Navigated Cementoplasty With O-Arm and Surgivisio: An Ambispective Comparison With Radiation Exposure

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Figure 1
Intraoperative views of the patient frame and the O-arm settings. We can notice the percutaneous insertion of the Jamshidi needles, and the cement filler fixed on its extremity. Note the pin within the posterior cresta iliaca (A). In case of thoracic spine procedure, a spinous clamp may be required (B).
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Figure 2
Intraoperative view of the patient frame fixed with Kirschner wires on spinous processes and a navigated Jamshidi needle with Surgivisio.
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Figure 3
Displayed view of the computerized navigation with O-arm for percutaneous cementoplasty (A).The 2-dimensional view of balloon reduction for percutaneous kyphoplasty (B).
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Figure 4
Displayed view of the computerized navigation with Surgivisio for percutaneous cementoplasty.

Table 1

Patient demographics and surgery data.

Variable	O-Arm Group (n = 62)	Surgivisio Group (n = 61)	P Value
Variable	O-Arm Group (n = 62)	Surgivisio Group (n = 61)	P Value	Sex ratio, men/women	24/38	24/37	>0.99^{^a}
Age, y	75 ± 11 (43–90)	69 ± 14 (36–94)	0.01^{^b}
Body mass index, kg/m²	25.05 ± 4.37 (17.11–39.09)	24.73 ± 5.46 (15.82–48.28)	0.72^{^b}
Operative time, min	34.52 ± 12.27 (15–90)	30.12 ± 9.36 (17–60)	0.03^{^b}
Operative time per level, min	28.75 ± 9.71 (15–60)	24.16 ± 9.19 (8.5–54)	0.01^{^b}
No. of cemented vertebrae	81	85	-
No. (%) of vertebroplasties	52 (64)	79 (93)	-
No. (%) of vertebral augmentations	29 (36)	6 (7)	-
No. (%) of unipedicular approaches	34 (42)	69 (81)	<0.001^{^a}
Surgeon experience ratio, junior/senior	24/38	11/50	0.02^{^a}

Table 2

Garnier classification of vertebral filling and cement leakage.

Radiological Classification	O-arm Group (n = 62)	Surgivisio Group (n = 61)	P Value^{^a}
Radiological Classification	O-arm Group (n = 62)	Surgivisio Group (n = 61)	P Value^{^a}	Cement filling	<0.001
Satisfactory (Y3, Z2, Z3)	78	69	-
Acceptable (X2, X3, Y2)	3	3	-
Poor (X1, Y1, Z1)	0	13	-
Cement leakage			0.09
Posterior	3	0	-
Cranial	2	2	-
Anterior	4	3	-
Caudal	1	5	-
Lateral	6	15	-
Need for revision	1	0	-
Total, n (%)	16 (21)	25 (29)	-

Table 3

Radiation exposure data comparison in the 2 groups.

Variable	O-arm Group (n = 62)	Surgivisio Group (n = 61)	P Value^{^a}
Variable	O-arm Group (n = 62)	Surgivisio Group (n = 61)	P Value^{^a}	2D imaging duration, s	25.99 ± 15.35 (7.17–84.87)	32.66 ± 20.06 (9–156)	0.04
No. of 3D acquisitions/patient	1.63 ± 0.96 (1–5)	1.01 ± 0.30 (1–2)	<0.001
Dose-length product, mGy·cm	622 ± 454 (88–2155)	-	-
Overall DAP, mGy·cm²	-	5326 ± 4180 (1258–25,090)	-
DAP related to 2D, mGy·cm²	10,222 ± 93,306 (1173–63,331)	2294 ± 2524 (344–13,298)	<0.001
Overall effective dose, mSv	11.47 ± 7.32 (2.92–33.59)	1.14 ± 0.67 (0.42–4.08)	<0.001
Effective dose per level, mSv	9.83 ± 6.94 (1.82–33.59)	0.88 ± 0.47 (0.24–2.82)	<0.001
Effective dose related to 2D, mSv	2.24 ± 1.80 (0.10–7.32)	0.47 ± 0.41 (0.12–2.57)	<0.001
Effective dose related to 3D, mSv	9.22 ± 6.78 (1.31–32.33)	0.67 ± 0.37 (0.22–2.18)	<0.001
Effective dose per 3D acquisition, mSv	5.84 ± 3.12 (1.31–12.56)	0.60 ± 0.27 (0.22–1.33)	<0.001
Effective dose related to 2D calculated with w ^{^b}, mSv	2.39 ± 2.19 (0.22–14.25)	0.57 ± 0.66 (0.07–3.46)	<0.001
Absolute risk of radiation-induced cancer equivalent to a whole-body exposure, %	4.9 × 10⁻⁴ ± 3.5 × 10⁻⁴ (9.1 × 10⁻⁵ − 1.7 × 10⁻³)	5.7 × 10⁻⁵ ± 3.4 × 10⁻⁵ (2.2 × 10⁻⁵ − 2.0 × 10⁻⁴)	<0.001

Abbreviations: 2D, 2-dimensional; 3D, 3-dimensional; DAP, dose-area product; E, effective dose.
Note: Results are expressed as mean ± SD (range) in their respective units.
↵a Student t test.
↵b w is the conversion factor used to calculate the effective dose from the DAP: 0.19 for thoracic and 0.26 mSv/Gy·cm² for lumbar spine.17

Table 4

Correlation of the effective dose and surgeon level with other parameters for the 2 groups.

Variable Comparison	O-arm Group (n = 62) P Value	Surgivisio Group (n = 61) P Value
			Effective dose and age^{^a}	0.02	0.79
			Effective dose and body mass index^{^a}	0.07	0.16
Effective dose and operative time^{^a}	0.3	<0.001
Effective dose and imaging duration^{^a}	<0.001	0.45
Effective dose and surgeon level^{^b}	0.28	0.17
Surgeon level and operative time^{^b}	0.73	0.12