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OBJECTIVE@#To compare the effectiveness of O-arm navigation and C-arm navigation for guiding percutaneous long sacroiliac screws in treatment of Denis type Ⅱ sacral fractures.@*METHODS@#A retrospective study was conducted on clinical data of the 46 patients with Denis type Ⅱ sacral fractures between April 2021 and October 2022. Among them, 19 patients underwent O-arm navigation assisted percutaneous long sacroiliac screw fixation (O-arm navigation group), and 27 patients underwent C-arm navigation assisted percutaneous long sacroiliac screw fixation (C-arm navigation group). There was no significant difference in gender, age, causes of injuries, Tile classification of pelvic fractures, combined injury, the interval from injury to operation between the two groups ( P>0.05). The intraoperative preparation time, the placement time of each screw, the fluoroscopy time of each screw during placement, screw position accuracy, the quality of fracture reduction, and fracture healing time were recorded and compared, postoperative complications were observed. Pelvic function was evaluated by Majeed score at last follow-up.@*RESULTS@#All operations were completed successfully, and all incisions healed by first intention. Compared to the C-arm navigation group, the O-arm navigation group had shorter intraoperative preparation time, placement time of each screw, and fluoroscopy time, with significant differences ( P<0.05). There was no significant difference in screw position accuracy and the quality of fracture reduction ( P>0.05). There was no nerve or vascular injury during screw placed in the two groups. All patients in both groups were followed up, with the follow-up time of 6-21 months (mean, 12.0 months). Imaging re-examination showed that both groups achieved bony healing, and there was no significant difference in fracture healing time between the two groups ( P>0.05). During follow-up, there was no postoperative complications, such as screw loosening and breaking or loss of fracture reduction. At last follow-up, there was no significant difference in pelvic function between the two groups ( P>0.05).@*CONCLUSION@#Compared with the C-arm navigation, the O-arm navigation assisted percutaneous long sacroiliac screws for the treatment of Denis typeⅡsacral fractures can significantly shorten the intraoperative preparation time, screw placement time, and fluoroscopy time, improve the accuracy of screw placement, and obtain clearer navigation images.
Subject(s)
Humans , Fracture Fixation, Internal/methods , Retrospective Studies , Imaging, Three-Dimensional , Bone Screws , Surgery, Computer-Assisted , Tomography, X-Ray Computed , Spinal Fractures/surgery , Fractures, Bone/surgery , Pelvic Bones/injuries , Postoperative Complications , Neck InjuriesABSTRACT
OBJECTIVE@#To compare the effectiveness of O-arm navigation and ultrasound volume navigation (UVN) in guiding screw placement during minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery.@*METHODS@#Sixty patients who underwent MIS-TLIF surgery for lumbar disc herniation between June 2022 and June 2023 and met the selection criteria were included in the study. They were randomly assigned to group A (screw placement guided by UVN during MIS-TLIF) or group B (screw placement guided by O-arm navigation during MIS-TLIF), with 30 cases in each group. There was no significant difference in baseline data, including gender, age, body mass index, and surgical segment, between the two groups ( P>0.05). Intraoperative data, including average single screw placement time, total radiation dose, and average single screw effective radiation dose, were recorded and calculated. Postoperatively, X-ray film and CT scans were performed at 10 days to evaluate screw placement accuracy and assess facet joint violation. Pearson correlation and Spearman correlation analyses were used to observe the relationship between the studied parameters (average single screw placement time and screw placement accuracy grading) and BMI.@*RESULTS@#The average single screw placement time in group B was significantly shorter than that in group A, and the total radiation dose of single segment and multi-segment and the average single screw effective radiation dose in group B were significantly higher than those in group A ( P<0.05). There was no significant difference in the total radiation dose between single segment and multiple segments in group B ( P>0.05), while the total radiation dose of multiple segments was significantly higher than that of single segment in group A ( P<0.05). No significant difference was found in the accuracy of screw implantation between the two groups ( P>0.05). In both groups, the grade 1 and grade 2 screws broke through the outer wall of the pedicle, and no screw broke through the inner wall of the pedicle. There was no significant difference in the rate of facet joint violation between the two groups ( P>0.05). In group A, both the average single screw placement time and screw placement accuracy grading were positively correlated with BMI ( r=0.677, P<0.001; r=0.222, P=0.012), while in group B, neither of them was correlated with BMI ( r=0.224, P=0.233; r=0.034, P=0.697).@*CONCLUSION@#UVN-guided screw placement in MIS-TLIF surgery demonstrates comparable efficiency, visualization, and accuracy to O-arm navigation, while significantly reducing radiation exposure. However, it may be influenced by factors such as obesity, which poses certain limitations.
