Intraoperative Navigation System Research Articles

A Case of Ear Canal Cancer with a High Venous Arch That Benefited from an Intraoperative Navigation System

Introduction: Cancers of the external auditory canal are rare. Surgery may be the treatment of choice for localized cases. Lateral temporal bone resection is one surgical treatment option. It is rarely performed by skilled surgeons and requires caudal and anterior cutting of the tympanic chamber bone, which is not usually performed in ear surgery. It is imperative to ensure that the internal jugular vein and important nerves are present. Case Presentation: In this report, we describe a case of adenoid cystic carcinoma of the external auditory canal in which lateral temporal bone resection was safely performed using intraoperative navigation. A 33-year-old woman was diagnosed with an adenoid cystic carcinoma of the right external auditory canal by another physician and presented to our department. After close examination, she was diagnosed with T3N0M0 cancer of the external auditory canal and was referred to our department for lateral temporal bone resection. Although the patient had a high venous arch, intraoperative navigation enabled unblocked resection without exposing the tumor or damaging the vital tissues. Conclusion: Intraoperative navigation is considered a safer lateral temporal bone resection approach.

Evaluation of Pedicle Screw Position on Computerized Tomography Using Three-Dimensional Reconstruction Software.

Background and Objectives: Recent advances in intraoperative navigation systems have improved the accuracy of pedicle screw placement in spine surgery. However, many hospitals have limited access to these advanced technologies due to resource constraints. In such settings, postoperative computed tomography (CT) evaluation remains crucial for assessing screw placement and related potential complications. Metal artifacts in CT scans often compromise the diagnostic accuracy. This study aimed to develop and validate three-dimensional (3-D) reconstruction software to enhance screw localization accuracy and facilitate its practical clinical application. Materials and Methods: This study included two phases: 3-D software development utilizing specific threshold values of Hounsfield units for titanium screws followed by internal validation. For validation, fifty pedicle screws were inserted into porcine lumbar vertebrae with random violation (superior, inferior, medial, or lateral). Three fellowship-trained surgeons evaluated screw positions using both conventional CT bone window settings and the developed software. Additional clinical validation involving 386 pedicle screws from cervical to lumbar spine was performed by two surgeons. Results: The software demonstrated significantly higher specificity (83% vs. 63%) and positive predictive value (96% vs. 91%) compared to conventional CT bone window settings, while maintaining 100% sensitivity and negative predictive value. Interobserver reliability was excellent for both methods (0.961 for bone window vs. 0.990 for software). In clinical validation, the software showed superior intraobserver (0.83 vs. 0.74) and interobserver reliability (0.855 vs. 0.513) compared to picture archiving and communication system (PACS) workstation evaluation. Conclusions: The developed software provides improved accuracy and reliability in pedicle screw position evaluation through distinct screw outline visualization and metal artifact reduction. Its equipment-independent nature and cost-effectiveness make it particularly valuable for clinical implementation.

Comparison of different imaging devices and navigation systems for cervical pedicle screw placement: an experimental study on screw accuracy, screw placement time and radiation dose

Cervical pedicle screws (CPS) provide biomechanically superior fixation compared to other techniques but are technically more demanding. Navigated CPS placement has been increasingly reported as a safe and accurate technique, yet there are few studies comparing different combinations of imaging and navigation systems under comparable conditions. With this study, we aimed to compare different imaging and navigation systems for CPS placement in terms of accuracy, screw placement time and applied radiation dose. For this experimental study, navigated CPS placement was performed at levels C2 to C7 in 24 identical radiopaque artificial spine models by two surgeons with different levels of experience using three different combinations of intraoperative 3D imaging devices and navigation systems. Accuracy, time and radiation dose were compared between the groups. In total, 288 screws were placed. Accuracy was > 98% in all groups with no significant differences between groups or between surgeons (P = 0.30 and P = 0.31, respectively), but the inexperienced surgeon required significantly more time (P < 0.001). Radiation dose was significantly higher with iCT compared to CBCT (P < 0.0001). Under experimental conditions, accuracy rates of > 98% were achieved for navigated CPS placement regardless of the imaging modality or navigation system used. Radiation doses were significantly lower for CBCT compared to iCT guidance.

