85. Comparison of novel machine vision image guidance system with a 3D fluoroscopy-based platform for pedicle screw placement: a randomized prospective study of radiation, accuracy, and cost

Object The goal of this study was to compare the accuracy of thoracic pedicle screw placement aided by two different image-guidance modalities. Methods The charts of 40 consecutive patients who had undergone stabilization of the thoracic spine between January 2003 and January 2005 were retrospectively reviewed. Three patients were excluded from the study because, on the basis of preoperative findings, small pedicle diameter precluded the use of pedicle screws. Thus, a total of 37 patients had 277 screws placed with the aid of either virtual fluoroscopy or isocentric C-arm 3D navigation. The indications for surgery included trauma, degenerative disease, and tumor, and were similar in both groups. All 37 patients underwent postoperative computed tomography scanning, and an independent reviewer graded all screws based on axial, sagittal, and coronal projections for a full determination of the placement of the screw in the pedicle. Results The rate of unintended perforations was found to depend on pedicle diameter (p < 0.0001). There were no statistical differences between groups with regard to rate or grade of cortical perforations. Overall, the rate and grade of perforations was low, and there were no neurological or vascular complications. Conclusions The authors have shown that either image-guidance system may be used with a high degree of accuracy and safety. Because both systems were found to be comparably safe and accurate, the choice of image-guidance modality may be determined by the level of surgeon comfort and/or availability of the system.

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Comparison of novel machine vision spinal image guidance system with existing 3D fluoroscopy-based navigation system: a randomized prospective study

The Spine Journal ◽

10.1016/j.spinee.2021.10.002 ◽

2021 ◽

Author(s):

Gregory M. Malham ◽

Nigel R. Munday

Keyword(s):

Machine Vision ◽

Prospective Study ◽

Navigation System ◽

Image Guidance ◽

Guidance System ◽

3D Fluoroscopy ◽

System A ◽

Spinal Image

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Image-guid ed thoracic pedicle screw placement: a technical study in cadavers and preliminary clinical experience

Neurosurgical FOCUS ◽

10.3171/foc.2001.10.2.3 ◽

2001 ◽

Vol 10 (2) ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Kee D. Kim ◽

J. Patrick Johnson ◽

Jesse D. Babbitz

Keyword(s):

Pedicle Screw ◽

Image Guidance ◽

Pedicle Screws ◽

Guidance System ◽

Basic Knowledge ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Image Guided ◽

Thoracic Pedicle Screw ◽

Thoracic Pedicle Screws

Object Thoracic pedicle screw fixation is effective and reliable in providing short-segment stabilization. Although the procedure is becoming more widely used, accurate insertion of the screws is difficult due to the small dimensions of thoracic pedicles, and the associated risk is high due to the proximity of the spinal cord. In previous studies authors have shown the accuracy of image-guided lumbar pedicle screw placement, but there have been no reported investigations into the accuracy of image-guided thoracic pedicle screw placement. The authors report their experience with such an investigation. Methods To evaluate the accuracy of image-guided thoracic pedicle screw placement in vitro and in vivo, thoracic pedicle screws were placed with an image-guidance system in five human cadavers and 10 patients. In cadavers, the accuracy of screw placement was assessed by postoperative computerized tomography and visual inspection and in patients by postoperative imaging studies. Of the 120 pedicle screws placed in five cadavers pedicle violation occurred in 23 cases (19.2%); there was one pedicle violation (4.2%) in each of the last two cadavers. Of the 45 pedicle screws placed in 10 patients, pedicle violations occurred in three (6.7%). Conclusions In comparison with historical controls, the accuracy of thoracic pedicle screw placement is improved with the use of an image-guidance system. It allows the surgeon to visualize the thoracic pedicle and the surrounding structures that are normally out of the surgical field of view. The surgeon, however, must be aware of the limitations of an image-guidance system and have a sound basic knowledge of spinal anatomy to avoid causing serious complications.

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The accuracy of pedicle screw placement using intraoperative image guidance systems

Journal of Neurosurgery Spine ◽

10.3171/2013.11.spine13413 ◽

2014 ◽

Vol 20 (2) ◽

pp. 196-203 ◽

Cited By ~ 155

Author(s):

Alexander Mason ◽

Renee Paulsen ◽

Jason M. Babuska ◽

Sharad Rajpal ◽

Sigita Burneikiene ◽

...