Subject(s)
Humans , Imaging, Three-Dimensional , Lumbar Vertebrae/surgery , Minimally Invasive Surgical Procedures , Pedicle Screws , Retrospective Studies , Spinal Fusion , Surgery, Computer-Assisted , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
With the proposal of the concept of precision surgery,doctors pay more attention to the precious balance of removing target lesions,protecting organs,and controlling damage.The application of intraoperative computed tomography (ICT) facilitates the realization of precision surgery.This paper summarizes the origination and development of ICT,as well as its wide applications in neurosurgery,otolaryngology,and maxillofacial surgery.Although ICT has many disadvantages to be improved,such as high radiation dose and high cost,it is still a good choice for improving the precision of treatment.
ABSTRACT
Objective@#To investigate the clinical outcomes and the accuracy of O-arm-navigation system assisted pedicle screw insertion in dystrophic scoliosis secondary to neurofibromatosis type Ⅰ(NF-1).@*Methods@#A retrospective study was conducted in 41 patients with dystrophic NF-1-associated thoracic scoliosis who were surgically treated at Department of Orthopaedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School between June 2012 and October 2014 with more than 18 months follow-up. The patients were then divided into two groups: 18 patients were under the assistance of O-arm-navigation-based pedicle screw insertion (O-arm group) and the remaining 23 patients′ pedicle screws insertion were conducted by free-hand (free-hand group). The X-ray and CT were analyzed to investigate the correction rate and safety of pedicle insertion. t-test was used to analyze measurement data and χ2 test was used to analyze accuracy of screw insertion between the two groups.@*Results@#The mean coronal Cobb angle was 63.2°±8.7° in the O-arm group and 66.9°±7.4° in the free-hand group (P>0.05), which was then corrected into 23.1°±6.8° and 30.2°±7.6°(t=2.231, P=0.031) after surgery respectively.Operation time was (265.0±70.3)minutes and estimated blood loss was (1 024±465)ml in the O-arm group. Operation time and estimated blood loss was (243.0±49.6)minutes and (1 228±521)ml respectively in the free-hand group, which had no significant difference between the two groups. However, the implant density was higher in the O-arm group than that in the free-hand group ((64.1±10.8)% vs.(44.3±15.3)%)(t=4.652, P=0.000). The O-arm group comprised 122 screws, of which 72.9% were excellent, 22.1% were good and 4.9% were bad. The free-hand group comprised 136 screws and 48.5% of them were excellent, 33.8% were good and 17.6% were bad.Accuracy of pedicle screw insertion was higher in the O-arm group than that in the free-hand group(χ2=10.140, P<0.05). By June 2016, the average follow-up period was (20.9±3.4)months(ranging from18 to 26 months), including (20.3±3.1)months in the O-arm group and (21.4±5.5)months in the free-hand group. At last follow-up point, coronal correction loss was significantly higher in the free-hand group than that in the O-arm group (6.3°±2.6° vs. 4.4°±1.6°)(t=2.719, P=0.009).@*Conclusions@#Compared with free-hand technique, O-arm-navigation technique could enhance accuracy of pedicle insertion and implant density of dystrophic region in dystrophic NF-1-associated scoliosis patients, which result in a better correction rate and less correction loss. Besides, the advantage of O-arm-navigation do not increase operative time and estimate blood loss.
ABSTRACT
Resumen: La técnica asistida por navegación intraoperatoria ha evolucionado y cambiado la forma de abordar ciertos casos complejos en la patología vertebral. Las principales ventajas de esta técnica consisten en aumentar la precisión de la intervención, reducir su morbilidad y carácter invasivo, disminuir la dosis de exposición radiológica y mejorar los protocolos quirúrgicos. Además de la fijación transpedicular, el sistema de navegación es útil en una alta variedad de padecimientos, como la descompresión medular o la resección tumoral. En el presente estudio mostramos varios casos donde se ha usado la navegación intraoperatoria en diferentes patologías y sus resultados clínicos.
Abstract: The intraoperative computer-assisted navigation technique has evolved and changed the way we approach certain complex cases in the vertebral pathologies. The main advantages of this technique are that it increases the accuracy of the procedure, reduces its morbidity and invasiveness, diminishes the radiation dose and improves surgical protocols. In addition to the transpedicular fixation, the navigation system is useful in a high variety of pathologies such as spinal decompression or tumor resection. In the present study, we show several cases where navigation is used intraoperatively in different pathologies and their clinical outcomes.