In-patient neurosurgical tumor treatments for malignant glioma patients in Germany

ObjectiveTreatment for malignant gliomas involves multiple disciplines, including neurosurgery, radiation therapy, medical and neuro-oncology, and palliative medicine, with function-preserving neurosurgical tumor removal being crucial. However, real-world data on hospital cases, treatment types, especially regarding surgical approaches, and the associated complication and mortality rates in Germany are lacking.MethodsWe analyzed data on hospital cases involving malignant gliomas (ICD-10-GM code C71) from the German §21 Hospital Remuneration Act, provided by the Institute for the Hospital Remuneration System (InEK GmbH), from 2019 to 2022. Our focus was on neuro-oncological operations defined by the German Cancer Society (DKG) and included specific operation and procedure (OPS) codes.ResultsFrom 2019 to 2022, there were 101,192 hospital cases involving malignant gliomas in Germany. Neurosurgical tumor removal was performed in 27,193 cases (26.9%). Microsurgical techniques were used in 95% of surgeries, intraoperative navigation systems in 84%, fluorescence-guided surgeries in 45.6%, and intraoperative neurophysiological monitoring (IONM) in 46.4%. Surgical or medical complications occurred in 2903 cases (10.7%). The hospital mortality rate was 2.7%. Mortality was significantly higher in patients aged 65 and older (Odds ratio 2.9, p < 0.0001), and lower in cases using fluorescence-guided procedures (Odds ratio 0.8, p = 0.015) and IONM (Odds ratio 0.5, p < 0.0001).ConclusionsOver the course of 4 years, over 100,000 hospital cases involving adult patients diagnosed with malignant gliomas were treated in Germany, with 27,193 cases undergoing tumor removal using various modern surgical techniques. The hospital mortality rate was 2.7%.

Adaptation of virtual surgical planning to midface reconstruction with intraoperative navigation: “navigation mediated midface reconstruction”

ObjectiveThe production of three dimensional models and materials according to preoperative virtual surgical planning is a time consuming process and causes high costs. We aimed to demonstrate the navigation mediated reconstruction of the patients who underwent the removal of tumoral mass in midfacial region according to their preoperatively prepared surgical plannings. Study DesignPatients who underwent the removal of tumoral mass and reconstruction in their midfacial region were included in the study. Virtual surgical planning was performed by the mirror imaging of unaffected side of maxillofacial bones. New created models were converted to DICOM (Digital Imaging and Communications in Medicine) data to use in the navigation system. Histogram analysis was performed to reveal the compatibility of navigation mediated reconstruction with preoperative virtual surgical planning. ResultsReconstruction of orbital floor was achieved in all of the cases. Histogram comparison of the localizations of orbital floor and maxillary walls was calculated at a confidence level of 95 % (p > 0.95) and mean difference was found 0.85 mm; while standard deviation was 3.55 mm. ConclusionWe found that virtually prepared reconstruction of midfacial area can be succesfully adapted to the surgery with the assistance of intraoperative navigation system.

Registration accuracy comparing different rendering techniques on local vs external virtual 3D liver model reconstruction for vascular landmark setting by intraoperative ultrasound in augmented reality navigated liver resection

PurposeAugmented reality navigation in liver surgery still faces technical challenges like insufficient registration accuracy. This study compared registration accuracy between local and external virtual 3D liver models (vir3DLivers) generated with different rendering techniques and the use of the left vs right main portal vein branch (LPV vs RPV) for landmark setting. The study should further examine how registration accuracy behaves with increasing distance from the ROI.MethodsRetrospective registration accuracy analysis of an optical intraoperative 3D navigation system, used in 13 liver tumor patients undergoing liver resection/thermal ablation.Results109 measurements in 13 patients were performed. Registration accuracy with local and external vir3DLivers was comparable (8.76 ± 0.9 mm vs 7.85 ± 0.9 mm; 95% CI = -0.73 to 2.55 mm; p = 0.272). Registrations via the LPV demonstrated significantly higher accuracy than via the RPV (6.2 ± 0.85 mm vs 10.41 ± 0.99 mm, 95% CI = 2.39 to 6.03 mm, p < 0.001). There was a statistically significant positive but weak correlation between the accuracy (dFeature) and the distance from the ROI (dROI) (r = 0.298; p = 0.002).ConclusionDespite basing on different rendering techniques both local and external vir3DLivers have comparable registration accuracy, while LPV-based registrations significantly outperform RPV-based ones in accuracy. Higher accuracy can be assumed within distances of up to a few centimeters around the ROI.

