Accuracy of Image-Guided Pedicle Screw Placement Using Intraoperative Computed Tomography-Based Navigation With Automated Referencing, Part I: Cervicothoracic Spine

Neurosurgery ◽  
2011 ◽  
Vol 69 (4) ◽  
pp. 782-795 ◽  
Author(s):  
Kai-Michael Scheufler ◽  
Joerg Franke ◽  
Anke Eckardt ◽  
Hildegard Dohmen
Keyword(s):  
Computed Tomography ◽  
Spinous Process ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Conventional Technique ◽  
Classification Systems ◽  
Angular Deviation ◽  
Intraoperative Computed Tomography ◽  
Image Guided ◽  
Thoracic Pedicle Screws

Abstract BACKGROUND: Image-guided spinal instrumentation reduces the incidence of implant misplacement. OBJECTIVE: To assess the accuracy of intraoperative computed tomography (iCT)-based neuronavigation (iCT-N). METHODS: In 35 patients (age range, 18-87 years), a total of 248 pedicle screws were placed in the cervical (C1-C7) and upper and midthoracic (T1-T8) spine. An automated iCT registration sequence was used for multisegmental instrumentation, with the reference frame fixed to either a Mayfield head clamp and/or the most distal spinous process within the instrumentation. Pediculation was performed with navigated drill guides or Jamshidi cannulas. The angular deviation between navigated tool trajectory and final implant positions (evaluated on postinstrumentation iCT or postoperative CT scans) was calculated to assess the accuracy of iCT-N. Final screw positions were also graded according to established classification systems. Mean follow-up was 16.7 months. RESULTS: Clinically significant screw misplacement or iCT-N failure mandating conversion to conventional technique did not occur. A total of 71.4% of patients self-rated their outcome as excellent or good at 12 months; 99.3% of cervical screws were compliant with Neo classification grades 0 and 1 (grade 2, 0.7%), and neurovascular injury did not occur. In addition, 97.8% of thoracic pedicle screws were assigned grades I to III of the Heary classification, with 2.2% grade IV placement. Accuracy of iCT-N progressively deteriorated with increasing distance from the spinal reference clamp but allowed safe instrumentation of up to 10 segments. CONCLUSION: Image-guided spinal instrumentation using iCT-N with automated referencing allows safe, highly accurate multilevel instrumentation of the cervical and upper and midthoracic spine. In addition, iCT-N significantly reduces the need for reregistration in multilevel surgery.

Accuracy of Image-Guided Pedicle Screw Placement Using Intraoperative Computed Tomography-Based Navigation With Automated Referencing. Part II: Thoracolumbar Spine

Neurosurgery ◽  
2011 ◽  
Vol 69 (6) ◽  
pp. 1307-1316 ◽  
Author(s):  
Kai-Michael Scheufler ◽  
Joerg Franke ◽  
Anke Eckardt ◽  
Hildegard Dohmen
Keyword(s):  
Computed Tomography ◽  
Radiation Exposure ◽  
Intraoperative Imaging ◽  
Thoracolumbar Spine ◽  
Spinal Instrumentation ◽  
Classification Systems ◽  
Intraoperative Computed Tomography ◽  
Image Guided ◽  
Thoracic Pedicle Screws ◽  
Automated Registration

Abstract BACKGROUND Image-guided spinal instrumentation may reduce complications in spinal instrumentation. OBJECTIVE To assess accuracy, time efficiency, and staff radiation exposure during thoracolumbar screw instrumentation guided by intraoperative computed tomography (iCT)-based neuronavigation (iCT-N). METHODS In 55 patients treated for idiopathic and degenerative deformities, 826 screws were inserted in the thoracic (T2–T12; n = 243) and lumbosacral (L1–S1; n = 545) spine, as well as ilium (n = 38) guided by iCT-N. Up to 17 segments were instrumented following a single automated registration sequence with the dynamic reference arc (DRA) uniformly attached to L5. Accuracy of iCT-N was assessed by calculating angular deviations between individual navigated tool trajectories and final implant positions. Final screw positions were also graded according to established classification systems. Clinical and radiological outcome was assessed at 12 to 14 months. RESULTS Additional intraoperative fluoroscopy was unnecessary, eliminating staff radiation exposure. Unisegmental K-wire insertion required 4.6 ± 2.9 minutes. Of the thoracic pedicle screws 98.4% were assigned grades I to III according to the Heary classification, with 1.6% grade IV placement. In the lumbar spine, 94.4% of screws were completely contained (Gertzbein classification grade 0), 4.6% displayed minor pedicle breaches <2 mm (grade 1), and 1% of lumbar screws deviated by >2 to <4 mm (grade 2). The accuracy of iCT-N progressively deteriorates with increasing distance from the DRA, but allows safe instrumentation of up to 12 segments. CONCLUSION iCT-N using automated referencing allows for safe, highly accurate multilevel instrumentation of the entire thoracolumbosacral spine and ilium, rendering additional intraoperative imaging dispensable. In addition, automated registration is time-efficient and significantly reduces the need for re-registration in multilevel surgery.

Image-Guided Spinal Surgery and Robotics in MIS: Where Are We Now?

