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International Orthopaedics

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01-07-2021 | Original Paper

O-arm navigation for sacroiliac screw placement in the treatment for posterior pelvic ring injury

Authors: Shengyu Lu, Keqin Yang, Cailing Lu, Ping’ou Wei, Zhi Gan, Zhipeng Zhu, Haitao Tan

Published in: International Orthopaedics | Issue 7/2021

Abstract

Purpose

This study aims to investigate the application value of O-arm navigation system in sacroiliac screw placement for the treatment of unstable pelvic ring injury.

Methods

A total of 40 patients (mean age = 30.75 ± 14.99 years, 25 males, 15 females) were included. From January 2016 to July 2018, 40 patients with posterior pelvic ring injury treated in our hospital were included. Of them, 19 patients underwent O-arm navigation for screw placement (O-arm group) while the other 21 received C-arm fluoroscopy guidance (C-arm group) for sacroiliac screw placement. Intraoperative outcomes and the outcome of screw placement were compared between groups. The quality of radiological images was assessed by Matta’s radiological outcome grade. The outcome of complex pelvic fracture treatment was evaluated by Majeed Functional score.

Results

All demographic and clinical characteristics were comparable between the two groups. Compared with the C-arm groups, the O-arm group had a shorter surgery time (33.19 ± 3.14 vs. 48.35 ± 4.38 min, P < 0.001), a higher overall good outcome “excellent + good” rate of screw placement (95.45% vs. 73.91%, P < 0.05), and a significantly higher Majeed Functional score better outcome of complex pelvic fracture treatment at 1 and 3 months postoperation (both P < 0.05).

Conclusion

Our results demonstrated that O-arm navigation system is feasible and safe for the treatment of posterior pelvic ring injury and can effectively improve the accuracy and safety of sacroiliac screw placement, shorten the operation time, and help rapid postoperative functional recovery.

Ghosh S, Aggarwal S, Kumar V et al (2019) Epidemiology of pelvic fractures in adults: our experience at a tertiary hospital. Chin J Traumatol 22:138–141. https://doi.org/10.1016/J.CJTEE.2019.03.003CrossRefPubMedPubMedCentral

Saxena P, Agrawal A, Sakale H (2014) Introduction to pelvic injury and its acute management. J Orthop Traumatol Rehabil 7:1. https://doi.org/10.4103/0975-7341.133995CrossRef

Richter PH, Gebhard F, Dehner C, Scola A (2016) Accuracy of computer-assisted iliosacral screw placement using a hybrid operating room. Injury 47:402–407. https://doi.org/10.1016/j.injury.2015.11.023CrossRefPubMed

Briem D, Linhart W, Lehmann W et al (2006) Computer-assisted screw insertion into the first sacral vertebra using a three-dimensional image intensifier: results of a controlled experimental investigation. Eur Spine J 15:757–763. https://doi.org/10.1007/s00586-005-0992-5CrossRefPubMed

Zwingmann J, Konrad G, Kotter E et al (2009) Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure. Clin Orthop Relat Res 467:1833–1838. https://doi.org/10.1007/s11999-008-0632-6CrossRefPubMed

De Silva T, Punnoose J, Uneri A et al (2018) Virtual fluoroscopy for intraoperative C-arm positioning and radiation dose reduction. J Med Imaging 5:1. https://doi.org/10.1117/1.JMI.5.1.015005CrossRef

Zwingmann J, Hauschild O, Bode G et al (2013) Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 133:1257–1265. https://doi.org/10.1007/s00402-013-1788-4CrossRefPubMed

Moed BR, Ahmad BK, Craig JG et al (1998) Intraoperative monitoring with stimulus-evoked electromyography during placement of iliosacral screws: an initial clinical study. J Bone Jt Surg - Ser A 80:537–546. https://doi.org/10.2106/00004623-199804000-00010CrossRef

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. Medicine (Baltimore) 95:e3581. https://doi.org/10.1097/MD.0000000000003581CrossRef

10.

Rosenberger RE, Dolati B, Larndorfer R et al (2010) Accuracy of minimally invasive navigated acetabular and iliosacral fracture stabilization using a targeting and noninvasive registration device. Arch Orthop Trauma Surg 130:223–230. https://doi.org/10.1007/s00402-009-0932-7CrossRefPubMed

11.

Behrendt D, Mütze M, Steinke H et al (2012) Evaluation of 2D and 3D navigation for iliosacral screw fixation. Int J Comput Assist Radiol Surg 7:249–255. https://doi.org/10.1007/s11548-011-0652-7CrossRefPubMed

12.

