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Ohashi M, Sato M, Tashi H, Minato K, Makino T, Kawashima H. Mixed Reality-Based Navigation for Pedicle Screw Placement: A Preliminary Study Using a 3D-Printed Spine Model. Cureus 2024; 16:e59240. [PMID: 38813326 PMCID: PMC11133951 DOI: 10.7759/cureus.59240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2024] [Indexed: 05/31/2024] Open
Abstract
Background and objectives Mixed reality (MR) is one of the image processing technologies that allows the user to manipulate three-dimensional (3D) virtual images (hologram). The aim of this study was to evaluate the accuracy of MR-based pedicle screw (PS) placement using 3D spine models. Materials and methods Using the preoperative CT data of a patient with adolescent idiopathic scoliosis (AIS) who had undergone posterior spinal fusion in our hospital, a 3D-printed spine model was created. On the other hand, a 3D hologram of the same patient was automatically created using the preoperative CT data uploaded to the Holoeyes MD service website (Holoeyes Inc., Tokyo, Japan). Using a Magic Leap One® headset (Magic Leap Inc., Plantation, FL), the 3D hologram with lines of predetermined PS trajectories was superimposed onto the 3D-printed spine model and PS were inserted bilaterally along with the trajectory lines from T5 to L3. As a control, we used a readymade 3D spine model of AIS and inserted PS bilaterally with a freehand technique from T4 to L3. The rate of pedicle violation was compared between the MR-based and freehand techniques. Results A total of 22 and 24 PS were placed into the 3D-printed spine model of our patient and the readymade 3D spine model, respectively. The rate of pedicle violation was 4.5% (1/22 screws) in the MR-based technique and 29.2% (7/24 screws) in the freehand technique (P = 0.049). Conclusions We demonstrated a significantly lower rate of PS misplacement in the MR-based technique than in the freehand technique. Therefore, an MR-assisted system is a promising tool for PS placement in terms of feasibility, safety, and accuracy, warranting further studies including cadaveric and clinical studies.
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Affiliation(s)
- Masayuki Ohashi
- Department of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, JPN
| | - Masayuki Sato
- Department of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, JPN
| | - Hideki Tashi
- Department of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, JPN
| | - Keitaro Minato
- Department of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, JPN
| | - Tatsuo Makino
- Department of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, JPN
| | - Hiroyuki Kawashima
- Department of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, JPN
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Soucy B, Lee D, Moreau-Bourbonnais A, Filiatrault M, Denis I, Chang MC, Boudier-Revéret M. Influence of resident involvement on fluoroscopy time and ionizing radiation exposure in fluoroscopy-guided spinal procedures. PM R 2024; 16:260-267. [PMID: 37639553 DOI: 10.1002/pmrj.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 07/05/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Fluoroscopic guidance has become the standard for a variety of medical procedures. Mastering these techniques requires practice, which may entail additional radiation for patients and providers. Despite their widespread use, the literature examining factors influencing radiation exposure in fluoroscopically guided pain procedures is scarce. OBJECTIVE To evaluate the influence of resident involvement on radiation exposure during fluoroscopy-guided spinal interventions. DESIGN Single-center, observational study. SETTING Outpatient physiatry clinic in a teaching hospital. PATIENTS All patients who received cervical or lumbar facet block(s) (FBs), transforaminal epidural steroid injection(s) (TFESIs) without digital subtraction, or a caudal epidural (CE) during the study period were included. INTERVENTIONS Resident involvement in the procedures: absent, observing, or participating. MAIN OUTCOME MEASURES Machine-indicated fluoroscopy time (seconds) and radiation dose (milligrays [mGy]). RESULTS Two hundred ninety six procedures were included: 188 FBs (58 cervical, 130 lumbar), 48 CEs, and 60 