scholarly journals Utilization of Spinal Intra-operative Three-dimensional Navigation by Canadian Surgeons and Trainees: A Population-based Time Trend Study

2019 ◽  
Vol 46 (1) ◽  
pp. 87-95 ◽  
Author(s):  
Daipayan Guha ◽  
Ali Moghaddamjou ◽  
Zaneen H. Jiwani ◽  
Naif M. Alotaibi ◽  
Michael G. Fehlings ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Spinal Instrumentation ◽  
Population Based ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Capital Costs ◽  
Orthopedic Surgeons ◽  
Surgical Trainees ◽  
Single Payer ◽  
The Impact

AbstractBackgroundComputer-assisted navigation (CAN) improves the accuracy of spinal instrumentation in vertebral fractures and degenerative spine disease; however, it is not widely adopted because of lack of training, high capital costs, workflow hindrances, and accuracy concerns. We characterize shifts in the use of spinal CAN over time and across disciplines in a single-payer health system, and assess the impact of intra-operative CAN on trainee proficiency across Canada.MethodsA prospectively maintained Ontario database of patients undergoing spinal instrumentation from 2005 to 2014 was reviewed retrospectively. Data were collected on treated pathology, spine region, surgical approach, institution type, and surgeon specialty. Trainee proficiency with CAN was assessed using an electronic questionnaire distributed across 15 Canadian orthopedic surgical and neurosurgical programs.ResultsIn our provincial cohort, 16.8% of instrumented fusions were CAN-guided. Navigation was used more frequently in academic institutions (15.9% vs. 12.3%, p<0.001) and by neurosurgeons than orthopedic surgeons (21.0% vs. 12.4%, p<0.001). Of residents and fellows 34.1% were fully comfortable using spinal CAN, greater for neurosurgical than orthopedic surgical trainees (48.1% vs. 11.8%, p=0.008). The use of CAN increased self-reported proficiency in thoracic instrumentation for all trainees by 11.0% (p=0.036), and in atlantoaxial instrumentation for orthopedic trainees by 18.0% (p=0.014).ConclusionsSpinal CAN is used most frequently by neurosurgeons and in academic centers. Most spine surgical trainees are not fully comfortable with the use of CAN, but report an increase in technical comfort with CAN guidance particularly for thoracic instrumentation. Increased education in spinal CAN for trainees, particularly at the fellowship stage and, specifically, for orthopedic surgery, may improve adoption.

scholarly journals P.088 Spinal computer-assisted intra-operative three-dimensional navigation in Canada: a population-based time trend study

2017 ◽  
Vol 44 (S2) ◽  
pp. S35-S36 ◽  
Author(s):  
D Guha ◽  
A Moghaddamjou ◽  
NM Alotaibi ◽  
A Yee ◽  
VX Yang
Keyword(s):  
Temporal Trends ◽  
Three Dimensional ◽  
Population Based ◽  
Learning Curves ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Diagnostic Codes ◽  
Orthopedic Surgeons ◽  
Spinal Fusions ◽  
Univariate Analyses

Background: Spinal computer-assisted navigation (CAN) is proven to increase instrumentation accuracy. Adoption remains limited by workflow restrictions, learning curves and costs. Here, we assess spinal CAN usage among Ontario surgeons to identify gaps in application, and temporal trends of usage. Methods: A prospectively-collected database of provincial insurance billables and diagnostic codes was reviewed retrospectively, from 2002-2014. Patients undergoing instrumented spinal fusions or percutaneous vertebroplasty/kyphoplasty were identified. Fee and diagnostic codes were applied to distinguish surgical indication and approach. The use of intra-operative navigation was determined for each case. Results: We identified 4607 instrumented spinal fusions in our cohort. Most cases were performed by orthopedic surgeons (63.2%) and the remainder by neurosurgeons. Of 2239 cases with identifiable etiology, CAN was utilized in 8.8%, predominantly for trauma and degenerative pathologies rather than deformity. In univariate analyses, CAN was used more often by neurosurgeons (21.0% vs. 12.4%, p<0.001), in academic institutions (15.9% vs. 12.3%, p<0.001), and when performed in/after 2010 (18.9% vs. 8.9%, p<0.001). Differences by specialty and year remained significant in multiple logistic regression. Conclusions: Spinal CAN has proven benefit for instrumentation accuracy, but is used preferentially by academic neurosurgeons. Significant gains must be made in cost and usability to improve access across disciplines and institutions.

