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Learning curve across 2000 thoracolumbar pedicle screw placements using O-arm navigation: technical difficulties and their solutions

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Abstract

Introduction

Instrumentation using the intraoperative O-arm navigation technique appears safer than its predecessor techniques. However, only a handful of surgeons often used navigation during spinal surgeries. Too many operative glitches and unreliable navigation accuracy were the important reasons cited even by experienced surgeons for not using spinal navigation. We have studied the accuracy of pedicle screw placement during the learning curve and beyond it. We have also discussed in detail the intricacies of the technique and solutions to the difficulties encountered using spinal navigation.

Materials and methods

A total of 2000 thoracolumbar pedicle screws have been placed in the 324 spine surgeries meeting the inclusion and exclusion criteria included in this retrospective study. We have divided 2000 pedicle screw placements into consecutive groups of 200 each. We have compared these groups for the accuracy of screw placement with the surgeon’s experience.

Results

The accuracy of pedicle screw placement using the “in-versus-out” grading system in group 1 was 85.5% which significantly increased in group 2 to 93.5% (p-value: 0.0099), and thereafter, there was a nonsignificant increase in subsequent groups with the graph achieving the shape of a plateau.

Conclusion

Surgeons should learn the correct principles of the technique of O-arm navigation to prevent the loss of accuracy and place pedicle screws with high accuracy. There is a learning curve of around 30–35 surgeries or 200 pedicle screw placements to acclimatize with the technique of O-arm navigation and learn its principles.

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References:

  1. Rivkin MA, Yocom SS (2014) Thoracolumbar instrumentation with CT-guided navigation (O-arm) in 270 consecutive patients: accuracy rates and lessons learned. Neurosurg Focus 36(3):E7

    Article  PubMed  Google Scholar 

  2. Katonis P, Christoforakis J, Aligizakis AC, Papadopoulos C, Sapkas G, Hadjipavlou A (2003) Complications and problems related to pedicle screw fixation of the Spine. Clin Orthop 411:86–94

    Article  Google Scholar 

  3. Hicks JM, Singla A, Shen FH, Arlet V. Complications of Pedicle Screw Fixation in Scoliosis Surgery. :6.

  4. Feng W, Wang W, Chen S, Wu K, Wang H (2020) O-arm navigation versus C-arm guidance for pedicle screw placement in spine surgery: a systematic review and meta-analysis. Int Orthop 44(5):919–926

    Article  PubMed  Google Scholar 

  5. Shin MH, Ryu KS, Park CK (2012) Accuracy and safety in pedicle screw placement in the thoracic and lumbar spines : comparison study between conventional C-Arm fluoroscopy and navigation coupled with O-arm® guided methods. J Korean Neurosurg Soc 52(3):204

    Article  PubMed  PubMed Central  Google Scholar 

  6. Jing L, Wang Z, Sun Z, Zhang H, Wang J, Wang G (2019) Accuracy of pedicle screw placement in the thoracic and lumbosacral spines using O-arm-based navigation versus conventional freehand technique. Chin Neurosurg J 5(1):6

    Article  PubMed  PubMed Central  Google Scholar 

  7. Silbermann J, Riese F, Allam Y, Reichert T, Koeppert H, Gutberlet M (2011) Computer tomography assessment of pedicle screw placement in lumbar and sacral spine: comparison between free-hand and O-arm based navigation techniques. Eur Spine J 20(6):875–881

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Waschke A, Walter J, Duenisch P, Reichart R, Kalff R, Ewald C (2013) CT-navigation versus fluoroscopy-guided placement of pedicle screws at the thoracolumbar spine: single center experience of 4,500 screws. Eur Spine J 22(3):654–660

    Article  PubMed  Google Scholar 

  9. Sun J, Wu D, Wang Q, Wei Y, Yuan F (2020) Pedicle screw insertion: Is O-arm–Based navigation superior to the conventional freehand technique? A systematic review and meta-analysis. World Neurosurg 144:e87-99

    Article  PubMed  Google Scholar 

  10. Gelalis ID, Paschos NK, Pakos EE, Politis AN, Arnaoutoglou CM, Karageorgos AC et al (2012) Accuracy of pedicle screw placement: A systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J 21(2):247–255

    Article  PubMed  Google Scholar 

  11. Choo AD, Regev G, Garfin SR, Kim CW. Surgeons’ perceptions of spinal navigation: analysis of key factors affecting the lack of adoption of spinal navigation technology. Minim INVASIVE Surg.

