Daipayan Guha1, Raphael Jakubovic2, Shaurya Gupta3, Naif M Alotaibi4, David Cadotte5, Leodante B da Costa5, Rajeesh George6, Chris Heyn7, Peter Howard7, Anish Kapadia8, Jesse M Klostranec8, Nicolas Phan5, Gamaliel Tan6, Todd G Mainprize5, Albert Yee9, Victor X D Yang10. 1. Division of Neurosurgery, Department of Surgery, University of Toronto, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada; Institute of Medical Science, School of Graduate Studies, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada; Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. 2. Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada; Department of Biomedical Physics, Ryerson University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada. 3. Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. 4. Division of Neurosurgery, Department of Surgery, University of Toronto, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada; Institute of Medical Science, School of Graduate Studies, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada. 5. Division of Neurosurgery, Department of Surgery, University of Toronto, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada. 6. JurongHealth, Ng Teng Fong General Hospital, 1 Jurong East Street, Singapore, 609606, Singapore. 7. Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. 8. Department of Medical Imaging, University of Toronto, 263 McCaul St., Toronto, ON, M5T 1W7, Canada. 9. Division of Orthopedic Surgery, Department of Surgery, University of Toronto, 149 College St., Toronto, ON, M5T 1P5, Canada. 10. Division of Neurosurgery, Department of Surgery, University of Toronto, 399 Bathurst St., Toronto, ON, M5T 2S8, Canada; Institute of Medical Science, School of Graduate Studies, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada; Biophotonics and Bioengineering Laboratory, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada; Department of Electrical and Computer Engineering, Ryerson University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada. Electronic address: Victor.Yang@sunnybrook.ca.
Abstract
BACKGROUND CONTEXT: Spinal intraoperative computer-assisted navigation (CAN) may guide pedicle screw placement. Computer-assisted navigation techniques have been reported to reduce pedicle screw breach rates across all spinal levels. However, definitions of screw breach vary widely across studies, if reported at all. The absolute quantitative error of spinal navigation systems is theoretically a more precise and generalizable metric of navigation accuracy. It has also been computed variably and reported in less than a quarter of clinical studies of CAN-guided pedicle screw accuracy. PURPOSE: This study aimed to characterize the correlation between clinical pedicle screw accuracy, based on postoperative imaging, and absolute quantitative navigation accuracy. DESIGN/ SETTING: This is a retrospective review of a prospectively collected cohort. PATIENT SAMPLE: We recruited 30 patients undergoing first-time posterior cervical-thoracic-lumbar-sacral instrumented fusion±decompression, guided by intraoperative three-dimensional CAN. OUTCOME MEASURES: Clinical or radiographic screw accuracy (Heary and 2 mm classifications) and absolute quantitative navigation accuracy (translational and angular error in axial and sagittal planes). METHODS: We reviewed a prospectively collected series of 209 pedicle screws placed with CAN guidance. Each screw was graded clinically by multiple independent raters using the Heary and 2 mm classifications. Clinical grades were dichotomized per convention. The absolute accuracy of each screw was quantified by the translational and angular error in each of the axial and sagittal planes. RESULTS: Acceptable screw accuracy was achieved for significantly fewer screws based on 2 mm grade versus Heary grade (92.6% vs. 95.1%, p=.036), particularly in the lumbar spine. Inter-rater agreement was good for the Heary classification and moderate for the 2 mm grade, significantly greater among radiologists than surgeon raters. Mean absolute translational-angular accuracies were 1.75 mm-3.13° and 1.20 mm-3.64° in the axial and sagittal planes, respectively. There was no correlation between clinical and absolute navigation accuracy. CONCLUSIONS: Radiographic classifications of pedicle screw accuracy vary in sensitivity across spinal levels, as well as in inter-rater reliability. Correlation between clinical screw grade and absolute navigation accuracy is poor, as surgeons appear to compensate for navigation registration error. Future studies of navigation accuracy should report absolute translational and angular errors. Clinical screw grades based on postoperative imaging may be more reliable if performed in multiple by radiologist raters.
