scholarly journals ACCURACY OF PEDICLE SCREW INSERTION: A COMPARISON BETWEEN FLUOROSCOPIC GUIDANCE AND NAVIGATION TECHNIQUES

2018 ◽  
Vol 26 (6) ◽  
pp. 397-400 ◽  
Author(s):  
Romero Pinto de Oliveira Bilhar ◽  
Diego Ariel de Lima ◽  
José Alberto Dias Leite ◽  
Maximiliano Aguiar Porto
Keyword(s):  
Thoracic Spine ◽  
Pedicle Screws ◽  
Computer Assisted ◽  
Fluoroscopic Guidance ◽  
Level Of Evidence ◽  
Assisted Navigation ◽  
Screw Insertion ◽  
Navigation Group ◽  
Duration Of Surgery ◽  
Navigation Equipment

ABSTRACT Objectives: To compare the accuracy of insertion of pedicle screws into the thoracic spine using fluoroscopic guidance or computer-assisted navigation techniques. Methods: Eight cadaveric thoracic spines were divided into two groups: the fluoroscopy group, in which pedicle screws were inserted with the guidance of a C-arm device, and the navigation group, in which insertion of the screws was monitored using computer-assisted navigation equipment. All procedures were performed by the same spinal surgeon. The rate of pedicle breach was compared between the two groups. Results: There was one intra-canal perforation in each group. Both perforations were medial in direction, and the breaches were 2 to 4 mm deep. There were no statistically significant differences in breach rate between the two groups. Conclusions: The accuracy of insertion of pedicle screws in the thoracic spine using computer-assisted navigation is equivalent to that achieved using fluoroscopic guidance. Computer-assisted navigation improves the safety of the surgical team during the procedure due to the absence of exposure to radiation. Therefore, there is a need for future randomized controlled trials to be conducted in the clinical setting to evaluate other outcomes, including duration of surgery and blood loss during the procedure. Level of evidence IV.

scholarly journals NAVIGATED TOTAL KNEE ARTHROPLASTY FOR OSTEOARTHRITIS WITH EXTRA-ARTICULAR DEFORMITY

2018 ◽  
Vol 26 (3) ◽  
pp. 170-174 ◽  
Author(s):  
IZUMI TANI ◽  
NAOKI NAKANO ◽  
KOJI TAKAYAMA ◽  
KAZUNARI ISHIDA ◽  
RYOSUKE KURODA ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Case Series ◽  
Computer Assisted ◽  
Level Of Evidence ◽  
Assisted Navigation ◽  
Radiographic Outcomes ◽  
Navigation Group ◽  
Significant Difference ◽  
Total Knee

ABSTRACT Objective It is difficult to achieve proper alignment after total knee arthroplasty (TKA) in patients with extra-articular deformity (EAD) because of altered anatomical axis and distorted landmarks. As of this writing, only case series have been reported with regard to the usefulness of computer-assisted navigation systems for TKA with EAD. This study therefore compared outcomes in TKA with EAD, with and without navigation. Methods Fourteen osteoarthritis patients with EAD due to previous fracture malunion or operations were assessed. Seven TKAs were performed with navigation (navigation group) and another 7 were performed without navigation (manual group). Clinical and radiographic outcomes were compared before and two years after surgery. Results The mean postoperative Knee Society function score was significantly higher in the navigation group. No significant difference was found in postoperative range of motion and Knee Society knee score. The rate of outliers in radiographic outcomes tended to be lower in the navigation group. Conclusion Better clinical outcomes were achieved in cases in which navigation was used. Computer-assisted navigation is useful in TKA for patients with EAD. Level of Evidence III; Case control study.

scholarly journals Conventional versus Smart Wireless Navigation in Total Knee Replacement: Similar Outcomes in a Randomized Prospective Study

