Validation and accuracy of intraoperative CT scan using the Philips AlluraXper FD20 angiography suite for assessment of spinal instrumentation

2017 ◽  
Vol 31 (6) ◽  
pp. 741-746 ◽  
Author(s):  
Edin Nevzati ◽  
Javier Fandino ◽  
Bawarjan Schatlo ◽  
Michel Heimberg ◽  
Serge Marbacher ◽  
...  
Keyword(s):  
Ct Scan ◽  
Spinal Instrumentation ◽  
Intraoperative Ct ◽  
Angiography Suite

Intraoperative computed tomography image–guided navigation for posterior thoracolumbar spinal instrumentation in spinal deformity surgery

2010 ◽  
Vol 28 (3) ◽  
pp. E11 ◽  
Author(s):  
Matthew J. Tormenti ◽  
Dean B. Kostov ◽  
Paul A. Gardner ◽  
Adam S. Kanter ◽  
Richard M. Spiro ◽  
...  
Keyword(s):  
Ct Scan ◽  
Spinal Deformity ◽  
Image Guidance ◽  
Wound Closure ◽  
Comparison Group ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Ct Scanning ◽  
Intraoperative Ct ◽  
Spinal Deformity Surgery

Object Placement of thoracolumbar pedicle screws in spinal deformity surgery has a reported inaccuracy rate as high as 30%. At present, image-guided navigation systems designed to improve instrumentation accuracy typically use intraoperative fluoroscopy or preoperative CT scans. The authors report the prospective evaluation of the accuracy of posterior thoracolumbar spinal instrumentation using a new intraoperative CT operative suite with an integrated image guidance system. They compare the accuracy of thoracolumbar pedicle screw placement using intraoperative CT image guidance with instrumentation placement utilizing fluoroscopy. Methods Between December 2007 and July 2008, 12 patients underwent posterior spinal instrumentation for spinal deformity correction using intraoperative CT-based image guidance. An intraoperative CT scan of the sterile surgical field was obtained after decompression and before instrumentation. Instrumentation was placed, and a postinstrumentation CT scan was obtained before wound closure to assess the accuracy of instrumentation placement and the potential need for revision. The accuracy of pedicle screw placement was later reviewed and recorded by independent observers. A comparison group of 14 patients who underwent thoracolumbar instrumentation utilizing fluoroscopy and postoperative CT scanning during the same time period was evaluated and included in this analysis. Results In the intraoperative CT-based image guidance group, a total of 164 thoracolumbar pedicle screws were placed. Two screws were found to have breached the pedicle wall (1.2%). Neither screw was deemed to need revision due to misplacement. In the comparison group, 211 pedicle screws were placed. Postoperative CT scanning revealed that 11 screws (5.2%) had breached the pedicle. One patient in the fluoroscopy group awoke with a radiculopathy attributed to a misplaced screw, which required revision. The difference in accuracy was statistically significant (p = 0.031). Conclusions Intraoperative CT-based image guidance for placement of thoracolumbar instrumentation has an accuracy that exceeds reported rates with other image guidance systems, such as virtual fluoroscopy and 3D isocentric C-arm-based stereotactic systems. Furthermore, with the use of intraoperative CT scanning, a postinstrumentation CT scan allows the surgeon to evaluate the accuracy of instrumentation before wound closure and revise as appropriate.

The Use of Skin Staples as Fiducial Markers to Confirm Intraoperative Spinal Navigation Registration and Accuracy

2021 ◽  
Author(s):  
Christopher Alvarez-Breckenridge ◽  
Matthew Muir ◽  
Laurence D Rhines ◽  
Claudio E Tatsui
Keyword(s):  
Minimally Invasive ◽  
Ct Scan ◽  
Image Guidance ◽  
Low Cost ◽  
Spinal Instrumentation ◽  
Fiducial Marker ◽  
Intraoperative Ct ◽  
Intraoperative Computed Tomography ◽  
Skin Staples ◽  
Spinal Navigation

