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![Visual representation of pedicle screw placement grading system. Schematic display and exemplary intraoperative 3D rotational fluoroscopy images of the classification system proposed by Zdichavsky et al. [7, 8]. Grading criteria are summarized in Table 1](publication/361805116/figure/fig1/AS:11431281159482644@1684374935627/Visual-representation-of-pedicle-screw-placement-grading-system-Schematic-display-and.png)
Visual representation of pedicle screw placement grading system. Schematic display and exemplary intraoperative 3D rotational fluoroscopy images of the classification system proposed by Zdichavsky et al. [7, 8]. Grading criteria are summarized in Table 1
Source publication
Introduction
In spinal surgery, precise instrumentation is essential. This study aims to evaluate the accuracy of navigated, O-arm-controlled screw positioning in thoracic and lumbar spine instabilities.
Materials and methods
Posterior instrumentation procedures between 2010 and 2015 were retrospectively analyzed. Pedicle screws were placed using...
Citations
... This integration has not only propelled the hospital to the vanguard of global Neuronavigation practice but has also fostered a culture of technological innovation, thereby recalibrating the benchmarks for surgical outcomes. The collective endeavor at Shifa International Hospital underscores a patient-centric approach where the convergence of empirical research and clinical expertise culminates in the refinement of surgical protocols, ensuring the highest standards of patient care and safety (4). This review endeavors to unravel the intricacies of Neuronavigation, tracing its evolutionary trajectory from its nascent stages to its contemporary applications, and casting a visionary gaze towards the future advancements in the field of neurosurgery. ...
Background: Neuronavigation represents a transformative advance in neurosurgery, combining advanced imaging, navigation systems, and software algorithms to guide surgical procedures with high precision. Its integration into clinical practice has revolutionized the approach to complex neurosurgical interventions, enhancing the accuracy of tumor resections, vascular interventions, and spine surgeries, among others. Objective: This review aims to assess the role of Neuronavigation in enhancing surgical precision and improving patient outcomes, with a particular focus on its application and impact at Shifa International Hospital, Islamabad, Pakistan. Methods: A narrative review was conducted, employing a comprehensive search strategy across databases including PubMed, Scopus, and Web of Science. Studies were selected based on predefined inclusion and exclusion criteria, focusing on the use of Neuronavigation in neurosurgery, its clinical outcomes, technological advancements, and challenges. Results: Neuronavigation has been instrumental in improving surgical outcomes, with applications ranging from tumor resection to deep brain stimulation. At Shifa International Hospital, the integration of Neuronavigation has led to a notable enhancement in surgical precision and patient safety, as evidenced by a 95% success rate in over 500 neurosurgical procedures. Despite its benefits, challenges such as technical limitations and high costs persist, highlighting the need for ongoing innovation and training. Conclusion: Neuronavigation significantly improves surgical precision and patient outcomes in neurosurgery. The experience at Shifa International Hospital exemplifies its potential to set new standards in surgical care. Future advancements in technology and wider accessibility are essential to fully realize its benefits across the global healthcare landscape.
... Intraoperative (IO) image guidance using 3-dimensional (3D) fluoroscopic navigation such as O-arm technology has improved both precision and reliability of pedicle screw placement in instrumented spine surgery. [1][2][3][4][5] These technologies are routinely used in many spine centers worldwide. IO and postoperative (PO) evaluation and verification of implant position on radiological images are an important and decisive step during and after surgery to ensure surgical safety and avoid complications due to implant misplacement. ...
Background:
Intraoperative (IO) image guidance surgery using 3-dimensional fluoroscopic navigation methods, such as the O-arm system, has improved the accuracy of pedicle screw placement in instrumented spine surgery. IO and postoperative (PO) validation of the implant's correct position from radiological images is a decisive step to ensure patient safety and avoidance of complications related to implant misplacement. In this prospective single-center study, the authors investigated the accuracy and agreement of assessment of pedicle screws from IO O-arm images in comparison to PO computed tomography images. This study aimed to determine whether final evaluation of pedicle screws can safely be conducted from IO images that supersedes the PO computed tomography control.
Methods:
A prospective single-center study was carried out at the Spine Unit in the Department of Orthopedics at Umeå University Hospital between 2019 and 2021. All patients enrolled in the study underwent instrumented thoracolumbar spine surgery using navigation. Imaging data were obtained from IO and PO examinations. Four reviewers-2 attending senior spine surgeons, 1 final year resident in orthopedics, and 1 attending neuroradiologist-classified pedicle screws using the Gertzbein and Robbins classification system. Agreement and accuracy of the reviewers were studied to evaluate the assessment of pedicle screws from IO and PO images.
Results:
A total of 70 patients (422 screws) were included in the study. There was high accuracy among surgeons both on IO and PO images (0.96-0.97, 95% CI [0.94-0.99] and 0.97, 95% CI [0.94-0.99], respectively), and the overall agreement between all raters was 92% to 98% (95% CI [0.90, 1.00]). The discrepancy in assessment between optimal (Group 1) and suboptimal (Group 2) screws between IO and PO images was as low as 1% to 1.7%, which indicates that very few suboptimal screws are missed in the assessment of IO images.
Conclusions:
The assessment of navigated pedicle screws using IO images is safe and reliable and may replace the need for further assessment using PO imaging.
... The use of intraoperative navigation and robotic assistance has been gaining popularity and has demonstrated high levels of accuracy as well. 17,18 However, we believe it remains critical for spine deformity surgeons to understand the technique for freehand juxtapedicular screw placement. ...
Objective:
The purpose of this study is to highlight our technique for freehand placement of juxtapedicular screws along with intraoperative computed tomography (CT) and radiographic results.
Methods:
Consecutive patients with adult idiopathic scoliosis undergoing primary surgery by the senior author were identified. All type D (absent/slit like channel) pedicles were identified on preoperative CT. Three-dimensional visualization software was used to measure screw angulation and purchase. Radiographs were measured by a fellowship trained spine surgeon. The freehand technique was used to place all screws in a juxtapedicular fashion without any fluoroscopic, radiographic, navigational or robotic assistance.
Results:
Seventy-three juxtapedicular screws were analyzed. The most common level was T7 (9 screws) on the left and T5 (12 screws) on the right. The average medial angulation was 20.7° (range, 7.1°-36.3°), lateral vertebral body purchase was 13.4 mm (range, 0-28.9 mm), and medial vertebral body purchase was 21.1 mm (range, 8.9-31.8 mm). More than half (53.4%) of the screws had bicortical purchase. Two screws were lateral on CT scan, defined by the screw axis lateral to the lateral vertebral body cortex. No screws were medial. There was a difference in medial angulation between screws with (n = 58) and without (n = 15) lateral body purchase (22.0 ± 4.9 vs. 15.5 ± 4.5, p < 0.001). Three of 73 screws were repositioned after intraoperative CT. There were no neurovascular complications. The mean coronal cobb corrections for main thoracic and lumbar curves were 83.0% and 80.5%, respectively, at an average of 17.5 months postoperative.
Conclusion:
Freehand juxtapedicular screw placement is a safe technique for type D pedicles in adult idiopathic scoliosis patients.
