Top

European Spine Journal

Published in:

Open Access 10-07-2023 | Scoliosis | Original Article

The machine-vision image guided surgery system reduces fluoroscopy time, ionizing radiation and intraoperative blood loss in posterior spinal fusion for scoliosis

Authors: Kevin Boon Leong Lim, Inez Su Xian Yeo, Stacy Wei Ling Ng, Woei Jack Pan, Nicole Kim Luan Lee

Published in: European Spine Journal | Issue 11/2023

Abstract

Purpose

To determine if the novel 3D Machine-Vision Image Guided Surgery (MvIGS) (FLASH™) system can reduce intraoperative radiation exposure, while improving surgical outcomes when compared to 2D fluoroscopic navigation.

Methods

Clinical and radiographic records of 128 patients (≤ 18 years of age) who underwent posterior spinal fusion (PSF), utilising either MvIGS or 2D fluoroscopy, for severe idiopathic scoliosis were retrospectively reviewed. Operative time was analysed using the cumulative sum (CUSUM) method to evaluate the learning curve for MvIGS.

Results

Between 2017 and 2021, 64 patients underwent PSF using pedicle screws with 2D fluoroscopy and another 64 with the MvIGS. Age, gender, BMI, and scoliosis aetiology were comparable between the two groups. The CUSUM method estimated that the MvIGS learning curve with respect to operative time was 9 cases. This curve consisted of 2 phases: Phase 1 comprises the first 9 cases and Phase 2 the remaining 55 cases. Compared to 2D fluoroscopy, MvIGS reduced intraoperative fluoroscopy time, radiation exposure, estimated blood loss and length of stay by 53%, 62% 44%, and 21% respectively. Scoliosis curve correction was 4% higher in the MvIGS group, without any increase in operative time.

Conclusion

MvIGS for screw insertion in PSF contributed to a significant reduction in intraoperative radiation exposure and fluoroscopy time, as well as blood loss and length of stay. The real-time feedback and ability to visualize the pedicle in 3D with MvIGS enabled greater curve correction without increasing the operative time.

Blevins K, Battenberg A, Beck A (2018) Management of scoliosis. Adv Pediatr. https://doi.org/10.1016/j.yapd.2018.04.013CrossRefPubMed

Hicks JM, Singla A, Shen FH, Arlet V (2010) Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0b013e3181d1021aCrossRefPubMed

Narain AS, Hijji FY, Yom KH, Kudaravalli KT, Haws BE, Singh K (2017) Radiation exposure and reduction in the operating room: perspectives and future directions in spine surgery. World J Orthop. https://doi.org/10.5312/wjo.v8.i7.524CrossRefPubMedPubMedCentral

Luan FJ, Wan Y, Mak KC, Ma CJ, Wang HQ (2020) Cancer and mortality risks of patients with scoliosis from radiation exposure: a systematic review and meta-analysis. Eur Spine J. https://doi.org/10.1007/s00586-020-06573-7CrossRefPubMed

Simony A, Hansen EJ, Christensen SB, Carreon LY, Andersen MO (2016) Incidence of cancer in adolescent idiopathic scoliosis patients treated 25 years previously. Eur Spine J. https://doi.org/10.1007/s00586-016-4747-2CrossRefPubMed

De Silva T, Punnoose J, Uneri A, Mahesh M, Goerres J, Jacobson M, Ketcha MD, Manbachi A, Vogt S, Kleinszig G, Khanna AJ, Wolinksy JP, Siewerdsen JH, Osgood G (2018) Virtual fluoroscopy for intraoperative C-arm positioning and radiation dose reduction. J Med Imaging (Bellingham). https://doi.org/10.1117/1.JMI.5.1.015005CrossRefPubMed

Liu, Hao, Yimeng Wang, Bin Pi, Zhonglai Qian, Xiaoyu Zhu, and Yang Huilin. (2017). Comparison of intraoperative o-arm- and conventional fluoroscopy (C-Arm)-assisted insertion of pedicle screws in the treatment of fracture of thoracic vertebrae. Vol. 25: J Orthop Surg Hong Kong.

Kalfas IH (2021) Machine vision navigation in spine surgery. Front Surg. https://doi.org/10.3389/fsurg.2021.640554CrossRefPubMedPubMedCentral

Malham GM, Munday NR (2022) Comparison of novel machine vision spinal image guidance system with existing 3d fluoroscopy-based navigation system: a randomized prospective study. Spine J. https://doi.org/10.1016/j.spinee.2021.10.002CrossRefPubMed

10.

Dorilio J, Utah N, Dowe C, Avrumova F, Alicea D, Brecevich A, Callanan T, Sama A, Lebl DR, Abjornson C, Cammisa FP (2021) Comparing the efficacy of radiation free machine-vision image-guided surgery with traditional 2-dimensional fluoroscopy: a randomized, single-center study. HSS J. https://doi.org/10.1177/15563316211029837CrossRefPubMedPubMedCentral

11.

Page ES. (1954). Continuous inspection schemes. Vol. 41: Biometrika.

12.

