Kaissar Farah1, Pierre Coudert2, Thomas Graillon3, Benjamin Blondel4, Henry Dufour3, Olivier Gille2, Stephane Fuentes3. 1. Department of Neurosurgery, La Timone University Hospital, Marseille, France; Spine Unit, La Timone University Hospital, Marseille, France. Electronic address: kaissar.farah@gmail.com. 2. Department of Spinal Surgery Unit 1, C.H.U Tripode Pellegrin, Bordeaux University Hospital, Bordeaux, France. 3. Department of Neurosurgery, La Timone University Hospital, Marseille, France; Spine Unit, La Timone University Hospital, Marseille, France. 4. Spine Unit, La Timone University Hospital, Marseille, France.
Abstract
OBJECTIVE: Pedicle screw placement remains challenging. The present study focuses on the comparison between 2 intraoperative-based neuronavigation systems (O-Arm and AIRO) during thoracolumbar screw instrumentation. METHODS: This is a prospective, comparative, nonrandomized study conducted in 2 French academic centers. The O-Arm was used at the University Hospital of Bordeaux, whereas the AIRO was used at the University Hospital of Marseille. Routine computed tomography was performed on postoperative day 2 to evaluate pedicle screw placement. Measures of radiation exposure were extracted directly from reports provided by each system. The effective dose was calculated. RESULTS: Overall, 74 screws were placed in 11 patients in the O-Arm group and 84 in 11 patients in the AIRO group. In the first group, 90.8% were rated as acceptable and 92.2% in the second (P > 0.05) according to the Heary and Gertzbein classifications, respectively, for thoracic and lumbar spine. Differences between both implantation systems were significant (P < 0.05) concerning dose length product (235 and 1039 mGy/cm, in O-Arm and AIRO, respectively), overall mean radiation dose received by 1 patient (3.52 and 15.6 mSv in O-Arm and AIRO, respectively), mean radiation dose per single scan (2.58 and 8.7 mSv in O-Arm and AIRO, respectively), mean effective dose per instrumented level (1.04 and 3.9 mSv in O-Arm and AIRO, respectively), and radiation dose received by the primary surgeon (0.63 and 0 μSv in O-Arm and AIRO, respectively). CONCLUSIONS: Intraoperative computed tomography-based navigation is a major innovation that improves the accuracy of pedicle screw positioning with acceptable patient radiation exposure and reduced surgical team exposure.
OBJECTIVE: Pedicle screw placement remains challenging. The present study focuses on the comparison between 2 intraoperative-based neuronavigation systems (O-Arm and AIRO) during thoracolumbar screw instrumentation. METHODS: This is a prospective, comparative, nonrandomized study conducted in 2 French academic centers. The O-Arm was used at the University Hospital of Bordeaux, whereas the AIRO was used at the University Hospital of Marseille. Routine computed tomography was performed on postoperative day 2 to evaluate pedicle screw placement. Measures of radiation exposure were extracted directly from reports provided by each system. The effective dose was calculated. RESULTS: Overall, 74 screws were placed in 11 patients in the O-Arm group and 84 in 11 patients in the AIRO group. In the first group, 90.8% were rated as acceptable and 92.2% in the second (P > 0.05) according to the Heary and Gertzbein classifications, respectively, for thoracic and lumbar spine. Differences between both implantation systems were significant (P < 0.05) concerning dose length product (235 and 1039 mGy/cm, in O-Arm and AIRO, respectively), overall mean radiation dose received by 1 patient (3.52 and 15.6 mSv in O-Arm and AIRO, respectively), mean radiation dose per single scan (2.58 and 8.7 mSv in O-Arm and AIRO, respectively), mean effective dose per instrumented level (1.04 and 3.9 mSv in O-Arm and AIRO, respectively), and radiation dose received by the primary surgeon (0.63 and 0 μSv in O-Arm and AIRO, respectively). CONCLUSIONS: Intraoperative computed tomography-based navigation is a major innovation that improves the accuracy of pedicle screw positioning with acceptable patient radiation exposure and reduced surgical team exposure.
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