Abstract
Study designQuality improvement evaluation with retrospective analysis.ObjectivesTo compare a technique to place pedicle screws (PS) using a novel detachable pedicle marker and probe (DPMP) and pulsed fluoroscopy (PF) vs. conventional technique utilizing PF with standard instruments (SI) and O-arm.Summary of background dataSpinal fusion with pedicle screw instrumentation (PSI) is the mainstay in treatment of spinal deformities. Reports suggest that CT navigated (O-arm) PS placement is more accurate than fluoroscopy. However, these studies have not considered the increased radiation exposure associated with CT.MethodsThirty-six patients with spinal deformity had PSI using PF and DPMPs. Accuracy of PS placement and radiation data from 14 dosimeters placed on the patient and around the operating room was analyzed. Results were compared to published data.ResultsMean fluoroscopic time was 13.4 s (range 6.0–32.4), and the mean cumulative dose was 3.1 mGy (range 0.2–16.4). Median estimated effective dose to the patient was 0.22 mSv (range 0.0–0.7). The effective dose of radiation was reduced by 80% (0.22 mSv vs. 1.11 mSv) compared to low-dose O-arm. The surgical team did not receive any detectable radiation. The seconds of PF used to assist and confirm placement of PSs was reduced to 1.2 s/level compared to previous reports of 4.49 s/level using SIs. DPMPs reduced fluoroscopy to 0.84 s/PS compared to 7.36 s/PS using SIs to assist and confirm PS placement. PSs were accurately placed in 561 of 576 (97.4%), which is comparable to O-arm and fluoroscopy with SIs.ConclusionsPS placement using PF and DPMPs to assist and confirm PS placement lowers radiation exposure to the patient and surgical team without compromising accuracy compared to O-arm and fluoroscopy with SIs.Level of evidenceTherapeutic, Level IV (Retrospective case series, historical control).
Highlights
Spinal fusion with pedicles screw (PS) instrumentation is widely used to treat patients with scoliosis [1]
This study describes a technique using a detachable pedicle marker and probe (DPMP) and pulsed fluoroscopy (PF) to provide a safe and accurate method for placing PSs
The majority of subjects were diagnosed with adolescent idiopathic scoliosis (63.9%) (Tables 1 and 2)
Summary
Spinal fusion with pedicles screw (PS) instrumentation is widely used to treat patients with scoliosis [1]. Rotational deformities and varying sizes of pedicles make accurate PS placement challenging in terms of avoiding neurological injury and ensuring biomechanical stability of the construct. Imaging modalities are an integral part of PS placement to ensure accuracy. The use of O-arm for PS placement has become popularized as an alternative to freehand placement with fluoroscopy. Multiple reports suggested that the O-arm significantly reduces the pedicle cortex perforation rate [2,3,4,5]. An increasing number of institutions are, mandating the use of O-arm to assist with
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