scholarly journals Fluoroscopy-based navigation system in spine surgery

2007 ◽  
Vol 221 (7) ◽  
pp. 813-820 ◽  
Author(s):  
P Merloz ◽  
J Troccaz ◽  
H Vouaillat ◽  
C Vasile ◽  
J Tonetti ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Navigation System ◽  
Surgical Procedure ◽  
Pedicle Screws ◽  
Computer Assisted ◽  
X Rays ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Computer Tomography Scan ◽  
Group A

The variability in width, height, and spatial orientation of a spinal pedicle makes pedicle screw insertion a delicate operation. The aim of the current paper is to describe a computer-assisted surgical navigation system based on fluoroscopic X-ray image calibration and three-dimensional optical localizers in order to reduce radiation exposure while increasing accuracy and reliability of the surgical procedure for pedicle screw insertion. Instrumentation using transpedicular screw fixation was performed: in a first group, a conventional surgical procedure was carried out with 26 patients (138 screws); in a second group, a navigated surgical procedure (virtual fluoroscopy) was performed with 26 patients (140 screws). Evaluation of screw placement in every case was done by using plain X-rays and post-operative computer tomography scan. A 5 per cent cortex penetration (7 of 140 pedicle screws) occurred for the computer-assisted group. A 13 per cent penetration (18 of 138 pedicle screws) occurred for the non computer-assisted group. The radiation running time for each vertebra level (two screws) reached 3.5s on average in the computer-assisted group and 11.5s on average in the non computer-assisted group. The operative time for two screws on the same vertebra level reaches 10 min on average in the non computer-assisted group and 11.9 min on average in the computer-assisted group. The fluoroscopy-based (two-dimensional) navigation system for pedicle screw insertion is a safe and reliable procedure for surgery in the lower thoracic and lumbar spine.

scholarly journals Computer-assisted surgery navigation of pedicle screw insertion by standardized trainees

2019 ◽  
Author(s):  
Ming Yong Liu
Keyword(s):  
Ct Scan ◽  
Pedicle Screw ◽  
Navigation System ◽  
Pedicle Screws ◽  
Computer Assisted Surgery ◽  
Control Group ◽  
Computer Assisted ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Thoracic Pedicle Screws

Objective: To assess the precision and efficiency computer-assisted surgery navigation of pedicle screw insertion by standardized trainees. Methods: From September 2013 to June 2016, 360 thoracic pedicle screws were inserted into 100 patients by standardized trainees (n = 30). Screws on the left side were inserted by hands (control group), while the other side were inserted under the guidance of computer-assistant navigation system (guided group). The insertion time and volume of blood lost by each screw were retrospectively analyzed. The precision ratio was assessed by computerized tomography (CT) scan after operation. Results: The time consumed in screw insertion was significantly shorter in the guided group than that in the control group. The blood lost volume was lesser in the guided group. Post-operation CT scan revealed higher precision in the guided group than that in the control group. Conclusion: Computer-assistant navigation system facilitates the learning of standardized trainees, and reduces the time-consuming and bleeding in thoracic pedicle screw insertion.

scholarly journals Computer-assisted surgery navigation of pedicle screw insertion by standardized trainees

2017 ◽  
Vol 6 (1) ◽  
Author(s):  
Mingyong Liu ◽  
Liang Zhang ◽  
Jianhua Zhao ◽  
Peng Liu
Keyword(s):  
Ct Scan ◽  
Pedicle Screw ◽  
Navigation System ◽  
Computer Assisted Surgery ◽  
Control Group ◽  
Computer Assisted ◽  
Low Grade ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Thoracic Pedicle Screw