Keyword(s):

Pedicle Screw ◽

Image Guidance ◽

Pedicle Screws ◽

Screw Placement ◽

Data Sets ◽

Pedicle Screw Placement ◽

Fluoroscopic Image ◽

Fluoroscopic Navigation ◽

Guidance Systems ◽

Accuracy Rates

Object Several retrospective studies have demonstrated higher accuracy rates and increased safety for navigated pedicle screw placement than for free-hand techniques; however, the accuracy differences between navigation systems has not been extensively studied. In some instances, 3D fluoroscopic navigation methods have been reported to not be more accurate than 2D navigation methods for pedicle screw placement. The authors of this study endeavored to identify if 3D fluoroscopic navigation methods resulted in a higher placement accuracy of pedicle screws. Methods A systematic analysis was conducted to examine pedicle screw insertion accuracy based on the use of 2D, 3D, and conventional fluoroscopic image guidance systems. A PubMed and MEDLINE database search was conducted to review the published literature that focused on the accuracy of pedicle screw placement using intraoperative, real-time fluoroscopic image guidance in spine fusion surgeries. The pedicle screw accuracy rates were segregated according to spinal level because each spinal region has individual anatomical and morphological variations. Descriptive statistics were used to compare the pedicle screw insertion accuracy rate differences among the navigation methods. Results A total of 30 studies were included in the analysis. The data were abstracted and analyzed for the following groups: 12 data sets that used conventional fluoroscopy, 8 data sets that used 2D fluoroscopic navigation, and 20 data sets that used 3D fluoroscopic navigation. These studies included 1973 patients in whom 9310 pedicle screws were inserted. With conventional fluoroscopy, 2532 of 3719 screws were inserted accurately (68.1% accuracy); with 2D fluoroscopic navigation, 1031 of 1223 screws were inserted accurately (84.3% accuracy); and with 3D fluoroscopic navigation, 4170 of 4368 screws were inserted accurately (95.5% accuracy). The accuracy rates when 3D was compared with 2D fluoroscopic navigation were also consistently higher throughout all individual spinal levels. Conclusions Three-dimensional fluoroscopic image guidance systems demonstrated a significantly higher pedicle screw placement accuracy than conventional fluoroscopy or 2D fluoroscopic image guidance methods.

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Spine Navigation Based on 3-Dimensional Robotic Fluoroscopy for Accurate Percutaneous Pedicle Screw Placement: A Prospective Study of 66 Consecutive Cases

World Neurosurgery ◽

10.1016/j.wneu.2017.08.149 ◽

2017 ◽

Vol 108 ◽

pp. 76-83 ◽

Cited By ~ 16

Author(s):

Edward Fomekong ◽

Salah Edine Safi ◽

Christian Raftopoulos

Keyword(s):

Prospective Study ◽

Pedicle Screw ◽

Screw Placement ◽

Pedicle Screw Placement ◽

3 Dimensional ◽

Percutaneous Pedicle Screw ◽

A Prospective Study ◽

Spine Navigation

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Placement of thoracic transvertebral pedicle screws using 3D image guidance

Journal of Neurosurgery Spine ◽

10.3171/2013.2.spine12819 ◽

2013 ◽

Vol 18 (5) ◽

pp. 479-483 ◽

Cited By ~ 19

Author(s):

Eric W. Nottmeier ◽

Stephen M. Pirris

Keyword(s):