Abstract BACKGROUND With the advent of intraoperative computed tomography (CT) for image guidance, numerous examples of accurate navigation being applied to cranial and spinal pathology have come to light. For spinal disorders, the utilization of image guidance for the placement of percutaneous spinal instrumentation, complex osteotomies, and minimally invasive approaches are frequently utilized in trauma, degenerative, and oncological pathologies. The use of intraoperative CT for navigation, however, requires a low target registration error that must be verified throughout the procedure to confirm the accuracy of image guidance. OBJECTIVE To present the use of skin staples as a sterile, economical fiducial marker for minimally invasive spinal procedures requiring intraoperative CT navigation. METHODS Staples are applied to the skin prior to obtaining the registration CT scan and maintained throughout the remainder of the surgery to facilitate confirmation of image guidance accuracy. RESULTS This low-cost, simple, sterile approach provides surface landmarks that allow reliable verification of navigation accuracy during percutaneous spinal procedures using intraoperative CT scan image guidance. CONCLUSION The utilization of staples as a fiducial marker represents an economical and easily adaptable technique for ensuring accuracy of image guidance with intraoperative CT navigation.

Computed Tomography-Based Image-Guided System in Spinal Surgery

2015 ◽  
Vol 11 (1) ◽  
pp. 59-68 ◽  
Author(s):  
Francesco Costa ◽  
Gianluigi Dorelli ◽  
Alessandro Ortolina ◽  
Andrea Cardia ◽  
Luca Attuati ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Spinal Instrumentation ◽  
P Value ◽  
Fisher Exact Test ◽  
Navigation Systems ◽  
Intraoperative Ct ◽  
Image Guided ◽  
Group I ◽  
Group Ii

Abstract BACKGROUND Image-guided navigation systems (IGS) grant excellent clinical and radiological results, minimizing risks correlated with spinal instrumentation. However, there is some concern regarding the real need for IGS and its indications. OBJECTIVE To analyze the accuracy, technical aspect, and radiation exposure data of the principal IGS based on computed tomography (CT) imaging. METHODS The data of all patients treated for spinal instrumentation with the aid of an IGS system from January 2003 to March 2013 were retrospectively analyzed. We defined 2 groups: group I with an IGS system based on a preoperative CT scan; group II relied on an intraoperative CT scan. Screw accuracy was assessed with a postoperative CT scan control. Radiation dosage for patients was defined by using the technical parameters and dose report data. Statistical analysis was performed using the Fisher exact test with a significance of 5% (P value < .05). RESULTS Two thousand twenty patients and 11 144 screws were analyzed. Group I had 794 patients (4246 screws); the accuracy was 96.1%. Group II had 1226 patients (6898 screws) treated, with 98.5% accuracy (P = .001). The radiation dose analysis showed better results in group II, with significant reduction of the effective dose to the patient. CONCLUSION The IGS based on an intraoperative CT scan grants excellent results, eliminating the rate of reoperation for misplaced instrumentations (screws, plate, and cage) or for inadequate bone decompression. However, this technology cannot replace the surgical skills, experience, and knowledge necessary for spine surgery.

Patient and Surgeon Radiation Exposure during Spinal Instrumentation Using Intraoperative CT-Based Navigation

2015 ◽  
Vol 15 (10) ◽  
pp. S169 ◽  
Author(s):  
Daniel Mendelsohn ◽  
Jason Strelzow ◽  
Nicolas Dea ◽  
Juliet N. Batke ◽  
Charles G. Fisher ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Spinal Instrumentation ◽  
Intraoperative Ct

Treatment of fresh thoracolumbar vertebral burst fracture based on intraoperative CT scan

2020 ◽  
Author(s):  
yuwei li ◽  
wei cui ◽  
Peng Zhou ◽  
Cheng Li ◽  
Wei Xiao ◽  
...  
Keyword(s):  
Treatment Group ◽  
Ct Scan ◽  
Cobb Angle ◽  
Dura Mater ◽  
Spinal Canal ◽  
Control Group ◽  
Intraoperative Ct ◽  
Bleeding Volume ◽  
Significant Difference ◽  
Cord Injury

