Artikel
Intraoperative assessability of pedicle screw placement using digital volume tomography
Intraoperative Beurteilbarkeit der Lage von Pedikelschraubenlage mittels digitaler Volumentomographie
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Autoren
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Johannes Woitzik
- Evangelisches Krankenhaus Oldenburg, Universitätsklinik für Neurochirurgie, Oldenburg, Deutschland
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Larina Wolter
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Nils Hecht
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Peter Vajkoczy
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
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Simon Heinrich Bayerl
- Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: Navigated pedicle screw placement can be performed using intraoperative computerized tomography (CT) or digital volume tomography (DVT). An additional benefit of using high-resolution intraoperative imaging, such as DVT, is the possibility to immediately assess screw placement with the chance of direct intraoperative revision, if needed. However, information onthe intraoperative assessability of navigated pedicle screws using DVT remains lacking. Therefore, weevaluated the intraoperative assessability of navigated pedicle screws across the entire spine using DVT-based intraoperative imaging compared to postoperative CT.
Methods: Between March 2017 and February 2019,944 subaxial pedicle screws were inserted in174 consecutive patients using DVT-based spinal navigation with the O-arm. Intraoperative image data sets underwent multiplanar 3-dimensional reconstruction and were analyzed regarding to pedicle screw accuracy and screw assessability in comparison to postoperative CT in 105 cases.In addition, unexpected adverse events (UAEs) were documented.
Results: Of all implanted screws, only0.4% (4/944) were rated ‘not-assessable’ due to artifacts (3/944 cervico-thoracic, 1/944 lower thoracic spine). Further,7% (67/944) of all screws were rated ‘poorly assessable’ due to the following reasons: 79% (53/67) due to artifacts, 10% (7/67) due to difficult distinction between bone and surrounding tissue and 10% (7/67) due to grade II or III obesity. Specifically,29% of screws in the lower cervical spine (C6-7), 18% in the upper thoracic spine (T1-4), 20% in the middle thoracic spine (T5-8), 3% in the lower thoracic spine (C9-12), 3% in the lumbar spine (L1-5) and 4% in the sacrum (S1)were rated ‘poorly accessible’. 44/944 pedicle screws (4.7%) were intraoperatively corrected in 31/174 cases (18%).
Conclusion: Intraoperative pedicle screw assessment with DVT is feasible but inferior to conventional CT imaging at the cervico-thoracic level and in obese patients due to anatomically associated artifact susceptibility. Overall, however, DVT permits reliable and clear intraoperative screw assessment.
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