scholarly journals Computer-assisted surgery navigation of pedicle screw insertion by standardized trainees

2017 ◽  
Vol 6 (1) ◽  
Author(s):  
Mingyong Liu ◽  
Liang Zhang ◽  
Jianhua Zhao ◽  
Peng Liu

<p><strong>Objective:</strong> To assess the precision and efficiency computer-assisted surgery navigation of pedicle screw insertion by standardized trainees. <strong>Methods</strong> From September 2013 to June 2016, 360 thoracic pedicle screws were inserted into 100 patients by standardized trainees (n = 30). Screws on the left side were inserted by hands (control group), while the other side were inserted under the guidance of computer-assistant navigation system (guided group). The insertion time and volume of blood lost by each screw were retrospectively analyzed. The precision ratio was assessed by computerized tomography (CT) scan after operation. <strong>Results</strong> The time consumed in screw insertion was significantly shorter in the guided group than that in the control group. The blood lost volume was lesser in the guided group. Post-operation CT scan revealed higher precision in the guided group than that in the control group.<strong> Conclusion</strong> Computer-assistant navigation system facilitates the learning of standardized trainees, and reduces the time-consuming and bleeding in thoracic pedicle screw insertion. Orthodontics training is the most important low-grade physician training in the orthopedic department1,2. Due to the complexity of spinal anatomy, professional required and high risk of spinal surgery, thoracic pedicle screw implantation has become a very demanding technique. Furthermore, the spine surgery learning is not conducive to the trainees. Since 2013, our department started to use the computer-assisted three-dimensional navigation technology to guide the implantation of screws3. We found that the computer-assisted navigation technology has greater advantage when compared with the traditional hand-implanted technology.</p>

Author(s):  
Ming Yong Liu

Objective: To assess the precision and efficiency computer-assisted surgery navigation of pedicle screw insertion by standardized trainees. Methods: From September 2013 to June 2016, 360 thoracic pedicle screws were inserted into 100 patients by standardized trainees (n = 30). Screws on the left side were inserted by hands (control group), while the other side were inserted under the guidance of computer-assistant navigation system (guided group). The insertion time and volume of blood lost by each screw were retrospectively analyzed. The precision ratio was assessed by computerized tomography (CT) scan after operation. Results: The time consumed in screw insertion was significantly shorter in the guided group than that in the control group. The blood lost volume was lesser in the guided group. Post-operation CT scan revealed higher precision in the guided group than that in the control group. Conclusion: Computer-assistant navigation system facilitates the learning of standardized trainees, and reduces the time-consuming and bleeding in thoracic pedicle screw insertion.


Spine ◽  
1997 ◽  
Vol 22 (11) ◽  
pp. 1254-1258 ◽  
Author(s):  
Timo Laine ◽  
Dietrich Schlenzka ◽  
Kirsti Mäkitalo ◽  
Kaj Tallroth ◽  
Lutz-P Nolte ◽  
...  

Author(s):  
P Merloz ◽  
J Troccaz ◽  
H Vouaillat ◽  
C Vasile ◽  
J Tonetti ◽  
...  

The variability in width, height, and spatial orientation of a spinal pedicle makes pedicle screw insertion a delicate operation. The aim of the current paper is to describe a computer-assisted surgical navigation system based on fluoroscopic X-ray image calibration and three-dimensional optical localizers in order to reduce radiation exposure while increasing accuracy and reliability of the surgical procedure for pedicle screw insertion. Instrumentation using transpedicular screw fixation was performed: in a first group, a conventional surgical procedure was carried out with 26 patients (138 screws); in a second group, a navigated surgical procedure (virtual fluoroscopy) was performed with 26 patients (140 screws). Evaluation of screw placement in every case was done by using plain X-rays and post-operative computer tomography scan. A 5 per cent cortex penetration (7 of 140 pedicle screws) occurred for the computer-assisted group. A 13 per cent penetration (18 of 138 pedicle screws) occurred for the non computer-assisted group. The radiation running time for each vertebra level (two screws) reached 3.5s on average in the computer-assisted group and 11.5s on average in the non computer-assisted group. The operative time for two screws on the same vertebra level reaches 10 min on average in the non computer-assisted group and 11.9 min on average in the computer-assisted group. The fluoroscopy-based (two-dimensional) navigation system for pedicle screw insertion is a safe and reliable procedure for surgery in the lower thoracic and lumbar spine.


2005 ◽  
Vol 12 (2) ◽  
pp. 123
Author(s):  
Young Joon Ahn ◽  
Choon Sung Lee ◽  
Ji Hyo Kim ◽  
Kyeong Il Jeong ◽  
Yung Tae Kim

2003 ◽  
Vol 99 (3) ◽  
pp. 257-263 ◽  
Author(s):  
Yoshihisa Kotani ◽  
Kuniyoshi Abumi ◽  
Manabu Ito ◽  
Akio Minami

Object. The authors introduce a unique computer-assisted cervical pedicle screw (CPS) insertion technique used in conjunction with specially modified original pedicle screw insertion instruments. The accuracy of screw placement as well as surgery-related outcome and complication rates were compared between two groups of patients: those in whom a computer-assisted and those in whom a conventional manual insertion technique was used. Methods. The screw insertion guiding system consisted of a modified awl, probe, tap and a screwdriver specially designed for a computer-assisted CPS insertion. Using this system, real-time instrument/screw tip information was three dimensionally identified in each step of screw insertion. Seventeen patients underwent CPS fixation in which a computer-assisted surgical navigation system was used. The cervical disorders consisted of spondylotic myelopathy with segmental instability or kyphosis, metastatic spinal tumor, rheumatoid spine, and postlaminectomy kyphosis. The rate of pedicle wall perforation was significantly lower in the computer-assisted group than that in the other group (1.2 and 6.7%, respectively; p < 0.05). The screw trajectory in the horizontal plane was significantly closer to the anatomical pedicle axis in the computer-assisted group compared with the manual insertion group (p < 0.05). This factor significantly reduced the incidence of screw perforation laterally. Complications such as neural damage or vascular injury were not demonstrated in the computer-assisted group (compared with 2% in the manual insertion treatment group). The overall surgery-related outcome was satisfactory. Conclusions. In contrast to the previously reported computer-assisted technique, our CPS insertion technique provides real-time three-dimensional instrument/screw tip information. This serves as a powerful tool for safe and accurate pedicle screw placement in the cervical spine.


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