Joints ◽  
2018 ◽  
Vol 06 (02) ◽  
pp. 090-094 ◽  
Author(s):  
Matteo Denti ◽  
Francesco Soldati ◽  
Francesca Bartolucci ◽  
Emanuela Morenghi ◽  
Laura De Girolamo ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Tibial Slope ◽  
Computer Assisted ◽  
Level Of Evidence ◽  
Assisted Navigation ◽  
Level Ii ◽  
Before And After ◽  
Total Knee ◽  
Generation Computer ◽  
Navigated Tka

Purpose The development of new computer-assisted navigation technologies in total knee arthroplasty (TKA) has attracted great interest; however, the debate remains open as to the real reliability of these systems. We compared conventional TKA with last generation computer-navigated TKA to find out if navigation can reach better radiographic and clinical outcomes. Methods Twenty patients with tricompartmental knee osteoarthritis were prospectively selected for conventional TKA (n = 10) or last generation computer-navigated TKA (n = 10). Data regarding age, gender, operated side, and previous surgery were collected. All 20 patients received the same cemented posterior-stabilized TKA. The same surgical instrumentation, including alignment and cutting guides, was used for both the techniques. A single radiologist assessed mechanical alignment and tibial slope before and after surgery. A single orthopaedic surgeon performed clinical evaluation at 1 year after the surgery. Wilcoxon's test was used to compare the outcomes of the two groups. Statistical significance was set at p < 0.05. Results No significant differences in mechanical axis or tibial slope was found between the two groups. The clinical outcome was equally good with both techniques. At a mean follow-up of 15.5 months (range, 13–25 months), all patients from both groups were generally satisfied with a full return to daily activities and without a significance difference between them. Conclusion Our data showed that clinical and radiological outcomes of TKA were not improved by the use of computer-assisted instruments, and that the elevated costs of the system are not warranted. Level of Evidence This is a Level II, randomized clinical trial.

Accuracy of Fluoroscopy Versus Computer-Assisted Navigation for the Placement of Anterior Cervical Pedicle Screws

Spine ◽  
2015 ◽  
Vol 40 (7) ◽  
pp. E404-E410 ◽  
Author(s):  
Andrew G. Patton ◽  
Randal P. Morris ◽  
Yong-Fang Kuo ◽  
Ronald W. Lindsey
Keyword(s):  
Pedicle Screws ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Cervical Pedicle ◽  
Cervical Pedicle Screws

scholarly journals Accuracy of Bony Resection Under Computer Assisted Navigation Compared with Free-Hand Cutting for Bone Tumors Around the Knee

10.29007/dd82 ◽  
2018 ◽  
Author(s):  
Zhiping Deng ◽  
Bin Li ◽  
Tao Jin ◽  
Qing Zhang ◽  
Lin Hao ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Bone Tumors ◽  
Salvage Surgery ◽  
Control Group ◽  
Computer Assisted ◽  
Limb Salvage Surgery ◽  
Assisted Navigation ◽  
Length Difference ◽  
Operative Specimen ◽  
Navigation Group

