scholarly journals Fluoroscopy for transpedicular screw placement in scoliosis: to what extent can radiation exposure be reduced by the freehand technique?

2012 ◽  
Author(s):  
Tolga Ege ◽  
Serkan Bilgic ◽  
Kenan Koca ◽  
Erbil Oguz ◽  
Erden Kilic ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Screw Placement ◽  
Freehand Technique ◽  
Transpedicular Screw

scholarly journals Transpedicular Screw Placement Accuracy Using the O-Arm Versus Freehand Technique at a Single Institution

2020 ◽  
pp. 219256822095697
Author(s):  
Benjamin D. Crawford ◽  
Corbyn M. Nchako ◽  
Kelsey A. Rebehn ◽  
Heidi Israel ◽  
Howard M. Place
Keyword(s):  
Pedicle Screw ◽  
Intraoperative Imaging ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Spinal Level ◽  
Imaging Tool ◽  
Freehand Technique ◽  
Transpedicular Screw ◽  
Significant Difference ◽  
Placement Accuracy

Study Design: Retrospective cohort. Objective: The objective of this study was to assess the effectiveness of the O-arm as an intraoperative imaging tool by comparing accuracy of pedicle screw placement to freehand technique. Methods: The study comprised a total of 1161 screws placed within the cervical (n = 187) thoracic (n = 657), or lumbar (n = 317) spinal level. A pedicle breach was determined by any measurable displacement of the screw outside of the pedicle cortex in any plane on postoperative images. Each pedicle screw was subsequently classified by its placement relative to the targeted pedicle. Statistical analysis was then performed to determine the frequency and type of pedicle screw mispositioning that occurred using the O-arm versus freehand technique. Results: A total of 155 cases (O-arm 84, freehand 71) involved the placement of 454 pedicle screws in the O-arm group and 707 pedicle screws in the freehand group. A pedicle breach occurred in 89 (12.6%) screws in the freehand group and 55 (12.1%) in the O-arm group ( P = .811). Spinal level operated upon did not influence pedicle screw accuracy between groups ( P > .05). Three screws required revision surgery between the 2 groups (O-arm 1, freehand 2, P > .05). The most frequent breach type was a lateral pedicle breach (O-arm 22/454, 4.8%; freehand 54/707, 7.6%), without a significant difference between groups ( P > .05). Conclusions: The use of the O-arm coupled with navigation does not assure improved transpedicular screw placement accuracy when compared with the freehand technique.

Intraoperative Radiation Exposure for Patients with Double-Curve Idiopathic Scoliosis in Freehand-Technique in Comparison to Fluoroscopic- and CT-Based Navigation

2020 ◽  
Author(s):  
Clara Berlin ◽  
Markus Quante ◽  
Björn Thomsen ◽  
Mark Köszegvary ◽  
Uwe Platz ◽  
...  
Keyword(s):  
Blood Loss ◽  
Idiopathic Scoliosis ◽  
Radiation Exposure ◽  
Pedicle Screws ◽  
Screw Placement ◽  
Total Radiation ◽  
Intraoperative Radiation ◽  
Assisted Navigation ◽  
Freehand Technique ◽  
Time Of Operation

Abstract Background In the operative treatment of idiopathic scoliosis, posterior correction and fusion in freehand technique is a proven procedure and is frequently performed. Malpositioned pedicle screws can result in serious neurovascular complications. Intraoperative fluoroscopy and neurophysiological measurements are performed to ensure the correct position of pedicle screws. Newer procedures with fluoroscopic- and computertomographic-assisted navigation are advertised as less dangerous and with a more accurate screw position. Hypothesis Is the freehand technique used in the surgical treatment of idiopathic scoliosis safer than other methods with regard to complications caused by screw malposition and intraoperative radiation exposure? Material and Methods Register data of 34 consecutive idiopathic scoliosis patients with two structural curves (Lenke 3 and 6) were collected prospectively in our scoliosis center and were retrospectively analyzed. The following parameters were evaluated: total radiation product, time of fluoroscopy, number of fused segments, time of operation, blood loss, screw-related complications and number of instrumented pedicle screws. All values were given as mean ± standard deviation and statistically analyzed. Finally, our data were compared on accuracy of screw placement and radiation exposure to data from literature with screw placement under navigation. Results Average age at the time of surgery was 23.6 ± 12 years. The average thoracic curve was 69.2 ± 14.2° preoperatively and 21.7 ± 12.8° postoperatively (correction 69.9%), the average lumbar curve was 64.3° ± 10.8° preoperatively and corrected to 15.6 ± 10.4° postoperatively (correction 76.2%). The total radiation product per patient was 145.7 ± 86.1 cGy*cm², the time of fluoroscopy 31.7 ± 23.5 s (11.5 segments), the time of operation 267.2 ± 64.1 min and the blood loss 700.4 ± 522.3 ml. A total of 803 pedicle screws were placed. No screw-associated complications were detected in the entire collective. The comparison of our data with freehand placement of pedicle screws to literature data showed a noticeable higher radiation exposure for the patient during fluoroscopic- and computertomographic-assisted navigation. Discussion The results showed that positioning of pedicle screws with freehand technique in patients with idiopathic scoliosis is accompanied with considerably lower intraoperative radiation exposure compared to fluoroscopic- or computertomographic-assisted navigation. An increased radiation exposure of these typically young patients is associated with an increased long-term risk for the occurrence of radiation-induced malignant diseases. With appropriate surgical experience, placement of pedicle screws in freehand technique is safe and effective and with similar accuracy than screws placed under navigation, but produces significantly less radiation exposure to the patients.