scholarly journals GP.01 Quantification of computational geometric congruence in surface-based registration for spinal intra-operative three-dimensional navigation

2017 ◽  
Vol 44 (S2) ◽  
pp. S7-S7
Author(s):  
D Guha ◽  
R Jakubovic ◽  
VX Yang
Keyword(s):  
Cervical Spine ◽  
Spinous Process ◽  
Thoracolumbar Spine ◽  
Three Dimensional ◽  
Spinal Instrumentation ◽  
Computational Modelling ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Subaxial Cervical Spine ◽  
Geometric Symmetry

Background: Computer-assisted navigation (CAN) may guide spinal instrumentation, and requires alignment of patient anatomy to imaging. Iterative-Closest-Point algorithms register anatomical and imaging datasets, which may fail in the presence of significant geometric congruence leading to inaccurate navigation. We computationally quantify geometric congruence in posterior spinal exposures, and identify predictors of potential navigation inaccuracy. Methods: Midline posterior exposures were performed from C1-S1 in four human cadavers. An optically-based CAN generated surface maps of the posterior elements at each level. Maps were reconstructed to include bilateral hemilamina, or unilateral hemilamina with/without the base of the spinous process. Maps were fitted to symmetrical geometries (cylindrical/spherical/planar) using computational modelling, and the degree of model fit quantified. Results: Increased cylindrical/spherical/planar symmetry was seen in the subaxial cervical spine relative to the high-cervical and thoracolumbar spine (p<0.001). Inclusion of the base of the spinous process decreased symmetry independent of spinal level (p<0.001). Registration with bilateral vs. unilateral hemilamina did not significantly reduce geometric symmetry. Conclusions: Geometric congruence is most evident at C1 and the subaxial cervical spine, warranting greater vigilance in navigation accuracy verification. At all levels, inclusion of the base of the spinous process in unilateral registration decreases the likelihood of geometric symmetry and navigation error.

CLINICAL VALIDATION OF A NOVEL SPRING LOADED TENSIONING DEVICE AND COMPUTER ASSISTED NAVIGATION

2006 ◽  
Vol 06 (01) ◽  
pp. 13-18
Author(s):  
S. BIGNOZZI ◽  
S. ZAFFAGNINI ◽  
S. MARTELLI ◽  
M. MARCACCI
Keyword(s):  
Randomized Study ◽  
Computer Software ◽  
Constant Load ◽  
Computer Assisted ◽  
Data Sets ◽  
Clinical Validation ◽  
Qualitative Comparison ◽  
Assisted Navigation ◽  
Orthopedic Surgeons ◽  
Ligament Tension

This study presents the validation of the tensioning device that applies a constant load to the medial and lateral compartments of knee joint separately, which can collapse or expand on each side independently, and that should be able to provide a better evaluation of ligament tension and allow the computer software to better plan the appropriate bone cuts or ligament release, and reports the first phase of the clinical validation of the tensioning device, including first qualitative comparison with standard navigated technique and consideration on the use of the device. A randomized study, involving five experienced orthopedic surgeons with 58 complete data sets, revealed that there is no statistical difference between the gaps obtained with standard navigated technique and tensioning device in extension, while in flexion there is an average difference 1.4 mm.

scholarly journals Application of a new percutaneous multi-function pedicle locator in minimally invasive spine surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xiaojian Liu ◽  
Hairun Liu ◽  
Yushan Wang
Keyword(s):  
Minimally Invasive ◽  
Spine Surgery ◽  
Three Dimensional ◽  
Operation Time ◽  
Minimally Invasive Spine Surgery ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Number Of Patients ◽  
Potential Benefits ◽  
Minimally Invasive Spine

