Dimitri Tkatschenko1, Paul Kendlbacher1, Marcus Czabanka1, Georg Bohner2, Peter Vajkoczy3, Nils Hecht1. 1. Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. 2. Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Berlin, Germany. 3. Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. peter.vajkoczy@charite.de.
Abstract
PURPOSE: Percutaneous paraspinal pedicle screw implantation (PPSI) reduces soft tissue trauma, blood loss, and postoperative pain but remains technically challenging and associated with radiation exposure and implant-related artefacts. Here, we determined the feasibility, screw accessibility, and the accuracy of navigated PPSI in the thoraco-lumbar sacral spine using intraoperative computed tomography (iCT) and robotic cone-beam CT (CBCT) imaging. METHODS: Between 2015 and 2018, 465 percutaneous paraspinal pedicle screws were implanted in 75 patients using iCT- or CBCT-based spinal navigation with 230 screws connected to rod reducers during screw assessment imaging (iCT 198; CBCT 32). Clinical and demographic data, intraoperative screw accessibility, and screw accuracy were analyzed and compared to a case-matched cohort of 75 patients undergoing navigated implantation of 481 pedicle screws through an open midline approach. RESULTS: Both iCT and CBCT permitted reliable assessment of each implanted screw, regardless of artifacts caused by rod reducers. Although overall accuracy for correct placement was comparable between PPSI and open surgery (PPSI 96.6%; Open 94.2%), PPSI compared favorably to open surgery regarding complete placement within the pedicle (PPSI 90.1%; Open 75.1%; p < 0.0001), regional placement accuracy in the lumbar (PPSI 97.8%; Open 91.5%; p < 0.001), and lumbar-sacral spine (PPSI 100%; Open 81.2%; p < 0.05), next to the duration of surgery and length of hospitalization. CONCLUSIONS: PPSI with iCT- and CBCT-based spinal navigation improves the accuracy, safety, and workflow of navigated spinal instrumentation. Next, a cost-effectiveness and outcome analysis should determine whether iCT and CBCT imaging are truly economically justified. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: Percutaneous paraspinal pedicle screw implantation (PPSI) reduces soft tissue trauma, blood loss, and postoperative pain but remains technically challenging and associated with radiation exposure and implant-related artefacts. Here, we determined the feasibility, screw accessibility, and the accuracy of navigated PPSI in the thoraco-lumbar sacral spine using intraoperative computed tomography (iCT) and robotic cone-beam CT (CBCT) imaging. METHODS: Between 2015 and 2018, 465 percutaneous paraspinal pedicle screws were implanted in 75 patients using iCT- or CBCT-based spinal navigation with 230 screws connected to rod reducers during screw assessment imaging (iCT 198; CBCT 32). Clinical and demographic data, intraoperative screw accessibility, and screw accuracy were analyzed and compared to a case-matched cohort of 75 patients undergoing navigated implantation of 481 pedicle screws through an open midline approach. RESULTS: Both iCT and CBCT permitted reliable assessment of each implanted screw, regardless of artifacts caused by rod reducers. Although overall accuracy for correct placement was comparable between PPSI and open surgery (PPSI 96.6%; Open 94.2%), PPSI compared favorably to open surgery regarding complete placement within the pedicle (PPSI 90.1%; Open 75.1%; p < 0.0001), regional placement accuracy in the lumbar (PPSI 97.8%; Open 91.5%; p < 0.001), and lumbar-sacral spine (PPSI 100%; Open 81.2%; p < 0.05), next to the duration of surgery and length of hospitalization. CONCLUSIONS: PPSI with iCT- and CBCT-based spinal navigation improves the accuracy, safety, and workflow of navigated spinal instrumentation. Next, a cost-effectiveness and outcome analysis should determine whether iCT and CBCT imaging are truly economically justified. These slides can be retrieved under Electronic Supplementary Material.
Authors: Jonathan S Hott; Stephen M Papadopoulos; Nicholas Theodore; Curtis A Dickman; Volker K H Sonntag Journal: Spine (Phila Pa 1976) Date: 2004-12-15 Impact factor: 3.468
Authors: Nicolas Dea; Charles G Fisher; Juliet Batke; Jason Strelzow; Daniel Mendelsohn; Scott J Paquette; Brian K Kwon; Michael D Boyd; Marcel F S Dvorak; John T Street Journal: Spine J Date: 2015-10-09 Impact factor: 4.166
Authors: Tarik Alp Sargut; Nils Hecht; Ran Xu; Georg Bohner; Marcus Czabanka; Julia Stein; Marcus Richter; Simon Bayerl; Johannes Woitzik; Peter Vajkoczy Journal: Eur Spine J Date: 2022-06-30 Impact factor: 2.721
Authors: Nils Beisemann; Jula Gierse; Eric Mandelka; Frank Hassel; Paul A Grützner; Jochen Franke; Sven Y Vetter Journal: Sci Rep Date: 2022-07-19 Impact factor: 4.996
Authors: Vanessa Hubertus; Lars Wessels; Anton Früh; Dimitri Tkatschenko; Irini Nulis; Georg Bohner; Vincent Prinz; Julia Onken; Marcus Czabanka; Peter Vajkoczy; Nils Hecht Journal: Sci Rep Date: 2022-09-22 Impact factor: 4.996