Abstract ObjectiveTo evaluate the value of intraoperative CT scanning in the treatment of fresh thoracolumbar burst fractures .MethodThe data of patients with thoracolumbar fractures from January 2008 to January 2015 were analyzed retrospectively,79 cases were treatment group which were treated with intraoperative CT scan and decompression mode was determined according to CT scan results during the period from October 2012 to January 2015; 82 patients as the observation group were treated without intraoperative CT scan and direct laminectomy were performed during the period from January 2008 to October 2012. In the treatment group, it is no further decompression of the spinal canal when the CT showed a reduction of the fracture block into the spinal canal, If the intraoperative CT showed that the fractures still occupied the spinal dura mater according to the three-dimensional CT information, The position and the size of the fracture of the spinal canal were determined, and the unilateral laminectomy was performed corresponding to the position of the lamina and intervertebral ligamentum flavum. The operative time, bleeding volume, neurological function, height of the anterior vertebral compression and Cobb angle were compared between the two groups.ResultIn the treatment group, CT scan showed 48 cases (60.8%) entered the spinal canal fracture completely or basically reset .31 cases (39.2%) still occupied the spinal canal compression spinal dura mater. There were significant differences in the operation time and bleeding volume between the two groups. The treatment group was less than the control group. There was no infection, secondary spinal cord injury, loose fixation and other complications. There was no difference in the ASIA classification before and after operation. The anterior vertebral height and COBB angle of the two groups were significantly improved compared with those before operation. There was no significant difference between the two groups in the postoperative height and COBB angle, but after 2 years the difference was statistically significant between the two groups, to retain the rear ligament complex treatment group was significantly better than the control group.ConclusionPatients of thoracolumbar vertebral fracture in hyperextension position combined with internal fixation can achieve good correction effect. Orthopedic postoperative CT scan and according to the results of the scan precision treatment can simplify the operation, there was no difference in clinical efficacy compared with total laminectomy, but some patients avoid the spinal canal decompression and part were treated by small fenestration laminectomy decompression, which is conducive to the protection of spinouts ligament complex integrity.

scholarly journals Is the Additional Effort for an Intraoperative CT Scan Justified for Distal Radius Fracture Fixations? A Comparative Clinical Feasibility Study

2020 ◽  
Vol 9 (7) ◽  
pp. 2254 ◽  
Author(s):  
Sascha Halvachizadeh ◽  
Till Berk ◽  
Alexander Pieringer ◽  
Emanuael Ried ◽  
Florian Hess ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Radiation Dose ◽  
Ct Scan ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Ct Scans ◽  
Radius Fractures ◽  
Ao Classification ◽  
Intraoperative Ct ◽  
Duration Of Surgery

Introduction: It is currently unclear whether the additional effort to perform an intraoperative computed tomography (CT) scan is justified for articular distal radius fractures (DRFs). The purpose of this study was to assess radiological, functional, and clinical outcomes after surgical treatment of distal radius fractures when using conventional fluoroscopy vs. intraoperative CT scans. Methods: Inclusion criteria: Surgical treatment of DRF between 1 January 2011 and 31 December 2011, age 18 and above. Group distribution: intraoperative conventional fluoroscopy (Group Conv) or intraoperative CT scans (Group CT). Exclusion criteria: Use of different image intensifier devices or incomplete data. DRF classification according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification. Outcome variables included requirement of revision surgeries, duration of surgery, absorbed radiation dose, and requirement of additional CT scans during hospitalization. Results: A total of 187 patients were included (Group Conv n = 96 (51.3%), Group CT n = 91 (48.7%)). AO Classification: Type A fractures n = 40 (50%) in Group Conv vs. n = 16 (17.6%) in Group CT, p < 0.001; Type B: 10 (10.4%) vs. 11 (12.1%), not significant (n.s.); Type C: 38 (39.6%) vs. 64 (70.3%), p < 0.001. In Group Conv, four (4.2%) patients required revision surgeries within 6 months, but in Group CT no revision surgery was required. The CT scan led to an intraoperative screw exchange/reposition in 23 (25.3%) cases. The duration of the initial surgery (81.7 ± 46.4 min vs. 90.1 ± 43.6 min, n.s.) was comparable. The radiation dose was significantly higher in Group CT (6.9 ± 1.3 vs. 2.8 ± 7.8 mGy, p < 0.001). In Group Conv, 11 (11.5%) patients required additional CT scans during hospitalization. Conclusion: The usage of intraoperative CT was associated with improved reduction and more adequate positioning of screws postoperatively with comparable durations of surgery. Despite increased efforts by utilizing the intraoperative CT scan, the decrease in reoperations may justify its use.