<p><strong>Objective:</strong> To assess the precision and efficiency computer-assisted surgery navigation of pedicle screw insertion by standardized trainees. <strong>Methods</strong> From September 2013 to June 2016, 360 thoracic pedicle screws were inserted into 100 patients by standardized trainees (n = 30). Screws on the left side were inserted by hands (control group), while the other side were inserted under the guidance of computer-assistant navigation system (guided group). The insertion time and volume of blood lost by each screw were retrospectively analyzed. The precision ratio was assessed by computerized tomography (CT) scan after operation. <strong>Results</strong> The time consumed in screw insertion was significantly shorter in the guided group than that in the control group. The blood lost volume was lesser in the guided group. Post-operation CT scan revealed higher precision in the guided group than that in the control group.<strong> Conclusion</strong> Computer-assistant navigation system facilitates the learning of standardized trainees, and reduces the time-consuming and bleeding in thoracic pedicle screw insertion. Orthodontics training is the most important low-grade physician training in the orthopedic department1,2. Due to the complexity of spinal anatomy, professional required and high risk of spinal surgery, thoracic pedicle screw implantation has become a very demanding technique. Furthermore, the spine surgery learning is not conducive to the trainees. Since 2013, our department started to use the computer-assisted three-dimensional navigation technology to guide the implantation of screws3. We found that the computer-assisted navigation technology has greater advantage when compared with the traditional hand-implanted technology.</p>

Augmented reality–assisted pedicle screw insertion: a cadaveric proof-of-concept study

2019 ◽  
Vol 31 (1) ◽  
pp. 139-146 ◽  
Author(s):  
Camilo A. Molina ◽  
Nicholas Theodore ◽  
A. Karim Ahmed ◽  
Erick M. Westbroek ◽  
Yigal Mirovsky ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Pedicle Screw ◽  
User Experience ◽  
Pedicle Screws ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Insertion Method ◽  
Comparative Accuracy ◽  
Placement Accuracy ◽  
Surgical Field

OBJECTIVEAugmented reality (AR) is a novel technology that has the potential to increase the technical feasibility, accuracy, and safety of conventional manual and robotic computer-navigated pedicle insertion methods. Visual data are directly projected to the operator’s retina and overlaid onto the surgical field, thereby removing the requirement to shift attention to a remote display. The objective of this study was to assess the comparative accuracy of AR-assisted pedicle screw insertion in comparison to conventional pedicle screw insertion methods.METHODSFive cadaveric male torsos were instrumented bilaterally from T6 to L5 for a total of 120 inserted pedicle screws. Postprocedural CT scans were obtained, and screw insertion accuracy was graded by 2 independent neuroradiologists using both the Gertzbein scale (GS) and a combination of that scale and the Heary classification, referred to in this paper as the Heary-Gertzbein scale (HGS). Non-inferiority analysis was performed, comparing the accuracy to freehand, manual computer-navigated, and robotics-assisted computer-navigated insertion accuracy rates reported in the literature. User experience analysis was conducted via a user experience questionnaire filled out by operators after the procedures.RESULTSThe overall screw placement accuracy achieved with the AR system was 96.7% based on the HGS and 94.6% based on the GS. Insertion accuracy was non-inferior to accuracy reported for manual computer-navigated pedicle insertion based on both the GS and the HGS scores. When compared to accuracy reported for robotics-assisted computer-navigated insertion, accuracy achieved with the AR system was found to be non-inferior when assessed with the GS, but superior when assessed with the HGS. Last, accuracy results achieved with the AR system were found to be superior to results obtained with freehand insertion based on both the HGS and the GS scores. Accuracy results were not found to be inferior in any comparison. User experience analysis yielded “excellent” usability classification.CONCLUSIONSAR-assisted pedicle screw insertion is a technically feasible and accurate insertion method.

scholarly journals Does the application of Robotics improve outcomes of pedicle screw insertion in spine surgery compared to conventional fluoroscopy guidance? A protocol for Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Vishal Kumar ◽  
Vishnu Baburaj ◽  
Prasoon Kumar ◽  
Sarvdeep Singh Dhatt
Keyword(s):  
Systematic Review ◽  
Pedicle Screw ◽  
Clinical Outcomes ◽  
Spine Surgery ◽  
Meta Analysis ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Fluoroscopy Guidance

AbstractBackgroundPedicle screw insertion is routinely carried out in spine surgery that has traditionally been performed under fluoroscopy guidance. Robotic guidance has recently gained popularity in order to improve the accuracy of screw placement. However, it is unclear whether the use of robotics alters the accuracy of screw placement or clinical outcomes.ObjectivesThis systematic review aims to compare the results of pedicle screws inserted under fluoroscopy guidance, with those inserted under robotic guidance, in terms of both short-term radiographic outcomes, as well as long-term clinical outcomes.MethodsThis systematic review will be conducted according to the PRISMA guidelines. A literature search will be conducted on the electronic databases of PubMed, Embase, Scopus, and Ovid with a pre-determined search strategy. A manual bibliography search of included studies will also be done. Original articles in English that directly compare pedicle screw insertion under robotic guidance to those inserted under fluoroscopy guidance will be included. Data on outcomes will be extracted from included studies and analysis carried out with the help of appropriate software.

