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International Journal of Computer Assisted Radiology and Surgery

Published in:

01-05-2017 | Original Article

Feasibility of laser-guided percutaneous pedicle screw placement in the lumbar spine using a hybrid-OR

Authors: P. H. Richter, F. Gebhard, M. Salameh, K. Schuetze, M. Kraus

Published in: International Journal of Computer Assisted Radiology and Surgery | Issue 5/2017

Abstract

Purpose

Innovations in intraoperative imaging lead to major changes in orthopaedic surgery. In our setting, a 3D flat-panel c-arm (Artis zeego) is mounted on a robotic arm offering an integrated aiming tool (Syngo iGuide). Our aim was to investigate the feasibility of Syngo iGuide for pedicle screw placement in comparison with fluoroscopic screw implantation.

Methods

In 10 lumbar models, 100 screws were implanted. In 5 models, a standard fluoroscopic technique was used. Syngo iGuide was used in all other models. Afterwards, CT-scans were performed and screw accuracy was investigated.

Results

The procedure time for the new technique was significantly longer in comparison with the standard technique. The post-operative CT showed the same accuracy in both groups.

Conclusions

Syngo iGuide proofed feasible for percutaneous implantation of pedicle screws in anatomic models. Syngo iGuide can be a help for screw implantation in difficult anatomic regions without the need of an additional navigation system.

Gautschi OP, Schatlo B, Schaller K, Tessitore E (2011) Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management: a literature review of 35,630 pedicle screws. Neurosurg Focus 31(4):E8CrossRefPubMed

Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K (2000) Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine 25(8):962–969CrossRefPubMed

Neo M, Sakamoto T, Fujibayashi S, Nakamura T (2005) The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine 30(24):2800–2805CrossRefPubMed

Tian NF, Huang QS, Zhou P, Zhou Y, Wu RK, Lou Y, Xu HZ (2011) Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies. Eur Spine J 20(6):846–59CrossRefPubMed

Tian NF, Xu HZ (2009) Image-guided pedicle screw insertion accuracy: a meta-analysis. Int Orthop 33(4):895–903CrossRefPubMedPubMedCentral

Kosmopoulos V, Schizas C (2007) Pedicle screw placement accuracy: a meta-analysis. Spine 32(3):E111–E120CrossRefPubMed

Shin BJ, James AR, Njoku IU, Hartl R (2012) Pedicle screw navigation: a systematic review and meta-analysis of perforation risk for computer-navigated versus freehand insertion. J Neurosurg Spine 17(2):113–22CrossRefPubMed

Ferrari V, Parchi P, Condino S, Carbone M, Baluganti A, Ferrari M, Mosca F, Lisanti M (2013) An optimal design for patient-specific templates for pedicle spine screws placement. Int J Med Robot 9(3):298–304CrossRefPubMed

Lu S, Xu YQ, Zhang YZ, Xie L, Guo H, Li DP (2009) A novel computer-assisted drill guide template for placement of C2 laminar screws. Eur Spine J 18(9):1379–85CrossRefPubMedPubMedCentral

10.

Radermacher K, Portheine F, Anton M, Zimolong A, Kaspers G, Rau G, Staudte HW (1998) Computer assisted orthopaedic surgery with image based individual templates. Clin Orthop Relat Res 354:28–38CrossRef

11.

Farshad M, Betz M, Farshad-Amacker NA, Moser M (2016) Accuracy of patient-specific template-guided vs. free-hand fluoroscopically controlled pedicle screw placement in the thoracic and lumbar spine: a randomized cadaveric study. Eur Spine J. doi:10.1007/s00586-016-4728-5

12.

Kaneyama S, Sugawara T, Sumi M (2015) Safe and accurate midcervical pedicle screw insertion procedure with the patient-specific screw guide template system. Spine 40(6):E341–E348CrossRefPubMed

13.

Sugawara T, Higashiyama N, Kaneyama S, Takabatake M, Watanabe N, Uchida F, Sumi M, Mizoi K (2013) Multistep pedicle screw insertion procedure with patient-specific lamina fit-and-lock templates for the thoracic spine: clinical article. J Neurosurg Spine 19(2):185–90CrossRefPubMed

14.

Merc M, Drstvensek I, Vogrin M, Brajlih T, Recnik G (2013) A multi-level rapid prototyping drill guide template reduces the perforation risk of pedicle screw placement in the lumbar and sacral spine. Arch Orthop Trauma Surg 133(7):893–899CrossRefPubMed

15.

Hu X, Ohnmeiss DD, Lieberman IH (2013) Robotic-assisted pedicle screw placement: lessons learned from the first 102 patients. Eur Spine J 22(3):661–666CrossRefPubMed

16.

Marcus HJ, Cundy TP, Nandi D, Yang GZ, Darzi A (2014) Robot-assisted and fluoroscopy-guided pedicle screw placement: a systematic review. Eur Spine J 23(2):291–297CrossRefPubMed

17.

Kantelhardt SR, Martinez R, Baerwinkel S, Burger R, Giese A, Rohde V (2011) Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement. Eur Spine J 20(6):860–868CrossRefPubMedPubMedCentral

18.

