gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Intrapoerative 3D-scan during transpedicular thoraco-lumbar canulated screw fixations – postoperative evaluation of benefits and accuracy

Meeting Abstract

Search Medline for

  • Andre Tomasino - Neurochirurgische Klinik, München Bogenhausen, Akademisches Lehrkrankenhaus,Technische Universität München, Deutschland
  • Sebastian Michl - Technische Universität München, Deutschland
  • Christianto B. Lumenta - Technische Universität München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1796

DOI: 10.3205/10dgnc267, URN: urn:nbn:de:0183-10dgnc2679

Published: September 16, 2010

© 2010 Tomasino et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: The use of an intraoperative 3D-C-arm is often combined with the use of 3D-navigation in spinal surgery. In our institution we use the 3D-C-arm to perform 3D-scans after transpedicular placement of K-wires to determine correct k-wire placement prior to screw insertion.

This study was to determine the possible benefits and accuracy of intraoperative 3D-scans during thoraco-lumbar cannulated transpedicular fusion procedures.

Methods: 739 screws in 147 procedures were reviewed. 3D-scans were performed by a Siemens IsoC Orbic 3D. A minimum of 1 scan was performed during surgery with k-wires positioned for transpedicular screw fixation. If misplacement of the k-wire was detected, the wire was replaced and confirmed by an optional additional scan. A postoperative CT scan was performed on a routine base. Intraoperative radiation exposure, numbers of scans, revisions of k-wires and OR-time was recorded. Placements of k-wires were analyzed and classified by a modified "Rongming Xu" criteria.

Results: Minimum of 1 scan and max of 4 scans were performed. Intraoperative k-wire scan correlate exactly with postoperative CT scan. Our revision rate was reduced to 1,48%.

Only 6 patients (11 screws) had revision surgery due misplaced screws. Within these cases 3 patients (6 screws) were analyzed in a poor transpedicular position retrospectively in reviewed 3D-scan. In 13% (58 patients), the placed k-wire was revised after performed 3D-scan. Postoperative CT scan showed excellent placement in 83%.

Intraoperative radiation exposure could be decreased by 50% during learning curve and is lower compared to standard fluoroscopy procedures in existing literature.

Conclusions: Intraoperative 3D-scans of transpedicular k-wires are a helpful, precise and safe tool during cannulated transpedicular fusion procedures, especially in departments were additional navigation is not available. Scans of implanted screws were seen to be not applicable for detection of misplacement due to high artifacts. A learning curve was detected with reduction of intraoperative radiation exposure and with increased recognition of misplaced k-wires. Placement of k-wires could predict to final screw position. Our revision rate was decreased to 1,48%.

With the knowledge of some pitfalls we could perform cannulated k-wire procedures safer, and with less radiation exposure for the patients and the surgeon.