TFESIs. For lumbar FBs, fluoroscopy time and radiation dose increased significantly when residents performed them (meantime = 24.5 s, confidence interval [CI] = 20.4-28.7; meandose = 3.53 mGy, CI = 2.57-4.49) compared to when they observed (meantime = 9.9 s, CI = 8.1-11.7; meandose = 1.28 mGy, CI = 0.98-1.59) (mean difference: time = 14.63 s, CI = 9.31-19.94; dose = 2.25 mGy, CI = 1.17-3.33) and were absent during the procedure (meantime = 12.9 s, CI = 11.1-14.6; meandose = 1.65 mGy, CI = 1.40-1.89) (mean difference: time = 11.67 s, CI = 7.35-15.98; dose = 1.88 mGy, CI = 1.01-2.76). In the case of TFESIs, time, but not dose, increased significantly when residents observed (meantime = 39.1 s, CI = 30.7-47.6; meandose = 6.73 mGy, CI = 3.39-10.07) compared to when they were absent (meantime = 27.1 s, CI = 22.4-31.8; meandose = 4.41 mGy, CI = 3.06-5.76 (mean difference: time = 11.99 s, CI = 1.37-22.61; dose = 2.32 mGy, CI = -1.20-5.84). Finally, resident involvement did not significantly affect the outcomes for CEs (ptime = .032, pdose = .74) and cervical FBs (ptime = .64, pdose = .68). CONCLUSION Resident participation affected lumbar FBs the most, with an increase in both fluoroscopy time and radiation dose.
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Affiliation(s)
- Béatrice Soucy
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Dillon Lee
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Amélie Moreau-Bourbonnais
- Department of Physical Medicine and Rehabilitation, CISSS des Laurentides, Saint-Jérôme, Québec, Canada
| | - Marc Filiatrault
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Isabelle Denis
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, South Korea
| | - Mathieu Boudier-Revéret
- Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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Timmermans M, Massalimova A, Li R, Davoodi A, Goossens Q, Niu K, Vander Poorten E, Fürnstahl P, Denis K. State-of-the-Art of Non-Radiative, Non-Visual Spine Sensing with a Focus on Sensing Forces, Vibrations and Bioelectrical Properties: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:8094. [PMID: 37836924 PMCID: PMC10574884 DOI: 10.3390/s23198094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023]
Abstract
In the research field of robotic spine surgery, there is a big upcoming momentum for surgeon-like autonomous behaviour and surgical accuracy in robotics which goes beyond the standard engineering notions such as geometric precision. The objective of this review is to present an overview of the state of the art in non-visual, non-radiative spine sensing for the enhancement of surgical techniques in robotic automation. It provides a vantage point that facilitates experimentation and guides new research projects to what has not been investigated or integrated in surgical robotics. Studies were identified, selected and processed according to the PRISMA guidelines. Relevant study characteristics that were searched for include the sensor type and measured feature, the surgical action, the tested sample, the method for data analysis and the system's accuracy of state identification. The 6DOF f/t sensor, the microphone and the electromyography probe were the most commonly used sensors in each category, respectively. The performance of the electromyography probe is unsatisfactory in terms of preventing nerve damage as it can only signal after the nerve is disturbed. Feature thresholding and artificial neural networks were the most common decision algorithms for state identification. The fusion of different sensor data in the decision algorithm improved the accuracy of state identification.
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Affiliation(s)
- Maikel Timmermans
- KU Leuven, Department of Mechanical Engineering, BioMechanics (BMe), Smart Instrumentation, 3000 Leuven, Belgium; (Q.G.); (K.D.)
| | - Aidana Massalimova
- Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, 8008 Zurich, Switzerland; (A.M.); (P.F.)
| | - Ruixuan Li
- KU Leuven, Department of Mechanical Engineering, Robot-Assisted Surgery Group (RAS), 3000 Leuven, Belgium; (R.L.); (A.D.); (K.N.); (E.V.P.)
| | - Ayoob Davoodi
- KU Leuven, Department of Mechanical Engineering, Robot-Assisted Surgery Group (RAS), 3000 Leuven, Belgium; (R.L.); (A.D.); (K.N.); (E.V.P.)