AbstractIn this study, a new percutaneous multi-function pedicle locator was designed for personalized three-dimensional positioning of a pedicle in minimally invasive spine surgery (MISS) without computer-assisted navigation technology. The proposed locator was used in a number of patients during MISS, and its advantages were analyzed. Based on the position of a pedicle determined by computed tomography (CT) and fluoroscopic images of a patient, 6 lines and 2 distances were used to determine the puncture point of a pedicle screw on skin, while 2 angles were used to indicate the direction of insertion of a pedicle guide needle from the patient's body surface. The results of the proposed locator were compared with those of the conventional freehand technique in MISS. The potential benefits of using the locator included enhanced surgical accuracy, reduced operation time, alleviation of the harmful intra-operative radiation exposure, lower costs, and shortened learning curve for young orthopedists.

scholarly journals Present and Future Spinal Robotic and Enabling Technologies

2021 ◽  
Vol 21 (Supplement_1) ◽  
pp. S48-S56
Author(s):  
Siri Sahib S Khalsa ◽  
Praveen V Mummaneni ◽  
Dean Chou ◽  
Paul Park
Keyword(s):  
Intraoperative Imaging ◽  
Three Dimensional ◽  
Robotic Systems ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Planning Software ◽  
Enabling Technologies ◽  
Advanced Planning ◽  
Spinal Navigation

Abstract Enabling technologies include surgical planning software, computer-assisted navigation, intraoperative three-dimensional (3D) imaging, and robotic systems. Presently, these technologies are in various stages of refinement. Spinal robots in particular are currently limited to the positioning of an alignment guide for pedicle screw placement. Current generation spinal robots, therefore, play a more limited role in spinal surgery. In contrast to spinal robots, intraoperative imaging technology has been developed further, to a stage that allows accurate 3D spinal image acquisition that can be readily utilized for spinal navigation. The integration of these various technologies has the potential to maximize the safety, consistency, reliability, and efficacy of surgical procedures. To that end, the trend for manufacturers is to incorporate various enabling technologies into the spinal robotic systems. In the near-term, it is expected that integration of more advanced planning software and navigation will result in wider applicability and value. In the long-term, there are a variety of enabling technologies such as augmented reality that may be a component of spinal robots. This article reviews the features of currently available spinal robots and discusses the likely future advancements of robotic platforms in the near- and long-term.

scholarly journals Efficacy of a simple intraoperative stem-anteversion measuring device in total hip arthroplasty

2020 ◽  
Author(s):  
Kentaro Iwakiri ◽  
Yoichi Ohta ◽  
Yohei Ohyama ◽  
Yukihide Minoda ◽  
Akio Kobayashi ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Three Dimensional ◽  
Computer Assisted ◽  
Level Of Evidence ◽  
Measuring Device ◽  
Correction Angle ◽  
Assisted Navigation ◽  
Total Hip ◽  
Flexion Extension

Abstract Background Background: Stem anteversion is important in reducing postoperative complications in total hip arthroplasty (THA). THA utilizing the combined-anteversion theory requires stem anteversion angle (SAA) measurement intraoperatively; however, intraoperative SAA estimation is difficult for surgeons without computer-assisted navigation system. We evaluated the accuracy of the SAA measured intraoperatively using a newly developed device by comparing the three-dimensional measurements using postoperative computed tomography (CT).Materials & Methods In 127 hips in 127 patients who underwent unilateral THA at our hospital, we used our newly developed device that can be easily attached to rasping broach handles for measuring the SAA intraoperatively, which required the addition of the correction angle obtained in the preoperative epicondylar view. Postoperative SAA and its discrepancies from the measured intraoperative SAA with or without adding the correction angle were compared between the groups to evaluate the usefulness of the device.Results The intraoperative SAA measured by the device was 17.93 ± 7.53°. The true SAA measured on postoperative CT was 26.40 ± 9.73°. The discrepancy between the intraoperative SAA and true SAA was 8.94 ± 5.44° (without the correction angle), and 4.93 ± 3.85° (with the correction angle). Accuracy with a discrepancy of <5 degrees was achieved in 77 (60.6%) and <10 degrees was achieved in 113 (89.0%). The accuracy was unaffected by the stem placement angle (varus/valgus, or flexion/extension), or ipsilateral knee osteoarthritis.Conclusion The SAA measuring device, easily attachable to various rasping handles, is useful to measure the intraoperative SAA in a simple, economical, and noninvasive manner during THA.Level of Evidence Therapeutic Level IV.

