Assessment of Pedicle Screw Placement Accuracy, Procedure Time, and Radiation Exposure Using a Miniature Robotic Guidance System

Objective To study the clinical application of lumbar isthmus parameters in guiding pedicle screw placement. Methods Lumbar isthmus parameters were measured in normal lumbar x-rays and cadaveric specimens from a Chinese Han population. Distance between the medial pedicle border and lateral isthmus border was recorded as a ‘D’ value and was compared between X-rays and cadavers. Orthopaedic surgeons estimated different distances (2–6 mm) and angles (5–20°), and bias ratios between estimated and real values were compared. Orthopaedic residents placed pedicle screws on cadaveric specimens before and after application of the ‘D’ value, and screw placement accuracy was compared. Results Except for L4 vertebrae, significant differences in the ‘D’ value were found between 25 cadaveric specimens and x-ray films from 120 patients. Distances and angles estimated by 40 surgeons were significantly different from all real values, except 2 mm distance. Accuracy of pedicle screw placement by six orthopaedic residents was significantly improved by applying the ‘D’ value. Conclusions Surgeon estimates of distance were more accurate than angle estimates. Addition of a ‘D’ value to conventional parameters may significantly improve pedicle screw placement accuracy in lumbar spine surgery.

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O-arm Assisted Cervicothoracic Spine Pedicle Screw Placement Accuracy is higher than C-arm Fluoroscopy

World Neurosurgery ◽

10.1016/j.wneu.2021.12.006 ◽

2021 ◽

Author(s):

Tomohisa Inoue ◽

Keiji Wada ◽

Ayako Tominaga ◽

Ryo Tamaki ◽

Tomoya Hirota ◽

...

Keyword(s):

Pedicle Screw ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Placement Accuracy

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806 Virtual Fluoroscopy Improves Lumbar Pedicle Screw Placement Accuracy

Neurosurgery ◽

10.1097/00006123-200008000-00154 ◽

2000 ◽

Vol 47 (2) ◽

pp. 530-530 ◽

Cited By ~ 1

Author(s):

Kevin T. Foley ◽

Ramesh L. Sahjpaul ◽

Gerald R. Rodts

Keyword(s):

Pedicle Screw ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Placement Accuracy ◽

Lumbar Pedicle

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A Novel Augmented-Reality-Based Surgical Navigation System for Spine Surgery in a Hybrid Operating Room: Design, Workflow, and Clinical Applications

Operative Neurosurgery ◽

10.1093/ons/opz236 ◽

2019 ◽

Vol 18 (5) ◽

pp. 496-502 ◽

Cited By ~ 18

Author(s):

Erik Edström ◽

Gustav Burström ◽

Rami Nachabe ◽

Paul Gerdhem ◽

Adrian Elmi Terander

Keyword(s):

Augmented Reality ◽

Radiation Exposure ◽

Pedicle Screw ◽

Operating Room ◽

Wound Closure ◽

Surgical Navigation ◽

Pedicle Screws ◽

Screw Placement ◽

Hybrid Operating Room ◽

Pedicle Screw Placement

Abstract BACKGROUND Treatment of several spine disorders requires placement of pedicle screws. Detailed 3-dimensional (3D) anatomic information facilitates this process and improves accuracy. OBJECTIVE To present a workflow for a novel augmented-reality-based surgical navigation (ARSN) system installed in a hybrid operating room for anatomy visualization and instrument guidance during pedicle screw placement. METHODS The workflow includes surgical exposure, imaging, automatic creation of a 3D model, and pedicle screw path planning for instrument guidance during surgery as well as the actual screw placement, spinal fixation, and wound closure and intraoperative verification of the treatment results. Special focus was given to process integration and minimization of overhead time. Efforts were made to manage staff radiation exposure avoiding the need for lead aprons. Time was kept throughout the procedure and subdivided to reflect key steps. The navigation workflow was validated in a trial with 20 cases requiring pedicle screw placement (13/20 scoliosis). RESULTS Navigated interventions were performed with a median total time of 379 min per procedure (range 232-548 min for 4-24 implanted pedicle screws). The total procedure time was subdivided into surgical exposure (28%), cone beam computed tomography imaging and 3D segmentation (2%), software planning (6%), navigated surgery for screw placement (17%) and non-navigated instrumentation, wound closure, etc (47%). CONCLUSION Intraoperative imaging and preparation for surgical navigation totaled 8% of the surgical time. Consequently, ARSN can routinely be used to perform highly accurate surgery potentially decreasing the risk for complications and revision surgery while minimizing radiation exposure to the staff.