| | - Quentin Goossens
- KU Leuven, Department of Mechanical Engineering, BioMechanics (BMe), Smart Instrumentation, 3000 Leuven, Belgium; (Q.G.); (K.D.)
| | - Kenan Niu
- KU Leuven, Department of Mechanical Engineering, Robot-Assisted Surgery Group (RAS), 3000 Leuven, Belgium; (R.L.); (A.D.); (K.N.); (E.V.P.)
| | - Emmanuel Vander Poorten
- KU Leuven, Department of Mechanical Engineering, Robot-Assisted Surgery Group (RAS), 3000 Leuven, Belgium; (R.L.); (A.D.); (K.N.); (E.V.P.)
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, 8008 Zurich, Switzerland; (A.M.); (P.F.)
| | - Kathleen Denis
- KU Leuven, Department of Mechanical Engineering, BioMechanics (BMe), Smart Instrumentation, 3000 Leuven, Belgium; (Q.G.); (K.D.)
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Kolz JM, Wagner SC, Vaccaro AR, Sebastian AS. Ergonomics in Spine Surgery. Clin Spine Surg 2022; 35:333-340. [PMID: 34321393 DOI: 10.1097/bsd.0000000000001238] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
As physician burnout and wellness become increasingly recognized as vital themes for the medical community to address, the topic of chronic work-related conditions in surgeons must be further evaluated. While improving ergonomics and occupational health have been long emphasized in the executive and business worlds, particularly in relation to company morale and productivity, information within the surgical community remains relatively scarce. Chronic peripheral nerve compression syndromes, hand osteoarthritis, cervicalgia and back pain, as well as other repetitive musculoskeletal ailments affect many spinal surgeons. The use of ergonomic training programs, an operating microscope or exoscope, powered instruments for pedicle screw placement, pneumatic Kerrison punches and ultrasonic osteotomes, as well as utilizing multiple surgeons or microbreaks for larger cases comprise several methods by which spinal surgeons can potentially improve workspace health. As such, it is worthwhile exploring these areas to potentially improve operating room ergonomics and overall surgeon longevity.
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Affiliation(s)
- Joshua M Kolz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
| | - Scott C Wagner
- Walter Reed National Military Medical Center, Bethesda, MD
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Ionizing Radiation Induces Disc Annulus Fibrosus Senescence and Matrix Catabolism via MMP-Mediated Pathways. Int J Mol Sci 2022; 23:ijms23074014. [PMID: 35409374 PMCID: PMC8999232 DOI: 10.3390/ijms23074014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 01/01/2023] Open
Abstract
Previous research has identified an association between external radiation and disc degeneration, but the mechanism was poorly understood. This study explores the effects of ionizing radiation (IR) on inducing cellular senescence of annulus fibrosus (AF) in cell culture and in an in vivo mouse model. Exposure of AF cell culture to 10–15 Gy IR for 5 min followed by 5 days of culture incubation resulted in almost complete senescence induction as evidenced by SA-βgal positive staining of cells and elevated mRNA expression of the p16 and p21 senescent markers. IR-induced senescent AF cells exhibited increased matrix catabolism, including elevated matrix metalloproteinase (MMP)-1 and -3 protein expression and aggrecanolysis. Analogous results were seen with whole body IR-exposed mice, demonstrating that genotoxic stress also drives disc cellular senescence and matrix catabolism in vivo. These results have important clinical implications in the potential adverse effects of ionizing radiation on spinal health.
