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Assessing intraoperative pedicle screw placement accuracy using biplanar radiographs compared to three-dimensional imaging – Lumbar Fusion

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This article discusses the use of biplanar imaging (2D) and three-dimensional (3D) imaging for assessing the position of pedicle screws in spinal surgery. The study retrospectively reviewed data from 204 patients who underwent instrumented fusion surgery. Among the patients, 91.6% had intraoperative images available for analysis. The results showed that postoperative CT scans and intraoperative 3D scans were consistent in assessing pedicle screw breach, indicating that 3D imaging was accurate. On the other hand, the M-line method used in 2D imaging falsely verified some screws, which were confirmed as inaccurate on 3D imaging. The study suggests that an intraoperative post-instrumentation 3D scan may be preferable to prevent the postoperative detection of falsely verified screws on biplanar imaging

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : best situated spine hospital on Harley Street UK

Published article

To date, biplanar imaging (2D) has been the method of choice for pedicle screw (PS) positioning and verified for the anteroposterior view and (spinal midline) M-line method. In recent years, the use of intraoperative three-dimensional (3D) imaging has become available with the Gertzbein-Robbins system (GRS) to assess PS breach and positioning confirmation. The aim is to determine if 2D imaging is sufficient to assess PS position in comparison to advanced 3D imaging.Retrospective review of…

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J Robot Surg. 2024 Feb 8;18(1):68. doi: 10.1007/s11701-023-01760-2.ABSTRACTTo date, biplanar imaging (2D) has been the method of choice for pedicle screw (PS) positioning and verified for the anteroposterior view and (spinal midline) M-line method. In recent years, the use of intraoperative three-dimensional (3D) imaging has become available with the Gertzbein-Robbins system (GRS) to assess PS,

J Robot Surg. 2024 Feb 8;18(1):68. doi: 10.1007/s11701-023-01760-2.

ABSTRACT

To date, biplanar imaging (2D) has been the method of choice for pedicle screw (PS) positioning and verified for the anteroposterior view and (spinal midline) M-line method. In recent years, the use of intraoperative three-dimensional (3D) imaging has become available with the Gertzbein-Robbins system (GRS) to assess PS breach and positioning confirmation. The aim is to determine if 2D imaging is sufficient to assess PS position in comparison to advanced 3D imaging.Retrospective review of prospectively collected data from 204 consecutive adult patients who underwent posterior thoracic and lumbar instrumented fusion for degenerative spinal surgery by a single surgeon (2019-2022).Of the 204 patients, 187 (91.6%) had intraoperative images available for analysis. A total of 1044 PS implants were used; 922 (88.3%) were robotically placed. Postoperative CT scans were verified with M-line/GRS findings. Among 103 patients (50.5%) with a total of 362 screws, (34.7%) had postoperative CT, intraoperative 3D scan, and intraoperative 2D scan for analysis. Postoperative CT findings were consistent with all GRS findings, validating that 3D imaging was accurate. Screws (1%) were falsely verified by the M-line as 3D imaging confirmed false negative or positive findings.In our series, intraoperative 3D scan was as accurate as postoperative CT scan in assessing PS breach. A significant number of PS may be falsely read as accurate on 2D imaging, that is in fact inaccurate when assessed on 3D imaging. An intraoperative post-instrumentation 3D scan may be preferable to prevent postoperative recognition of a falsely verified screw on biplanar imaging.

PMID:38329623 | DOI:10.1007/s11701-023-01760-2

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Assessing intraoperative pedicle screw placement accuracy using biplanar radiographs compared to three-dimensional imaging

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J Robot Surg. 2024 Feb 8;18(1):68. doi: 10.1007/s11701-023-01760-2.ABSTRACTTo date, biplanar imaging (2D) has been the method of choice for pedicle screw (PS) positioning and verified for the anteroposterior view and (spinal midline) M-line method. In recent years, the use of intraoperative three-dimensional (3D) imaging has become available with the Gertzbein-Robbins system (GRS) to assess PS

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