Interpedicular Screw Placement Image Guided Navigation Surgery Simulator

✓ The authors sought to evaluate the feasibility and accuracy of three-dimensional (3D) fluoroscopic guidance for percutaneous placement of thoracic and lumbar pedicle screws in three cadaveric specimens. After attaching a percutaneous dynamic reference array to the surgical anatomy, an isocentric C-arm fluoroscope was used to obtain images of the region of interest. Light-emitting diodes attached to the C-arm unit were tracked using an electrooptical camera. The image data set was transferred to the image-guided workstation, which performed an automated registration. Using the workstation display, pedicle screw trajectories were planned. An image-guided drill guide was passed through a stab incision, and this was followed by sequential image-guided pedicle drilling, tapping, and screw placement. Pedicle screws of various diameters (range 4–6.5 mm) were placed in all pedicles greater than 4 mm in diameter. Postoperatively, thin-cut computerized tomography scans were obtained to determine the accuracy of screw placement. Eighty-nine (94.7%) of 94 percutaneous screws were placed completely within the cortical pedicle margins, including all 30 lumbar screws (100%) and 59 (92%) of 64 thoracic screws. The mean diameter of all thoracic pedicles was 6 mm (range 2.9–11 mm); the mean diameter of the five pedicles in which wall violations occurred was 4.6 mm (range 4.1–6.3 mm). Two of the violations were less than 2 mm beyond the cortex; the others were between 2 and 3 mm. Coupled with an image guidance system, 3D fluoroscopy allows highly accurate spinal navigation. Results of this study suggest that this technology will facilitate the application of minimally invasive techniques to the field of spine surgery.

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Personalised image-based templates for intra-operative guidance

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1243/095441105x9273 ◽

2005 ◽

Vol 219 (2) ◽

pp. 111-118 ◽

Cited By ~ 56

Author(s):

E Berry ◽

M Cuppone ◽

S Porada ◽

P A Millner ◽

A Rao ◽

...

Keyword(s):

Computed Tomography ◽

Dimensional Stability ◽

Ct Images ◽

High Rate ◽

Screw Placement ◽

Navigation Systems ◽

Application Area ◽

Screw Insertion ◽

Image Guided ◽

Improve Accuracy

The high rate of unplanned perforation, poor fixation, and nerve injury with freehand pedicle screw insertion has led to the use of image-guided navigation systems. Although these improve accuracy, they have several drawbacks that could be overcome by using image-based drilling guide templates. The accuracy of such templates was tested in a cadaveric study of screw placement in the lumbar, thoracic, and cervical regions of the spine. The dimensional stability with autoclaving of duraform polyamide, to be used for manufacturing the guides, was first determined using test specimens. Computed tomography (CT) images were acquired of 4 cadaveric spines, and placement of 4 cervical, 32 thoracic, and 14 lumbar screws was planned. Eighteen personalized drilling guide templates, in four different designs, were built. Orthopaedic surgeons experienced in the freehand techniques used the templates. CT images were acquired to assess placement position with respect to the pedicle. Duraform polyamide was found to be unaffected by sterilization. Two of the template designs facilitated the placement of 20/20 screws without error. Templates can lead to successful screw placement, even in small pedicles, providing their design is optimized for the application area, e.g. with enhanced rotational stabilization.

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Pediatric Pedicle Screw Placement Using Intraoperative Computed Tomography and 3-Dimensional Image-Guided Navigation

Spine ◽

10.1097/brs.0b013e31822a2e0a ◽

2012 ◽

Vol 37 (3) ◽

pp. E188-E194 ◽

Cited By ~ 69

Author(s):

A. Noelle Larson ◽

Edward R. G. Santos ◽

David W. Polly ◽

Charles G. T. Ledonio ◽

Jonathan N. Sembrano ◽

...

Keyword(s):

Computed Tomography ◽

Pedicle Screw ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Intraoperative Computed Tomography ◽

3 Dimensional ◽

Dimensional Image ◽

Image Guided

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Image-guided navigation surgery for bilateral choanal atresia with a Tessier number 3 facial cleft in an adult

Archives of Craniofacial Surgery ◽

10.7181/acfs.2019.00661 ◽

2020 ◽

Vol 21 (1) ◽

pp. 64-68

Author(s):

Ji Yoon Sung ◽

Kyu-Sup Cho ◽

Yong Chan Bae ◽

Seong Hwan Bae

Keyword(s):

Choanal Atresia ◽

Navigation Surgery ◽

Facial Cleft ◽

Image Guided

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Cost-Effectiveness of Image-Guided Spine Surgery

The Open Orthopaedics Journal ◽

10.2174/1874325001004010228 ◽

2010 ◽

Vol 4 (1) ◽

pp. 228-233 ◽

Cited By ~ 57

Author(s):

Robert Green Watkins ◽

Akash Gupta ◽

Robert Green Watkins

Keyword(s):

Pedicle Screw ◽

Spine Surgery ◽

Image Guidance ◽

Pedicle Screws ◽

Cost Savings ◽

Cost Effective ◽

Guidance System ◽

Screw Placement ◽

Image Guided ◽

Time Required

Objective: To determine if image-guided spine surgery is cost effective. Methods: A prospective case series of the first 100 patients undergoing thoracolumbar pedicle screw instrumentation under image-guidance was compared to a retrospective control group of the last 100 patients who underwent screw placement prior to the use of image-guidance. The image-guidance system was NaviVision (Vector Vision-BrainLAB) and Arcadis Orbic (Siemens). Results: The rate of revision surgery was reduced from 3% to 0% with the use of image guidance (p=0.08). The cost savings of image guidance for the placement of pedicle screws was $71,286 per 100 cases. Time required for pedicle screw placement with image guidance was 20 minutes for 2 screws, 29 minutes for 4 screws, 38 minutes for 6 screws, and 50 min for 8 screws. Cost savings for the time required for placement of pedicle screws with image guidance can be estimated by subtracting the time required with currently used techniques without image guidance from the above averages, then multiplying by $93 per minute. The approximate costs of the navigation system is $475,000 ( $225,000 for Vector Vision-BrainLAB and $250,000 for Arcadis Orbic-Siemens). Conclusion: Image guidance for the placement of pedicle screws may be cost effective in spine practices with heavy volume, that perform surgery in difficult cases, and that require long surgical times for the placement of pedicle screws.

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