Placement of 2 cages using navigation-guided biportal endoscopic transforaminal lumbar interbody fusion: illustrative case.

In recent developments, full endoscopic and unilateral biportal endoscopic (UBE) spine surgery have emerged to aid the transforaminal lumbar interbody fusion (TLIF) procedure. Yet, both approaches present a challenge due to limited space for cage insertion, potentially leading to complications such as cage subsidence or nonfusion in long-term assessments. Utilizing double cages may mitigate these concerns. This paper presents a unique case in which a patient successfully underwent computed tomography (CT) navigation-guided UBE-TLIF with 2 converging cages, highlighting the potential benefits and feasibility of this innovative approach. A 59-year-old female diagnosed with degenerative spondylolisthesis at the L4-5 level underwent a UBE-TLIF. The operation is detailed step by step and supported by illustrative figures and surgical videos. Postsurgery results revealed a significant improvement in the patient's condition, with the visual analog scale score decreasing from 7 to 3 on the first day, leading to a satisfaction rate of 90% at the last follow-up. Utilizing endoscopic visualization complemented by contrast medium has substantially elevated the quality of disc preparation. From their observations, the authors affirm that the integration of intraoperative CT navigation systems significantly augments safety and pinpoint accuracy in UBE-TLIF procedures. The strategy of employing 2 converging cages through a unilateral technique stands as a practical solution, potentially optimizing the fusion outcomes of UBE-TLIF surgery. https://thejns.org/doi/10.3171/CASE23512.

Technologically Comprehensive Reconstruction of Fronto-Orbito-Sphenoidal Craniofacial Fibrous Dysplasia.

Craniofacial fibrous dysplasia (CFD) is a benign bone condition that presents unique challenges due to its proximity to vital organs, esthetic significance, and variability in each case. Consequently, a meticulous and personalized surgical approach becomes imperative. Diverse techniques and technologies have been employed sporadically to tackle various aspects of CFD. Our approach includes a comprehensive integration of emerging methods and technologies, encompassing presurgical strategizing, three-dimensional computer-aided manufacturing (3D-CAM), intraoperative navigation systems, and a prefabricated drilling guide in a fronto-orbito-sphenoidal CFD case. This combined strategy is aimed at effectively addressing the complexities of this demanding ailment. Moreover, a collaborative team consisting of plastic surgeons, neurosurgeons, and oculoplastic surgeons cooperates to orchestrate the procedure. Embracing a multidisciplinary team and a holistic technological strategy appears to be the key to addressing the multifaceted challenges posed by intricate conditions like CFD.

A Network Meta-Analysis Comparing the Efficacy and Safety of Pedicle Screw Placement Techniques Using Intraoperative Conventional, Navigation, Robot-Assisted, and Augmented Reality Guiding Systems.

Studies were reviewed and collected to compare different image guidance systems for pedicle screw placement (PSP) regarding accuracy and safety outcomes. Included were conventional, navigation, robot-assisted, and recent technology such as augmented reality (AR) guiding systems. This network meta-analysis obtained human comparative studies and randomized controlled trials (RCTs) regarding PSP found in 3 databases (Cochrane, PubMed, and Scopus). Data extraction for accuracy, safety, and clinical outcomes were collected. The network meta-analysis was analyzed, and a surface under the cumulative ranking curve (SUCRA) was used to rank the treatment for all outcomes. The final 61 studies, including 13 RCTs and 48 non-RCTs, were included in the meta-analysis. These studies included a total of 17,023 patients and 35,451 pedicle screws. The surface under the cumulative ranking curve ranking demonstrated the supremacy of robotics in almost all accuracy outcomes except for the facet joint violation. Regarding perfect placement, the risk difference for AR was 19.1 (95% CI: 8.1-30.1), which was significantly higher than the conventional method. The robot-assisted and navigation systems had improved outcomes but were not significantly different in accuracy vs the conventional technique. There was no statistically significant difference concerning safety or clinical outcomes. The accuracy of PSP achieved by robot-assisted technology was the highest, whereas the safety and clinical outcomes of the different methods were comparable. The recent AR technique provided better accuracy compared with navigation and conventional methods.