Biomechanical Effects of Lumbar Pedicle Screw Insertion Depth on Screw Loosening and Fulcrum Location

2013 ◽  
Author(s):  
Laura E. Buckenmeyer ◽  
Kristophe J. Karami ◽  
Ata M. Kiapour ◽  
Vijay K. Goel ◽  
Constantine K. Demetropoulos ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Pedicle Screws ◽  
Screw Loosening ◽  
Pullout Strength ◽  
Insertion Depth ◽  
Bone Implant ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Increased Risk ◽  
Screw Length

Osteoporosis is a critical challenge in orthopedic surgery. Osteoporotic patients have an increased risk of loosening and failure of implant constructs due to a weaker bone-implant interface than with healthy bone. Pullout strength of pedicle screws is enhanced by increased screw insertion depth. However, more knowledge is needed to define optimal pedicle screw insertion depth in relation to screw-bone interface biomechanics and the resulting loosening risk. This study evaluates the effects of screw length on loosening risk in the osteoporotic lumbar spine.

scholarly journals CT-to-fluoroscopy registration versus scan-and-plan registration for robot-assisted insertion of lumbar pedicle screws

2022 ◽  
Vol 52 (1) ◽  
pp. E8
Keyword(s):  
Pedicle Screw ◽  
Lumbar Fusion ◽  
Pedicle Screws ◽  
Retrospective Chart Review ◽  
Robot Assisted ◽  
Registration Method ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Radiology Reports ◽  
Lumbar Pedicle

OBJECTIVE Pedicle screw insertion for stabilization after lumbar fusion surgery is commonly performed by spine surgeons. With the advent of navigation technology, the accuracy of pedicle screw insertion has increased. Robotic guidance has revolutionized the placement of pedicle screws with 2 distinct radiographic registration methods, the scan-and-plan method and CT-to-fluoroscopy method. In this study, the authors aimed to compare the accuracy and safety of these methods. METHODS A retrospective chart review was conducted at 2 centers to obtain operative data for consecutive patients who underwent robot-assisted lumbar pedicle screw placement. The newest robotic platform (Mazor X Robotic System) was used in all cases. One center used the scan-and-plan registration method, and the other used CT-to-fluoroscopy for registration. Screw accuracy was determined by applying the Gertzbein-Robbins scale. Fluoroscopic exposure times were collected from radiology reports. RESULTS Overall, 268 patients underwent pedicle screw insertion, 126 patients with scan-and-plan registration and 142 with CT-to-fluoroscopy registration. In the scan-and-plan cohort, 450 screws were inserted across 266 spinal levels (mean 1.7 ± 1.1 screws/level), with 446 (99.1%) screws classified as Gertzbein-Robbins grade A (within the pedicle) and 4 (0.9%) as grade B (< 2-mm deviation). In the CT-to-fluoroscopy cohort, 574 screws were inserted across 280 lumbar spinal levels (mean 2.05 ± 1.7 screws/ level), with 563 (98.1%) grade A screws and 11 (1.9%) grade B (p = 0.17). The scan-and-plan cohort had nonsignificantly less fluoroscopic exposure per screw than the CT-to-fluoroscopy cohort (12 ± 13 seconds vs 11.1 ± 7 seconds, p = 0.3). CONCLUSIONS Both scan-and-plan registration and CT-to-fluoroscopy registration methods were safe, accurate, and had similar fluoroscopy time exposure overall.

scholarly journals Improved accuracy of computer-assisted cervical pedicle screw insertion

2003 ◽  
Vol 99 (3) ◽  
pp. 257-263 ◽  
Author(s):  
Yoshihisa Kotani ◽  
Kuniyoshi Abumi ◽  
Manabu Ito ◽  
Akio Minami
Keyword(s):  
Real Time ◽  
Pedicle Screw ◽  
Computer Assisted ◽  
Insertion Technique ◽  
Content Type ◽  
Cervical Pedicle Screw ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Cervical Pedicle ◽  
Fine Print

