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Three-dimensional Fluoroscopy-based Navigation for the pedicle screw placement in Patients with Primary Invasive Spinal Tumors

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Chinese Medical Journal 2016年第21期129卷 2552-2558页

作者： Bo Jin ,Yi-Bing Su Ji-Zong Zhao Department of Neurosurgery Beijing Tiantan Hospital Capital Medical University Beijing 100050 China China National Clinical Research Center for Neurological Diseases Beijing 100050 China Department of Neurosurgery Beijing Jishuitan Hospital Fourth Medical College of Peking University Beijing 100035 China

Background：Although pedicle screw placement （PSP） is a well-established technique for spine surgery,the treatment of patients with primary invasive spinal tumor （PIST） has high surgical risks secondary to destroyed *** three-dimensional fluoroscopy-based navigation （ITFN） system permits safe and accurate instrumentation of the spine with the advantage of obtaining intraoperative real-time three-dimensional images and automatic *** aim of this study is to evaluate the feasibility and accuracy of PSP using ITFN system for patients afflicted with PIST in the thoracic ***：Fifty-one patients diagnosed with PISTs were retrospectively analyzed,and 157 pedicles screws were implanted in 23 patients using the free-hand technique （free-hand group） and 197 pedicle screws were implanted in 28 patients using the ITFN system （ITFN group）.Modified classification of Gertzbein and Robbins was used to evaluate the accuracy of PSP,and McCormick classification was applied for assessment of neurological *** data and factors affecting accuracy of screw insertion were compared using independent t-test while comparison of accuracy of screw insertion between the two groups was analyzed with Chi-square ***：Of 51 patients,39 demonstrated improved neurological status and the other 12 patients reported that symptoms remained the *** the free-hand group,145 screws （92.4%） were Grade Ⅰ,9 screws （5.7%） were Grade Ⅱ,and 3 screws （1.9%） were Grade Ⅲ.In the ITFN group,192 screws （97.4%） were Grade Ⅰ,5 screws （2.6%） were Grade Ⅱ,and no Grade Ⅲ screw was *** analysis showed that the accuracies of pedicle screws in the two groups are significantly different （χ^2 =4.981,P =0.026）.Conclusions：The treatments of PISTs include total tumor resection and reconstruction of spine *** ITFN system provides a high accuracy of pedicle screw placement.

关键词： Navigation pedicle screw placement Spinal Cord Tumor Three-dimensional Fluoroscopy

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A new free-hand pedicle screw placement technique with reference to the supraspinal ligament

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The Journal of Biomedical Research 2014年第1期28卷 64-70页

作者： Juming Li Hong Zhao Hao Xie Lipeng Yu Jifu Wei Min Zong Feng Chen Ziqiang Zhu Ning Zhang Xiaojian Cao Department of Orthopaedics the First Affiliated Hospital of Nanjing Medical University Department of radiology the First Affiliated Hospital of Nanjing Medical University Department of Statistics Nanjing Medical University

We sought to compare the safety and accuracy of a new free-hand pedicle screw placement technique to that of the conventional technique. One hundred fifty-three consecutive adult patients with simple fracture in the tho- racic or/and lumbar spine were alternately assigned to either the new free-hand or the conventional group. In the new free-hand technique group, preoperative computerized tomography （CT） images were used to calculate the targeted medial-lateral angle of each pedicle trajectory and the pedicle screw was inserted perpendicular to the corresponding supraspinal ligament. In the conventional technique group, the medial-lateral and cranial-caudal angle of each pedicle trajectory was determined by intraoperatively under fluoroscopic guidance. The accuracy rate of pedicle screw placement, the time of intraoperative fluoroscopy, the operating time and the amount of blood loss during operation were respectively compared. All screws were analyzed by using intraoperative ra- diographs, intraoperative triggered electromyography （EMG） monitoring data, postoperative CT data and clinical outcomes. The accuracy rate of pedicle screw placement in the new free-hand technique group and the conven- tional technique group was 96.3% and 94.2% （P 〈 0.05）, respectively. The intraoperative fluoroscopy time of the new technique group was less than that of the conventional technique group （5.37 seconds vs. 8.79 seconds, P 〈 0.05）. However, there was no statistical difference in the operating time and the amount of blood loss during op- eration （P 〉 0.05）. pedicle screw placement with the free-hand technique which keeps the screw perpendicular to the supraspinal ligament is an accurate, reliable and safe technique to treat simple fracture in the thoracic or lum- bar spine.

关键词： spine fracture pedicle screw placement radiation exposure supraspinal ligament anatomy reference

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Revised in-depth meta-analysis on the efficacy of robot-assisted versus traditional free-hand pedicle screw insertion

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Laparoscopic, Endoscopic, and Robotic Surgery 2024年第4期7卷 155-165页

作者： Chumnanvej S. Pillai B.M. Suthakorn J. Neurosurgery Division Department of Surgery Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand Department of Anesthesiology and Operating Room Phramongkutklao Hospital Bangkok Thailand Center for Biomedical and Robotics Technology (BART LAB) Faculty of Engineering Mahidol University Bangkok Thailand

Objective: Robot-assisted pedicle screw insertion has recently emerged as an alternative to the traditional free-hand technique. However, discrepancies in the accuracy of screw placement between the 2 methods have been highlighted by some comparative studies. This meta-analysis was conducted to synthesize evidence comparing these techniques. Methods: Searches were conducted in 5 electronic databases adhering to specific eligibility criteria for randomized and observational studies. The data were analyzed using RevMan software and the results are presented as odds ratios (ORs), mean differences, or standard mean differences (SMDs) with 95% confidence intervals (CIs). Our analysis included 12 studies (7 randomized trials and 5 observational studies, involving 883 patients and 4903 screws). Results: The results demonstrated a higher rate of Grade A Gertzbein and Robbins pedicle placement score (OR: 1.77; 95% CI: 1.10–2.87), a lower rate of revision surgeries (OR: 0.21; 95% CI: 0.09–0.52), and a shorter radiation exposure duration (SMD = −1.38, 95% CI: −2.32 to −0.44) in the robot-assisted group compared with the free-hand group. Nonetheless, the length of hospital stay, volume of intraoperative blood loss, postoperative visual analogue scale scores for back pain, and rate of wound infection were similar between the 2 groups. Significant heterogeneity was observed in some outcomes. Conclusion: Compared with the free-hand method, the robot-assisted technique provides greater accuracy and reduced radiation exposure. The efficacy of the robot-assisted technique is expected to improve further as experience with its use in surgery grows. © 2024 Zhejiang University

关键词： Fluoroscopy Free-hand Meta-analysis pedicle screw placement Robotic surgery

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