Gender differences in unintended anterior pelvic roll during primary THA in the lateral position

BackgroundFundamental morphologic differences between male and female pelvises are historically recognised. Despite this, little consideration has been given as to whether or not conventional positioning supports used for primary total hip arthroplasties (THAs) performed in the lateral position do an equally effective job of maintaining the intended set up position when comparing genders. Given that recent research has highlighted that unintended pelvic roll occurs commonly during hip surgery, and that such movement may have a mechanically-deleterious consequence upon final construct performance and complication rates, this study was undertaken to explore the differences in pelvic roll between genders.MethodsThe output of a high-precision, commercially-available, imageless intra-operative navigation system was prospectively-collected for 85 consecutive patients undergoing unilateral, primary THAs. These data were separated by gender and were utilised to determine differences in pelvic movement around a central sagittal axis.ResultsDemographic data were similar between genders, with no between-group differences in mean BMI (p = 0.09) or indication for surgery (p = 0.66), however participating males (mean 68.04) were slightly younger than females (mean 73.31). The mean anterior pelvic roll for females was 9.50°, and for males 8.68°. There were no statistically significant independent correlations observed between gender (p = 0.21) and pelvic roll.ConclusionThe findings of this novel study do not suggest gender differences in the magnitude of unintended, intra-operative, anterior roll, even when corrected for BMI and surgical indication. Average roll of ~ 9° was demonstrated across both groups. An awareness of such positional change during THA surgery may reduce potentially-avoidable post-operative complications.

A Novel Intraoperative CT Navigation System for Spinal Fusion Surgery in Lumbar Degenerative Disease: Accuracy and Safety of Pedicle Screw Placement.

Background: In recent years, intraoperative computed tomography (CT) navigation has become widely used for the insertion of pedicle screws in spinal fusion surgery. However, conventional intraoperative CT navigation may be impaired by infrared interference between the infrared camera and surgical instruments, which can lead to the misplacement of pedicle screws. Recently, a novel intraoperative CT navigation system, NextAR, has been developed. It uses a small infrared camera mounted on surgical instruments within the surgical field. NextAR navigation can minimize the problem of infrared interference and be expected to improve the accuracy of pedicle screw placement. Methods: This study investigated the accuracy of pedicle screw insertion under NextAR navigation in spinal fusion surgery for lumbar degenerative diseases. The accuracy of pedicle screw placement was evaluated in 15 consecutive patients using a CT grading scale. Results: Screw perforation occurred in only 1 of the total 70 screws (1.4%). Specifically, there was one grade 1 perforation within 2 mm, but no perforations larger than 2 mm. There were no reoperations or neurological complications due to screw misplacement. Conclusions: NextAR navigation can provide high accuracy for pedicle screw insertion and help ensure safe spinal fusion surgery for lumbar degenerative diseases.

460 Frame Navigation Guided Percutaneous Balloon Compression for Intractable Trigeminal Neuralgia Secondary to Multiple Sclerosis

