Use of an inertial measurement unit sensor in pedicle screw placement improves trajectory accuracy.

Autor: Baba S; Department of Spine Surgery, Saga Medical Center, Koseikan, Saga, Japan.; Trauma Center, Saga Medical Center, Koseikan, Saga, Japan.; Department of Orthopedic Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan., Kawaguchi K; Department of Orthopedic Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan., Itamoto K; Department of Small Animal Clinical Science, Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi, Japan., Watanabe T; Department of Orthopedic Surgery, Watanabe Orthopedic Hospital, Itoshima, Fukuoka, Japan., Hayashida M; Department of Spine Surgery, Saga Medical Center, Koseikan, Saga, Japan.; Trauma Center, Saga Medical Center, Koseikan, Saga, Japan.; Department of Orthopedic Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan., Mae T; Trauma Center, Saga Medical Center, Koseikan, Saga, Japan.; Department of Orthopedic Surgery, Saga Medical Center, Koseikan, Saga, Japan., Nakashima Y; Department of Orthopedic Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan., Kato G; Department of Spine Surgery, Saga Medical Center, Koseikan, Saga, Japan.; Trauma Center, Saga Medical Center, Koseikan, Saga, Japan.; Department of Orthopedic Surgery, Fukuoka Red Cross Hospital, Fukuoka, Japan.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Nov 16; Vol. 15 (11), pp. e0242512. Date of Electronic Publication: 2020 Nov 16 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0242512
Abstrakt: Ascertaining the accuracy of the pedicle screw (PS) trajectories is important as PS malpositioning can cause critical complications. We aimed to determine the angle range over which estimation is unreliable; build a low-cost PS placement support system that uses an inertial measurement unit (IMU) to enable the monitoring of surgical tools and PS trajectories, and determine the situations where IMU support would be most beneficial. In PS insertion experiments, we used cadaver samples that included lumbar porcine spines. Computed tomography images obtained before and after PS insertion were viewed. Offsets between the planned and implanted PS trajectories in the freehand and IMU-assisted groups were analyzed. The PS cortical bone breaches were classified according to the Gertzbein and Robbins criteria (GRC). Added head-down tilted sample experiments were repeated wherein we expected a decreased rostro-caudal rotational accuracy of the PS according to the angle estimation ability results. Evaluation of the PS trajectory accuracy revealed no significant advantage of IMU-assisted rostro-caudal rotational accuracy versus freehand accuracy. According to the GRC, IMU assistance significantly increased the rate of clinically acceptable PS positions (RoCA) than the freehand technique. In the head-down tilted sample experiments, IMU assist provided increased accuracies with both rostro-caudal and medial rotational techniques when compared with the freehand technique. In the freehand group, RoCA was significantly decreased in samples with rostral tilting relative to that in the samples without. However, In the IMU-assisted group, no significant difference in RoCA between the samples with and without head-down tilting was observed. Even when the planned PS medial and/or rostro-caudal rotational angle was relatively large and difficult to reproduce manually, IMU-support helped maintain the PS trajectory accuracy and positioning safety. IMU assist in PS placement was more beneficial, especially for larger rostro-caudal and/or medial rotational pedicle angles.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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