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Reduction in CT scan number with the reference frame middle attachment method in intraoperative CT navigation for adolescent idiopathic scoliosis

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Abstract

Purpose

Elucidate whether it is preferable to use the reference frame (RF) middle attachment (RFMA) method over the edge of the planned pedicle screw (PS) insertion area for RF placement in the surgery for adolescent idiopathic scoliosis (AIS) with intraoperative computed tomography (CT) navigation.

Methods

Eighty-six consecutive patients (76 female and 10 male; mean age: 15.9 years) with AIS who underwent posterior spinal fusion using intraoperative CT navigation were enrolled. The group with the RF placed at the most distal part of the CT scan range was defined as the distal group (Group D), with other placements classified into the middle group (Group M). PS perforation rate and surgical outcome were compared between the groups.

Results

There was no significant difference in perforation rate between Group M and Group D (3.4% vs. 3.0%, P = 0.754). The mean ± standard deviation number of instrumented vertebrae at the first CT scan was significantly higher in Group M (8.2 ± 1.2 vs. 6.3 ± 1.2, P < 0.001), while mean blood loss was significantly lower (266 ± 185 mL vs. 416 ± 348 mL, P = 0.011). The frequency of needing a second CT scan for PS insertion was significantly lower in Group M (38% vs. 69%, P = 0.04).

Conclusion

The RFMA method in thoracic scoliosis surgery for AIS with intraoperative CT navigation could significantly decrease the number of CT scans and blood loss while maintaining a comparable PS perforation rate to RF placement at the distal end of the planned PS insertion range.

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References

  1. Suk SI, Lee CK, Kim WJ, Chung YJ, Park YB (1995) Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine 20:1399–405

    Article  CAS  PubMed  Google Scholar 

  2. Watanabe K, Yamazaki A, Hirano T, Izumi T, Sano A, Morita O, Kikuchi R, Ito T (2010) Descending aortic injury by a thoracic pedicle screw during posterior reconstructive surgery: a case report. Spine 35:E1064–E1068. https://doi.org/10.1097/BRS.0b013e3181ed29c1

    Article  PubMed  Google Scholar 

  3. Smorgick Y, Millgram MA, Anekstein Y, Floman Y, Mirovsky Y (2005) Accuracy and safety of thoracic pedicle screw placement in spinal deformities. J Spinal Disord Tech 18:522–6. https://doi.org/10.1097/01.bsd.0000154448.90707.a8

    Article  PubMed  Google Scholar 

  4. Kakkos SK, Shepard AD (2008) Delayed presentation of aortic injury by pedicle screws: report of two cases and review of the literature. J Vasc Surg 47:1074–1082. https://doi.org/10.1016/j.jvs.2007.11.005

    Article  PubMed  Google Scholar 

  5. Rabellino M, Garcia-Monaco R, Cesareo V, Rostagno R, Sola C (2013) Endovascular treatment of iatrogenic aortic injury after spinal surgery. Minim Invasive Ther Allied Technol 22:56–60. https://doi.org/10.3109/13645706.2012.692332

    Article  PubMed  Google Scholar 

  6. Minor ME, Morrissey NJ, Peress R, Carroccio A, Ellozy S, Agarwal G, Teodorescu V, Hollier LH, Marin ML (2004) Endovascular treatment of an iatrogenic thoracic aortic injury after spinal instrumentation: case report. J Vasc Surg 39:893–896. https://doi.org/10.1016/j.jvs.2003.10.056

    Article  PubMed  Google Scholar 

  7. Oba H, Ebata S, Takahashi J, Koyama K, Uehara M, Kato H, Haro H, Ohba T (2018) Pedicle perforation while inserting screws using O-arm navigation during surgery for adolescent idiopathic scoliosis: risk factors and effect of insertion order. Spine 43:E1463–E1468

    Article  PubMed  Google Scholar 

  8. Tanikawa Y, Oba H, Fujii M, Ikegami S, Uehara M, Mimura T, Miyagawa J, Hatakenaka T, Kuraishi S, Takizawa T, Munakata R, Kamanaka T, Miyaoka Y, Michihiko K, Takahashi J (2022) Intraoperative cone beam CT in hybrid operation room for pediatric scoliosis patients: comparison of pedicle screw violation rate at normal and low radiation doses. Spine 47:E507–E513. https://doi.org/10.1097/BRS.0000000000004226

