Routine spinal navigation for thoraco–lumbar pedicle screw insertion using the O-arm three-dimensional imaging system improves placement accuracy

OBJECTIVEAugmented reality (AR) is a novel technology that has the potential to increase the technical feasibility, accuracy, and safety of conventional manual and robotic computer-navigated pedicle insertion methods. Visual data are directly projected to the operator’s retina and overlaid onto the surgical field, thereby removing the requirement to shift attention to a remote display. The objective of this study was to assess the comparative accuracy of AR-assisted pedicle screw insertion in comparison to conventional pedicle screw insertion methods.METHODSFive cadaveric male torsos were instrumented bilaterally from T6 to L5 for a total of 120 inserted pedicle screws. Postprocedural CT scans were obtained, and screw insertion accuracy was graded by 2 independent neuroradiologists using both the Gertzbein scale (GS) and a combination of that scale and the Heary classification, referred to in this paper as the Heary-Gertzbein scale (HGS). Non-inferiority analysis was performed, comparing the accuracy to freehand, manual computer-navigated, and robotics-assisted computer-navigated insertion accuracy rates reported in the literature. User experience analysis was conducted via a user experience questionnaire filled out by operators after the procedures.RESULTSThe overall screw placement accuracy achieved with the AR system was 96.7% based on the HGS and 94.6% based on the GS. Insertion accuracy was non-inferior to accuracy reported for manual computer-navigated pedicle insertion based on both the GS and the HGS scores. When compared to accuracy reported for robotics-assisted computer-navigated insertion, accuracy achieved with the AR system was found to be non-inferior when assessed with the GS, but superior when assessed with the HGS. Last, accuracy results achieved with the AR system were found to be superior to results obtained with freehand insertion based on both the HGS and the GS scores. Accuracy results were not found to be inferior in any comparison. User experience analysis yielded “excellent” usability classification.CONCLUSIONSAR-assisted pedicle screw insertion is a technically feasible and accurate insertion method.

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Comparison of Radiation Exposure in Lumbar Pedicle Screw Placement With Fluoroscopy Vs Computer-Assisted Image Guidance With Intraoperative Three-Dimensional Imaging

Journal of Spinal Cord Medicine ◽

10.1080/10790268.2008.11753648 ◽

2008 ◽

Vol 31 (5) ◽

pp. 532-537 ◽

Cited By ~ 96

Author(s):

Harvey Smith ◽

Matthew Welsch ◽

Hatice Ugurlu ◽

Rick Sasso ◽

Alexander Vaccaro

Keyword(s):

Radiation Exposure ◽

Pedicle Screw ◽

Image Guidance ◽

Three Dimensional ◽

Screw Placement ◽

Computer Assisted ◽

Pedicle Screw Placement ◽

Three Dimensional Imaging ◽

Computer Assisted Image ◽

Lumbar Pedicle

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Morphometric Measurement of Cortical Bone Trajectory for Lumbar Pedicle Screw Insertion Using Computed Tomography

Journal of Spinal Disorders & Techniques ◽

10.1097/bsd.0b013e318288ac39 ◽

2013 ◽

Vol 26 (6) ◽

pp. E248-E253 ◽

Cited By ~ 72

Author(s):

Keitaro Matsukawa ◽

Yoshiyuki Yato ◽

Osamu Nemoto ◽

Hideaki Imabayashi ◽

Takashi Asazuma ◽

...

Keyword(s):

Computed Tomography ◽

Cortical Bone ◽

Pedicle Screw ◽

Morphometric Measurement ◽

Cortical Bone Trajectory ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Lumbar Pedicle

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CT-to-fluoroscopy registration versus scan-and-plan registration for robot-assisted insertion of lumbar pedicle screws

Neurosurgical FOCUS ◽

10.3171/2021.10.focus21506 ◽

2022 ◽

Vol 52 (1) ◽

pp. E8

Keyword(s):

Pedicle Screw ◽

Lumbar Fusion ◽

Pedicle Screws ◽

Retrospective Chart Review ◽

Robot Assisted ◽

Registration Method ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Radiology Reports ◽

