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This study explored the combined use of the O-arm and real-time navigation during spinal fixation. The clinical data for 60 patients undergoing spinal fixation, at Beijing Tsinghua Chang Gung Hospital between May 5, 2015 and May 1, 2017, were retrospectively analyzed. Pre-, intra-, and postoperative imaging findings were assessed. The patients were classified into the occipitocervical fusion (32 cases) and thoracic/lumbar/sacral spine fixation (28 cases, including 6 cases of percutaneous pedicle screw) groups. Lesion resections were performed microscopically. An O-arm, combined with real-time navigation, was used to assess spinal fixation. Efficacy was evaluated using operative times, X-ray times, screw positioning, and complications. Within the occipitocervical fusion group, 182 screws were placed in the cervical spine and 96 in the occipital bone. However, 6 screws penetrated the bone cortex and were adjacent to the vertebral arteries, based on O-arm three-dimensional imaging; therefore, the precision rate was 96.7%. Within the thoracic/lumbar/sacral spine fixation group, 148 pedicle screws were implanted, with 4 initially outside the vertebral body, yielding a precision rate of 97.3%. Ten percutaneous pedicle screws were implanted and well positioned. O-arm scans were performed 3 times/patient, with an average of 20–30 min/time. Screw implantation times were 5–7 min (cervical spine), 8–10 min (thoracic spine), and 6–8 min (lumbar spine). Intraoperative O-arm scans, combined with real-time navigation technology, allow real-time observation of screw angles and depths, improving the accuracy and safety of posterior screw fixations and reducing the radiation dose and frequency experienced by patients and surgeons.


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Application of intraoperative O-arm-assisted real-time navigation technique for spinal fixation

Show Author's information Zhenxing Sun1Dan Yuan2Yaxing Sun3Zhanquan Zhang4Guihuai Wang1Yi Guo1Guoqin Wang1Dongkang Liu1Peng Chen1Linkai Jing1Feng Yang1Peihai Zhang1Huifang Zhang1Youtu Wu1Wei Shi1James Wang1( )
Department of Neurosurgery, Changgung Hospital, Medical Center, Tsinghua University, Beijing 102218, China
Department of Nephrology, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China
Department of Psychiatry, Zaozhuang Mental Health Center, Zaozhuang 277103, China
Department of Neurosurgery, The Fifth People’s Hospital of Datong, Regional Medical Center Of Shanxi Province, Datong 037006, China

Abstract

This study explored the combined use of the O-arm and real-time navigation during spinal fixation. The clinical data for 60 patients undergoing spinal fixation, at Beijing Tsinghua Chang Gung Hospital between May 5, 2015 and May 1, 2017, were retrospectively analyzed. Pre-, intra-, and postoperative imaging findings were assessed. The patients were classified into the occipitocervical fusion (32 cases) and thoracic/lumbar/sacral spine fixation (28 cases, including 6 cases of percutaneous pedicle screw) groups. Lesion resections were performed microscopically. An O-arm, combined with real-time navigation, was used to assess spinal fixation. Efficacy was evaluated using operative times, X-ray times, screw positioning, and complications. Within the occipitocervical fusion group, 182 screws were placed in the cervical spine and 96 in the occipital bone. However, 6 screws penetrated the bone cortex and were adjacent to the vertebral arteries, based on O-arm three-dimensional imaging; therefore, the precision rate was 96.7%. Within the thoracic/lumbar/sacral spine fixation group, 148 pedicle screws were implanted, with 4 initially outside the vertebral body, yielding a precision rate of 97.3%. Ten percutaneous pedicle screws were implanted and well positioned. O-arm scans were performed 3 times/patient, with an average of 20–30 min/time. Screw implantation times were 5–7 min (cervical spine), 8–10 min (thoracic spine), and 6–8 min (lumbar spine). Intraoperative O-arm scans, combined with real-time navigation technology, allow real-time observation of screw angles and depths, improving the accuracy and safety of posterior screw fixations and reducing the radiation dose and frequency experienced by patients and surgeons.

Keywords: navigation, application, O-arm, spinal fixation

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Publication history

Received: 06 June 2017
Revised: 10 July 2017
Accepted: 17 July 2017
Published: 01 September 2017
Issue date: September 2017

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© The authors 2017.

Acknowledgements

This project was supported by the Beijing Tsinghua Changgung Hospital Fund (No. 12015C1045). The authors thank Peihai Zhang and Linkai Jing for collecting the archived data and Guihuai Wang and Jin Wang for technical help.

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