scholarly journals A national mixed-mode seroprevalence random population-based cohort on SARS-CoV-2 epidemic in France: the socio-epidemiological EpiCov study

2021 ◽  
Author(s):  
Josiane WARSZAWSKI ◽  
Nathalie BAJOS ◽  
Muriel BARLET ◽  
Xavier de LAMBALLERIE ◽  
Delphine RAHIB ◽  
...  
Keyword(s):  
Survey Methodology ◽  
Poverty Line ◽  
Population Based ◽  
Living Conditions ◽  
The Other ◽  
Computer Assisted ◽  
Population Census ◽  
Poverty Level ◽  
Wide Range ◽  
The Impact

Background: the EpiCov study, initiated at the end of the first national lockdown in France, aimed to provide national and regional estimates of the seroprevalence of SARS-CoV-2 infection, and to analyze relations between living conditions and the dynamics of the epidemic. We present and discuss here the survey methodology, and describe the first-round fieldwork. Method: 371,000 individuals aged 15 years or more were randomly selected from the national tax register, stratified by departments, including three overseas departments, and by poverty level with over-representation of people living below the poverty line. Health, socio-economics, migration history, and living conditions were collected through self-computed-assisted web interviews or via computer-assisted telephone interviews. The first-round survey was conducted in May. A random subsample was eligible to receive material for home blood self-sample on dried blood spot (DBS), in order to detect IgG antibodies against the spike protein (Euroimmun ELISA-S), and neutralizing antibodies for non-negative ELISA-S. For the second-round conducted in November, all respondents were eligible for the antibodies detection from home DBS sample, as well as the other household members aged 6 years or more for 20% of them. Participation and adjustment for nonresponse: 134,391 respondents completed the first-round questionnaire from May 2 to June 1, 2020, including 16,970 (12.6%) respondents under the poverty line. Multimodal web/tel interviews was randomly assigned to 20% of the sample. The other were assigned to exclusive CAWI. Overall 17,441 respondents were eligible for home blood sample, among them 12,114 returned the DBS (interquartile date: May 25- June 5). The response probability was first estimated from logit models adjusted on a wide range of auxiliary demographic and socio-economic variables available from the sampling frame, and final weights calibrated to the margins of the population census permitted to correct for a large part of the non-response bias. Conclusion: The Epicov study is one of the largest national random population-based seroprevalence cohort, with both an epidemiological and sociological approaches to evaluate the spread of the COVID-19 epidemic, and the impact on health and living conditions. One of the major interests of this study is the broad coverage of the socio-economic and territorial diversity of the population.

The effect of simulation training on resident proficiency in thoracolumbar pedicle screw placement using computer-assisted navigation

2021 ◽  
Vol 34 (1) ◽  
pp. 127-134
Author(s):  
Andrew M. Gardeck ◽  
Xuan Pu ◽  
Qiuyu Yang ◽  
David W. Polly ◽  
Kristen E. Jones
Keyword(s):  
Pedicle Screw ◽  
Orthopedic Surgery ◽  
Simulation Training ◽  
Spinal Instrumentation ◽  
Screw Placement ◽  
Computer Assisted ◽  
Pedicle Screw Placement ◽  
Assisted Navigation ◽  
Significant Difference ◽  
Standardized Curriculum

