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Degulmadi D, Dave BR, Chauhan V, Krishnan A, Mayi SC, Rai R, Dave MB, Bali S, Charde P, Anil A. Comparative Study on Accuracy of Intra-Operative Computed Tomography-Navigation Based Pedicle Screw Placement With Skin vs Bone Fixed Dynamic Reference Frame in Minimally Invasive Transforaminal Lumbar Interbody Fusion. Global Spine J 2023:21925682231181884. [PMID: 37279918 DOI: 10.1177/21925682231181884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVE To compare the accuracy of intra-operative navigation-assisted percutaneous pedicle screw insertion between bone fixed and skin fixed dynamic reference frame (DRF) in Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). METHODS Between October 2018 and September 2022, patients who underwent MIS-TLIF were included in this study with DRF fixed either on bone (group B) or skin (group S). Pedicle screws were inserted under the guidance of intra-operative Cone bean Computed tomography (cbCT) based navigation. Accuracy of pedicle screw placement was immediately checked by a final intra-operative cbCT Spin. RESULTS Among 170 patients, group B included 91 patients and group S included 79 patients. Out of total 680 screws, 364 screws (group B) and 316 screws (group S) were placed. Patient's demographic data and distribution of screws showed no statistically significant difference. The accuracy showed no significant difference between both the groups (94.5% in group B and 94.3% in group S). CONCLUSION Skin fixed DRF can serve as an alternate way for placement and avoids extra incision with similar accuracy in pedicle screw insertions with bone fixed DRF using intra-operative CT guided navigation in MIS TLIF.
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Affiliation(s)
- Devanand Degulmadi
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Ahmedabad, India
| | - Bharat R Dave
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Ahmedabad, India
| | - Vikrant Chauhan
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Ahmedabad, India
| | - Ajay Krishnan
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Ahmedabad, India
| | - Shivanand C Mayi
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Ahmedabad, India
| | - Ravi Rai
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Ahmedabad, India
| | - Mirant Bharat Dave
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Ahmedabad, India
| | - Shivkumar Bali
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Ahmedabad, India
| | - Pranav Charde
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Ahmedabad, India
| | - Abhijith Anil
- Department of Spine Surgery, Stavya Spine Hospital and Research Institute, Nr Nagari Hospital, Ahmedabad, India
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Comadoll SM, Haselhuhn JJ, Sembrano JN, Ogilvie CM, Cheng EY, Jones KE, Martin CT, Polly DW. Sacroiliac joint fusion navigation: how accurate is pin placement? Neurosurg Focus 2023; 54:E9. [PMID: 36587403 DOI: 10.3171/2022.10.focus22608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/18/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Sacroiliac joint (SIJ) fusion utilizing intraoperative navigation requires a standard reference frame, which is often placed using a percutaneous pin. Proper placement ensures the correct positioning of SIJ fusion implants. There is currently no grading scheme for evaluation of pin placement into the pelvis. The purpose of this study was to evaluate the occurrence of ideal percutaneous pin placement into the posterior ilium during navigated SIJ fusion. METHODS After IRB approval was obtained, electronic medical records and intraoperative computed tomography images of patients who underwent navigated SIJ fusion by the senior author between October 2013 and January 2020 were reviewed. A pin placement grading scheme and the definition of "ideal" placement were developed by the authors and deemed acceptable by fellow attending surgeons. Six attending surgeons completed two rounds of pin placement grading, and statistical analysis was conducted. RESULTS Of 90 eligible patients, 73.3% had ideal pin placement, 17.8% medial/lateral breach, and 8.9% complete miss. Male patients were 3.7 times more likely to have ideal placement than females (p < 0.05). There was no relationship between BMI, SIJ fusion laterality, or pin placement laterality and ideal placement. Interobserver reliability was 0.72 and 0.70 in the first and second rounds, respectively, and defined as "substantial agreement." Intraobserver reliability ranged from 0.74 (substantial agreement) to 0.92 (almost perfect agreement). CONCLUSIONS Nonideal pin placement occurred in 26.7% of cases, but a true "miss" into the sacrum was rare. Ideal pin placement was more likely in males and was not associated with BMI, SIJ fusion laterality, or pin placement laterality. The grading scheme developed has high intraobserver and interobserver reliability, indicating that it is reproducible and can be used for future studies. When placing percutaneous pins, surgeons must be aware of factors that can decrease placement accuracy, regardless of location.
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Affiliation(s)
| | | | | | | | | | - Kristen E Jones
- Departments of1Orthopedic Surgery and.,2Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| | | | - David W Polly
- Departments of1Orthopedic Surgery and.,2Neurosurgery, University of Minnesota, Minneapolis, Minnesota
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Alluri RK, Sivaganesan A, Vaishnav AS, Dupont M, Qureshi SA. Surface Navigation and the Influence of Navigation on MIS Surgery. Global Spine J 2022; 12:19S-26S. [PMID: 35393880 PMCID: PMC8998479 DOI: 10.1177/21925682211028587] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Literature review. OBJECTIVES To review the evidence for surface-based navigation in minimally-invasive spine surgery (MIS), provide an outline for its workflow, and present a wide range of MIS case examples in which surface-based navigation may be advantageous. METHODS A comprehensive review of the literature and compilation of findings related to surface-based navigation in MIS was performed. Workflow and case examples utilizing surface-based navigation were described. RESULTS The nascent literature regarding surface-based intraoperative navigation (ION) in spine surgery is encouraging and initial studies have shown that surface-based navigation can allow for accurate pedicle screw placement and decreased operative time, fluoroscopy time, and radiation exposure when compared to traditional fluoroscopic imaging. Surface-based navigation may be particularly useful in MIS cervical and lumbar decompressions and MIS lumbar instrumentation cases. CONCLUSIONS Overall, it is possible that surface-based ION will become a mainstay in the armamentarium of enabling technologies utilized by minimally-invasive spine surgeons, but further studies are needed assessing its accuracy, complications, and cost-effectiveness.