    Article  PubMed  Google Scholar 

  9. Oba H, Ikegami S, Kuraishi S, Uehara M, Takizawa T, Munakata R, Hatakenaka T, Kamanaka T, Koseki M, Takahashi J (2020) Perforation rate of pedicle screws using hybrid operating room combined with intraoperative computed tomography navigation for adolescent idiopathic scoliosis: impact of distance from the reference frame and other risk factors. Spine 45:E1357–E1364. https://doi.org/10.1097/BRS.0000000000003673

    Article  PubMed  Google Scholar 

  10. Oba H, Uehara M, Ikegami S, Hatakenaka T, Kamanaka T, Miyaoka Y, Kurogouchi D, Fukuzawa T, Mimura T, Tanikawa Y, Koseki M, Ohba T, Takahashi J (2023) Tips and pitfalls to improve accuracy and reduce radiation exposure in intraoperative CT navigation for pediatric scoliosis: a systematic review. Spine J 23:183–196. https://doi.org/10.1016/j.spinee.2022.09.004

    Article  PubMed  Google Scholar 

  11. Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG, Blanke K (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83:1169–1181

    Article  CAS  PubMed  Google Scholar 

  12. Gertzbein SD, Robbins SE (1990) Accuracy of pedicular screw placement in vivo. Spine 15:11–4

    Article  CAS  PubMed  Google Scholar 

  13. Rao G, Brodke DS, Rondina M et al (2002) Comparison of computerized tomography and direct visualization in thoracic pedicle screw placement. J Neurosurg 97:223–226. https://doi.org/10.1097/00007632-199001000-00004

    Article  PubMed  Google Scholar 

  14. Uehara M, Takahashi J, Ikegami S, Kuraishi S, Shimizu M, Futatsugi T, Oba H, Kato H (2017) Are pedicle screw perforation rates influenced by distance from the reference frame in multilevel registration using a computed tomography-based navigation system in the setting of scoliosis? Spine J 17:499–504. https://doi.org/10.1016/j.spinee.2016.10.019

    Article  PubMed  Google Scholar 

  15. Simony A, Hansen EJ, Christensen SB, Carreon LY, Andersen MO (2016) Incidence of cancer in adolescent idiopathic scoliosis patients treated 25 years previously. Eur Spine J 25:3366–3370. https://doi.org/10.1007/s00586-016-4747-2

    Article  PubMed  Google Scholar 

  16. Presciutti SM, Karukanda T, Lee M (2014) Management decisions for adolescent idiopathic scoliosis significantly affect patient radiation exposure. Spine J 14:1984–1990. https://doi.org/10.1016/j.spinee.2013.11.055

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Takayuki Kamanaka, M.D., Yoshinari Miyaoka, M.D., Daisuke Kurogouchi, M.D., Takuma Fukuzawa, M.D., Koji Hayashi, MD, Tetsuhiko Mimura, M.D., Jun Miyagawa, R.T. Masahiro Fujii, R.T., Prof. Yasunari Fujinaga, M.E. Yuki Michinaga, M.E. Daichi Watanabe, Ns. Rika Watanabe, Prof. Michihiko Koseki, M.D. Yuki Maruyama, as well as Prof. Mikito Kawamata for their help with surgery in the hybrid OR.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan

    Hiroki Oba, Shota Ikegami, Masashi Uehara, Terue Hatakenaka & Jun Takahashi

  2. Department of Orthopaedic Surgery, Konan Kosei Hospital, 137 Omatsubara, Takayacho, Konan, Aichi, 483-8704, Japan

    Tokumi Kanemura

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  1. Hiroki Oba
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  2. Shota Ikegami
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  3. Masashi Uehara
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  4. Terue Hatakenaka
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  6. Jun Takahashi
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Contributions

HO wrote and prepared the manuscript, and all of the authors participated in the study design. All authors have read, reviewed, and approved the article.

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Correspondence to Hiroki Oba.

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The authors declare that there are no conflict of interest.

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Approval code 4633, Shinshu University School of Medicine.

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Informed consent was obtained by all participants in this study.

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Oba, H., Ikegami, S., Uehara, M. et al. Reduction in CT scan number with the reference frame middle attachment method in intraoperative CT navigation for adolescent idiopathic scoliosis. Eur Spine J 32, 3133–3139 (2023). https://doi.org/10.1007/s00586-023-07842-x

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  • DOI: https://doi.org/10.1007/s00586-023-07842-x

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