INTRODUCTIONBone tumor surgery can be more accurate under the computer assisted navigation. The researches have shown the benefit of margin control in pelvic, joint sparing surgery. The traditional method for bone cutting in limb salvage was by free hand. There was no literature focused on the comparison of cutting accuracy in bone tumors around the knee joint. The aim of this study was to compare the accuracy for bony resection under navigation and by free hand in limb salvage surgery around the knee.MATERIALS AND METHODSThirty-nine cases of bone tumors around the knee joint were resected under navigation (Stryker System) in our department from 2008 Sep to 2017 Nov. All the cases were performed intercalary resection in femur or tibia. The initial aim to use navigation was to make the resection more close to the pre-operative planning. The pre-operative planning was performed with the software OrthoMap at the working station (Stryker Company). The CT and MRI imaging were input to the system. We used intraoperative navigation (Iso-C based) to find the cutting plane and use the jig saw to cut the bone. The post-operative specimen was used for verification and compared with the pre-operative plan. The length difference was defined as specimen length minus planning resection length. The control group included 117 cases of tumors around the knee performed limb salvage surgery when bony cutting was achieved by free hand. This was a non-randomized control study. The method to find the cutting plane was by measuring the length from the joint line to the planned plane by ruler. The length of post-operative specimen by free hand was compared with the surgical plan. The length difference was detected in this control group. Then the differences in two groups were compared and analyzed.RESULTSThe resection lengths in navigation group ranged from 85-282mm and in the free hand group the length ranged from 90-330mm. The length difference between post-operative verification and pre-operative plan was detected. In the navigation group, the length difference was 0.5±2.5mm (range ,-5～5mm), while in the free hand group the length difference was 3.4±9.6mm (range ,-20～29mm), P&lt;0.01. For the absolute value differences analysis, the difference was 2.0±1.6mm and 8.3±6.0mm for navigation and free hand group respectively, P&lt;0.01.DISCUSSIONOur study shows that bone cutting with navigation can be more accurate than freehand cutting. The average length difference was 2.0mm (95% CI, 0.4 to 3.6mm) when compared to average 8.3mm (95% CI, 2.3 to 14.3mm). The accuracy with navigation is similar to the previous researches. Our comparison with free hand group gives the data how accurate the navigation can help surgeon to achieve. The result indicates that computer assisted navigation can make a role in limb salvage surgery if the precise resection is required.

scholarly journals Efficacy of a simple intraoperative stem-anteversion measuring device in total hip arthroplasty

2020 ◽  
Author(s):  
Kentaro Iwakiri ◽  
Yoichi Ohta ◽  
Yohei Ohyama ◽  
Yukihide Minoda ◽  
Akio Kobayashi ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Three Dimensional ◽  
Computer Assisted ◽  
Level Of Evidence ◽  
Measuring Device ◽  
Correction Angle ◽  
Assisted Navigation ◽  
Total Hip ◽  
Flexion Extension

Abstract Background Background: Stem anteversion is important in reducing postoperative complications in total hip arthroplasty (THA). THA utilizing the combined-anteversion theory requires stem anteversion angle (SAA) measurement intraoperatively; however, intraoperative SAA estimation is difficult for surgeons without computer-assisted navigation system. We evaluated the accuracy of the SAA measured intraoperatively using a newly developed device by comparing the three-dimensional measurements using postoperative computed tomography (CT).Materials & Methods In 127 hips in 127 patients who underwent unilateral THA at our hospital, we used our newly developed device that can be easily attached to rasping broach handles for measuring the SAA intraoperatively, which required the addition of the correction angle obtained in the preoperative epicondylar view. Postoperative SAA and its discrepancies from the measured intraoperative SAA with or without adding the correction angle were compared between the groups to evaluate the usefulness of the device.Results The intraoperative SAA measured by the device was 17.93 ± 7.53°. The true SAA measured on postoperative CT was 26.40 ± 9.73°. The discrepancy between the intraoperative SAA and true SAA was 8.94 ± 5.44° (without the correction angle), and 4.93 ± 3.85° (with the correction angle). Accuracy with a discrepancy of <5 degrees was achieved in 77 (60.6%) and <10 degrees was achieved in 113 (89.0%). The accuracy was unaffected by the stem placement angle (varus/valgus, or flexion/extension), or ipsilateral knee osteoarthritis.Conclusion The SAA measuring device, easily attachable to various rasping handles, is useful to measure the intraoperative SAA in a simple, economical, and noninvasive manner during THA.Level of Evidence Therapeutic Level IV.

scholarly journals Biomechanics and clinical outcome after posterior stabilization of mid-thoracic vertebral body fractures: a systematic literature review

2020 ◽  
Author(s):  
Ulrich J. Spiegl ◽  
Georg Osterhoff ◽  
Philipp Bula ◽  
Frank Hartmann ◽  
Max J. Scheyerer ◽  
...  
Keyword(s):  
Pedicle Screws ◽  
Posterior Stabilization ◽  
Level Of Evidence ◽  
Intraoperative 3D Imaging ◽  
Screw Insertion ◽  
Vertebral Body Fractures ◽  
High Penetration ◽  
Placement Accuracy ◽  
Insertion Techniques ◽  
The Impact

