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Interest of intra-operative 3D imaging in spine surgery: a prospective randomized study

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Abstract

Purpose

We report a single-center, prospective, randomized study for pedicle screw insertion in opened and percutaneous spine surgeries, using a computer-assisted surgery (CAS) technique with three-dimensional (3D) intra-operative images intensifier (without planification on pre-operative CT scan) vs conventional surgical procedure.

Material and method

We included 143 patients: Group C (conventional, 72 patients) and Group N (3D Fluoronavigation, 71 patients). We measured the pedicle screw running time, and surgeon’s radiation exposure. All pedicle runs were assessed according to Heary by two independent radiologists on a post-operative CT scan.

Results

3D Fluoronavigation appeared less accurate in percutaneous procedures (24 % of misplaced pedicle screws vs 5 % in Group C) (p = 0.007), but more accurate in opened surgeries (5 % of misplaced pedicle screws vs 17 % in Group C) (p = 0.025). For one vertebra, the average surgical running time reached 8 min in Group C vs 21 min in Group N for percutaneous surgeries (p = 3.42 × 10−9), 7.33 min in Group C vs 16.33 min in Group N (p = 2.88 × 10−7) for opened surgeries. The 3D navigation device delivered less radiation in percutaneous procedures [0.6 vs 1.62 mSv in Group C (p = 2.45 × 10−9)]. For opened surgeries, it was twice higher in Group N with 0.21 vs 0.1 mSv in Group C (p = 0.022).

Conclusion

The rate of misplaced pedicle screws with conventional techniques was nearly the same as most papers and a little bit higher with CAS. Surgical running time and radiation exposure were consistent with many studies. Our work hypothesis is partially confirmed, depending on the type of surgery (opened or closed procedure).

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Acknowledgments

We would like to give special thanks to the following M.Ds: Arnaud Bodin, Aurélien Courvoisier and Ahmad Eid. We thank them for their implication in our work and their advice. We also would like to thank the Grenoble University Hospital for its financial help in this project.

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Authors and Affiliations

  1. University Department of Orthopaedic Surgery and Traumatology, CHU A. Michallon, 38043, Grenoble Cedex, France

    Sébastien Ruatti, G. Kerschbaumer, M. Milaire, J. Tonetti & Ph. Merloz

  2. University Department of Medical Imaging, CHU A. Michallon, 38043, Grenoble Cedex, France

    C. Dubois

  3. Clinical Investigation and Technological Innovation Center (CIC-IT), Joseph Fourier University, 38043, Grenoble Cedex, France

    E. Chipon & A. Moreau-Gaudry

Authors
  1. Sébastien Ruatti
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  2. C. Dubois
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  3. E. Chipon
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  4. G. Kerschbaumer
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  5. M. Milaire
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  6. A. Moreau-Gaudry
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  7. J. Tonetti
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  8. Ph. Merloz
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Correspondence to Sébastien Ruatti.

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Ruatti, S., Dubois, C., Chipon, E. et al. Interest of intra-operative 3D imaging in spine surgery: a prospective randomized study. Eur Spine J 25, 1738–1744 (2016). https://doi.org/10.1007/s00586-015-4141-5

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  • DOI: https://doi.org/10.1007/s00586-015-4141-5

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