Suk SI, Lee SM, Chung ER, Kim JH, Kim SS (2005) Selective thoracic fusion with segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis: more than 5-year follow-up. Spine (Phila Pa 1976). https://doi.org/10.1097/01.brs.0000169452.50705.61CrossRefPubMed

13.

Asher M, Lai SM, Burton D, Manna B, Cooper A (2004) Safety and efficacy of isola instrumentation and arthrodesis for adolescent idiopathic scoliosis: two- to 12-year follow-up. Spine (Phila Pa 1976). https://doi.org/10.1097/01.brs.0000138275.49220.81CrossRefPubMed

14.

Cheng I, Kim Y, Gupta MC, Bridwell KH, Hurford RK, Lee SS, Theerajunyaporn T, Lenke LG (2005) Apical sublaminar wires versus pedicle screws-which provides better results for surgical correction of adolescent idiopathic scoliosis? Spine (Phila Pa 1976). https://doi.org/10.1097/01.brs.0000179261.70845.b7CrossRefPubMed

15.

Merloz P, Troccaz J, Vouaillat H, Vasile C, Tonetti J, Eid A, Plaweski S (2007) Fluoroscopy-based navigation system in spine surgery. Proc Inst Mech Eng. https://doi.org/10.1243/09544119JEIM268CrossRef

16.

Meng XT, Guan XF, Zhang HL, He SS (2016) Computer navigation versus fluoroscopy-guided navigation for thoracic pedicle screw placement: a meta-analysis. Neurosurg Rev. https://doi.org/10.1007/s10143-015-0679-2CrossRefPubMed

17.

Su AW, McIntosh AL, Schueler BA, Milbrandt TA, Winkler JA, Stans AA, Larson AN (2017) How does patient radiation exposure compare with low-dose O-arm versus fluoroscopy for pedicle screw placement in idiopathic scoliosis? J Pediatr Orthop. https://doi.org/10.1097/BPO.0000000000000608CrossRefPubMed

18.

Konieczny MR, Senyurt H, Krauspe R (2013) Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. https://doi.org/10.1007/s11832-012-0457-4CrossRefPubMed

19.

Pennington, Zach, Brendan F. Judy, Hesham M. Zakaria, Nikita Lakomkin, Anthony L. Mikula, Benjamin D. Elder, and Nicholas Theodore. (2022) Learning curves in robot-assisted spine surgery: a Systematic review and proposal of application to residency curricula. Neurosurg focus 52, no. 1 (2022–01–01): E3. Accessed 2022–10–28T04:18:23. https://doi.org/10.3171/2021.10.focus21496.

20.

Lonstein JE, Carlson JM (1984) The prediction of curve progression in untreated idiopathic scoliosis during growth. J Bone Joint Surg Am 66(7):1061–1071CrossRefPubMed

21.

Daffner SD, Beimesch CF, Wang JC (2010) Geographic and demographic variability of cost and surgical treatment of idiopathic scoliosis. Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0b013e3181d88e78CrossRefPubMed

22.

Fletcher ND, Bellaire LL, Dilbone ES, Ward LA, Bruce RW (2020) Variability in length of stay following neuromuscular spinal fusion. Spine Deform. https://doi.org/10.1007/s43390-020-00081-wCrossRefPubMed

23.

Borrego D, Lowe EM, Kitahara CM, Lee C (2018) Assessment of Pcxmc for patients with different body size in chest and abdominal X ray examinations: a monte carlo simulation study. Phys Med Biol. https://doi.org/10.1088/1361-6560/aab13eCrossRefPubMedPubMedCentral

24.

Siddiqui AA, Andras LM, Obana KK, Murgai R, Illingworth KD, Tolo VT, Mariscal M, Ponrartana S, Skaggs DL (2021) Using a dedicated spine radiology technologist is associated with reduced fluoroscopy time, radiation dose, and surgical time in pediatric spinal deformity surgery. Spine Deform 9(1):85–89. https://doi.org/10.1007/s43390-020-00183-5CrossRefPubMed

Title: The machine-vision image guided surgery system reduces fluoroscopy time, ionizing radiation and intraoperative blood loss in posterior spinal fusion for scoliosis
Authors: Kevin Boon Leong Lim
Inez Su Xian Yeo
Stacy Wei Ling Ng
Woei Jack Pan
Nicole Kim Luan Lee
Publication date: 10-07-2023
Publisher: Springer Berlin Heidelberg
Keywords: Scoliosis
Adolescent Idiopathic Scoliosis
Published in: European Spine Journal / Issue 11/2023
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-023-07848-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The machine-vision image guided surgery system reduces fluoroscopy time, ionizing radiation and intraoperative blood loss in posterior spinal fusion for scoliosis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2023

The Finnish spine register (FinSpine): development, design, validation and utility

Adolescent idiopathic scoliosis is associated with muscle area asymmetries in the lumbar spine

Pre-operative prediction of post-operative urinary retention in lumbar surgery: a prospective validation of machine learning model

Distal fusion level, complications, and reoperations in individuals with cerebral palsy undergoing surgery for scoliosis

Evaluation of cerebellum volume and trunk oscillation velocity in cases with adolescent idiopathic scoliosis: a preliminary report

Deep learning-based high-accuracy detection for lumbar and cervical degenerative disease on T2-weighted MR images