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Safety and accuracy of robot-assisted versus fluoroscopy-assisted pedicle screw insertion in thoracolumbar spinal surgery: a prospective randomized controlled trial

Journal of Neurosurgery Spine ◽

10.3171/2018.10.spine18487 ◽

2019 ◽

Vol 30 (5) ◽

pp. 615-622 ◽

Cited By ~ 24

Author(s):

Xiaoguang Han ◽

Wei Tian ◽

Yajun Liu ◽

Bo Liu ◽

Da He ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Radiation Exposure ◽

Pedicle Screw ◽

Spinal Surgery ◽

Facet Joint ◽

Postoperative Hospital Stay ◽

Screw Placement ◽

Pedicle Screw Placement ◽

The Mean

OBJECTIVEThe object of this study was to compare the safety and accuracy of pedicle screw placement using the TiRobot system versus conventional fluoroscopy in thoracolumbar spinal surgery.METHODSPatients with degenerative or traumatic thoracolumbar spinal disorders requiring spinal instrumentation were randomly assigned to either the TiRobot-assisted group (RG) or the freehand fluoroscopy-assisted group (FG) at a 1:1 ratio. The primary outcome measure was the accuracy of screw placement according to the Gertzbein-Robbins scale; grades A and B (pedicle breach < 2 mm) were considered clinically acceptable. In the RG, discrepancies between the planned and actual screw placements were measured by merging postoperative CT images with the trajectory planning images. Secondary outcome parameters included proximal facet joint violation, duration of surgery, intraoperative blood loss, conversion to freehand approach in the RG, postoperative hospital stay, and radiation exposure.RESULTSA total of 1116 pedicle screws were implanted in 234 patients (119 in the FG, and 115 in the RG). In the RG, 95.3% of the screws were perfectly positioned (grade A); the remaining screws were graded B (3.4%), C (0.9%), and D (0.4%). In the FG, 86.1% screws were perfectly positioned (grade A); the remaining screws were graded B (7.4%), C (4.6%), D (1.4%), and E (0.5%). The proportion of clinically acceptable screws was significantly greater in the RG than in the FG (p < 0.01). In the RG, the mean deviation was 1.5 ± 0.8 mm for each screw. The most common direction of screw deviation was lateral in the RG and medial in the FG. Two misplaced screws in the FG required revision surgery, whereas no revision was required in the RG. None of the screws in the RG violated the proximal facet joint, whereas 12 screws (2.1%) in the FG violated the proximal facet joint (p < 0.01). The RG had significantly less blood loss (186.0 ± 255.3 ml) than the FG (217.0 ± 174.3 ml; p < 0.05). There were no significant differences between the two groups in terms of surgical time and postoperative hospital stay. The mean cumulative radiation time was 81.5 ± 38.6 seconds in the RG and 71.5 ± 44.2 seconds in the FG (p = 0.07). Surgeon radiation exposure was significantly less in the RG (21.7 ± 11.5 μSv) than in the FG (70.5 ± 42.0 μSv; p < 0.01).CONCLUSIONSTiRobot-guided pedicle screw placement is safe and useful in thoracolumbar spinal surgery.Clinical trial registration no.: NCT02890043 (clinicaltrials.gov)

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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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