INTRODUCTION: Patients with multiple sclerosis (MS) are more likely to develop trigeminal neuralgia (TN) compared to the regular population, due to scarring of the nerve and the development of a demyelination plaque. Despite treatment, approximately 10% of MS patients treated for TN experience symptom recurrence, including the development of MS-like symptoms such as optic neuritis and bilateral facial pain. METHODS: A computed tomography (CT) scan was performed preoperatively on two patients diagnosed with multiple sclerosis (MS) who experienced secondary trigeminal neuralgia (TN). The acquired images were then introduced into a navigation system for intraoperative navigation. The preliminary CT images were registered using the navigation system and the bony landmarks were set. Fluoroscopy-guided cannulation was performed under general anesthesia to complete the procedure. RESULTS: Two patients diagnosed with multiple sclerosis (MS) who experienced refractory trigeminal neuralgia (TN) underwent percutaneous balloon compression. The patients were 38 and 56 years old and complained of facial pain in the V1-V2 and V3 distribution. Initial conservative treatment and one dosage of Gamma Knife Radiosurgery (GKR) resulted in symptom control for a few weeks. However, both patients had an acute recurrence of pain; thus, percutaneous retrogasserian balloon compression was performed. During follow-up, the patients reported a 70% decrease in pain after the procedure, with minimal recurrence of shooting episodes. CONCLUSIONS: The management of trigeminal neuralgia secondary to drug-resistant multiple sclerosis presents a persistent challenge. The percutaneous technique for retrogasserian balloon compression may offer a solution for some patients, but it can be technically challenging. Microvascular decompression remains a debated approach for this population, given the complexity of the pathogenesis, target identification, and the potential absence of neurovascular conflict, while stereotactic radiosurgery may be a promising alternative.

Revolutionizing bone tumor management: cutting-edge breakthroughs in limb-saving treatments.

Limb salvage surgery has revolutionized the approach to bone tumors in orthopedic oncology, steering away from historical amputations toward preserving limb function and enhancing patient quality of life. This transformative shift underscores the delicate balance between tumor eradication and optimal postoperative function. Primary and metastatic bone tumors present challenges in early detection, differentiation between benign and malignant tumors, preservation of function, and the risk of local recurrence. Conventional methods, including surgery, radiation therapy, chemotherapy, and targeted therapies, have evolved with a heightened focus on personalized medicine. A groundbreaking development in limb salvage surgery is the advent of 3D-printed patient-specific implants, which significantly enhance anatomical precision, stability, and fixation. These implants reduce soft tissue disruption and the associated risks, fostering improved osseointegration and correction of deformities for a more natural and functional postoperative outcome. Biological and molecular research has reshaped the understanding of bone tumors, guiding surgical interventions with advancements such as genomic profiling, targeted intraoperative imaging, precision targeting of molecular pathways, and immunotherapy tailored to individual tumor characteristics. In the realm of imaging technologies, MRI, CT scans, and intraoperative navigation systems have redefined preoperative planning, minimizing collateral damage and optimizing outcomes through accurate resections. Postoperative rehabilitation plays a crucial role in restoring function and improving the quality of life. Emphasizing early mobilization, effective pain management, and a multidisciplinary approach, rehabilitation addresses the physical, psychological, and social aspects of recovery. Looking ahead, future developments may encompass advanced biomaterials, smart implants, AI algorithms, robotics, and regenerative medicine. Challenges lie in standardization, cost-effectiveness, accessibility, long-term outcome assessment, mental health support, and fostering global collaboration. As research progresses, limb salvage surgery emerges not just as a preservation tool but as a transformative approach, restoring functionality, resilience, and hope in the recovery journey. This review summarizes the recent advances in limb salvage therapy for bone tumors over the past decade.

Multimodality Imaging for 3D Printing and Surgical Rehearsal in Complex Spine Surgery.

Surgery is the mainstay treatment of symptomatic spinal tumors. It aids in restoring functionality, managing pain and tumor growth, and improving overall quality of life. Over the past decade, advancements in medical imaging techniques combined with the use of three-dimensional (3D) printing technology have enabled improvements in the surgical management of spine tumors by significantly increasing the precision, accuracy, and safety of the surgical procedures. For complex spine surgical cases, the use of multimodality imaging is necessary to fully visualize the extent of disease, including both soft-tissue and bone involvement. Integrating the information provided by these examinations in a cohesive manner to facilitate surgical planning can be challenging, particularly when multiple surgical specialties work in concert. The digital 3-dimensional (3D) model or 3D rendering and the 3D printed model created from imaging examinations such as CT and MRI not only facilitate surgical planning but also allow the placement of virtual and physical surgical or osteotomy planes, further enhancing surgical planning and rehearsal. The authors provide practical information about the 3D printing workflow, from image acquisition to postprocessing of a 3D printed model, as well as optimal material selection and incorporation of quality management systems, to help surgeons utilize 3D printing for surgical planning. The authors also highlight the process of surgical rehearsal, how to prescribe digital osteotomy planes, and integration with intraoperative surgical navigation systems through a case-based discussion. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Current status and reflection on minimal access breast surgery