Intraoperative CT Scan Verification of Pedicle Screw Placement in AIS to Prevent Malpositioned Screws: Safety Benefit and Cost

2018 ◽  
Vol 6 (6) ◽  
pp. 662-668 ◽  
Author(s):  
Jennifer M. Bauer ◽  
Jeffrey A. Moore ◽  
Rajiv Rangarajan ◽  
Brian S. Gibbs ◽  
Petya K. Yorgova ◽  
...  
Keyword(s):  
Ct Scan ◽  
Pedicle Screw ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Intraoperative Ct ◽  
Safety Benefit

Image guided navigation by intraoperative CT scan for cochlear implantation

2012 ◽  
Vol 17 (3) ◽  
pp. 153-160 ◽  
Author(s):  
Klaus Stelter ◽  
Georg Ledderose ◽  
John Martin Hempel ◽  
Dominik F.B. Morhard ◽  
Wilhelm Flatz ◽  
...  
Keyword(s):  
Ct Scan ◽  
Cochlear Implantation ◽  
Intraoperative Ct ◽  
Image Guided

Combined Image Guidance and Intraoperative Computed Tomography in Facilitating Endoscopic Orientation within and around the Paranasal Sinuses

2008 ◽  
Vol 22 (6) ◽  
pp. 635-641 ◽  
Author(s):  
Sarah K. Wise ◽  
Richard J. Harvey ◽  
John C. Goddard ◽  
Patrick O. Sheahan ◽  
Rodney J. Schlosser
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Paranasal Sinus ◽  
Image Guidance ◽  
Sinus Surgery ◽  
Intraoperative Ct ◽  
Intraoperative Computed Tomography ◽  
Significant Difference ◽  
Preoperative Ct ◽  
Anatomic Region

Background The utility of image guidance (image-guided surgery [IGS]) and intraoperative computed tomography (CT) scanning as a tool for less experienced endoscopic surgeons to aid in localization of paranasal sinus and skull base anatomic structures was evaluated. Methods Partial endoscopic dissection was performed on cadaver specimens by three fellowship trained rhinologists. Anatomic sites within and around the sinuses were tagged with radio-opaque markers. Otolaryngology residents identified tagged anatomic sites using four successive levels of technology: endoscopy alone (simulating outpatient clinic), endoscopy plus preoperative CT (simulating endoscopic sinus surgery [ESS] without IGS), endoscopy plus IGS registered to preoperative CT (simulating current ESS with IGS), and endoscopy plus IGS registered to real-time intraoperative CT. Responses were graded as follows: consensus rhinologist answer (4 points), close answer without clinically significant difference (3 points), within anatomic region but definite clinical difference (2 points), outside of anatomic region (1 point), no answer (0 points). Results Eleven residents participated. Of 20 specific anatomic sites, IGS-intraoperative CT provided the most accurate anatomic identification at 16 sites. For 8 sites, IGS-intraoperative CT had a significantly higher score than endoscopy alone (p < 0.05; eta2 = 0.29-0.67). For 6 sites, IGS-preoperative CT scan had a significantly higher score than endoscopy alone (p < 0.05; eta2 = 0.30-0.67). All participants found that IGS-intraoperative CT scan made them most comfortable in identifying anatomy. Conclusion Combined IGS and intraoperative CT scan technology may be an instructional adjunct for less experienced paranasal sinus surgeons for dissection and evaluation of unfamiliar or distorted anatomy.

Sign in / Sign up

Export Citation Format

Share Document