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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Navigated carbon-fiber reinforced PEEK instrumentation using intraoperative CT, robotic cone beam CT and cone beam CT in spinal oncology

Navigierte carbon-fiber reinforced PEEK Instrumentierung mit der Verwendung von intraoperativer CT, robotic cone beam CT und cone beam CT in der spinalen Onkologie

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  • presenting/speaker Vanessa Hubertus - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Lars Wessels - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Anton Früh - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Dimitri Tkatschenko - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Irini Nulis - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Georg Bohner - Charité – Universitätsmedizin Berlin, Neuroradiologie, Berlin, Deutschland
  • Vincent Prinz - Universitätsklinikum Frankfurt, Klinik für Neurochirurgie, Frankfurt a. M., Deutschland
  • Julia Sophie Onken - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Marcus Czabanka - Universitätsklinikum Frankfurt, Klinik für Neurochirurgie, Frankfurt a. M., Deutschland
  • Peter Vajkoczy - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Nils Hecht - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV233

doi: 10.3205/22dgnc225, urn:nbn:de:0183-22dgnc2256

Published: May 25, 2022

© 2022 Hubertus 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: Navigated pedicle screw placement holds distinct advantages in spinal oncology. New implant materials such as carbon-fiber reinforced PEEK (CFRP) additionally increase the quality of radiological follow-up and adjuvant radiation therapy planning through the reduction of imaging artifacts compared to standard titanium implants. However, little is known about the feasibility of these implants for intraoperative image-guided spinal navigation. The aim of the present study is to determine the accuracy and assessability of CFRP pedicle screw implants in navigated spinal instrumentation due to oncologic spinal pathologies using intraoperative CT (iCT), robotic cone beam CT (rCBCT), and cone beam CT (CBCT) and imaging.

Methods: In this single-center retrospective cohort study, between 2018-2021 thirty-three patients with spinal tumors were treated with navigated posterior spinal instrumentation using CFRP implants, combined with iCT, rCBCT, and CBCT. Demographic, clinical and outcome data was assessed. Four independent observers blinded towards intraoperative imaging modality assessed screw accuracy and assessability. Inter-observer reliability was tested using Fleiss` Kappa analysis.

Results: A total of 243 CFRP pedicle screws were placed using spinal navigation and intraoperative imaging (iCT 93, rCBCT 99, CBCT 51). Screw accuracy and accessibility was highest in iCT, followed by rCBCT and CBCT. Perceived imaging quality was rated highest in iCT, not differing between observers. Time necessitated for accuracy assessment was longest in CBCT in all observers. Inter-observer reliability for screw accuracy and assessability was lowest in CBCT, however relevant pedicle breaches were reliably detected in all imaging modalities.

Conclusion: The usage of iCT, rCBCT and CBCT for navigated CFRP pedicle screw placement in spinal oncology is feasible and screw accuracy and assessability can be reliably assessed with all three imaging modalities.