Accuracy of intraoperative computed tomography image-guided surgery in placing pedicle and pelvic screws for primary versus revision spine surgery

2014 ◽  
Vol 36 (3) ◽  
pp. E2 ◽  
Author(s):  
Joseph C. Hsieh ◽  
Doniel Drazin ◽  
Alexander O. Firempong ◽  
Robert Pashman ◽  
J. Patrick Johnson ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Tactile Feedback ◽  
Image Guided Surgery ◽  
Intraoperative Computed Tomography ◽  
Guided Surgery ◽  
Image Guided ◽  
Costovertebral Joint ◽  
Fluoroscopic Imaging ◽  
Spine Surgeon ◽  
Computed Tomography Image

Object Revision spine surgery, which is challenging due to disrupted anatomy, poor fluoroscopic imaging, and altered tactile feedback, may benefit from CT image-guided surgery (CT-IGS). This study evaluates accuracy of CT-IGS–navigated screws in primary versus revision spine surgery. Methods Pedicle and pelvic screws placed with the O-arm in 28 primary (313 screws) and 33 revision (429 screws) cases in which institutional postoperative CT scans were available were retrospectively reviewed for placement accuracy. Screw accuracy was categorized as 1) good (< 1-mm pedicle breach in any direction or “in-out-in” thoracic screws through the lateral thoracic pedicle wall and in the costovertebral joint); 2) fair (1- to 3-mm breach); or 3) poor (> 3-mm breach). Results Use of CT-IGS resulted in high rates of good or fair screws for both primary (98.7%) and revision (98.6%) cases. Rates of good or fair screws were comparable for the following regions: C7–T3 at 100% (good or fair) in primary versus 100% (good or fair) in revision; T4–9 at 96.8% versus 100%; T10–L2 at 98.2% versus 99.3%; L3–5 at 100% versus 99.2%; and pelvis at 98.7% versus 98.6%, respectively. On the other hand, revision sacral screws had statistically significantly lower rates of good placement compared with primary (100% primary vs 80.6% revision, p = 0.027). Of these revision sacral screws, 11.1% had poor placement, with bicortical screws extending > 3 mm beyond the anterior cortex. Revision pelvic screws demonstrated the highest rate of fair placement (28%), with the mode of medial breach in all cases directed into the sacral-iliac joint. Conclusions In the cervical, thoracic, and lumbar spine, CT-IGS demonstrated comparable accuracy rates for both primary and revision spine surgery. Use of 3D imaging of the bony pedicle anatomy appears to be sufficient for the spine surgeon to overcome the difficulties associated with instrumentation in revision cases. Although the bony structures of sacral pedicles and pelvis are relatively larger, the complexity of local anatomy was not overcome with CT-IGS, and an increased trend toward inaccurate screw placement was demonstrated.

scholarly journals Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Terrence T. Kim ◽  
J. Patrick Johnson ◽  
Robert Pashman ◽  
Doniel Drazin
Keyword(s):  
Minimally Invasive ◽  
Cone Beam Ct ◽  
Posterior Spinal Fusion ◽  
Illustrative Case ◽  
Minimally Invasive Spinal Surgery ◽  
Intraoperative Computed Tomography ◽  
Image Guided ◽  
Tomography Image ◽  
Fluoroscopic Imaging ◽  
Computed Tomography Image

We present our perioperative minimally invasive spine surgery technique using intraoperative computed tomography image-guided navigation for the treatment of various lumbar spine pathologies. We present an illustrative case of a patient undergoing minimally invasive percutaneous posterior spinal fusion assisted by the O-arm system with navigation. We discuss the literature and the advantages of the technique over fluoroscopic imaging methods: lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy.

Computed Tomography Image Guided Surgery in Complex Acetabular Fractures

2000 ◽  
Vol 370 ◽  
pp. 219-226 ◽  
Author(s):  
George A. Brown ◽  
Michael C. Willis ◽  
Keikhosrow Firoozbakhsh ◽  
Adam Barmada ◽  
Charles L. Tessman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acetabular Fractures ◽  
Image Guided Surgery ◽  
Guided Surgery ◽  
Image Guided ◽  
Tomography Image ◽  
Computed Tomography Image

scholarly journals Video-assisted thoracoscopic image-guided spine surgery: evolution of 19 years of experience, from endoscopy to fully integrated 3D navigation