Lumbar Pedicle

OBJECTIVE Pedicle screw insertion for stabilization after lumbar fusion surgery is commonly performed by spine surgeons. With the advent of navigation technology, the accuracy of pedicle screw insertion has increased. Robotic guidance has revolutionized the placement of pedicle screws with 2 distinct radiographic registration methods, the scan-and-plan method and CT-to-fluoroscopy method. In this study, the authors aimed to compare the accuracy and safety of these methods. METHODS A retrospective chart review was conducted at 2 centers to obtain operative data for consecutive patients who underwent robot-assisted lumbar pedicle screw placement. The newest robotic platform (Mazor X Robotic System) was used in all cases. One center used the scan-and-plan registration method, and the other used CT-to-fluoroscopy for registration. Screw accuracy was determined by applying the Gertzbein-Robbins scale. Fluoroscopic exposure times were collected from radiology reports. RESULTS Overall, 268 patients underwent pedicle screw insertion, 126 patients with scan-and-plan registration and 142 with CT-to-fluoroscopy registration. In the scan-and-plan cohort, 450 screws were inserted across 266 spinal levels (mean 1.7 ± 1.1 screws/level), with 446 (99.1%) screws classified as Gertzbein-Robbins grade A (within the pedicle) and 4 (0.9%) as grade B (< 2-mm deviation). In the CT-to-fluoroscopy cohort, 574 screws were inserted across 280 lumbar spinal levels (mean 2.05 ± 1.7 screws/ level), with 563 (98.1%) grade A screws and 11 (1.9%) grade B (p = 0.17). The scan-and-plan cohort had nonsignificantly less fluoroscopic exposure per screw than the CT-to-fluoroscopy cohort (12 ± 13 seconds vs 11.1 ± 7 seconds, p = 0.3). CONCLUSIONS Both scan-and-plan registration and CT-to-fluoroscopy registration methods were safe, accurate, and had similar fluoroscopy time exposure overall.

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How to improve the safety of bicortical pedicle screw insertion in the thoracolumbar vertebrae: Analysis base on three-dimensional CT reconstruction of patients in the prone position

10.21203/rs.2.19695/v2 ◽

2020 ◽

Author(s):

Chao Xu ◽

Qingxian Hou ◽

Yanchen Chu ◽

Xiuling Huang ◽

Wenjiu Yang ◽

...

Keyword(s):

Pedicle Screw ◽

Prone Position ◽

Vertebral Body ◽

Supine Position ◽

Three Dimensional ◽

Vena Cava ◽

Ct Reconstruction ◽

Screw Insertion ◽

Pedicle Screw Insertion ◽

Significant Difference

Abstract Background: Through the comparison of three-dimensional CT reconstruction between the supine position and the prone position, the relative position of thoracolumbar great vessels and vertebral body was studied, and the shortest safe distance between them was measured to improve the safety of bicortical pedicle screw insertion and reduce the risk of vascular injury. Methods: Forty adults were selected to participate the research. Three-dimensional reconstruction of thoracolumbar (T9-L3) CT was performed in the prone position and the supine position. The relative distance between the Aorta/Inferior Vena Cava (IVC) and vertebral body was obtained as AVD/VVD respectively. The relative angle of the Aorta/ IVC and the vertebral body was calculated as ∠AOY/∠VOY. Self-controlled experiments were carried out in the prone and the supine positions, and the data obtained were analyzed using SPSS 22.0 statistical software. Results: The AVD of the prone position and the supine position was the shortest at T12 (3.18 ±0.68mm), but the difference was not statistically significant. The aorta of the T9-L3 segment was shifted from the anterolateral to the anteromedial. The ∠AOY of the other groups differed significantly between the prone and supine positions in all vertebrae except L1 (P < 0.05), and the aorta in the prone position was more anteromedial than that of supine position. With regard to VVD/∠VOY, there was no significant difference between the prone and supine positions (P≥0.05), and the minimum VVD of L3 segment is greater than 5.4mm. The IVC has no obvious mobility and is fixed in the range of 20 °~ 30 ° near the midline. Conclusion: When using bicortical anchoring of pedicle screws, it is safe to ensure that the protruding tips of the screw is less than 3mm. Due to the mobility of the aorta in different postures and individual differences in anatomy, the prone position CT can help doctors to make better preoperative plans and decisions.

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