Abstract Purpose The aim of this review is to systematically screen the literature for clinical and biomechanical studies dealing with posterior stabilization of acute traumatic mid-thoracic vertebral fractures in patients with normal bone quality. Methods This review is based on articles retrieved by a systematic search in the PubMed and Web of Science database for publications up to December 2018 dealing with the posterior stabilization of fractures of the mid-thoracic spine. Results Altogether, 1012 articles were retrieved from the literature search. A total of 960 articles were excluded. A total of 16 articles were dealing with the timing of surgery in polytraumatized patients, patients suffering of neurologic deficits after midthoracic fractures, and the impact of concomitant thoracic injuries and were excluded. Thus, 36 remaining original articles were included in this systematic review depicting the topics biomechanics, screw insertion, and outcome after posterior stabilization. The overall level of evidence of the vast majority of studies is low. Conclusion High quality studies are lacking. Long-segmental stabilization is indicated in unstable midthoracic fractures with concomitant sternal fractures. Generally, long-segmental constructs seem to be the safer treatment strategy considering the relative high penetration rate of pedicle screws in this region. Thereby, navigated insertion techniques and intraoperative 3D-imaging help to improve pedicle screw placement accuracy.

scholarly journals Application of computer-assisted navigation in mandibular angle osteotomy

2019 ◽  
Vol 47 (7) ◽  
pp. 3160-3170 ◽  
Author(s):  
Liqin Lin ◽  
Bokai Fan ◽  
Zheyuan Yu ◽  
Liang Xu ◽  
Jie Yuan ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Computer Assisted ◽  
Clinical Approach ◽  
Mandibular Angle ◽  
Traditional Group ◽  
Assisted Navigation ◽  
Surgical Safety ◽  
Traditional Technique ◽  
Computed Tomography Images ◽  
Navigation Group

Objective To compare the effectiveness, accuracy, and surgical safety of a navigation technique with those of a traditional technique for intraoperative mandibular angle osteotomy. Methods Forty-three postsurgical patients with mandibular angle hypertrophy who were admitted to our Department from June 2014 to June 2017 were retrospectively reviewed. Of these patients, 23 underwent mandibular angle osteotomy using computer-assisted navigation (navigation group), and 20 underwent osteotomy using a traditional technique (traditional group). Postoperative computed tomography images were analyzed by three-dimensional software. Each patient’s facial proportion indices were measured using Mimics 19.0 software, and statistical comparisons and analyses were performed preoperatively and postoperatively. Results The postoperative facial contour morphology and facial proportion were improved in both groups; the navigation group showed greater improvement. The difference between the predicted and postoperative values was smaller in the navigation group than traditional group. The postoperative shape of the mandibular angle sample was similar to the preoperative predicted shape in the navigation group. No complications occurred in the navigation group, but paresthesia occurred in 17% of patients in the traditional group. Conclusions Mandibular angle osteotomy aided with computer-assisted navigation is more effective, accurate, and safe than the traditional technique and represents a promising clinical approach.

Free-Hand Pedicle Screw Insertion of Thoracic Spine Using Fennell Technique: Initial Results and Review of Literature

2019 ◽  
Vol 16 (01) ◽  
pp. 10-13
Author(s):  
Ayusman Satapathy ◽  
Chinmaya Dash ◽  
Arunav Sharma ◽  
Rabi Narayan Sahu
Keyword(s):  
Pedicle Screw ◽  
Thoracic Spine ◽  
Pedicle Screws ◽  
Wound Complications ◽  
Reliable Technique ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Number Of Patients ◽  
Thoracic Pedicle Screw ◽  
Safe Technique