BACKGROUND CONTEXT: Spinal intraoperative computer-assisted navigation (CAN) may guide pedicle screw placement. Computer-assisted navigation techniques have been reported to reduce pedicle screw breach rates across all spinal levels. However, definitions of screw breach vary widely across studies, if reported at all. The absolute quantitative error of spinal navigation systems is theoretically a more precise and generalizable metric of navigation accuracy. It has also been computed variably and reported in less than a quarter of clinical studies of CAN-guided pedicle screw accuracy. PURPOSE: This study aimed to characterize the correlation between clinical pedicle screw accuracy, based on postoperative imaging, and absolute quantitative navigation accuracy. DESIGN/ SETTING: This is a retrospective review of a prospectively collected cohort. PATIENT SAMPLE: We recruited 30 patients undergoing first-time posterior cervical-thoracic-lumbar-sacral instrumented fusion±decompression, guided by intraoperative three-dimensional CAN. OUTCOME MEASURES: Clinical or radiographic screw accuracy (Heary and 2 mm classifications) and absolute quantitative navigation accuracy (translational and angular error in axial and sagittal planes). METHODS: We reviewed a prospectively collected series of 209 pedicle screws placed with CAN guidance. Each screw was graded clinically by multiple independent raters using the Heary and 2 mm classifications. Clinical grades were dichotomized per convention. The absolute accuracy of each screw was quantified by the translational and angular error in each of the axial and sagittal planes. RESULTS: Acceptable screw accuracy was achieved for significantly fewer screws based on 2 mm grade versus Heary grade (92.6% vs. 95.1%, p=.036), particularly in the lumbar spine. Inter-rater agreement was good for the Heary classification and moderate for the 2 mm grade, significantly greater among radiologists than surgeon raters. Mean absolute translational-angular accuracies were 1.75 mm-3.13° and 1.20 mm-3.64° in the axial and sagittal planes, respectively. There was no correlation between clinical and absolute navigation accuracy. CONCLUSIONS: Radiographic classifications of pedicle screw accuracy vary in sensitivity across spinal levels, as well as in inter-rater reliability. Correlation between clinical screw grade and absolute navigation accuracy is poor, as surgeons appear to compensate for navigation registration error. Future studies of navigation accuracy should report absolute translational and angular errors. Clinical screw grades based on postoperative imaging may be more reliable if performed in multiple by radiologist raters.
Authors: Houssem-Eddine Gueziri; Simon Drouin; Charles X B Yan; D Louis Collins Journal: Int J Comput Assist Radiol Surg Date: 2019-06-28 Impact factor: 2.924
Authors: Daipayan Guha; Raphael Jakubovic; Shaurya Gupta; Michael G Fehlings; Todd G Mainprize; Albert Yee; Victor X D Yang Journal: Global Spine J Date: 2018-10-09
Authors: Gustav Burström; Marcin Balicki; Alexandru Patriciu; Sean Kyne; Aleksandra Popovic; Ronald Holthuizen; Robert Homan; Halldor Skulason; Oscar Persson; Erik Edström; Adrian Elmi-Terander Journal: Sci Rep Date: 2020-05-05 Impact factor: 4.379
Authors: Raphael Jakubovic; Daipayan Guha; Shaurya Gupta; Michael Lu; Jamil Jivraj; Beau A Standish; Michael K Leung; Adrian Mariampillai; Kenneth Lee; Peter Siegler; Patryk Skowron; Hamza Farooq; Nhu Nguyen; Joseph Alarcon; Ryan Deorajh; Joel Ramjist; Michael Ford; Peter Howard; Nicolas Phan; Leo da Costa; Chris Heyn; Gamaliel Tan; Rajeesh George; David W Cadotte; Todd Mainprize; Albert Yee; Victor X D Yang Journal: Sci Rep Date: 2018-10-05 Impact factor: 4.379
Authors: Adrian Elmi-Terander; Rami Nachabe; Halldor Skulason; Kyrre Pedersen; Michael Söderman; John Racadio; Drazenko Babic; Paul Gerdhem; Erik Edström Journal: Spine (Phila Pa 1976) Date: 2018-07-15 Impact factor: 3.241