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Giubilei DB, Santos DRD, Gomes MJ, Carvalho MOPD. ENDOSCOPIC INTERLAMINAR SPINE SURGERY GUIDED BY PORTABLE ULTRASOUND: A NEW TECHNIQUE. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222102260083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT This paper describes the technique of interlaminar endoscopic surgery guided by a portable ultrasound device. This innovation allows endoscopic surgery to be performed without the use of real-time radiography, which is associated with a higher risk of radiation damage. The portable wireless ultrasound device used for this technique, which has not been yet described in the world literature for minimally invasive surgeries, can be used as an imaging tool to delimit the interlaminar space in minimally invasive surgeries via both transverse and sagittal views. Level of evidence I; Quality of evidence A.
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AMARAL CARLOSALEXANDREBOTELHODO, ANDRADE RICARDOALVES, LABRONICI PEDROJOSÉ. ESTIMATED EXPOSURE OF SPINE SURGEONS TO RADIATION. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212003235324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective To estimate the amount of radiation received and accumulated in the bodies of two surgeons, one being the responsible surgeon and the other the assistant, performing spine surgery procedures over a period of 25 years. Methods Seventy-two spinal surgeries were performed during a seven-month period and the radiation loads were measured in both surgeons. The measurement of radiation was captured in fluoroscopy in anteroposterior and lateral incidences. The surgeon and the assistant used two dosimeters, one in the cervical region protecting the thyroid and the other on the lead apron in the genital region. The radioactive loads were measured in millisieverts and the accumulated charges were recorded monthly in both regions of the body in the two surgeons for seven months and the means for the work periods (1, 5, 10, 15, 20 and 25 years) were estimated. Results It was observed that in the surgeon the average accumulated radiation loads were 131.9% and 176.92% higher than those of the assistant in the cervical and genital regions, respectively. Conclusion While the use of X-rays is indispensable in routine orthopedic surgery, we have to consider the development of techniques of protection, rigor and discipline in the use of safety materials for surgeons. Preventive exposure reduction measures such as using thyroid protection equipment and turning the head away from the patient during fluoroscopy, among others, should be mandatory to promote less radiation exposure. Level of evidence II; Comparative prospective study.
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Pacult MA, Walker CT, Godzik J, Turner JD, Uribe JS. Emerging Technologies in Spinal Surgery: Ultra-Low Radiation Imaging Platforms. Oper Neurosurg (Hagerstown) 2021; 21:S39-S45. [PMID: 34128066 DOI: 10.1093/ons/opaa324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/02/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Spine surgery has seen tremendous growth in the past 2 decades. A variety of safety, practical, and market-driven needs have spurred the development of new imaging technologies as necessary tools for modern-day spine surgery. Although current imaging techniques have proven satisfactory for operative needs, it is well-known that these techniques have negative consequences for operators and patients in terms of radiation risk. Several mitigating techniques have arisen in recent years, ranging from lead protection to radiation-reducing protocols, although each technique has limits. A hitherto-problematic barrier has been the fact that efforts to diminish radiation emission come at the cost of reduced image quality. OBJECTIVE To describe new ultra-low radiation imaging modalities that have the potential to drastically reduce radiation risk and minimize unacceptable adverse effects. METHODS A literature review was performed of articles and studies that used either of 2 ultra-low radiation imaging modalities, the EOS system (EOS-Imaging S.A., Paris, France) and LessRay (NuVasive, San Diego, CA). RESULTS Both ultra-low radiation imaging modalities reduce radiation exposure in the preoperative and perioperative settings. EOS provides 3-dimensional reconstructive capability, and LessRay offers intraoperative tools that facilitate spinal localization and proper visual alignment of the spine. CONCLUSION These novel radiation-reducing technologies diminish patient and surgeon exposure, aid the surgeon in preoperative planning, and streamline intraoperative workflow.
