gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Accuracy of neuronavigated pedicle screw placement by using a robotic 3D flat panel C-arm CT in a hybrid operating room

Meeting Abstract

  • Jason Perrin - Universitätsklinikum Mannheim, Neurochirurgische Klinik, Mannheim, Deutschland
  • Gregory Ehrlich - Mannheim, Deutschland
  • Dirk-Michael Schulte - Mannheim, Deutschland
  • Mirko Arp - Mannheim, Deutschland
  • Daniel Hänggi - Mannheim, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.21.08

doi: 10.3205/17dgnc299, urn:nbn:de:0183-17dgnc2998

Published: June 9, 2017

© 2017 Perrin et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: The continuously increasing number of spinal stabilization demands a constant improvement of accurate pedicle screw placement to reduce possible complications and postoperative morbidities. Consequentially the use of spinal navigation systems has become more frequent in the vast majority of spinal surgery centers. Common applied technologies include intraoperative mobile or stationary CTs and 2D or 3D fluoroscopy. We evaluated the accuracy of neuronavigated pedicle screw placement by use of a robotic 3D-flat panel C-arm CT (Artis Zeego, SyngoDynaCT, Siemens Health Care) combined with a spinal neuronavigation system (BrainLab Curve, BrainLab) in a hybrid OR setting.

Methods: Standard procedure was to place a midline incision above the spinal levels that were to be treated and then fixate the BrainLab spinal process reference to the most cranial level. Subsequently CT data was acquired with the robotic 3D flat panel C-arm CT followed by an automated registration process with the BrainLab Curve System. During this process, no added draping or repositioning of the patient was needed. All pedicle screws were then placed with the image-guided neuronavigation. As additional accuracy test of the navigational reference a standard a.p. X-ray was conducted after placement of the first pedicle screw in every surgery. Interbody cages were placed under fluoroscopic view with the same robotic C-arm system. Postoperative CT scans were performed to evaluate pedicle screw positioning. The grade of pedicle screw violation was classified into four groups: screws fully contained into the pedicle, perforated screws up to 2 mm displacement (Grade A), 2–4 mm (Grade B), and greater than 4 mm displacement (Grade C).

Results: A total of 136 navigated pedicle screws, 102 lumbosacral and 34 thoracle, were placed with the robotic 3D flat panel C-arm CT system within a time period of 12 Months at our institute. Postoperative CT evaluation revealed that 133 of the 136 screws were fully contained into the pedicles leading to an accuracy of 97.8%. 3 screws being 2.2% showed a Grade A displacement without the need of revision surgery. Nore Grade B or Grade C displacements were recorded. Furthermore, no robotic C-arm associated complications, e.g. injuring C-arm patient collisions or surgical field contaminations, could be detected.

Conclusion: Neuronavigational placement of pedicle screws with this unique robotic 3D flat panel C-arm CT in a hybrid OR shows equivalent accuracies to other high resolution intraoperative spinal navigation systems whilst simultaneously offering the benefits of conventional fluoroscopy e.g for interbody cage placement or verification of the reference accuracy on a large display system. Additional Studies will be conducted with detailed analysis of radiation exposure and surgery times.