  12. Härtl R, Lam KS, Wang J, Korge A, Kandziora F, Audigé L (2013) Worldwide survey on the use of navigation in spine surgery. World Neurosurg 79(1):162–172

    Article  PubMed  Google Scholar 

  13. Rampersaud YR, Pik JHT, Salonen D, Farooq S (2005) Clinical accuracy of fluoroscopic computer-assisted pedicle screw fixation: A CT analysis. Spine 30(7):E183–E190

    Article  PubMed  Google Scholar 

  14. Crawford BD, Nchako CM, Rebehn KA, Israel H, Place HM (2022) Transpedicular screw placement accuracy using the O-arm versus freehand technique at a single institution. Glob Spine J 12(3):447–451

    Article  Google Scholar 

  15. Upendra BN, Meena D, Chowdhury B, Ahmad A, Jayaswal A (2008) Outcome-based classification for assessment of thoracic pedicular screw placement. Spine 33(4):384–390

    Article  PubMed  Google Scholar 

  16. Nottmeier EW, Crosby TL (2007) Timing of paired points and surface matching registration in three-dimensional (3D) image-guided spinal surgery. J Spinal Disord Tech 20(4):268–270

    Article  PubMed  Google Scholar 

  17. Rahmathulla G, Nottmeier EW, Pirris SM, Deen HG, Pichelmann MA (2014) Intraoperative image-guided spinal navigation: technical pitfalls and their avoidance. Neurosurg Focus 36(3):E3

    Article  PubMed  Google Scholar 

  18. Kotwal S, Pumberger M, Hughes A, Girardi F (2011) Degenerative scoliosis: a review. HSS Journal® Musculoskelet J Hosp Spec Surg. ;7(3):257–64.

  19. Baldwin KD, Kadiyala M, Talwar D, Sankar WN, Flynn JM, Anari JB (2022) Does intraoperative CT navigation increase the accuracy of pedicle screw placement in pediatric spinal deformity surgery? A systematic review and meta-analysis. Spine Deform 10(1):19–29

    Article  PubMed  Google Scholar 

  20. Hirano T, Hasegawa K, Takahashi HE, Uchiyama S, Hara T, Washio T et al (1997) Structural characteristics of the pedicle and its role in screw stability. Spine 21:2504–2510

    Article  Google Scholar 

  21. Wittenberg RH, Lee KS, Shea M, White AA, Hayes WC (1993) Effect of screw diameter, insertion technique, and bone cement augmentation of pedicular screw fixation strength. Clin Orthop 296:278–287

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Spine Surgery, Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India

    Shailesh Hadgaonkar, Siddharth Aiyer & Pramod Bhilare

  2. Department of Spine Surgery, Indraprastha Apollo Hospital, New Delhi, India

    Alok Gupta

  3. Sancheti Institute of Orthopaedics and Rehabilitation, Pune, Maharashtra, India

    Parag Sancheti

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  1. Shailesh Hadgaonkar
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  2. Alok Gupta
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  3. Siddharth Aiyer
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Correspondence to Alok Gupta.

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Hadgaonkar, S., Gupta, A., Aiyer, S. et al. Learning curve across 2000 thoracolumbar pedicle screw placements using O-arm navigation: technical difficulties and their solutions. Eur Spine J 32, 3753–3763 (2023). https://doi.org/10.1007/s00586-023-07922-y

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  • DOI: https://doi.org/10.1007/s00586-023-07922-y

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