Minimal access breast surgery with the assistance of an endoscopy or robot has been an important advancement in surgical treatment in recent years. Compared to conventional open surgery, minimal access breast surgery only requires small incisions in concealed areas such as axillary fossa, avoiding visible scars on the surface of the breast, significantly improving the postoperative aesthetic appearance and patient satisfaction. With the rapid development of minimal access breast surgery, several institutions have established their own distinctive techniques. The concept of membrane anatomy in the breast, for example, has led to more natural-looking breast reconstruction following endoscopic procedures. The adoption of the reverse space dissection technique has greatly optimized the workflow of endoscopic breast cancer resection. Intraoperative navigation system for endoscopic breast-conserving surgery could allow precise localization of excision margins. Furthermore, the widespread use of the cold dissection technique for flap separation has reduced surgical duration and minimized flap damage. The emergence of unique techniques in the field of minimal access breast surgery promises to further advance and promote the adoption of minimal access breast surgery in China.

Intraoperative Navigation in Reverse Shoulder Arthroplasty: Advantages and Future Prospects.

Intraoperative navigation is a novel technology that can provide real-time feedback to the surgeon during implantation and enhance the accuracy and precision of glenoid component positioning. Applications of intraoperative navigation systems have demonstrated increased precision in baseplate version and inclination, as well as improved baseplate screw placement, with fewer screws used and greater purchase length achieved when compared to standard instrumentation. Early clinical studies have shown favorable results, with significantly improved patient-reported and clinical outcomes and decreased complications. The implementation of intraoperative navigation is associated with a short learning curve and a minimal increase in operative time. Nevertheless, further research is necessary to substantiate the clinical benefit of navigation and evaluate its economic cost-effectiveness and impact on implant survival. Augmented reality and robotic-assisted surgery are additional emerging technologies that, while novel, hold the potential to further advance the field of shoulder arthroplasty.

Virtual Reality and 3D Simulation in the Treatment of Pediatric Patients with Central Nervous System Tumors

Pediatric central nervous system tumors are the primary solid malignancies in children and remain a leading cause of mortality in infancy. Advances in pediatric neuro-oncology, driven by molecular oncology research, emphasize the critical need for high-quality pathological tissue to support advanced molecular investigations. However, the vast heterogeneity of these tumors requires precise discrimination of collection sites, aligning with preoperative imaging data. Surgical resection, a pivotal step in diagnosis and treatment, could result in potential morbidities influencing children's neurological status. This, in turn, affects the feasibility of subsequent oncological treatments, influencing overall prognosis and quality of life. To address these challenges, technological tools enhance neurosurgeon orientation in pre-surgical planning and resection. While stereotactic navigation systems reduce morbidity, limitations persist in providing only two-dimensional anatomical information. Recent developments in 3D surgical simulation and virtual reality revolutionize procedural planning, offering real-time integration with intraoperative navigation systems. Beyond surgery, virtual reality has potential in case discussions, preoperative planning, and operative guidance, aiming to improve care and patient outcomes. The virtual reality experience, coupled with detailed anatomical visualization, facilitates meticulous surgical strategy planning for minimal invasiveness. Despite expanding literature on virtual reality applications in neurosurgery, pediatric neurosurgical oncology experiences remain limited. Scientific evaluation of simulation systems' impact on techniques and outcomes, combined with advances in neuroimaging, offers promise for adapting surgical approaches based on neoplastic brain lesion behavior.&#x0D; In conclusion, incorporating 3D surgical simulation and virtual reality technologies in pediatric neurosurgical oncology holds substantial benefits, offering improved procedural planning, enhanced precision, and patient-specific adaptation. Despite limited reported experiences, the compelling advantages underscore the need for further exploration and consideration in the evolving landscape of pediatric neuro-oncology.

