Risk-benefit analysis of navigation techniques for vertebral transpedicular instrumentation: a prospective study
| Autor: | David C. Noriega, Francisco Ardura, Ricardo Torres, Rubén Hernández-Ramajo, Antonio Krüger, Israel Sanchez-Lite, Raul Corredera, Fiona Rodríguez-Monsalve Milano, Borja Toribio |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Cone beam computed tomography medicine.medical_specialty Transpedicular instrumentation Context (language use) Asymptomatic Neurosurgical Procedures 03 medical and health sciences Random Allocation 0302 clinical medicine Postoperative Complications Pedicle Screws medicine Fluoroscopy Humans Orthopedics and Sports Medicine Prospective Studies Pedicle screw Prospective cohort study Aged 030222 orthopedics Lumbar Vertebrae medicine.diagnostic_test business.industry Middle Aged Surgery Surgery Computer-Assisted Observational study Female Neurology (clinical) Radiology medicine.symptom business Tomography X-Ray Computed 030217 neurology & neurosurgery |
| Zdroj: | The spine journal : official journal of the North American Spine Society. 17(1) |
| ISSN: | 1878-1632 |
| Popis: | Pedicle screws in spinal surgery have allowed greater biomechanical stability and higher fusion rates. However, malposition is very common and may cause neurologic, vascular, and visceral injuries and compromise mechanical stability.The purpose of this study was to compare the malposition rate between intraoperative computed tomography (CT) scan assisted-navigation and free-hand fluoroscopy-guided techniques for placement of pedicle screw instrumentation.This is a prospective, randomized, observational study.A total of 114 patients were included: 58 in the assisted surgery group and 56 in the free-hand fluoroscopy-guided surgery group.Analysis of screw position was assessed using the Heary classification. Breach severity was defined according to the Gertzbein classification. Radiation doses were evaluated using thermoluminescent dosimeters, and estimates of effective and organ doses were made based on scan technical parameters.Consecutive patients with degenerative disease, who underwent surgical procedures using the free-hand, or intraoperative navigation technique for placement of transpedicular instrumentation, were included in the study.Forty-four out of 625 implanted screws were malpositioned: 11 (3.6%) in the navigated surgery group and 33 (10.3%) in the free-hand group (p.001). Screw position according to the Heary scale was Grade II (4 navigated surgery, 6 fluoroscopy guided), Grade III (3 navigated surgery, 11 fluoroscopy guided), Grade IV (4 navigated surgery, 16 fluoroscopy guided), and Grade V (1 fluoroscopy guided). There was only one symptomatic case in the conventional surgery group. Breach severity was seven Grade A and four Grade B in the navigated surgery group, and eight Grade A, 24 Grade B, and one Grade C in free-hand fluoroscopy-guided surgery group. Radiation received per patient was 5.8 mSv (4.8-7.3). The median dose received in the free-hand fluoroscopy group was 1 mGy (0.8-1.1). There was no detectable radiation level in the navigation-assisted surgery group, whereas the effective dose was 10 µGy in the free-hand fluoroscopy-guided surgery group.Malposition rate, both symptomatic and asymptomatic, in spinal surgery is reduced when using CT-guided placement of transpedicular instrumentation compared with placement under fluoroscopic guidance, with radiation values within the safety limits for health. Larger studies are needed to determine risk-benefit in these patients. |
| Databáze: | OpenAIRE |
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