Skip to main content

Advertisement

SpringerLink
Log in

O-arm navigation for sacroiliac screw placement in the treatment for posterior pelvic ring injury

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

This study aims to investigate the application value of O-arm navigation system in sacroiliac screw placement for the treatment of unstable pelvic ring injury.

Methods

A total of 40 patients (mean age = 30.75 ± 14.99 years, 25 males, 15 females) were included. From January 2016 to July 2018, 40 patients with posterior pelvic ring injury treated in our hospital were included. Of them, 19 patients underwent O-arm navigation for screw placement (O-arm group) while the other 21 received C-arm fluoroscopy guidance (C-arm group) for sacroiliac screw placement. Intraoperative outcomes and the outcome of screw placement were compared between groups. The quality of radiological images was assessed by Matta’s radiological outcome grade. The outcome of complex pelvic fracture treatment was evaluated by Majeed Functional score.

Results

All demographic and clinical characteristics were comparable between the two groups. Compared with the C-arm groups, the O-arm group had a shorter surgery time (33.19 ± 3.14 vs. 48.35 ± 4.38 min, P < 0.001), a higher overall good outcome “excellent + good” rate of screw placement (95.45% vs. 73.91%, P < 0.05), and a significantly higher Majeed Functional score better outcome of complex pelvic fracture treatment at 1 and 3 months postoperation (both P < 0.05).

Conclusion

Our results demonstrated that O-arm navigation system is feasible and safe for the treatment of posterior pelvic ring injury and can effectively improve the accuracy and safety of sacroiliac screw placement, shorten the operation time, and help rapid postoperative functional recovery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ghosh S, Aggarwal S, Kumar V et al (2019) Epidemiology of pelvic fractures in adults: our experience at a tertiary hospital. Chin J Traumatol 22:138–141. https://doi.org/10.1016/J.CJTEE.2019.03.003

    Article  PubMed  PubMed Central  Google Scholar 

  2. Saxena P, Agrawal A, Sakale H (2014) Introduction to pelvic injury and its acute management. J Orthop Traumatol Rehabil 7:1. https://doi.org/10.4103/0975-7341.133995

    Article  CAS  Google Scholar 

  3. Richter PH, Gebhard F, Dehner C, Scola A (2016) Accuracy of computer-assisted iliosacral screw placement using a hybrid operating room. Injury 47:402–407. https://doi.org/10.1016/j.injury.2015.11.023

    Article  CAS  PubMed  Google Scholar 

  4. Briem D, Linhart W, Lehmann W et al (2006) Computer-assisted screw insertion into the first sacral vertebra using a three-dimensional image intensifier: results of a controlled experimental investigation. Eur Spine J 15:757–763. https://doi.org/10.1007/s00586-005-0992-5

    Article  CAS  PubMed  Google Scholar 

  5. Zwingmann J, Konrad G, Kotter E et al (2009) Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure. Clin Orthop Relat Res 467:1833–1838. https://doi.org/10.1007/s11999-008-0632-6

    Article  PubMed  Google Scholar 

  6. De Silva T, Punnoose J, Uneri A et al (2018) Virtual fluoroscopy for intraoperative C-arm positioning and radiation dose reduction. J Med Imaging 5:1. https://doi.org/10.1117/1.JMI.5.1.015005

    Article  CAS  Google Scholar 

  7. Zwingmann J, Hauschild O, Bode G et al (2013) Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 133:1257–1265. https://doi.org/10.1007/s00402-013-1788-4

    Article  PubMed  Google Scholar 

  8. Moed BR, Ahmad BK, Craig JG et al (1998) Intraoperative monitoring with stimulus-evoked electromyography during placement of iliosacral screws: an initial clinical study. J Bone Jt Surg - Ser A 80:537–546. https://doi.org/10.2106/00004623-199804000-00010

    Article  CAS  Google Scholar 

  9. Liu Z, Jin M, Qiu Y et al (2016) The superiority of intraoperative O-arm navigation-assisted surgery in instrumenting extremely small thoracic pedicles of adolescent idiopathic scoliosis. Medicine (Baltimore) 95:e3581. https://doi.org/10.1097/MD.0000000000003581

    Article  CAS  Google Scholar 

  10. Rosenberger RE, Dolati B, Larndorfer R et al (2010) Accuracy of minimally invasive navigated acetabular and iliosacral fracture stabilization using a targeting and noninvasive registration device. Arch Orthop Trauma Surg 130:223–230. https://doi.org/10.1007/s00402-009-0932-7

    Article  PubMed  Google Scholar 

  11. Behrendt D, Mütze M, Steinke H et al (2012) Evaluation of 2D and 3D navigation for iliosacral screw fixation. Int J Comput Assist Radiol Surg 7:249–255. https://doi.org/10.1007/s11548-011-0652-7

    Article  PubMed  Google Scholar 

  12. Coste C, Asloum Y, Marcheix PS et al (2013) Percutaneous iliosacral screw fixation in unstable pelvic ring lesions: the interest of O-ARM CT-guided navigation. Orthop Traumatol Surg Res 99:S273–S278. https://doi.org/10.1016/j.otsr.2013.03.002

    Article  CAS  PubMed  Google Scholar 

  13. Ghisla S, Napoli F, Lehoczky G et al (2018) Posterior pelvic ring fractures: intraoperative 3D-CT guided navigation for accurate positioning of sacro-iliac screws. Orthop Traumatol Surg Res 104:1063–1067. https://doi.org/10.1016/j.otsr.2018.07.006