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Affiliation(s)
- Mark A Pacult
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Corey T Walker
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Wang B, Cao J, Chang J, Yin G, Cai W, Li Q, Huang Z, Yu L, Cao X. Effectiveness of Tirobot-assisted vertebroplasty in treating thoracolumbar osteoporotic compression fracture. J Orthop Surg Res 2021; 16:65. [PMID: 33468187 PMCID: PMC7816462 DOI: 10.1186/s13018-021-02211-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/05/2021] [Indexed: 01/02/2023] Open
Abstract
Background Percutaneous kyphoplasty is the main method in the treatment of thoracolumbar osteoporotic compression fractures. However, much radiation exposure during the operation harms the health of surgeons and patients. In addition, the accuracy of this surgery still needs to be improved. This study aimed to assess the radiation exposure and clinical efficacy of Tirobot-assisted vertebroplasty in treating thoracolumbar osteoporotic compression fracture. Methods Included in this retrospective cohort study were 60 patients (60–90 years) who had undergone unilateral vertebroplasty for thoracolumbar osteoporotic compression fracture at our hospital between June 2019 and June 2020. All showed no systemic diseases and were assigned to Tirobot group (treated with Tirobot-assisted approach) and control group (treated with traditional approach). Fluoroscopic frequency, operative duration, length of stay (LOS), post-operative complications (cement leakage, infection, and thrombosis), and pre-operative and pre-discharge indexes (VAS score, JOA score, and Cobb’s angle) were compared. Results The fluoroscopic frequency (P < 0.001) and post-operative complications (P = 0.035) in Tirobot group were significantly lower than those in control group. The operative duration and LOS in the Tirobot group were shorter than those in the control group, but the differences were not statistically significant (P = 0.183). Pre-discharge VAS score and Cobb’s angle decreased, and JOA increased after surgeries in both groups. These three indexes showed a significant difference after surgery in each group (P < 0.001), but not between groups (PVAS = 0.175, PCobb’s = 0.585, PJOA = 0.448). Conclusion The Tirobot-assisted vertebroplasty can reduce surgery-related trauma, post-operative complications, and patients’ and operators’ exposure to radiation. As a safe and effective strategy, this surgery can realize the quick recovery from thoracolumbar osteoporotic compression fracture.
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Affiliation(s)
- Boyao Wang
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Jiang Cao
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Jie Chang
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Guoyong Yin
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Weihua Cai
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Qingqing Li
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Zhenfei Huang
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Lipeng Yu
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
| | - Xiaojian Cao
- Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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Upasani VV, Bandaralage H, Farnsworth CL. 3D cone-beam tomosynthesis provides axial imaging of the spine with lower radiation compared to computed tomography. Spine Deform 2021; 9:41-49. [PMID: 32930997 DOI: 10.1007/s43390-020-00199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/29/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Three imaging techniques were compared using porcine spines. OBJECTIVES To compare image acquisition time, radiation exposure, pedicle width measurement, assessment of screw breach, and image artifact between cone-beam tomosynthesis (CBT) single mode, CBT dual mode (stereotactic CBT), and computed tomography (CT) imaging with and without spinal implants. CT is the standard for axial imaging of orthopedic procedures. CBT technology is being developed, allowing real-time intraoperative imaging and 3D surgical guidance. CBT may deliver useful axial imaging quicker with less radiation than current technologies. METHODS Six porcine spines were instrumented with bilateral pedicle screws at six levels connected with 5.5 mm rods. Dosimeters were attached to four surfaces of spines. CT, CBT single and CBT dual images were acquired pre-implant and post-implant. Image acquisition and 3D reconstruction times were recorded. Pedicle widths were measured before and after instrumentation. Screw medial breaches were graded (0: no breach, 1: < 2 mm, 2: 2-4 mm, 3: > 4 mm). Artifact and/or distortion of each image was ranked (0 = none, 1 = mild, 2 = moderate, 3 = large). Image acquisition and reconstruction times, radiation dose, pedicle width, screw breach and artifact were compared between techniques. RESULTS Total image acquisition and reconstruction times of CBT was significantly less (single: 9.9 ± 0.2 s, p < 0.001; dual: 60.0 ± 8.7 s, p < 0.001) than CT (250.3 ± 36.7 s). CBT had significantly less radiation exposure than CT (CT: 0.7 ± 0.1 rad, single: 0.03 ± 0.02 rad, dual: 0.07 ± 0.03 rad; p < 0.001). No difference in pedicle width change pre-implant to post-implant was found (CT: p = 0.449, single: p = 0.430, dual: p = 0.528). Pedicle width (pre-implant: p > 0.5, post-implant: p > 0.9) and pedicle width change (p > 0.4) was similar amongst all techniques. Breach assessment was not different between groups (p = 0.257). CBT images had consistently lower artifact grades than CT. CONCLUSIONS Although CBT axial image quality appeared subjectively inferior to CT, it enabled consistent assessment of pedicle width and screw breach, at half time and 10× lower radiation exposure. With continued refinements, CBT technology may allow for adequate intra-operative axial imaging using low radiation exposure.