Coste C, Asloum Y, Marcheix PS et al (2013) Percutaneous iliosacral screw fixation in unstable pelvic ring lesions: the interest of O-ARM CT-guided navigation. Orthop Traumatol Surg Res 99:S273–S278. https://doi.org/10.1016/j.otsr.2013.03.002CrossRefPubMed

13.

Ghisla S, Napoli F, Lehoczky G et al (2018) Posterior pelvic ring fractures: intraoperative 3D-CT guided navigation for accurate positioning of sacro-iliac screws. Orthop Traumatol Surg Res 104:1063–1067. https://doi.org/10.1016/j.otsr.2018.07.006CrossRefPubMed

14.

Hsu AR, Lee S (2014) Evaluation of tarsal navicular stress fracture fixation using intraoperative O-arm computed tomography. Foot Ankle Spec 7:515–521. https://doi.org/10.1177/1938640014532130CrossRefPubMed

15.

Majeed SA (1989) Grading the outcome of pelvic fractures. J Bone Jt Surg - Ser B 71:304–306. https://doi.org/10.1302/0301-620x.71b2.2925751CrossRef

16.

Qureshi S, Lu Y, McAnany S, Baird E (2014) Three-dimensional intraoperative imaging modalities in orthopaedic surgery: a narrative review. J Am Acad Orthop Surg 22:800–809CrossRef

17.

He J, Tan G, Zhou D et al (2016) Comparison of isocentric C-arm 3-dimensional navigation and conventional fluoroscopy for percutaneous retrograde screwing for anterior column fracture of acetabulum: an observational study. Medicine (Baltimore) 95:e2470. https://doi.org/10.1097/MD.0000000000002470CrossRef

18.

Takao M, Nishii T, Sakai T et al (2014) Iliosacral screw insertion using CT-3D-fluoroscopy matching navigation. Injury 45:988–994. https://doi.org/10.1016/j.injury.2014.01.015CrossRefPubMed

19.

Verma SK, Singh PK, Agrawal D et al (2016) O-arm with navigation versus C-arm: a review of screw placement over 3 years at a major trauma center. Br J Neurosurg 30:658–661. https://doi.org/10.1080/02688697.2016.1206179CrossRefPubMed

20.

Takao M, Nishii T, Sakai T, Sugano N (2013) CT-3D-fluoroscopy matching navigation can reduce the malposition rate of iliosacral screw insertion for less-experienced surgeons. J Orthop Trauma 27:716–721. https://doi.org/10.1097/BOT.0b013e31828fc4a5CrossRefPubMed

21.

Grelat M, Zairi F, Quidet M et al (2015) Assessment of the surgeon radiation exposure during a minimally invasive TLIF: comparison between fluoroscopy and O-arm system. Neurochirurgie 61:255–259. https://doi.org/10.1016/j.neuchi.2015.04.002CrossRefPubMed

22.

Guo N, Zhang H, Li J et al (2013) O-arm based navigation vs X-ray fluoroscopy in accuracy of pedicle drilling in bovine lumber spine specimens. J Third Mil Med Univ 35:277–279

23.

Tow BPB, Yue WM, Srivastava A et al (2015) Does navigation improve accuracy of placement of pedicle screws in single-level lumbar degenerative spondylolisthesis? A comparison between free-hand and three-dimensional o-arm navigation techniques. J Spinal Disord Tech 28:E472–E477. https://doi.org/10.1097/BSD.0b013e3182a9435eCrossRef

24.

Pitteloud N, Gamulin A, Barea C et al (2017) Radiation exposure using the O-arm® surgical imaging system. Eur Spine J 26:651–657. https://doi.org/10.1007/s00586-016-4773-0CrossRefPubMed

25.

Su AW, Luo TD, McIntosh AL et al (2016) Switching to a pediatric dose O-arm protocol in spine surgery significantly reduced patient radiation exposure. J Pediatr Orthop 36:621–626. https://doi.org/10.1097/bpo.0000000000000504CrossRefPubMed

26.

Kassis SZ, Abukwedar LK, Msaddi AK et al (2016) Combining pedicle screw stimulation with spinal navigation, a protocol to maximize the safety of neural elements and minimize radiation exposure in thoracolumbar spine instrumentation. Eur Spine J 25:1724–1728. https://doi.org/10.1007/s00586-015-3973-3CrossRefPubMed

Title: O-arm navigation for sacroiliac screw placement in the treatment for posterior pelvic ring injury
Authors: Shengyu Lu
Keqin Yang
Cailing Lu
Ping’ou Wei
Zhi Gan
Zhipeng Zhu
Haitao Tan
Publication date: 01-07-2021
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 7/2021
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04832-2

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

O-arm navigation for sacroiliac screw placement in the treatment for posterior pelvic ring injury

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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