placement accuracy
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2022 ◽  
Vol 97 ◽  
pp. 7-11
Author(s):  
M. Maher Hulou ◽  
Benton Maglinger ◽  
Christopher J. McLouth ◽  
Catalina M. Reusche ◽  
Justin F. Fraser

2022 ◽  
Vol 52 (1) ◽  
pp. E10

OBJECTIVE Several approaches have been studied for internal fixation of the spine using pedicle screws (PSs), including CT navigation, 2D and 3D fluoroscopy, freehand, and robotic assistance. Robot-assisted PS placement has been controversial because training requirements, cost, and previously unclear benefits. This meta-analysis compares screw placement accuracy, operative time, intraoperative blood loss, and overall complications of PS insertion using traditional freehand, navigated, and robot-assisted methods. METHODS A systematic review was performed of peer-reviewed articles indexed in several databases between January 2000 and August 2021 comparing ≥ 2 PS insertion methods with ≥ 10 screws per treatment arm. Data were extracted for patient outcomes, including PS placement, misplacement, and accuracy; operative time, overall complications, intraoperative blood loss, postoperative hospital length of stay, postoperative Oswestry Disability Index (ODI) score, and postoperative visual analog scale (VAS) score for back pain. Risk of bias was assessed using the Newcastle-Ottawa score and Cochrane tool. A network meta-analysis (NMA) was performed to estimate PS placement accuracy as the primary outcome. RESULTS Overall, 78 studies consisting of 6262 patients and > 31,909 PSs were included. NMA results showed that robot-assisted and 3D-fluoroscopy PS insertion had the greatest accuracy compared with freehand (p < 0.01 and p < 0.001, respectively), CT navigation (p = 0.02 and p = 0.04, respectively), and 2D fluoroscopy (p < 0.01 and p < 0.01, respectively). The surface under the cumulative ranking (SUCRA) curve method further demonstrated that robot-assisted PS insertion accuracy was superior (S = 0.937). Optimal screw placement was greatest in robot-assisted (S = 0.995) placement, and misplacement was greatest with freehand (S = 0.069) approaches. Robot-assisted placement was favorable for minimizing complications (S = 0.876), while freehand placement had greater odds of complication than robot-assisted (OR 2.49, p < 0.01) and CT-navigation (OR 2.15, p = 0.03) placement. CONCLUSIONS The results of this NMA suggest that robot-assisted PS insertion has advantages, including improved accuracy, optimal placement, and minimized surgical complications, compared with other PS insertion methods. Limitations included overgeneralization of categories and time-dependent effects.


Author(s):  
Kevin A. Hao ◽  
Christopher D. Sutton ◽  
Thomas W. Wright ◽  
Bradley S. Schoch ◽  
Jonathan O. Wright ◽  
...  

2021 ◽  
Author(s):  
Halen Baker Erdman ◽  
Evgeniya Kornilov ◽  
Eilat Kahana ◽  
Omer Zarchi ◽  
Johnathan Reiner ◽  
...  

Deep brain stimulation (DBS) is commonly and safely performed for selective Parkinson's disease patients. Many centers perform DBS lead positioning exclusively under local anesthesia, to allow for brain microelectrode recordings (MER) and testing of stimulation-related therapeutic and side effects. These measures enable physiological identification of the DBS targets based on electrophysiological properties like firing rates and patterns, optimization of lead placement accuracy, and intra-operative evaluation of therapeutic window. Nevertheless, due to the challenges of awake surgery, some centers use sedation or general anesthesia, despite the distortion of discharge properties, and potential impact on clinical outcomes. Thus, there is a need for a novel anesthesia regimen that enables sedation without compromising intra-operative monitoring. This study investigates the use of low-dose ketamine for conscious sedation during lead positioning in subthalamic nucleus (STN) DBS for Parkinson's disease patients. Three anesthetic regimens were retrospectively compared in 38 surgeries across three DBS centers: 1) Interleaved propofol-ketamine (PK), 2) Interleaved propofol-awake (PA), and 3) Fully awake (AA). All anesthesia regimens achieved satisfactory MER. Automatic detection of STN borders and subdomains using a Hidden Markov Model was similar between the groups. Patients' symptoms and cooperation during stimulation testing in the ketamine group was not altered. No major adverse effects were reported in the different anesthesia protocols. These results support the use of low-dose ketamine as a novel alternative for the existing DBS anesthesia regimens, optimizing patient's experience while preserving lead placement accuracy. A prospective study should be performed to confirm these findings.