    Article  PubMed  Google Scholar 

  14. Hsu AR, Lee S (2014) Evaluation of tarsal navicular stress fracture fixation using intraoperative O-arm computed tomography. Foot Ankle Spec 7:515–521. https://doi.org/10.1177/1938640014532130

    Article  PubMed  Google Scholar 

  15. Majeed SA (1989) Grading the outcome of pelvic fractures. J Bone Jt Surg - Ser B 71:304–306. https://doi.org/10.1302/0301-620x.71b2.2925751

    Article  CAS  Google Scholar 

  16. Qureshi S, Lu Y, McAnany S, Baird E (2014) Three-dimensional intraoperative imaging modalities in orthopaedic surgery: a narrative review. J Am Acad Orthop Surg 22:800–809

    Article  Google Scholar 

  17. He J, Tan G, Zhou D et al (2016) Comparison of isocentric C-arm 3-dimensional navigation and conventional fluoroscopy for percutaneous retrograde screwing for anterior column fracture of acetabulum: an observational study. Medicine (Baltimore) 95:e2470. https://doi.org/10.1097/MD.0000000000002470

    Article  Google Scholar 

  18. Takao M, Nishii T, Sakai T et al (2014) Iliosacral screw insertion using CT-3D-fluoroscopy matching navigation. Injury 45:988–994. https://doi.org/10.1016/j.injury.2014.01.015

    Article  PubMed  Google Scholar 

  19. Verma SK, Singh PK, Agrawal D et al (2016) O-arm with navigation versus C-arm: a review of screw placement over 3 years at a major trauma center. Br J Neurosurg 30:658–661. https://doi.org/10.1080/02688697.2016.1206179

    Article  CAS  PubMed  Google Scholar 

  20. Takao M, Nishii T, Sakai T, Sugano N (2013) CT-3D-fluoroscopy matching navigation can reduce the malposition rate of iliosacral screw insertion for less-experienced surgeons. J Orthop Trauma 27:716–721. https://doi.org/10.1097/BOT.0b013e31828fc4a5

    Article  PubMed  Google Scholar 

  21. Grelat M, Zairi F, Quidet M et al (2015) Assessment of the surgeon radiation exposure during a minimally invasive TLIF: comparison between fluoroscopy and O-arm system. Neurochirurgie 61:255–259. https://doi.org/10.1016/j.neuchi.2015.04.002

    Article  CAS  PubMed  Google Scholar 

  22. Guo N, Zhang H, Li J et al (2013) O-arm based navigation vs X-ray fluoroscopy in accuracy of pedicle drilling in bovine lumber spine specimens. J Third Mil Med Univ 35:277–279

    CAS  Google Scholar 

  23. Tow BPB, Yue WM, Srivastava A et al (2015) Does navigation improve accuracy of placement of pedicle screws in single-level lumbar degenerative spondylolisthesis? A comparison between free-hand and three-dimensional o-arm navigation techniques. J Spinal Disord Tech 28:E472–E477. https://doi.org/10.1097/BSD.0b013e3182a9435e

    Article  Google Scholar 

  24. Pitteloud N, Gamulin A, Barea C et al (2017) Radiation exposure using the O-arm® surgical imaging system. Eur Spine J 26:651–657. https://doi.org/10.1007/s00586-016-4773-0

    Article  PubMed  Google Scholar 

  25. Su AW, Luo TD, McIntosh AL et al (2016) Switching to a pediatric dose O-arm protocol in spine surgery significantly reduced patient radiation exposure. J Pediatr Orthop 36:621–626. https://doi.org/10.1097/bpo.0000000000000504

    Article  PubMed  Google Scholar 

  26. Kassis SZ, Abukwedar LK, Msaddi AK et al (2016) Combining pedicle screw stimulation with spinal navigation, a protocol to maximize the safety of neural elements and minimize radiation exposure in thoracolumbar spine instrumentation. Eur Spine J 25:1724–1728. https://doi.org/10.1007/s00586-015-3973-3

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful for the help from Professor Tan Haitao who is the secretary of the hospital’s party committee and the chief physician of orthopedics, as well as the help from the team of orthopedic surgeons.

Funding

This study is supported by the Inversion and Application of Scientific and Technical Payoffs of Guigang, Guangxi Province (GKZ 1701002), Guangxi Science and Technology Project (AD17129017, AD17195042), Guangxi Natural Science Foundation Project (2018GXNSFAA294129), the Key Clinical Specialty Construction Projects in Guangxi Zhuang Autonomous Region, and Guigang Scientific Research and Technology Development Projects (GKT 1834002).

Author information

Authors and Affiliations

  1. Department of Orthopedic Trauma, Guigang City People’s Hospital, No. 1 Zhongshan Road, Gangbei District, Guigang, 537100, Guangxi Province, China

    Shengyu Lu, Keqin Yang, Cailing Lu, Ping’ou Wei, Zhi Gan, Zhipeng Zhu & Haitao Tan

Authors
  1. Shengyu Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keqin Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cailing Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ping’ou Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhi Gan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhipeng Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Haitao Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Haitao Tan.

Ethics declarations

This study was approved by the institutional review board of our hospital. Written informed consent was obtained from each patient.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lu, S., Yang, K., Lu, C. et al. O-arm navigation for sacroiliac screw placement in the treatment for posterior pelvic ring injury. International Orthopaedics (SICOT) 45, 1803–1810 (2021). https://doi.org/10.1007/s00264-020-04832-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-020-04832-2

Keywords

Search

Navigation