Object. The authors introduce a unique computer-assisted cervical pedicle screw (CPS) insertion technique used in conjunction with specially modified original pedicle screw insertion instruments. The accuracy of screw placement as well as surgery-related outcome and complication rates were compared between two groups of patients: those in whom a computer-assisted and those in whom a conventional manual insertion technique was used. Methods. The screw insertion guiding system consisted of a modified awl, probe, tap and a screwdriver specially designed for a computer-assisted CPS insertion. Using this system, real-time instrument/screw tip information was three dimensionally identified in each step of screw insertion. Seventeen patients underwent CPS fixation in which a computer-assisted surgical navigation system was used. The cervical disorders consisted of spondylotic myelopathy with segmental instability or kyphosis, metastatic spinal tumor, rheumatoid spine, and postlaminectomy kyphosis. The rate of pedicle wall perforation was significantly lower in the computer-assisted group than that in the other group (1.2 and 6.7%, respectively; p < 0.05). The screw trajectory in the horizontal plane was significantly closer to the anatomical pedicle axis in the computer-assisted group compared with the manual insertion group (p < 0.05). This factor significantly reduced the incidence of screw perforation laterally. Complications such as neural damage or vascular injury were not demonstrated in the computer-assisted group (compared with 2% in the manual insertion treatment group). The overall surgery-related outcome was satisfactory. Conclusions. In contrast to the previously reported computer-assisted technique, our CPS insertion technique provides real-time three-dimensional instrument/screw tip information. This serves as a powerful tool for safe and accurate pedicle screw placement in the cervical spine.

scholarly journals Comparison of intraoperative O-arm- and conventional fluoroscopy (C-arm)-assisted insertion of pedicle screws in the treatment of fracture of thoracic vertebrae

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668409 ◽  
Author(s):  
Hao Liu ◽  
Yimeng Wang ◽  
Bin Pi ◽  
Zhonglai Qian ◽  
Xiaoyu Zhu ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Thoracic Vertebrae ◽  
Pedicle Screw Placement ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Computed Tomography Images ◽  
Hospitalization Time ◽  
Time Required

Purpose: To introduce the intraoperative O-arm-assisted pedicle screw insertion without any navigation system in the treatment of thoracic vertebrae fracture and compare it to conventional fluoroscopy (C-arm)-assisted pedicle screw insertion technique. Methods: About 156 pedicle screws were inserted in 23 patients (C-arm group), and 208 pedicle screws were inserted in 30 patients (O-arm group). The postoperative computed tomography images were analyzed for pedicle violation based on Gertzbein classification. The total surgery time, the average time required for inserting a screw, the mean action times of adjusting guide probe and pedicle screw, and the hospitalization time were compared in both groups, respectively. The American Spinal Injury Association (ASIA) was used for evaluating the health outcomes pre- and postoperatively. Results: There are the higher accuracy rate of satisfactory pedicle screw placement (grades 0 and 1) and the less incidence of medial perforation in the O-arm group compared to the C-arm group ( p < 0.05). The average time required for inserting a screw, the action times of adjusting the guide probe and pedicle screw, and the hospitalization time in the O-arm group are less than the respective ones in the C-arm group ( p < 0.05). There was no significant difference for the total surgery time between both groups. No further damage of the nerve function postoperatively is found according to the ASIA grade. Conclusion: The O-arm-assisted pedicle screw insertion without navigation we described provides higher accuracy of pedicle screw placement and better clinical efficacy compared to conventional fluoroscopy (C-arm) technique.

scholarly journals Experience of Percutaneous Pedicle Screw Insertion System SEXTANT with Intra-operative 3D-CT Navigation System

2009 ◽  
Vol 58 (2) ◽  
pp. 156-160
Author(s):  
Masayuki Nakahara ◽  
Kenki Nishida ◽  
Koichi Ogawa ◽  
Kenichiro Hanabusa ◽  
Yuichi Takahashi ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Navigation System ◽  
3D Ct ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Percutaneous Pedicle Screw
Sign in / Sign up

Export Citation Format

Share Document