Comparison of the One-Time Accuracy of Simulated Freehand and Navigation Simulated Pedicle Screw Insertion

Comparison of major spine navigation platforms based on key performance metrics: a meta-analysis of 16,040 screws

PURPOSE

The objective of this meta-analysis is to compare available computer-assisted navigation platforms by key performance metrics including pedicle screw placement accuracy, operative time, neurological complications, and blood loss.

METHODS

A systematic review was conducted using major databases for articles comparing pedicle screw accuracy of computer-assisted navigation to conventional (freehand or fluoroscopy) controls via post-operative computed tomography. Outcome data were extracted and pooled by random-effects model for analysis.

RESULTS

All navigation platforms demonstrated significant reduction in risk of breach, with Stryker demonstrating the highest accuracy compared to controls (OR 0.16 95% CI 0.06 to 0.41, P < 0.00001, I2 = 0%) followed by Medtronic. There were no significant differences in accuracy or most surgical outcome measures between platforms; however, BrainLab demonstrated significantly faster operative time compared to Medtronic by 30 min (95% CI - 63.27 to - 2.47, P = 0.03, I2 = 74%). Together, there was significantly lower risk of major breach in the navigation group compared to controls (OR 0.42, 95% CI 0.27-0.63, P < 0.0001, I2 = 56%).

CONCLUSIONS

When comparing between platforms, Stryker demonstrated the highest accuracy, and Brainlab the shortest operative time, both followed by Medtronic. No significant difference was found between platforms regarding neurologic complications or blood loss. Overall, our results demonstrated a 60% reduction in risk of major breach utilizing computer-assisted navigation, coinciding with previous studies, and supporting its validity. This study is the first to directly compare available navigation platforms offering insight for further investigation and aiding in the institutional procurement of platforms. LEVEL 3 EVIDENCE: Meta-analysis of Level 3 studies.

Usefulness of Preoperative Planning by Three-Dimensional Planning Software for Pedicle Screw Placement in Thoracolumbar Surgeries: <i>Misplacement Rate and Associated Risk Factors</i>

Introduction

A number of imaging technologies have been developed to reduce the risk of pedicle screw (PS) misplacement. For example, preoperative three-dimensional (3D) planning can reportedly enhance implant placement accuracy in some orthopedic surgeries. However, no study has investigated the effect of preoperative 3D planning on PS placement without intraoperative 3D navigation. Thus, in this study, we aim to examine the accuracy of PS placement and identify the risk factors for PS misplacement in thoracolumbar surgeries performed using preoperative 3D planning software with intraoperative fluoroscopic guidance in a retrospective study.

Methods

In total, 25 consecutive patients (197 PSs) underwent thoracic or lumbar spinal fusion surgeries using preoperative 3D planning with intraoperative fluoroscopic guidance. PS misplacement was graded based on the degree of perforation (Grade 0, no perforation; Grade 1, <2 mm; Grade 2, 2-4 mm; Grade 3, >4 mm) observed in postoperative computed tomography (CT). Deviations between planned and actual PSs were evaluated by matching preoperative and postoperative CT volume images for each vertebra.

Results

The overall PS misplacement rate was 6.6% (Grade 1: 4.0%, Grade 2: 1.5%, Grade 3: 1.0%). The median linear deviations of PS entry points between planned and actual locations were determined to be 3.3 mm and 3.3 mm for the horizontal and vertical axes, respectively. The median angular deviations of the PS axis were 6.2° and 4.5° for the transverse and sagittal planes, respectively. Multivariate analysis revealed that horizontal deviation of the PS entry point was the sole factor associated with Grade ≥1 PS misplacement (odds ratio=2.47, p<0.001).

Conclusions

Preoperative 3D planning software without intraoperative 3D navigation was able to achieve a relatively low PS misplacement ratio among the reported ratio of conventional techniques without navigation. Surgeons should carefully ensure that the entry point is consistent with preoperative planning, especially in the mediolateral direction to avoid misplacement in this method.

Safety and efficacy of percutaneous kyphoplasty assisted with O-arm navigation for the treatment of osteoporotic vertebral compression fractures at T6 to T9 vertebrae

PURPOSE

To evaluate the safety and efficacy of PKP under O-arm navigation system guidance for treating middle thoracic OVCF (T6~T9).

METHODS

A retrospective study was conducted for 44 consecutive T6~T9 OVCF patients who received PKP assisted with O-arm navigation (n = 20) or fluoroscopy (n = 24) from January 2016 to December 2017. Demographic data, radiographic parameters, and clinical outcomes were collected and analyzed at pre-operative, post-operative, and final follow-up period. Complications including tissue lesion, needle malposition, and leakage of bone cement were also recorded amid operation.

RESULTS

A total of 44 patients (4 males and 40 females, with mean age of 71.1 ± 8.7) were enrolled in this study, and the mean follow-up time was 14.4 months. In surgical details, navigation system could obtain more satisfactory volume of injected cement and less loss of blood, as well did not increase surgical time compared with fluoroscopy. Both radiological and clinical outcomes improved significantly at post-operative and final follow-up, while did not differed between two groups. For adverse events, the incidence of cement leakage was similar between two groups. However, O-arm navigation can achieve lower rate of complications than fluoroscopy.

CONCLUSION

Our preliminary study demonstrated that PKP assisted with O-arm navigation is a safe and effective procedure that applied for middle thoracic OVCF (T6~T9), which can achieve favourable radiological and clinical outcomes, and low rate of complications.

Navigated robotic assistance improves pedicle screw accuracy in minimally invasive surgery of the lumbosacral spine: 600 pedicle screws in a single institution

BACKGROUND

In the emerging field of robot-assisted spine surgery, radiographic evaluation of pedicle screw accuracy in the surgical setting is of high interest. Advances in medical imaging have improved the accuracy of pedicle screw placement, from fluoroscopy-guided to computer-aided navigation.

METHODS

A retrospective, institutional review board-exempt review of the first 106 navigated robot-assisted spine surgery cases was performed. Radiographic evaluation of preoperative and postoperative computerized tomography (CT) scans were collected.

RESULTS

In the first 106 cases, 630 lumbosacral pedicle screws were placed. Thirty screws were placed in five patients without the robot because of surgeon discretion. Of the 600 pedicle screws inserted by navigated robotic guidance, only 1.5% (9/600) were repositioned intraoperatively.

CONCLUSION

This study demonstrated a high level of accuracy (98.2%) in terms of grade A or B pedicle screw breach scores in the clinical use of navigated, robot-assisted surgery in its first 101 cases.