Can Postoperative CT Imaging in Spine Surgery Be Replaced by Intraoperative 3D Rotation With the C-Arm?: Results of a Prospective Single Center Cohort Study.

Mohammed Banat,Johannes Wach,Lisa Domurath,Jasmin Scorzin,Hartmut Vatter,Abdallah Salemdawod

doi:10.3389/fsurg.2021.692189

Abstract

Objective: Dorsal instrumentation of the spine is an established treatment option for a range of spinal pathologies. Intraoperative fluoroscopy connected with navigation minimize the risk of incorrect screws placement. In several cases, post-operative CT scans are needed to verify possible mismatches. In this study, we evaluated the efficacy of 3D intraoperative fluoroscopy as compared to post-operative CT and the need of post-operative CT.Methods: We conducted a prospective single-center cohort study, 94 patients were included. The screws were implanted using 3D rotation with C-arm and navigation system. The definitive position of the screws was verified by a post-operative CT scan. Finally, we compared the discrepance between intraoperative imaging and post-operative CT scan using Rampersaud-grade (A-D).Results: 607 screws in 94 patients were included. Some 3% of the screws had to be replaced immediately intraoperative due to inadequate position with lateral or medial trajectory. An A-score was achieved for 85.5% of the 3D controlled screws and 87% of the post-operative CT. A B-score was found in 11.5% of either groups. In the 3D group a C-score was achieved for 2.5% and in the CT group for 0.8%. A D-score was found in 0.5% of the screws in both groups, p = 0.45. Only a mismatch of 3% could be detected for the intraoperative and post-operative imaging results.Conclusion: Our study data shows that the placement of screws using the 3D rotation and navigation tool is safe and accurate. There were no relevant mismatches between intraoperative images and the post-operative CT.

Highlights

Dorsal instrumentation of the spine is an established treatment option for a range of spinal pathologies, including instable trauma, degenerative diseases, deformity of the spine, neoplasia and infection [1,2,3]
A total of documented 607 screws in 94 patients were included in the Analysis
We found that 97.5% of the implanted screws were positioned with high accuracy using the 3D rotation coupled with the navigation (Grade A and B)

Summary

Introduction

Dorsal instrumentation of the spine is an established treatment option for a range of spinal pathologies, including instable trauma, degenerative diseases, deformity of the spine, neoplasia and infection [1,2,3] To this day, the “free-hand” technique using fluoroscopy is the approach most commonly used [4]. The use of intraoperative fluoroscopy during the operation in combination with coupled navigation system reduces the risk of incorrect placement of the screws [5,6,7,8] This technique is used more often in academic and scientific than in community institutions [9], and the important question of which method and kind of instrumentation are better, is the recent subject of controversial discussion in the literature. The main aim of this study was to evaluate the effectiveness and usefulness of the intraoperative 3D fluoroscopy with C-arm (in combination with coupled navigation system) for placing screws and to consider screw placement during the operation as compared with post-operative control CT scans and the necessity of postoperative CT

Methods

Results

Discussion

Conclusion