Is Intraoperative CT Navigation feasible for excision of osteoid osteoma in the appendicular skeleton? – Retrospective analysis of 58 cases

BackgroundThe use of intraoperative CT navigation to manage osteoid osteoma is not common. We report our experience managing osteoid osteoma in the appendicular skeleton using an intraoperative AIRO CT navigation system. Materials & methodsBetween May 2013 and December 2022, 59 patients underwent Navigation-assisted excision of osteoid osteoma in the appendicular skeleton. Our primary study outcome was to assess for recurrence of the tumour with recurrence of symptoms. For our secondary outcomes, we evaluated the complications associated with the procedure and evaluated the histological slides of all patients to see for the presence of nidus. ResultsOf the 58 patients available for review, no patient had a lesion recurrence, and all were symptom-free at an average follow-up of 45.6 months (6–100). Two patients (3.5%) had a superficial infection managed conservatively, and 43 patients (74.1%) had the presence of nidus in curetted samples. No patient developed a pathological fracture after the procedure. ConclusionUsing intraoperative CT navigation to manage osteoid osteoma in the appendicular skeleton is safe, minimally invasive, and effective in completely removing the nidus with a negligible complication rate. The absence of nidus on histology should not be a concern to clinicians once thorough burring and verification of excision of nidus has been confirmed intra-operatively. Study designRetrospective Case Series. Level of evidenceLevel IV.

Assessing Procedural Accuracy in Lateral Spine Surgery: A Retrospective Analysis of Percutaneous Pedicle Screw Placement with Intraoperative CT Navigation.

Percutaneous pedicle screws (PPSs) are commonly used in posterior spinal fusion to treat spine conditions such as trauma, tumors, and degenerative diseases. Precise PPS placement is essential in preventing neurological complications and improving patient outcomes. Recent studies have suggested that intraoperative computed tomography (CT) navigation can reduce the dependence on extensive surgical expertise for achieving accurate PPS placement. However, more comprehensive documentation is needed regarding the procedural accuracy of lateral spine surgery (LSS). In this retrospective study, we investigated patients who underwent posterior instrumentation with PPSs in the thoracic to lumbar spine, utilizing an intraoperative CT navigation system, between April 2019 and September 2023. The system's methodology involved real-time CT-based guidance during PPS placement, ensuring precision. Our study included 170 patients (151 undergoing LLIF procedures and 19 trauma patients), resulting in 836 PPS placements. The overall PPS deviation rate, assessed using the Ravi scale, was 2.5%, with a notably higher incidence of deviations observed in the thoracic spine (7.4%) compared to the lumbar spine (1.9%). Interestingly, we found no statistically significant difference in screw deviation rates between upside and downside PPS placements. Regarding perioperative complications, three patients experienced issues related to intraoperative CT navigation. The observed higher rate of inaccuracies in the thoracic spine suggests that various factors may contribute to these differences in accuracy, including screw size and anatomical variations. Further research is required to refine PPS insertion techniques, particularly in the context of LSS. In conclusion, this retrospective study sheds light on the challenges associated with achieving precise PPS placement in the lateral decubitus position, with a significantly higher deviation rate observed in the thoracic spine compared to the lumbar spine. This study emphasizes the need for ongoing research to improve PPS insertion techniques, leading to enhanced patient outcomes in spine surgery.

Robot-assisted orthopedic surgeries around shoulder joint: where we are?

This study aims to comprehensively review the current literatures about robot-assisted techniques for shoulder joint arthroplasty and also in experimental articles or case series about around shoulder soft tissue surgeries including arthroscopy, tendon transfer and brachial plexus surgeries. This article evaluates the existing literature and clinical studies to suggests future direction of robotic-assisted techniques in shoulder joint surgeries. Robotic surgery has emerged as an innovative and transformative technology in orthopedics, offering advancements in surgical precision and optimization particularly during total hip and knee arthroplasty. In shoulder joint, patients specific instrumentation with preoperative planning and intraoperative navigation system are being used. Robotic-assisted shoulder arthroplasty will be introduced. In soft tissue surgery, robot-assisted tendon transfer and around brachial plexus surgeries is being clinically tried. In additions, postoperative robot-assisted rehabilitation after may have potential advantages. With the overall development of several industries including robotic technology, robot-assisted pre-, intra- and post-operative techniques could be an essential part of the overall shoulder surgery. However, further research and larger-scale studies are needed to establish its long-term efficacy, and potential complications.