Top

International Orthopaedics

Published in:

01-09-2018 | Original Paper

Improved accuracy of screw implantation could decrease the incidence of post-operative hydrothorax? O-arm navigation vs. free-hand in thoracic spinal deformity correction surgery

Authors: Zhihui Zhao, Zhen Liu, Zongshan Hu, Changchun Tseng, Jie Li, Wei Pan, Yong Qiu, Zezhang Zhu

Published in: International Orthopaedics | Issue 9/2018

Abstract

Purpose

The purpose of this study was to analyze the occurrence of PE after intra-operative O-arm navigation-assisted surgery and determine whether the post-operative PE incidence could be decreased by using O-arm navigation as compared to conventional free-hand technique.

Methods

A cohort of 27 patients with spinal deformity who were operated upon with an O-arm navigated system (group A) between 2013 and 2016 were enrolled in the study. A total of 27 curve-matched patients treated by conventional free-hand technique were included as the control group (group B). Whole spine posterior-anterior and lateral radiographs, and CT scans were taken pre and post-operation. Radiologic parameters and volume of PE were measured and compared between the two groups.

Results

There were no significant differences in age, Cobb angle, and sagittal contour between the two groups pre-operatively. The mean total volume of post-operative PE was significantly larger in the free-hand group (p < 0.001). In the O-arm group, 59 malpositioned screws were identified in 22 patients. In the free-hand group, 88 malpositioned screws were found among 26 patients. The screw perforation rate was higher in the free-hand group than in the O-arm group (p = 0.007). In the O-arm group, the mean volume of PE was significantly larger among patients with malpositioned screws than those without malpositioned screws (p < 0.001), as well as in the free-hand group.

Conclusion

The volume of PE after correction surgery can be significantly decreased by application of O-arm navigation system as compared to conventional free-hand technique. We ascribed the improvement to the accuracy of screw implantation navigated by O-arm.

Reames DL, Smith JS, Fu KM et al (2011) Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the Scoliosis Research Society Morbidity and Mortality database. Spine 36:1484–1491. https://doi.org/10.1097/BRS.0b013e3181f3a326 CrossRefPubMed

de Mendonca RG, Sawyer JR, Kelly DM (2016) Complications after surgical treatment of adolescent idiopathic scoliosis. Orthop Clin North Am 47:395–403. https://doi.org/10.1016/j.ocl.2015.09.012. CrossRefPubMed

Modi HN, Suh SW, Yang JH et al (2009) Surgical complications in neuromuscular scoliosis operated with posterior-only approach using pedicle screw fixation. Scoliosis 4:11. https://doi.org/10.1186/1748-7161-4-114. CrossRefPubMedPubMedCentral

Schwab FJ, Lafage V, Farcy JP et al (2008) Predicting outcome and complications in the surgical treatment of adult scoliosis. Spine 33:2243–2247. https://doi.org/10.1097/BRS.0b013e31817d1d4e CrossRefPubMed

Hayashi K, Terai H, Toyoda H et al (2017) Incidence of pleural fluid and its associated risk factors after posterior spinal fusion in patients with adolescent idiopathic scoliosis. Spine 42:603–609. https://doi.org/10.1097/BRS.0000000000001861 CrossRefPubMed

Sarwahi V, Suggs W, Wollowick AL et al (2014) Pedicle screws adjacent to the great vessels or viscera: a study of 2132 pedicle screws in pediatric spine deformity. J Spinal Disord Tech 27:64–69. https://doi.org/10.1097/BSD.0b013e31825bfecd CrossRefPubMed

Ogura Y, Watanabe K, Hosogane N et al (2013) Acute respiratory failure due to hemothorax after posterior correction surgery for adolescent idiopathic scoliosis: a case report. BMC Musculoskelet Disord 14:132. https://doi.org/10.1186/1471-2474-14-132 CrossRefPubMedPubMedCentral

Liang W, Yu B, Wang Y et al (2016) Pleural effusion in spinal deformity correction surgery—a report of 28 cases in a single center. PLoS One 11:e0154964. https://doi.org/10.1371/journal.pone.0154964 eCollection 2016CrossRefPubMedPubMedCentral

Ammirati M, Salma A (2013) Placement of thoracolumbar pedicle screws using O-arm-based navigation: technical note on controlling the operational accuracy of the navigation system. Neurosurg Rev 36:157–162. https://doi.org/10.1007/s10143-012-0421-2 CrossRefPubMed

10.

Oertel MF, Hobart J, Stein M, Schreiber V et al (2013) Clinical and methodological precision of spinal navigation assisted by 3D intraoperative O-arm radiographic imaging. J Neurosurg Spine 14(4):532–536. https://doi.org/10.3171/2010.10.SPINE091032 CrossRef

11.

Er S, Ledonio CG, Castro CA, Truong WH et al (2012) The accuracy of intraoperative O-arm images for the assessment of pedicle screw position. Spine (Phila Pa 1976) 37(2):E119–E125. https://doi.org/10.1097/BRS.0b013e3182257cae CrossRef

12.

