Radiation doses of sliding gantry ct-based as compared to mobile cone-beam CT-based navigated pedicle screw placement in a homogenous cohort

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.

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

Global Spine Journal ◽

10.1055/s-0035-1554331 ◽

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

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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

Brain and Spine ◽

10.1016/j.bas.2021.100178 ◽

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

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

10.21203/rs.3.rs-256928/v1 ◽

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.

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