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Affiliation(s)
- Vidyadhar V Upasani
- University of California San Diego, San Diego, CA, USA.
- Rady Children's Hospital-San Diego, 3020 Children's Way, MC 5062, San Diego, CA, 92123, USA.
| | - Harsha Bandaralage
- Rady Children's Hospital-San Diego, 3020 Children's Way, MC 5062, San Diego, CA, 92123, USA
| | - Christine L Farnsworth
- Rady Children's Hospital-San Diego, 3020 Children's Way, MC 5062, San Diego, CA, 92123, USA
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Kothari EA, Urakov TM. Spine surgery is kyphosing to spine surgeon. Acta Neurochir (Wien) 2020; 162:967-971. [PMID: 32043183 DOI: 10.1007/s00701-020-04258-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spine surgery is a demanding surgical specialty which requires surgeons to operate for hours on end, often compromising good posture. Sustained poor posture in the operating room (OR) can be the source of many adverse health effects on spine surgeons. This study will analyze posture of a spine surgeon in different types of spine surgery cases. METHODS Posture of a surgeon was measured using the UPRIGHT Posture Training Device. The device was worn by the surgeon in the OR through a wide variety of spine surgery cases. RESULTS The percent time spent slouched while performing cervical, adult deformity, and lumbar spine surgeries is 39.9, 58.9, and 38.6, respectively. For all surgeries recorded, the percent time slouched is 41.6. The average procedure time was 145.3 min, with adult deformity cases on average being the longest (245.6 min) followed by cervical (152.9 min) and then lumbar (122.5 min). CONCLUSION Poor posture while operating is very likely to occur for many spine surgeons regardless of case type. This poor posture is maintained for long periods of time given the average spine surgery procedure recorded in the study was roughly 2.5 h long. Spine surgeons should be aware of the tendency for poor posture while operating, and they should try using posture-improving techniques to maintain good spine health.
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Affiliation(s)
- Ezan A Kothari
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd., Orlando, FL, 32827, USA.
| | - Timur M Urakov
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
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Urakov TM, Wang MY, Levi AD. Workflow Caveats in Augmented Reality-Assisted Pedicle Instrumentation: Cadaver Lab. World Neurosurg 2019; 126:e1449-e1455. [PMID: 30904807 DOI: 10.1016/j.wneu.2019.03.118] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Augmented reality (AR) is gaining popularity in gaming, industrial, military, and medical fields. Neurosurgical applications are currently limited and underdeveloped. METHODS The cadaver lab session was prepared with the currently available AR equipment and software. Pedicle instrumentation was performed from thoracic 1 to the pelvis with either fluoroscopy or AR. RESULTS A total of 38 screws were placed. There were no major breaches on the fluoroscopy-assisted side. Among the AR screws, 3 had a major medial breach and 4 had a major inferior breach. The cause of a 3 breaches appeared to be related to an error in the starting position, as their overall orientation remained correctly parallel to the original trajectory. CONCLUSIONS The article discusses the potential and limitations of AR in its current state and identifies strategies for successful AR application in future surgery.
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Affiliation(s)
- Timur M Urakov
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Allan D Levi
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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