Abstract Aim of the Study This article aims to study the safety and feasibility of Fennell technique of free-hand pedicle screw insertion in thoracic spine. Methods Consecutive 10 patients in whom 40 thoracic pedicle screw were inserted using Fennell’s technique were included in the study. Postoperative computed tomography scan was done in all the patients. Breach in individual pedicle was analyzed using Gertzbein classification. Results A total of 40 screws were placed in the thoracic spine in 10 patients by free-hand technique described by Fennell et al. Out of 40 pedicle screws, 26 were placed at the D10 to D12 level, 8 screws were placed at the D7 to D9 level, and 6 screws were placed at the D1 to D6 level. There was one pedicle with grade 1 lateral breach and one pedicle with grade 1 medial breach as per Gertzbein classification. All other screws were contained within the pedicle (Gertzbein grade 0). None of the patients had any added deficits or wound complications in the postoperative period. Conclusion Thoracic pedicle screw insertion is challenging in nature because of the anatomic variability and proximity of critical structures to the pedicles. Our experience suggests that Fennell technique is a reliable technique, which can be used to place thoracic pedicles consistently, with acceptable rates of pedicle breach. A study involving larger number of patients might prove to establish this technique as an easily reproducible and safe technique for free-hand pedicle screw insertion in thoracic spine.

scholarly journals Assessment of Surgical Procedural Time, Pedicle Screw Accuracy, and Clinician Radiation Exposure of a Novel Robotic Navigation System Compared With Conventional Open and Percutaneous Freehand Techniques: A Cadaveric Investigation

2019 ◽  
Vol 10 (7) ◽  
pp. 814-825
Author(s):  
Alexander R. Vaccaro ◽  
Jonathan A. Harris ◽  
Mir M. Hussain ◽  
Rishi Wadhwa ◽  
Victor W. Chang ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Surgical Procedure ◽  
Pedicle Screws ◽  
Setup Time ◽  
Procedure Time ◽  
Assisted Navigation ◽  
Screw Insertion ◽  
Percutaneous Procedures ◽  
Procedural Time ◽  
Improved Accuracy

Study Design: Cadaveric study. Objective: To evaluate accuracy, radiation exposure, and surgical time of a new robotic-assisted navigation (RAN) platform compared with freehand techniques in conventional open and percutaneous procedures. Methods: Ten board-certified surgeons inserted 16 pedicle screws at T10–L5 (n = 40 per technique) in 10 human cadaveric torsos. Pedicle screws were inserted with (1) conventional MIS technique (L2–L5, patient left pedicles), (2) MIS RAN (L2–L5, patient right pedicles), (3) conventional open technique (T10–L1, patient left pedicles), and (4) open RAN (T10–L1, patient right pedicles). Output included (1) operative time, (2) number of fluoroscopic images, and (3) screw accuracy. Results: In the MIS group, compared with the freehand technique, RAN allowed for use of larger screws (diameter: 6.6 ± 0.6 mm vs 6.3 ± 0.5 mm; length: 50.3 ± 4.1 mm vs 46.9 ± 3.5 mm), decreased the number of breaches >2 mm (0 vs 7), fewer fluoroscopic images (0 ± 0 vs 108.3 ± 30.9), and surgical procedure time per screw (3.6 ± 0.4 minutes vs 7.6 ± 2.0 minutes) (all P < .05). Similarly, in the open group, RAN allowed for use of longer screws (46.1 ± 4.1 mm vs 44.0 ± 3.8 mm), decreased the number of breaches >2 mm (0 vs 13), fewer fluoroscopic images (0 ± 0 vs 24.1 ± 25.8) (all P < .05), but increased total surgical procedure time (41.4 ± 8.8 minutes vs 24.7 ± 7.0 minutes, P = .000) while maintaining screw insertion time (3.31.4 minutes vs 3.1 ± 1.0 minutes, P = .650). Conclusion: RAN significantly improved accuracy and decreased radiation exposure in comparison to freehand techniques in both conventional open and percutaneous surgical procedures in cadavers. RAN significantly increased setup time compared with both conventional procedures.

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