Devito DP, Kaplan L, Dietl R, Pfeiffer M, Horne D, Silberstein B, Hardenbrook M, Kiriyanthan G, Barzilay Y, Bruskin A, Sackerer D, Alexandrovsky V, Stuer C, Burger R, Maeurer J, Donald GD, Schoenmayr R, Friedlander A, Knoller N, Schmieder K, Pechlivanis I, Kim IS, Meyer B, Shoham M (2010) Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study. Spine 35(24):2109–2115CrossRefPubMed

19.

Roser F, Tatagiba M, Maier G (2013) Spinal robotics: current applications and future perspectives. Neurosurgery 72(Suppl 1):12–18CrossRefPubMed

20.

Barzilay Y, Schroeder JE, Hiller N, Singer G, Hasharoni A, Safran O, Liebergall M, Itshayek E, Kaplan L (2014) Robot-assisted vertebral body augmentation: a radiation reduction tool. Spine 39(2):153–157CrossRefPubMed

21.

Onen MR, Simsek M, Naderi S (2014) Robotic spine surgery: a preliminary report. Turk Neurosurg 24(4):512–518PubMed

22.

Gebhard F, Riepl C, Richter P, Liebold A, Gorki H, Wirtz R, Konig R, Wilde F, Schramm A, Kraus M (2012) The hybrid operating room. Home of high-end intraoperative imaging. Unfallchirurg 115(2):107–120CrossRefPubMed

23.

Richter PH, Gebhard F (2013) The interdisciplinary hybrid operation theatre. Current experience and future. Chirurg 84(12):1036–1040CrossRefPubMed

24.

Richter PH, Yarboro S, Kraus M, Gebhard F (2015) One year orthopaedic trauma experience using an advanced interdisciplinary hybrid operating room. Injury 46(Suppl 4):S129–S134CrossRefPubMed

25.

Ritter M, Rassweiler MC, Hacker A, Michel MS (2013) Laser-guided percutaneous kidney access with the Uro Dyna-CT: first experience of three-dimensional puncture planning with an ex vivo model. World J Urol 31(5):1147–1151CrossRefPubMed

26.

Mabray MC, Datta S, Lillaney PV, Moore T, Gehrisch S, Talbott JF, Levitt MR, Ghodke BV, Larson PS, Cooke DL (2016) Accuracy of flat panel detector CT with integrated navigational software with and without MR fusion for single-pass needle placement. J Neurointerv Surg 8(7):731–735. doi:10.1136/neurintsurg-2015-011799

27.

Ritter M, Rassweiler MC, Michel MS (2015) The Uro Dyna-CT enables three-dimensional planned laser-guided complex punctures. Eur Urol 68(5):880–884CrossRefPubMed

28.

Freundt MI, Ritter M, Al-Zghloul M, Groden C, Kerl HU (2013) Laser-guided cervical selective nerve root block with the Dyna-CT: initial experience of three-dimensional puncture planning with an ex-vivo model. PLoS One 8(7):e69311CrossRefPubMedPubMedCentral

29.

Tam AL, Mohamed A, Pfister M, Chinndurai P, Rohm E, Hall AF, Wallace MJ (2010) C-arm cone beam computed tomography needle path overlay for fluoroscopic guided vertebroplasty. Spine 35(10):1095–1099CrossRefPubMed

30.

Czerny C, Eichler K, Croissant Y, Schulz B, Kronreif G, Schmidt R, von Roden M, Schomerus C, Vogl TJ, Marzi I, Zangos S (2015) Combining C-arm CT with a new remote operated positioning and guidance system for guidance of minimally invasive spine interventions. J Neurointerv Surg 7(4):303–308CrossRefPubMed

31.

Kathuria SE, Ehtiati T, Gandhi D (2010) E-040 Utility of Syngo iGuide needle guidance system for intraoperative navigation in percutaneous spine interventions: a cadaveric study. J NeuroIntervent Surg 2:A41CrossRef

32.

Verhoeven E, Katsargyris A, Topel I, Steinbauer M (2013) Hybrid operating rooms: only for advanced endovascular procedures? Zentralbl Chir 138(5):516–520CrossRefPubMed

33.

Kleiman N (2012) Room considerations with TAVR. Methodist Debakey Cardiovasc J 8(2):19–21CrossRefPubMedPubMedCentral

34.

Dea N, Fisher CG, Batke J, Strelzow J, Mendelsohn D, Paquette SJ, Kwon BK, Boyd MD, Dvorak MF, Street JT (2016) Economic evaluation comparing intraoperative cone beam CT-based navigation and conventional fluoroscopy for the placement of spinal pedicle screws: a patient-level data cost-effectiveness analysis. Spine J 16(1):23–31CrossRefPubMed

Title: Feasibility of laser-guided percutaneous pedicle screw placement in the lumbar spine using a hybrid-OR
Authors: P. H. Richter
F. Gebhard
M. Salameh
K. Schuetze
M. Kraus
Publication date: 01-05-2017
Publisher: Springer International Publishing
Published in: International Journal of Computer Assisted Radiology and Surgery / Issue 5/2017
Print ISSN: 1861-6410
Electronic ISSN: 1861-6429
DOI: https://doi.org/10.1007/s11548-017-1529-1

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Feasibility of laser-guided percutaneous pedicle screw placement in the lumbar spine using a hybrid-OR

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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