Abstract
PurposeMultiple solutions for navigation-guided pedicle screw placement are available. However, the efficiency with regard to clinical and resource implications has not yet been analyzed.The present study’s aim was to analyze whether an operating room sliding gantry CT (ORCT)-based approach for spinal instrumentation is more efficient than a mobile cone-beam CT (CBCT)-based approach.MethodsThis cohort study included a random sample of 853 patients who underwent spinal instrumentation using ORCT-based or CBCT-based pedicle screw placement due to tumor, degenerative, trauma, infection, or deformity disorders between November 2015 and January 2020.ResultsMore screws had to be revised intraoperatively in the CBCT group due to insufficient placement (ORCT: 98, 2.8% vs. CBCT: 128, 4.0%; p = 0.0081). The mean time of patients inside the OR (Interval 5 Entry–Exit) was significantly shorter for the ORCT group (ORCT: mean, [95% CI] 256.0, [247.8, 264.3] min, CBCT: 283.0, [274.4, 291.5] min; p < 0.0001) based on shorter times for Interval 2 Positioning—Incision (ORCT: 18.8, [18.1, 19.9] min, CBCT: 33.6, [32.2, 35.5] min; p < 0.0001) and Interval 4 Suture—Exit (ORCT: 24.3, [23.6, 26.1] min, CBCT: 29.3, [27.5, 30.7] min; p < 0.0001).ConclusionsThe choice of imaging technology for navigated pedicle screw placement has significant impact on standard spine procedures even in a high-volume spine center with daily routine in such devices. Particularly with regard to the duration of surgeries, the shorter time needed for preparation and de-positioning in the ORCT group made the main difference, while the accuracy was even higher for the ORCT.
Highlights
Several imaging modalities are available for the navigation in spinal fusion surgery
The number of patients who underwent decompression did not differ between the groups but the number of decompressed levels per surgery was significantly higher in the cone-beam CT (CBCT) group (ORCT: median 1, range 0–8 vs. CBCT: 2, 0–8 p = 0.0275)
The significant difference of the patients’ presence in the operating room (OR) (Interval 5 Entry—Exit) was significantly shorter for the operating room sliding gantry CT (ORCT) group mainly base on the significantly shorter duration needed for preparing the positioned patient for the intraoperative CT (ioCT)-based imaging and to a lesser extent on shorter times needed for the de-positioning of the patient (Fig. 3)
Summary
Several imaging modalities are available for the navigation in spinal fusion surgery. Mobile CT scanners were recommended for the imaging of long constructs, patients with a high body-mass-index, and cervicothoracic fusion [13]. In addition to these mobile CT scanner solutions, permanently in the operating room (OR)-installed CT scanners (ORCT) using a sliding gantry exist [7, 14, 15]. The solution of an ORCT has recently been described as a scarcely used technique in neurosurgery [16], it offers the potential to be efficient for navigated spinal instrumentation alone in a high-volume neurosurgical university center
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