2021 ◽  
Vol 50 (1) ◽  
pp. E8
Author(s):  
George Hanna ◽  
Terrence T. Kim ◽  
Syed-Abdullah Uddin ◽  
Lindsey Ross ◽  
J. Patrick Johnson
Keyword(s):  
Spine Surgery ◽  
Technology Use ◽  
Image Guidance ◽  
Ct Scanning ◽  
Image Guided Surgery ◽  
Years Of Experience ◽  
Intraoperative Ct ◽  
Guided Surgery ◽  
Image Guided ◽  
Matching Techniques

OBJECTIVEThe purpose of this study was to describe the evolution of thoracoscopic spine surgery from basic endoscopic procedures using fluoroscopy and anatomical localization through developmental iterations to the current technology use in which endoscopy and image-guided surgery are merged with intraoperative CT scanning.METHODSThe authors provided detailed explanations of their thoracoscopic spine surgery techniques, beginning with their early-generation endoscopy with fluoroscopic localization, which was followed with point surface matching techniques and early image guidance. The authors supplanted this with the modern era of image guidance, thoracoscopic spine surgery, and seamless integration that has reached its current level of refinement.RESULTSA retrospective review of single-institution thoracoscopic procedures performed by the senior author over the course of 19 years yielded a total of 160 patients, including 73 women and 87 men. The mean patient age was 55 years, and the range included patients 16–94 years of age. There were no patients with worsened neurological function. One hundred sixteen patients underwent surgery for thoracic disc herniation, 18 for underlying neoplasms with spinal cord compression, 14 for osteomyelitis and discitis, 12 for thoracic deformity with neurological changes, and 8 for traumatic etiologies.CONCLUSIONSMore than 19 years of experience has revealed the benefits of integrating thoracoscopic spine surgery with intraoperative CT scanning and image-guided surgery, including direct decompression without manipulation of neural elements, superior 3D spatial orientation, and localization of complex spinal anatomy. With the exponential growth of machine learning, robotics, artificial intelligence, and advances in imaging techniques and endoscopic imaging, there may be further refinements of this technique on the horizon.

scholarly journals Instrumenting the small thoracic pedicle: the role of intraoperative computed tomography image–guided surgery

2014 ◽  
Vol 36 (3) ◽  
pp. E6 ◽  
Author(s):  
Sunil Jeswani ◽  
Doniel Drazin ◽  
Joseph C. Hsieh ◽  
Faris Shweikeh ◽  
Eric Friedman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Surgical Navigation ◽  
Imaging System ◽  
Screw Placement ◽  
Neurological Involvement ◽  
Image Guided Surgery ◽  
Intraoperative Computed Tomography ◽  
Guided Surgery ◽  
Image Guided

Object Traditionally, instrumentation of thoracic pedicles has been more difficult because of their relatively smaller size. Thoracic pedicles are at risk for violation during surgical instrumentation, as is commonly seen in patients with scoliosis and in women. The laterally based “in-out-in” approach, which technically results in a lateral breach, is sometimes used in small pedicles to decrease the comparative risk of a medial breach with neurological involvement. In this study the authors evaluated the role of CT image–guided surgery in navigating screws in small thoracic pedicles. Methods Thoracic (T1–12) pedicle screw placements using the O-arm imaging system (Medtronic Inc.) were evaluated for accuracy with preoperative and postoperative CT. “Small” pedicles were defined as those ≤ 3 mm in the narrowest diameter orthogonal to the long axis of the pedicle on a trajectory entering the vertebral body on preinstrumentation CT. A subset of “very small” pedicles (≤ 2 mm in the narrowest diameter, 13 pedicles) was also analyzed. Screw accuracy was categorized as good (< 1 mm of pedicle breach in any direction or in-out-in screws), fair (1–3 mm of breach), or poor (> 3 mm of breach). Results Twenty-one consecutive patients (age range 32–71 years) had large (45 screws) and small (52 screws) thoracic pedicles. The median pedicle diameter was 2.5 mm (range 0.9–3 mm) for small and 3.9 mm (3.1–6.7 mm) for large pedicles. Computed tomography–guided surgical navigation led to accurate screw placement in both small (good 100%, fair 0%, poor 0%) and large (good 96.6%, fair 0%, poor 3.4%) pedicles. Good screw placement in very small or small pedicles occurred with an in-out-in trajectory more often than in large pedicles (large 6.8% vs small 36.5%, p < 0.0005; vs very small 69.2%, p < 0.0001). There were no medial breaches even though 75 of the 97 screws were placed in postmenopausal women, traditionally at higher risk for osteoporosis. Conclusions Computed tomography–guided surgical navigation allows for safe, effective, and accurate instrumentation of small (≤ 3 mm) to very small (≤ 2 mm) thoracic pedicles.

