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Spinal navigation for minimally invasive thoracic and lumbosacral spine fixation: implications for radiation exposure, operative time, and accuracy of pedicle screw placement

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Abstract

Purpose

Navigation is emerging as a useful adjunct in percutaneous, minimally invasive spinal surgery (MIS). The aim of this study was to compare C-Arm navigated, O-Arm navigated and conventional 2D-fluoroscopy assisted MIS thoracic and lumbosacral spine fixation techniques in terms of operating time, radiation exposure and accuracy of pedicle screw (PS) placement.

Methods

Retrospective observational study of 152 consecutive adults who underwent MIS fixations for spinal instability: 96 2D-fluoroscopy assisted, 39 3D-C-Arm navigated and 27 using O-Arm navigated.

Results

O-Arm navigation significantly reduced PS misplacement (1.23%, p) compared to 3D-C-Arm navigation (7.29%, p = 0.0082) and 2D-fluoro guided placement (5.16%, p = 0379). 3D-C-Arm navigation was associated with lower procedural radiation exposure of the patient (0.4 mSv) than O-Arm navigation (3.24 mSv) or 2D-fluoro guidance (1.5 mSv). Operative time was comparable between three modalities.

Conclusions

O-Arm navigation provides greater accuracy of percutaneous instrumentation placement with an acceptable procedural radiation dose delivered to the patients and comparable operative times.

Graphical abstract

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Authors and Affiliations

  1. Division of Neurosurgery, Cambridge University Hospital’s NHS Foundation Trust, Hills Road, Box 167, Cambridge, CB2 0QQ, UK

    T. Tajsic, K. Patel, R. J. Mannion & R. A. Trivedi

  2. Department of Radiology, Cambridge University Hospital’s NHS Foundation Trust, Cambridge, UK

    R. Farmer

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  1. T. Tajsic
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  2. K. Patel
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  3. R. Farmer
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  4. R. J. Mannion
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Correspondence to T. Tajsic.

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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Tajsic, T., Patel, K., Farmer, R. et al. Spinal navigation for minimally invasive thoracic and lumbosacral spine fixation: implications for radiation exposure, operative time, and accuracy of pedicle screw placement. Eur Spine J 27, 1918–1924 (2018). https://doi.org/10.1007/s00586-018-5587-z

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  • DOI: https://doi.org/10.1007/s00586-018-5587-z

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