Author(s):  
Tomohisa Inoue ◽  
Keiji Wada ◽  
Ayako Tominaga ◽  
Ryo Tamaki ◽  
Tomoya Hirota ◽  
...  

Author(s):  
MG Hamilton ◽  
C Ball ◽  
R Holubkov ◽  
G Urbaneja ◽  
A Isaacs

Background: Ventriculoperitoneal (VP) shunt failures in adult patients are common and subject patients to multiple surgeries and a decreased quality of life. A prospective cohort Shunt Outcomes Quality Improvement (ShOut-QI) initiative was implemented to reduce shunt failure incidence through neuronavigation-assisted proximal catheter insertion and laparoscopy-guided distal catheter anchoring over the liver dome to drain CSF away from the omentum. Methods: “Pre-ShOut” and “Post-ShOut” groups of patients included those with and without neuronavigation/laparoscopy, respectively for insertion of a new VP shunt. The primary outcome was shunt failure which was defined as any return to surgery for shunt revision as determined with a standardized clinical and radiology follow-up protocol. Results: 244 patients (97 Pre-ShOut, 147 Post-ShOut), mean age 73 years, were enrolled over a 7-year interval and observed for a mean duration of 4 years after shunt insertion. Neuronavigation improved proximal catheter placement accuracy by 20% (p<.001), and shunt failure occurred in 57% vs 23% in the Pre-ShOut and Post-ShOut groups, respectively (p=.008), representing a 53% relative risk reduction in the incidence of shunt failure. Conclusions: Adult shunt failure incidence may be significantly reduced by improving the accuracy of proximal catheter placement with neuronavigation and reducing the risk of distal catheter failure with laparoscopic-guided placement.


2021 ◽  
Vol 128 ◽  
pp. 110738
Author(s):  
Katy H. Stimpson ◽  
Aaron E. Embry ◽  
Jesse C. Dean

2021 ◽  
Author(s):  
Tadeh Avanessian ◽  
Jim Clatterbaugh ◽  
Robin L. Zinsmaster ◽  
Leyla Hashemi

Abstract Epoxy die attach is widely used in microcircuit assembly and enjoys advantages such as ease of deposition, fast curing, reworkability, and non-toxicity. These qualities also make it suitable for automated mass production. However, this method falls short when high placement accuracy is desired as the die can shift on uncured epoxy leading to die displacement from its original location. Gold to gold face-up bonding is another method utilized in microelectronics packaging given its proven bonding reliability and high placement accuracy for small devices. Nevertheless, it is difficult to achieve a reliable bond using this method for relatively larger devices. The nonplanarity of the bonding collet or the variation in the height of the gold bumps results in a tilted die attach and/or a weak bond between the die and the substrate. Moreover, CTE (Coefficient of Thermal Expansion) mismatch between the die, the gold bumps, and/or the substrate leads to bond failure due to temperature fatigue. This paper discusses a hybrid method to take advantage of the strengths of both methods mentioned above, culminating in a reliable process with high XYZ placement accuracy. To apply this method, epoxy is first dispensed on a gold-plated substrate. Using a flip chip machine, samples with plated gold bumps on their ground side are then placed on the substrate. The gold bumps are mainly used as targets and stand-offs to improve the placement accuracy and to control epoxy glue-line thickness. The force applied on the die, the time the force is applied, and the substrate temperature are controlled for optimum die attach. Moreover, along with the force applied by the vacuum tip, epoxy is partially cured on the flip chip machine heated stage before it is moved to an oven to complete the cure process. Die shear test results before and after temperature conditioning are compared with standard epoxy die attach and gold to gold face-up bonding for identical samples and the advantages are discussed.


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