Radiation Exposure Analysis on 274 Patients With Vertebral Augmentation Using the Surgivisio Intraoperative Navigation System

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
Figure 1
Depiction of the Surgivisio surgical platform. Left: Unified platform composed of a C-arm, a navigation station, and an infrared camera. Right: Surgivisio disposable instruments (from top to bottom): imaging phantom, patient tracker, and navigated trocar.
Download figure
Open in new tab
Download powerpoint
Figure 2
SpineJack is a titanium implant designed to restore the anatomical height of the vertebral body. It is inserted into the vertebral body and positioned in a craniocaudal orientation (from left to right): SpineJack before expansion, SpineJack after expansion, and SpineJack with cement injected into the vertebra.
Download figure
Open in new tab
Download powerpoint
Figure 3
Presentation of the surgical platform setup and instrumentation. (A) Placement of the patient reference using 3 metal pins. (B) Imaging phantom magnetically fixed to the patient reference; the lasers are used to correctly center the C-arm. (C) Surgivisio C-arm during the image acquisition process. (D) Navigation of the trocar after placing the patient tracker on the reference.

Table 1

Patient and surgical characteristics.

Characteristic	Vertebroplasty (n = 252)	SpineJack (n = 22)	P
Age, y, median (IQR)	75 (62.5–82)	53 (48–61.5)	<0.001
Sex, n (%)
Men	90 (35.8%)	14 (61.9%)	0.012
Women	162 (64.2%)	8 (38.1%)
BMI, median (IQR)	24.1 (22–27.5)	21.7 (20.7–23.4)	0.03
Regions treated, n
Thoracic	127	9	0.59
Lumbar	120	13
Sacroiliac	5	0
No. of levels treated, n
1	161	22	0.005
2	54	0
3	20	0
≥4	17	0
Mean No. of treated vertebrae, median (IQR)	1 (1–2)	1 (1–1)	0.001

Table 2

Radiation exposure and operative time comparisons between vertebroplasty and SpineJack.

Outcome Measure	Vertebroplasty	SpineJack	P
DAP, Gy.cm²
Total	3.47 (2.70–5.73)	3.80 (2.83–4.62)	0.83
3D	1.90 (1.5–3)	2.05 (1.60–3.10)	0.90
2D	1.30 (0.9–2.2)	1.44 (1.13–1.90)	0.68
3D contribution to DAP, %	56.30	53.70
DAP per treated vertebra, Gy.cm²	2.90 (1.90–4.37)	3.80 (2.83–4.62)	0.03
Dose, mSv	0.81 (0.57–1.30)	0.80 (0.69–1.12)	0.81
Dose per treated vertebra, mSv	0.65 (0.41–1.04)	0.80 (0.69–1.12)	0.049
Operative time, min	30 (23–41.25)	33 (28–38.5)	0.67

Abbreviations: 2D, 2-dimensional; 3D, 3-dimensional; DAP, dose-area product.
Note: Data presented as median (interquartile range) unless otherwise specified. Boldface indicates statistically significant findings at P < 0.05.

Table 3

Subgroup analysis results based on the number of 3D acquisitions.

Image and Dose measurements	Procedures With ≤1 3D Acquisition	Procedures With >1 3D Acquisition	P
No. of procedures	239	35
No. of vertebrae per 3D image	1.45 (343–237)	0.99 (73–74)
Median No. of 3D image	1 (1–1)	2 (2–2)	<0.001
DAP per vertebra, Gy.cm²	2.8 (1.9–3.9)	6.05 (2.71–9.8)	<0.001
Dose per vertebra, mSv	0.65 (0.42–0.96)	1.57 (0.54–1.92)	<0.001

Abbreviations: 3D, 3-dimensional; DAP, dose-area product.
Note: Data are presented as median (interquartile range) unless otherwise specified. Boldface indicates statistically significant findings at P < 0.05.

Table 4

Survey question results.

Survey Item	Total No. of Answers	No. of Respondent Surgeons	No. of Positive Ratings (4/5 and 5/5)	Satisfaction Rate, %
2D image quality	24	7	22	95.8
3D image quality	24	7	23	95.8
Ease of use	40	8	34	85.0
Full experience with Surgivisio	24	7	23	95.8