2018 ◽  
Vol 1 (2) ◽  
pp. 2
Author(s):  
Chiung Chyi Shen
Keyword(s):  
Pedicle Screw ◽  
Spinal Surgery ◽  
Surgical Navigation ◽  
Improve Patient Safety ◽  
Intraoperative Imaging ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Computer Assisted ◽  
Navigation Systems ◽  
Image Guided

Use of pedicle screws is widespread in spinal surgery for degenerative, traumatic, and oncological diseases. The conventional technique is based on the recognition of anatomic landmarks, preparation and palpation of cortices of the pedicle under control of an intraoperative C-arm (iC-arm) fluoroscopy. With these conventional methods, the median pedicle screw accuracy ranges from 86.7% to 93.8%, even if perforation rates range from 21.1% to 39.8%.The development of novel intraoperative navigational techniques, commonly referred to as image-guided surgery (IGS), provide simultaneous and multiplanar views of spinal anatomy. IGS technology can increase the accuracy of spinal instrumentation procedures and improve patient safety. These systems, such as fluoroscopy-based image guidance ("virtual fluoroscopy") and computed tomography (CT)-based computer-guidance systems, have sensibly minimized risk of pedicle screw misplacement, with overall perforation rates ranging from between 14.3% and 9.3%, respectively."Virtual fluoroscopy" allows simultaneous two-dimensional (2D) guidance in multiple planes, but does not provide any axial images; quality of images is directly dependent on the resolution of the acquired fluoroscopic projections. Furthermore, computer-assisted surgical navigation systems decrease the reliance on intraoperative imaging, thus reducing the use of intraprocedure ionizing radiation. The major limitation of this technique is related to the variation of the position of the patient from the preoperative CT scan, usually obtained before surgery in a supine position, and the operative position (prone). The next technological evolution is the use of an intraoperative CT (iCT) scan, which would allow us to solve the position-dependent changes, granting a higher accuracy in the navigation system. 

Intraoperative Computed Tomography Versus 3D C-Arm Imaging for Navigated Spinal Instrumentation

Spine ◽  
2018 ◽  
Vol 43 (5) ◽  
pp. 370-377 ◽  
Author(s):  
Nils Hecht ◽  
Hadya Yassin ◽  
Marcus Czabanka ◽  
Bettina Föhre ◽  
Klaus Arden ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Spinal Instrumentation ◽  
Intraoperative Computed Tomography

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

Spine ◽  
2012 ◽  
Vol 37 (3) ◽  
pp. E188-E194 ◽  
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

73. Analysis of Triggered Electromyographic Threshold of Thoracic Pedicle Screws Assessed by Computed Tomography

2007 ◽  
Vol 7 (5) ◽  
pp. 36S ◽  
Author(s):  
Jahangir Asghar ◽  
David Clements ◽  
Joshua Pahys ◽  
Amer Samdani ◽  
Linda D'Andrea ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pedicle Screws ◽  
Thoracic Pedicle Screws

Ball tip technique for thoracic pedicle screw placement in patients with adolescent idiopathic scoliosis

2010 ◽  
Vol 13 (2) ◽  
pp. 246-252 ◽  
Author(s):  
Kota Watanabe ◽  
Morio Matsumoto ◽  
Takashi Tsuji ◽  
Ken Ishii ◽  
Hironari Takaishi ◽  
...  
Keyword(s):  
Clinical Study ◽  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Pedicle Screws ◽  
Conventional Technique ◽  
Cadaveric Study ◽  
Conventional Group ◽  
Starting Point ◽  
Freehand Technique ◽  
Thoracic Pedicle Screws

Object The aim in this study was to evaluate the efficacy of the ball tip technique in placing thoracic pedicle screws (TPSs), as compared with the conventional freehand technique, in both a cadaveric study and a clinical study of patients with adolescent idiopathic scoliosis. Although posterior spinal surgery using TPSs has been widely applied, these screws are associated with the potential risk of vascular, pulmonary, or neurological complications. To further enhance the accuracy and safety of TPS placement, the authors developed the ball tip technique. Methods After creating an appropriate starting point for probe insertion, a specially designed ball tip probe consisting of a ball-shaped tip with a flexible metal shaft is used to make a guide hole into the pedicle. Holding the probe with the fingertips while using an appropriate amount of pressure or by tapping it gently and continuously with a hammer, one can safely insert the ball tip probe into the cancellous channel in the pedicle. In a cadaveric study, 5 spine fellows with similar levels of experience in placing TPSs applied the ball tip or the conventional technique to place screws in 5 cadavers with no spinal deformities. The incidence of misplaced screws was evaluated by dissecting the spines. In a clinical study, 40 patients with adolescent idiopathic scoliosis underwent posterior surgery with TPS placement via the ball tip or conventional technique (20 patients in each treatment group). The accuracy of the TPS placements was evaluated on postoperative axial CT scanning. Results In the cadaveric study, 100 TPSs were evaluated, and the incidence of misplaced screws was 14% in the ball tip group and 34% in the conventional group (p = 0.0192). In the clinical study, 574 TPSs were evaluated. One hundred seventy-one intrapedicular screws (67%) were recognized in the conventional group and 288 (90%) in the ball tip group (p < 0.01). In the conventional and ball tip groups, the respective numbers of TPSs with a pedicle breach of ≤ 2 mm were 20 (8%) and 15 (5%), those with a pedicle breach of > 2 mm were 32 (13%) and 9 (3%; p < 0.01), and those located in the costovertebral joints were 32 (13%) and 7 (2%). Conclusions In both cadaveric and clinical studies the ball tip technique enhanced the accuracy of TPS placement as compared with the conventional freehand technique. Thus, the ball tip technique is useful for the accurate and safe placement of TPSs in deformed spines.

Evaluation of the implantation of transpedicular screws in spinal instrumentation with free-hand technique and navigation-assisted with intraoperative computed tomography: An analytical-positional study

Neurocirugía ◽  
2021 ◽  
Author(s):  
Pedro Miguel González-Vargas ◽  
Lourdes Calero Félix ◽  
Álvaro Martín-Gallego ◽  
José Luis Thenier-Villa ◽  
Adolfo Ramón de la Lama Zaragoza ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Spinal Instrumentation ◽  
Intraoperative Computed Tomography ◽  
Free Hand Technique
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