BPB T, Yue WM, Srivastava A, Lai JM et al (2015) Does navigation improve accuracy of placement of pedicle screws in single level lumbar degenerative spondylolisthesis?—A comparison between free-hand and 3D O-arm navigation techniques. J Spinal Disord Tech 28(8):E472–E477. https://doi.org/10.1097/BSD.0b013e3182a9435e CrossRef

13.

Diebo B, Liu S, Lafage V et al (2014) Osteotomies in the treatment of spinal deformities: indications, classification, and surgical planning. Eur J Orthop Surg Traumatol 24(Suppl 1):S11–S20. https://doi.org/10.1007/s00590-014-1471-7 CrossRefPubMed

14.

Guo ZJ, Lin Q, Liu HT et al (2013) The preliminary exploration of 64-slice volume computed tomography in the accurate measurement of pleural effusion. Acta Radiol 54:765–769. https://doi.org/10.1177/0284185113483675 CrossRefPubMed

15.

Jeswani S, Drazin D, Hsieh JC et al (2014) Instrumenting the small thoracic pedicle: the role of intraoperative computed tomography image–guided surgery. Neurosurg Focus 36:E6. https://doi.org/10.3171/2014.1.FOCUS13527 CrossRefPubMed

16.

17.

Lai PL (2006) Delayed massive pleural effusion after scoliosis correction and thoracoplasty: a case report. J Trauma 61:746–748. https://doi.org/10.1097/01.ta.0000224899.55790.e3 CrossRefPubMed

18.

Klineberg EO, Passias PG, Jalai CM et al (2016) Predicting extended length of hospital stay in an adult spinal deformity surgical population. Spine 41:E798–E805. https://doi.org/10.1097/BRS.0000000000001391 CrossRefPubMed

19.

Ferrick MR, Kowalski JM, Simmons ED Jr (1997) Reliability of roentgenogram evaluation of pedicle screw position. Spine (Phila Pa 1976) 22(11):1249–1252CrossRef

20.

Laine T, Makitalo K, Schlenzka D, Schlenzka D, Tallroth K et al (1997) Accuracy of pedicle screw insertion: a prospective CT study in 30 low back patients. Eur Spine J 6(6):402–405CrossRefPubMedPubMedCentral

21.

Weinstein JN, Spratt KF, Spengler D, Brick C et al (1988) Spinal pedicle fixation: reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement. Spine (Phila Pa 1976) 13(9):1012–1018CrossRef

22.

Ling JM, Dinesh SK, Pang BC et al (2014) Routine spinal navigation for thoraco-lumbar pedicle screw insertion using the O-arm three-dimensional imaging system improves placement accuracy. J Clin Neurosci Mar 21(3):493–498. https://doi.org/10.1016/j.jocn.2013.02.034 CrossRef

23.

Liu Z, Jin M, Qiu Y et al (2016) The superiority of intraoperative O-arm navigation-assisted surgery in instrumenting extremely small thoracic pedicles of adolescent idiopathic scoliosis: a case-control study. Medicine 95:e3581. https://doi.org/10.1097/MD.0000000000003581 CrossRefPubMedPubMedCentral

24.

Amato V, Giannachi L, Irace C, Corona C et al (2010) Accuracy of pedicle screw placement in the lumbosacral spine using conventional technique: computed tomography postoperative assessment in 102 consecutive patients. J Neurosurg Spine 12(3):306–313. https://doi.org/10.3171/2009.9.SPINE09261 CrossRefPubMed

25.

Hadjipavlou AG, Nicodemus CL, al-Hamdan FA, Simmons JW et al (1997) Correlation of bone equivalent mineral density to pull-out resistance of triangulated pedicle screw construct. J Spinal Disord 10(1):12–19CrossRefPubMed

Title: Improved accuracy of screw implantation could decrease the incidence of post-operative hydrothorax? O-arm navigation vs. free-hand in thoracic spinal deformity correction surgery
Authors: Zhihui Zhao
Zhen Liu
Zongshan Hu
Changchun Tseng
Jie Li
Wei Pan
Yong Qiu
Zezhang Zhu
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 9/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-3889-8

ACC 2024 Congress

Springer Medicine

Improved accuracy of screw implantation could decrease the incidence of post-operative hydrothorax? O-arm navigation vs. free-hand in thoracic spinal deformity correction surgery

Abstract

Purpose

Methods

Results

Conclusion

ACC 2024 Congress

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2018

“Knee osteoarthritis and current research for evidence—are we on the right way?”

Re-admissions treble the risk of late mortality after primary total hip arthroplasty

Soft tissue tension is four times lower in the unstable primary total hip arthroplasty: does this comparison make sense?

Association of gout with osteoporotic fractures

Prospective study of comminuted articular distal radius fractures stabilized by volar plating in the elderly

The treatment of chronic radial head dislocation in Monteggia fracture without annular ligament reconstruction