OBJECTIVEResidency work-hour restrictions necessitate efficient, reproducible training. Simulation training for spinal instrumentation placement shows significant benefit to learners’ subjective and objective proficiency. Cadaveric laboratories are most effective but have high cost and low availability. The authors’ goal was to create a low-cost, efficient, reproducible spinal instrumentation placement simulation curriculum for neurosurgery and orthopedic surgery residents using synthetic models and 3D computer-assisted navigation, assessing subjective and objective proficiency with placement of thoracolumbar pedicle screws.METHODSFifteen neurosurgery and orthopedic surgery residents participated in a standardized curriculum with lecture followed by two separate sessions of thoracolumbar pedicle screw placement in a synthetic spine model utilizing 3D computer-assisted navigation. Data were collected on premodule experience, time and accuracy of screw placement, and both subjective and objective ratings of proficiency.RESULTSFifteen of 15 residents demonstrated improvement in subjective (Physician Performance Diagnostic Inventory Scale [PPDIS]) and 14 in objective (Objective Structured Assessment of Technical Skills [OSATS]) measures of proficiency in navigated screw placement with utilization of this curriculum (p < 0.001 for both), regardless of the number of cases of previous experience using thoracolumbar spinal instrumentation. Fourteen of 15 residents demonstrated decreased time per screw placement from session 1 to session 2 (p = 0.006). There was no significant difference in pedicle screw accuracy between session 1 and session 2.CONCLUSIONSA standardized curriculum using synthetic simulation training for navigated thoracolumbar pedicle screw placement results in significantly improved resident subjective and objective proficiency. Development of a nationwide competency curriculum using simulation training for spinal instrumentation placement should be considered for safe, efficient resident training.

scholarly journals Improving patient safety and efficiency of medication reconciliation through the development and adoption of a computer-assisted tool with automated electronic integration of population-based community drug data: the RightRx project

2017 ◽  
Vol 25 (5) ◽  
pp. 482-495 ◽  
Author(s):  
Robyn Tamblyn ◽  
Nancy Winslade ◽  
Todd C Lee ◽  
Aude Motulsky ◽  
Ari Meguerditchian ◽  
...  
Keyword(s):  
Medication Reconciliation ◽  
Health Centre ◽  
Cluster Randomized Trial ◽  
Patient Characteristics ◽  
Population Based ◽  
Agile Development ◽  
Computer Assisted ◽  
User Centered Design ◽  
Control Units ◽  
The Impact

Abstract Background and Objective Many countries require hospitals to implement medication reconciliation for accreditation, but the process is resource-intensive, thus adherence is poor. We report on the impact of prepopulating and aligning community and hospital drug lists with data from population-based and hospital-based drug information systems to reduce workload and enhance adoption and use of an e-medication reconciliation application, RightRx. Methods The prototype e-medical reconciliation web-based software was developed for a cluster-randomized trial at the McGill University Health Centre. User-centered design and agile development processes were used to develop features intended to enhance adoption, safety, and efficiency. RightRx was implemented in medical and surgical wards, with support and training provided by unit champions and field staff. The time spent per professional using RightRx was measured, as well as the medication reconciliation completion rates in the intervention and control units during the first 20 months of the trial. Results Users identified required modifications to the application, including the need for dose-based prescribing, the role of the discharge physician in prescribing community-based medication, and access to the rationale for medication decisions made during hospitalization. In the intervention units, both physicians and pharmacists were involved in discharge reconciliation, for 96.1% and 71.9% of patients, respectively. Medication reconciliation was completed for 80.7% (surgery) to 96.0% (medicine) of patients in the intervention units, and 0.7% (surgery) to 82.7% of patients in the control units. The odds of completing medication reconciliation were 9 times greater in the intervention compared to control units (odds ratio: 9.0, 95% confidence interval, 7.4-10.9, P &lt; .0001) after adjusting for differences in patient characteristics. Conclusion High rates of medication reconciliation completion were achieved with automated prepopulation and alignment of community and hospital medication lists.

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