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Affiliation(s)
| | | | | | | | - Sheeraz A. Qureshi
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
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Judy BF, Soriano-Baron H, Jin Y, Zakaria HM, Kopparapu S, Hussain M, Pratt C, Theodore N. Pearls and pitfalls of posterior superior iliac spine reference frame placement for spinal navigation: cadaveric series. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21621. [PMID: 36130544 PMCID: PMC9379659 DOI: 10.3171/case21621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/20/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Navigation and robotics are important tools in the spine surgeon’s armamentarium and use of these tools requires placement of a reference frame. The posterior superior iliac spine (PSIS) is a commonly used site for reference frame placement, due to its location away from the surgical corridor and its ability to provide solid fixation. Placement of a reference frame requires not only familiarity with proper technique, but also command of the relevant anatomy.
OBSERVATIONS
Cadaveric analysis demonstrates a significant difference in PSIS location in males versus females, and additionally provides average thickness for accurate placement.
LESSONS
In this technical note, the authors describe the precise technique for PSIS frame placement in addition to relevant anatomy and offer solutions to commonly encountered problems.
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Affiliation(s)
- Brendan F. Judy
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland; and
| | | | - Yike Jin
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland; and
| | - Hesham M. Zakaria
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland; and
| | - Srujan Kopparapu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland; and
| | | | | | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland; and
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Ma HH, Wu PH, Yao YC, Chou PH, Lin HH, Wang ST, Chang MC. Postoperative spinal orthosis may not be necessary for minimally invasive lumbar spine fusion surgery: a prospective randomized controlled trial. BMC Musculoskelet Disord 2021; 22:619. [PMID: 34253219 PMCID: PMC8276445 DOI: 10.1186/s12891-021-04490-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background With the progress and success in minimally invasive surgery of transforaminal lumbar interbody fusion (MIS TLIF), the musculoskeletal injury was minimized. However, the role of postoperative orthosis in MIS TLIF has not been established and there is little evidence supporting the routine use of orthosis in MIS TLIF. Methods This is a prospective randomized clinical study. 90 patients who underwent MIS TLIF were randomly divided into groups A (with postoperative spinal orthosis) and B (without postoperative spinal orthosis). Patients were followed up for an average of 12.6 months. Clinical outcome was assessed using the Oswestry disability index (ODI) and visual analogue scale (VAS). Fusion rate was classified with the BSF scale system at postoperative 6-month, and 12-month. Results Both groups had similar patient demographics. The use of postoperative spinal orthosis had no significant influence on instrumentation-related complications or radiological parameters at each follow-up. Conclusions In this study, we conclude that postoperative spinal orthosis is not necessary for MIS TLIF. Patients without postoperative spinal orthosis had the same fusion rates and improvement of VAS and ODI scores.
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Affiliation(s)
- Hsuan-Hsiao Ma
- Department, of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Section. 2, Shi-pai Road, Taipei, 11217, Taiwan, ROC.,School, of Medicine, National Yang Ming Chiao Tung University University, Taipei City, Taiwan, ROC
| | - Pei-Hsi Wu
- Department, of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Section. 2, Shi-pai Road, Taipei, 11217, Taiwan, ROC.,School, of Medicine, National Yang Ming Chiao Tung University University, Taipei City, Taiwan, ROC
| | - Yu-Cheng Yao
- Department, of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Section. 2, Shi-pai Road, Taipei, 11217, Taiwan, ROC.,School, of Medicine, National Yang Ming Chiao Tung University University, Taipei City, Taiwan, ROC
| | - Po-Hsin Chou
- Department, of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Section. 2, Shi-pai Road, Taipei, 11217, Taiwan, ROC.,School, of Medicine, National Yang Ming Chiao Tung University University, Taipei City, Taiwan, ROC
| | - Hsi-Hsien Lin
- Department, of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Section. 2, Shi-pai Road, Taipei, 11217, Taiwan, ROC. .,School, of Medicine, National Yang Ming Chiao Tung University University, Taipei City, Taiwan, ROC.
| | - Shih-Tien Wang
- Department, of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Section. 2, Shi-pai Road, Taipei, 11217, Taiwan, ROC.,School, of Medicine, National Yang Ming Chiao Tung University University, Taipei City, Taiwan, ROC
| | - Ming-Chau Chang
- Department, of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Section. 2, Shi-pai Road, Taipei, 11217, Taiwan, ROC.,School, of Medicine, National Yang Ming Chiao Tung University University, Taipei City, Taiwan, ROC
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