scholarly journals A useful intraoperative technique for transiliac-transsacral screws: a point-to-point coaxial guide apparatus

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ze-hang Zheng ◽  
Fei Xu ◽  
Zheng-qiang Luo ◽  
Ye Ren ◽  
Tao Fu ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Pelvic Fracture ◽  
Operative Time ◽  
Screw Placement ◽  
Screw Insertion ◽  
Average Operative Time ◽  
Free Hand Technique ◽  
Point To Point ◽  
Postoperative Fracture

Abstract Background The transiliac-transsacral screw placement is a clinical challenge for surgeons. This study explored a point-to-point coaxial guide apparatus assisting the transiliac-transsacral screw insertion and aimed to investigate the feasibility and accuracy of the guide apparatus in the treatment of posterior ring unstable pelvic fracture compared with a free-hand technique. Methods A retrospective study was performed to evaluate patients treated with transiliac-transsacral screws assisted by the point-to-point coaxial guide apparatus or free-hand technique. The intraoperative data of operative time and radiation exposure times were recorded. Postoperative radiographs and CT scans were performed to scrutinize the accuracy of screws position. The quality of the postoperative fracture reduction was assessed according to Matta radiology criteria. The pelvic function was assessed according to the Majeed scoring criteria at 6 months postoperatively. Results From July 2017 to December 2019, a total of 38 patients were included in this study, 20 from the point-to-point guide apparatus group and 18 from the free-hand group. There were no significant differences between the two groups in gender, age, injury causes, pelvic fracture type, screws level, and follow-up time (P > 0.05). The average operative time of the guide apparatus group for each screw was significantly less than that in the free-hand group (25.8 ± 4.7 min vs 40.5 ± 5.1, P < 0.001). The radiation exposure times were significantly lower in the guide apparatus group than that in the free-hand group (24.4 ± 6.0 vs 51.6 ± 8.4, P < 0.001). The intraosseous and juxtacortical rate of screw placement (100%) higher than in the free-hand group (94.4%). Conclusion The point-to-point coaxial guide apparatus is feasible for assisting the transiliac-transsacral screw in the treatment of posterior unstable pelvic fractures. It has the advantages of simple operation, reasonable design and no need for expensive equipment, and provides an additional surgical strategy for the insertion of the transiliac-transsacral screw.

scholarly journals Navigated iliac screw placement may reduce radiation and OR time in lumbopelvic fixation of unstable complex sacral fractures

2021 ◽  
Author(s):  
M. F. Hoffmann ◽  
E. Yilmaz ◽  
D. C. Norvel ◽  
T. A. Schildhauer
Keyword(s):  
Radiation Exposure ◽  
Operative Time ◽  
Pelvic Ring ◽  
Screw Placement ◽  
Fluoroscopy Time ◽  
Complication Rates ◽  
Lumbopelvic Fixation ◽  
Navigation Group ◽  
Iliac Screws ◽  
Iliac Screw

Abstract Purpose Instability of the posterior pelvic ring may be stabilized by lumbopelvic fixation. The optimal osseous corridor for iliac screw placement from the posterior superior iliac spine to the anterior inferior iliac spine requires multiple ap- and lateral-views with additional obturator-outlet and -inlet views. The purpose of this study was to determine if navigated iliac screw placement for lumbopelvic fixation influences surgical time, fluoroscopy time, radiation exposure, and complication rates. Methods Bilateral lumbopelvic fixation was performed in 63 patients. Implants were inserted as previously described by Schildhauer. A passive optoelectronic navigation system with surface matching on L4 was utilized for navigated iliac screw placement. To compare groups, demographics were assessed. Operative time, fluoroscopic time, and radiation were delineated. Results Conventional fluoroscopic imaging for lumbopelvic fixation was performed in 32 patients and 31 patients underwent the procedure with navigated iliac screw placement. No differences were found between the groups regarding demographics, comorbidities, or additional surgical procedures. Utilization of navigation led to fluoroscopy time reduction of more than 50% (3.2 vs. 8.6 min.; p < 0.001) resulting in reduced radiation (2004.5 vs. 5130.8 Gy*cm2; p < 0.001). Operative time was reduced in the navigation group (176.7 vs. 227.4 min; p = 0.002) despite the necessity of additional surface referencing. Conclusion For iliac screws, identifying the correct entry point and angle of implantation requires detailed anatomic knowledge and multiple radiographic views. In our study, additional navigation reduced operative time and fluoroscopy time resulting in a significant reduction of radiation exposure for patients and OR personnel.

scholarly journals A five-step remedial screw placement method to treat severe spinal deformity with free-hand transpedicular screw placement

2012 ◽  
Vol 22 (2) ◽  
pp. 417-424 ◽  
Author(s):  
Jing-Ming Xie ◽  
Zhi Zhao ◽  
Hua Yang ◽  
Ying-Song Wang ◽  
Ying Zhang ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Screw Placement ◽  
Placement Method ◽  
Transpedicular Screw ◽  
Severe Spinal Deformity

Morphometry of the Thoracic and Lumbar Spine Related to Transpedicular Screw Placement for Surgical Spinal Fixation

Spine ◽  
1988 ◽  
Vol 13 (1) ◽  
pp. 27-32 ◽  
Author(s):  
MARTIN H. KRAG ◽  
DONALD L. WEAVER ◽  
BRUCE D. BEYNNON ◽  
LARRY D. HAUGH
Keyword(s):  
Lumbar Spine ◽  
Screw Placement ◽  
Spinal Fixation ◽  
Transpedicular Screw ◽  
Thoracic And Lumbar Spine

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

2019 ◽  
Vol 18 (5) ◽  
pp. 496-502 ◽  
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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