Arm) Imaging and Navigation on Pedicle Screw Placement in Adult Spinal Surgery

2015 ◽  
Vol 5 (1_suppl) ◽  
pp. s-0035-1554331-s-0035-1554331
Author(s):  
Jason Strelzow ◽  
Danny Mendelsohn ◽  
Nicolas Dea ◽  
Mélissa Nadeau ◽  
Marcel Dvorak ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Spinal Surgery ◽  
Cone Beam Ct ◽  
Cone Beam ◽  
Screw Placement ◽  
Controlled Study ◽  
Pedicle Screw Placement

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

2021 ◽  
Author(s):  
Simon Peh ◽  
Julian Pfarr ◽  
Jost Philipp Schäfer ◽  
Jan-Hendrik Christensen ◽  
Anindita Chatterjea ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Pedicle Screw ◽  
Operating Room ◽  
Cone Beam Ct ◽  
Pedicle Screws ◽  
Roc Curves ◽  
Cone Beam ◽  
Screw Placement ◽  
Hybrid Operating Room ◽  
Effective Radiation Dose

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

scholarly journals A Novel Augmented-Reality-Based Surgical Navigation System for Spine Surgery in a Hybrid Operating Room: Design, Workflow, and Clinical Applications

2019 ◽  
Vol 18 (5) ◽  
pp. 496-502 ◽  
Author(s):  
Erik Edström ◽  
Gustav Burström ◽  
Rami Nachabe ◽  
Paul Gerdhem ◽  
Adrian Elmi Terander
Keyword(s):  
Augmented Reality ◽  
Radiation Exposure ◽  
Pedicle Screw ◽  
Operating Room ◽  
Wound Closure ◽  
Surgical Navigation ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Hybrid Operating Room ◽  
Pedicle Screw Placement

Abstract BACKGROUND Treatment of several spine disorders requires placement of pedicle screws. Detailed 3-dimensional (3D) anatomic information facilitates this process and improves accuracy. OBJECTIVE To present a workflow for a novel augmented-reality-based surgical navigation (ARSN) system installed in a hybrid operating room for anatomy visualization and instrument guidance during pedicle screw placement. METHODS The workflow includes surgical exposure, imaging, automatic creation of a 3D model, and pedicle screw path planning for instrument guidance during surgery as well as the actual screw placement, spinal fixation, and wound closure and intraoperative verification of the treatment results. Special focus was given to process integration and minimization of overhead time. Efforts were made to manage staff radiation exposure avoiding the need for lead aprons. Time was kept throughout the procedure and subdivided to reflect key steps. The navigation workflow was validated in a trial with 20 cases requiring pedicle screw placement (13/20 scoliosis). RESULTS Navigated interventions were performed with a median total time of 379 min per procedure (range 232-548 min for 4-24 implanted pedicle screws). The total procedure time was subdivided into surgical exposure (28%), cone beam computed tomography imaging and 3D segmentation (2%), software planning (6%), navigated surgery for screw placement (17%) and non-navigated instrumentation, wound closure, etc (47%). CONCLUSION Intraoperative imaging and preparation for surgical navigation totaled 8% of the surgical time. Consequently, ARSN can routinely be used to perform highly accurate surgery potentially decreasing the risk for complications and revision surgery while minimizing radiation exposure to the staff.

scholarly journals Feasibility and accuracy of a robotic guidance system for navigated spine surgery in a hybrid operating room: a cadaver study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Gustav Burström ◽  
Marcin Balicki ◽  
Alexandru Patriciu ◽  
Sean Kyne ◽  
Aleksandra Popovic ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Operating Room ◽  
Spine Surgery ◽  
Surgical Navigation ◽  
Guidance System ◽  
Screw Placement ◽  
Robot Arm ◽  
Hybrid Operating Room ◽  
Pedicle Screw Placement ◽  
Technical Accuracy

AbstractThe combination of navigation and robotics in spine surgery has the potential to accurately identify and maintain bone entry position and planned trajectory. The goal of this study was to examine the feasibility, accuracy and efficacy of a new robot-guided system for semi-automated, minimally invasive, pedicle screw placement. A custom robotic arm was integrated into a hybrid operating room (OR) equipped with an augmented reality surgical navigation system (ARSN). The robot was mounted on the OR-table and used to assist in placing Jamshidi needles in 113 pedicles in four cadavers. The ARSN system was used for planning screw paths and directing the robot. The robot arm autonomously aligned with the planned screw trajectory, and the surgeon inserted the Jamshidi needle into the pedicle. Accuracy measurements were performed on verification cone beam computed tomographies with the planned paths superimposed. To provide a clinical grading according to the Gertzbein scale, pedicle screw diameters were simulated on the placed Jamshidi needles. A technical accuracy at bone entry point of 0.48 ± 0.44 mm and 0.68 ± 0.58 mm was achieved in the axial and sagittal views, respectively. The corresponding angular errors were 0.94 ± 0.83° and 0.87 ± 0.82°. The accuracy was statistically superior (p < 0.001) to ARSN without robotic assistance. Simulated pedicle screw grading resulted in a clinical accuracy of 100%. This study demonstrates that the use of a semi-automated surgical robot for pedicle screw placement provides an accuracy well above what is clinically acceptable.

Sign in / Sign up

Export Citation Format

Share Document