Comparison of pedicle screw placement accuracy between two types of imaging support (Artis Zeego versus two-dimensional fluoroscopy): a cross-sectional observational study.
2D X-ray fluoroscopy
Artis Zeego
Cone-beam computed tomography
Pedicle screw system
Spine surgery
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
05 Jul 2022
05 Jul 2022
Historique:
received:
19
04
2022
accepted:
28
06
2022
entrez:
5
7
2022
pubmed:
6
7
2022
medline:
8
7
2022
Statut:
epublish
Résumé
The pedicle screw system is widely used in spine surgery, and it provides rigid fixation and leads to successful subsequent deformity correction and bony fusion. The standard imaging technique for pedicle screw insertion is two-dimensional images obtained from C-arm-type X-ray fluoroscopy. Artis Zeego is an emerging intraoperative imaging technique that can provide conventional two-dimensional fluoroscopic images and rapid three-dimensional fluoroscopic computed tomography reconstruction imaging. The aim of this study is to compare the insertion accuracies of PS placement using Artis Zeego and conventional 2D X-ray fluoroscopy. In this study, we retrospectively reviewed the postoperative images of thoracolumbar fusion patients who underwent surgery using pedicle screws between 2013 and 2018. Pedicle screw malplacement was assessed using a four-grade classification by Rao et al. Misplacement rates were compared between pedicle screws assisted with Artis Zeego and two-dimensional fluoroscopy. A total of 1107 pedicle screws in 153 patients were inserted using Artis Zeego, and 427 pedicle screws in 80 patients were inserted using fluoroscopy. The overall perforation rate was 4.2% (46 perforations of 1106 pedicle screws) in the Artis Zeego group and 7.7% (33 perforations of 427 pedicle screws) in the fluoroscopy group. In the Artis Zeego group, 43 (3.9%) screws were classified as grade 1, and three (0.3%) screws were classified as grade 2. In the fluoroscopy group, 21 (4.9%) screws were classified as grade 1, 10 (2.3%) screws were classified as grade 2, and 2 (0.5%) screws were classified as grade 3. The use of Artis Zeego was associated with a significantly lower screw malplacement rate than was the use of fluoroscopy (p < 0.001). Our results demonstrated that pedicle screw placement with Artis Zeego was associated with a lower malplacement rate than was conventional two-dimensional fluoroscopy. No severe malplacement was observed in the Artis Zeego group. Thus, Artis Zeego could be a good option for improving pedicle screw accuracy.
Sections du résumé
BACKGROUND
BACKGROUND
The pedicle screw system is widely used in spine surgery, and it provides rigid fixation and leads to successful subsequent deformity correction and bony fusion. The standard imaging technique for pedicle screw insertion is two-dimensional images obtained from C-arm-type X-ray fluoroscopy. Artis Zeego is an emerging intraoperative imaging technique that can provide conventional two-dimensional fluoroscopic images and rapid three-dimensional fluoroscopic computed tomography reconstruction imaging. The aim of this study is to compare the insertion accuracies of PS placement using Artis Zeego and conventional 2D X-ray fluoroscopy.
METHODS
METHODS
In this study, we retrospectively reviewed the postoperative images of thoracolumbar fusion patients who underwent surgery using pedicle screws between 2013 and 2018. Pedicle screw malplacement was assessed using a four-grade classification by Rao et al. Misplacement rates were compared between pedicle screws assisted with Artis Zeego and two-dimensional fluoroscopy.
RESULTS
RESULTS
A total of 1107 pedicle screws in 153 patients were inserted using Artis Zeego, and 427 pedicle screws in 80 patients were inserted using fluoroscopy. The overall perforation rate was 4.2% (46 perforations of 1106 pedicle screws) in the Artis Zeego group and 7.7% (33 perforations of 427 pedicle screws) in the fluoroscopy group. In the Artis Zeego group, 43 (3.9%) screws were classified as grade 1, and three (0.3%) screws were classified as grade 2. In the fluoroscopy group, 21 (4.9%) screws were classified as grade 1, 10 (2.3%) screws were classified as grade 2, and 2 (0.5%) screws were classified as grade 3. The use of Artis Zeego was associated with a significantly lower screw malplacement rate than was the use of fluoroscopy (p < 0.001).
CONCLUSIONS
CONCLUSIONS
Our results demonstrated that pedicle screw placement with Artis Zeego was associated with a lower malplacement rate than was conventional two-dimensional fluoroscopy. No severe malplacement was observed in the Artis Zeego group. Thus, Artis Zeego could be a good option for improving pedicle screw accuracy.
Identifiants
pubmed: 35790951
doi: 10.1186/s12891-022-05602-4
pii: 10.1186/s12891-022-05602-4
pmc: PMC9254419
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
644Informations de copyright
© 2022. The Author(s).
Références
Acta Neurochir (Wien). 2003 Nov;145(11):949-54; discussion 954-5
pubmed: 14628199
Eur Spine J. 2017 Nov;26(11):2906-2916
pubmed: 28528479
Heart Lung Circ. 2016 Jul;25(7):668-75
pubmed: 26906283
Eur Spine J. 2012 Feb;21(2):247-55
pubmed: 21901328
J Korean Neurosurg Soc. 2020 Nov;63(6):777-783
pubmed: 33181866
Spine (Phila Pa 1976). 1996 Jun 1;21(11):1296-300
pubmed: 8725919
Oper Neurosurg (Hagerstown). 2018 Mar 1;14(3):273-278
pubmed: 28973631
Int Orthop. 2020 May;44(5):919-926
pubmed: 31912228
J Neurosurg Spine. 2014 Feb;20(2):196-203
pubmed: 24358998
Med Phys. 2001 Jun;28(6):1042-55
pubmed: 11439474
Spine (Phila Pa 1976). 2015 Sep 1;40(17):E954-63
pubmed: 25929207
Orthop Traumatol Surg Res. 2020 Feb;106(1S):S19-S25
pubmed: 31734181
Spine (Phila Pa 1976). 1995 Apr 15;20(8):936-40
pubmed: 7644959
J Spinal Disord Tech. 2015 Jul;28(6):E347-51
pubmed: 23563342
J Bone Joint Surg Am. 1999 Nov;81(11):1519-28
pubmed: 10565643
Spine (Phila Pa 1976). 2010 May 1;35(10):E378-84
pubmed: 20431473
J Neurosurg Spine. 2018 Oct;29(4):397-406
pubmed: 29979141
Spine (Phila Pa 1976). 2009 Oct 1;34(21):E761-5
pubmed: 19934796
J Neurosurg Spine. 2014 Sep;21(3):320-8
pubmed: 24926927
Spine (Phila Pa 1976). 1996 Jun 1;21(11):1320-4
pubmed: 8725923
Spine (Phila Pa 1976). 2007 Feb 1;32(3):E111-20
pubmed: 17268254
Spine (Phila Pa 1976). 1990 Jan;15(1):11-4
pubmed: 2326693
Bone Joint J. 2015 Aug;97-B(8):1111-7
pubmed: 26224830
J Neurosurg Spine. 2010 Mar;12(3):306-13
pubmed: 20192632
J Bone Joint Surg Am. 2000 Oct;82(10):1458-76
pubmed: 11057475
J Neurosurg. 2002 Sep;97(2 Suppl):223-6
pubmed: 12296683