Three-Dimensional Localization: From Image-Guided Surgery to Information-Guided Therapy

Methods ◽  
2001 ◽  
Vol 25 (2) ◽  
pp. 186-200 ◽  
Author(s):  
Richard D. Bucholz ◽  
Kurt R. Smith ◽  
Keith A. Laycock ◽  
Leslie L. McDurmont
Keyword(s):  
Three Dimensional ◽  
Image Guided Surgery ◽  
Guided Surgery ◽  
Image Guided ◽  
Guided Therapy

scholarly journals Radiopharmaceutical and Eu3+ doped gadolinium oxide nanoparticles mediated triple-excited fluorescence imaging and image-guided surgery

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Xiaojing Shi ◽  
Caiguang Cao ◽  
Zeyu Zhang ◽  
Jie Tian ◽  
Zhenhua Hu
Keyword(s):  
Fluorescent Probes ◽  
Signal Intensity ◽  
Tumor Imaging ◽  
Tumor Resection ◽  
Optical Signal ◽  
Gadolinium Oxide ◽  
Image Guided Surgery ◽  
Guided Surgery ◽  
Image Guided ◽  
The Impact

AbstractCerenkov luminescence imaging (CLI) is a novel optical imaging technique that has been applied in clinic using various radionuclides and radiopharmaceuticals. However, clinical application of CLI has been limited by weak optical signal and restricted tissue penetration depth. Various fluorescent probes have been combined with radiopharmaceuticals for improved imaging performances. However, as most of these probes only interact with Cerenkov luminescence (CL), the low photon fluence of CL greatly restricted it’s interaction with fluorescent probes for in vivo imaging. Therefore, it is important to develop probes that can effectively convert energy beyond CL such as β and γ to the low energy optical signals. In this study, a Eu3+ doped gadolinium oxide (Gd2O3:Eu) was synthesized and combined with radiopharmaceuticals to achieve a red-shifted optical spectrum with less tissue scattering and enhanced optical signal intensity in this study. The interaction between Gd2O3:Eu and radiopharmaceutical were investigated using 18F-fluorodeoxyglucose (18F-FDG). The ex vivo optical signal intensity of the mixture of Gd2O3:Eu and 18F-FDG reached 369 times as high as that of CLI using 18F-FDG alone. To achieve improved biocompatibility, the Gd2O3:Eu nanoparticles were then modified with polyvinyl alcohol (PVA), and the resulted nanoprobe PVA modified Gd2O3:Eu (Gd2O3:Eu@PVA) was applied in intraoperative tumor imaging. Compared with 18F-FDG alone, intraoperative administration of Gd2O3:Eu@PVA and 18F-FDG combination achieved a much higher tumor-to-normal tissue ratio (TNR, 10.24 ± 2.24 vs. 1.87 ± 0.73, P = 0.0030). The use of Gd2O3:Eu@PVA and 18F-FDG also assisted intraoperative detection of tumors that were omitted by preoperative positron emission tomography (PET) imaging. Further experiment of image-guided surgery demonstrated feasibility of image-guided tumor resection using Gd2O3:Eu@PVA and 18F-FDG. In summary, Gd2O3:Eu can achieve significantly optimized imaging property when combined with 18F-FDG in intraoperative tumor imaging and image-guided tumor resection surgery. It is expected that the development of the Gd2O3:Eu nanoparticle will promote investigation and application of novel nanoparticles that can interact with radiopharmaceuticals for improved imaging properties. This work highlighted the impact of the nanoprobe that can be excited by radiopharmaceuticals emitting CL, β, and γ radiation for precisely imaging of tumor and intraoperatively guide tumor resection.

Image‐guided surgery in otolaryngology: A review of current applications and future directions in head and neck surgery

Head & Neck ◽  
2021 ◽  
Author(s):  
Sarah Y. Bessen ◽  
Xiaotian Wu ◽  
Michael T. Sramek ◽  
Yuan Shi ◽  
David Pastel ◽  
...  
Keyword(s):  
Head And Neck ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Image Guided Surgery ◽  
Future Directions ◽  
Guided Surgery ◽  
Image Guided
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