Computer-assisted screw insertion into the first sacral vertebra using a three-dimensional image intensifier: results of a controlled experimental investigation.

D Briem; W Linhart; W Lehmann; P G Begemann; G Adam; U Schumacher; D M Cullinane; J M Rueger; J Windolf

doi:10.1007/s00586-005-0992-5

Home/Archive/PubMed

PubMed · 16010599

Computer-assisted screw insertion into the first sacral vertebra using a three-dimensional image intensifier: results of a controlled experimental investigation.

D Briem·W Linhart·W Lehmann·P G Begemann·G Adam·U Schumacher·D M Cullinane·J M Rueger·J Windolf

View original source ↗Export metadata ↓

Abstract

Currently there are few data available regarding the application and efficacy of computer-assisted procedures in the sacral spine. In order to optimize and standardize this procedure, a controlled experimental investigation has been performed. The aim of the study is to systematically assess the efficacy of a novel three-dimensional image intensifier used for navigated transiliac screw insertion into the first sacral vertebra. Screws were inserted iliosacrally into the first sacral vertebra of preserved human cadaver specimens. The instrument navigated procedure was performed with the "Siremobil Iso-C(3D) " (Siemens Medical Solutions) and the "Navigation System" by Stryker. The accuracy and quality of the imaging procedure as well as the fluoroscopic exposure times were measured. These results were compared to three control groups (CT-based navigation, C-arm navigation, and fluoroscopic guidance). In each group a total amount of 20 screws was implanted. Screw position was postoperatively assessed by Iso-C(3D) or CT-scan. The navigated procedure using the Iso-C(3D) provided good feasibility characteristics without requiring a specific matching process. It revealed the shortest procedure time of all navigated procedures and significantly decreased fluoroscopic time compared to C-arm navigation and fluoroscopic guidance. Furthermore, Iso-C(3D) navigation showed no screw malposition and was in this regard superior to C-arm navigated and fluoroscopic guided procedures. The quality of imaging was sufficient for accurate placement, but did not share the high-resolution level of CT-based navigation. These findings indicate that application of the Iso-C(3D) for navigated transiliac screw insertion into S1 can be recommended as a feasible and safe technique, enabling the surgeon to reduce procedure and fluoroscopic time. Further progress in improving the quality of the Iso-C(3D) image should be attempted.

Explore related subjects

Bone Screws Cadaver Fluoroscopy Humans Imaging, Three-Dimensional Sacrum Surgery, Computer-Assisted Tomography, X-Ray Computed X-Ray Intensifying Screens Comparative Study Evaluation Study Journal Article Research Support, Non-U.S. Gov't

Keep this discovery

Explore connections, maps & timelines

BibTeX RIS

D Briem, W Linhart, W Lehmann, P G Begemann, G Adam, U Schumacher, D M Cullinane, J M Rueger, J Windolf. 2005-07-12. Computer-assisted screw insertion into the first sacral vertebra using a three-dimensional image intensifier: results of a controlled experimental investigation.. https://doi.org/10.1007/s00586-005-0992-5

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2007

Experimental validation of noninvasive referencing in navigated procedures on long bones.

Navigation procedures in orthopedic surgery require fixation of reference markers to the anatomic region of interest. Inadequate fixation might lead to micromotion or loosening of the reference marker, consequently causing registration failures or errors in navigation. Osseous rigid fixation is usually achieved by minimally invasive Schanz screws or pins. The goal of this study was to evaluate a non invasive external fixation device, a headband so far used in cranial navigation, as an alternative invasive fixation technique to reference markers in the femur. A common navigation system with an adapted trauma software application was used to track the positions of the soft tissue-attached headband relative to an invasive reference marker on the femur during manipulations of the thigh. Relative translative and rotational movements of the headband were measured during defined movements of the hip and knee and manipulations of the headband itself. The results revealed high translative and rotational movements, up to 6 mm and 3 degrees , respectively, due to minor manipulations of the affected lower extremity. Noninvasive soft tissue fixation with a headband does not allow rigid fixation for accurate navigated registration or operative procedures at the femur. Necessary intraoperative movements or manipulations would cause substantial registration failures. Invasive fixation techniques with screws or pins are still the method of choice.

Bone Screws↗

PubMed2007

Safety of computer-assisted surgery for cannulated hip screws.

Computer-assisted orthopaedic surgery has developed considerably during the past few years. Several manufacturers produce hardware and software for use in trauma surgery. Validation of these systems before clinical application is mandatory to be sure they work accurately and safely. The accuracy of surgical performance is highly correlated with the cut-out percentages of hip screws. In a standardized operative setting, three cannulated hip screws were inserted in each of 20 sawbones. The screws were positioned either by fluoroscopic navigation technique or by conventional operative technique depending on randomization. Our primary aim was to assess whether computer-navigated screw fixation is equally safe compared with conventional screw fixation using fluoroscopy. To determine safety, we investigated number of drilling attempts, screw position, and radiation time. Secondary to these safety parameters, we also compared the operating time between the two procedures to assess the efficiency of computer navigation. Statistical analysis showed no differences regarding accuracy of screw position. Computer-assisted surgery resulted in fewer drilling attempts and less radiation time, with a similar operation time. We believe the currently used navigation system is safe and accurate.

Bone Screws↗

PubMed2007

Techniques of posterior C1-C2 stabilization.

Instability of the atlantoaxial complex may result from inflammatory, traumatic, congenital, neoplastic, or degenerative disorders and often requires surgical stabilization. Initial dorsal wiring techniques allow safe fixation but require rigid external immobilization and have been associated with high fusion failure rates. Rigid screw fixation techniques including transarticular screw fixation and C1-C2 rod-cantilever fixation offer higher fusion rates and less need for rigid immobilization but are more technically demanding. C1-C2 fixation using crossing C2 laminar screws offers rigid fixation but without the technical demands of C2 pars placement. The history and techniques of dorsal fixation of the atlantoaxial complex are reviewed, and the success rates and complications of each are discussed.

Bone Screws↗