Pedicle Screw ◽

Image Guidance ◽

Pedicle Screws ◽

Guidance System ◽

Ct Scans ◽

Screw Placement ◽

Clinical Consequence ◽

3D Image ◽

Cortical Layers ◽

Disc Space

Object Transvertebral pedicle screws have successfully been used in the treatment of high-grade L5–S1 spondylolisthesis. An advantage of transvertebral pedicle screws is the purchase of multiple cortical layers across 2 vertebrae, thereby increasing the stability of the construct. At the lumbosacral junction, transvertebral pedicle screws have been shown to be biomechanically superior to pedicle screws placed in the standard fashion. The use of transvertebral pedicle screws at spinal levels other than L5–S1 has not been reported in the literature. The authors describe their technique of transvertebral pedicle screw placement in the thoracic spine using 3D image guidance. Methods Twelve patients undergoing cervicothoracic or thoracolumbar fusion had 41 thoracic transvertebral pedicle screws placed across 26 spinal levels using this technique. Indications for placement of thoracic transvertebral pedicle screws in earlier cases included osteoporosis and pedicle screw salvage. However, in subsequent cases screws were placed in patients undergoing multilevel thoracolumbar fusion without osteoporosis, particularly near the top of the construct. Image guidance in this study was accomplished using the Medtronic StealthStation S7 image guidance system used in conjunction with the O-arm. All patients were slated to undergo postoperative CT scanning at approximately 4–6 months for fusion assessment, which also allowed for grading of the transvertebral pedicle screws. Results No thoracic transvertebral pedicle screw placed in this study had to be replaced or repositioned after intraoperative review of the cone beam CT scans. Review of the postoperative CT scans revealed all transvertebral screws to be across the superior disc space with the tips in the superior vertebral body. Six pedicle screws were placed using the in-out-in technique in patients with narrow pedicles, leaving 35 screws that underwent breach analysis. No pedicle breach was noted in 34 of 35 screws. A Grade 1 (< 2 mm) medial breach was noted in 1 screw without clinical consequence. Solid fusion was observed across 25 of 26 spinal levels that underwent transvertebral screw placement including 7 spinal levels located at the top of a multilevel construct. Conclusions This report describes the authors' initial in vivo experience with the 3D image-guided placement of 41 thoracic transvertebral pedicle screws. Advantages of thoracic transvertebral screws include the purchase of 2 vertebral segments across multiple cortical layers. A high fusion rate was observed across spinal levels in which transvertebral screws were placed. A formal biomechanical study is needed to assess the biomechanical advantages of this technique and is currently being planned.

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Accuracy of percutaneous lumbar pedicle screw placement using the oblique or “owl's-eye” view and novel guidance technology

Journal of Neurosurgery Spine ◽

10.3171/2010.4.spine09580 ◽

2010 ◽

Vol 13 (4) ◽

pp. 509-515 ◽

Cited By ~ 35

Author(s):

Cary Idler ◽

Kevin W. Rolfe ◽

Josef E. Gorek

Keyword(s):

Pedicle Screw ◽

Facet Joint ◽

Pedicle Screws ◽

Guidance System ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Screw Insertion ◽

Percutaneous Pedicle Screw ◽

Clinical Series ◽

Lumbar Pedicle

Object This study was conducted to assess the in vivo safety and accuracy of percutaneous lumbar pedicle screw placement using the owl's-eye view of the pedicle axis and a new guidance technology system that facilitates orientation of the C-arm into the appropriate fluoroscopic view and the pedicle cannulation tool in the corresponding trajectory. Methods A total of 326 percutaneous pedicle screws were placed from L-3 to S-1 in 85 consecutive adult patients. Placement was performed using simple coaxial imaging of the pedicle with the owl's-eye fluoroscopic view. NeuroVision, a new guidance system using accelerometer technology, helped align the C-arm trajectory into the owl's-eye view and the cannulation tool in the same trajectory. Postoperative fine-cut CT scans were acquired to assess screw position. Medical records were reviewed for complications. Results Five of 326 screws breached a pedicle cortex—all breaches were less than 2 mm—for an accuracy rate of 98.47%. Five screws violated an adjacent facet joint. All were at the S-1 superior facet and included in a fusion. No screw violated an adjacent mobile facet or disc space. There were no cases of new or worsening neurological symptoms or deficits for an overall clinical accuracy of 100%. Conclusions The owl's-eye technique of coaxial pedicle imaging with the C-arm fluoroscopy, facilitated by NeuroVision, is a safe and accurate means by which to place percutaneous pedicle screws for degenerative conditions of the lumbar spine. This is the largest series reported to use the oblique or owl's-eye projection for percutaneous pedicle screw insertion. The accuracy of percutaneous screw insertion with this technique meets or exceeds that of other reported clinical series or techniques.

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