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Integrating navigation assistance for redirecting freehanded spinal instrumentation: experience and technique – Lumbar Fusion

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The article retrospectively reviewed all spinal fusions involving the thoracolumbar and/or sacroiliac at a single institution, performed by a single surgeon over a period of time. The study focused on misdirected screws identified on intraoperative CT scans and the use of navigation to redirect them. The mA threshold to trigger an EMG response for all redirected screws was examined. A total of 50 redirected screws were identified, and their new trajectories were confirmed satisfactory through independent review. Four screws could not be verified by post-operative imaging, but no patients experienced post-operative deficits. The study concluded that redirection of misdirected screws using intraoperative CT and navigation is a viable method to ensure appropriate screw placement

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : innovative spinal clinic on Harley Street UK

Published article

Retrospective review of all spinal fusions > 3 levels involving the thoracolumbar and/or sacroiliac at a single institution, by a single surgeon between 3/12/2020 and 8/13/2021 were reviewed. All screws that were secondarily navigated after identified as misdirected on intraoperative CT scan were included. Neuromonitoring reports were culled for mA threshold to triggered EMG response for all redirected screws. Intraoperative, post-de novo screw placement images (fluoroscopy scout and…

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J Robot Surg. 2023 Sep 4. doi: 10.1007/s11701-023-01686-9. Online ahead of print.ABSTRACTRetrospective review of all spinal fusions > 3 levels involving the thoracolumbar and/or sacroiliac at a single institution, by a single surgeon between 3/12/2020 and 8/13/2021 were reviewed. All screws that were secondarily navigated after identified as misdirected on intraoperative CT scan were included.,

J Robot Surg. 2023 Sep 4. doi: 10.1007/s11701-023-01686-9. Online ahead of print.

ABSTRACT

Retrospective review of all spinal fusions > 3 levels involving the thoracolumbar and/or sacroiliac at a single institution, by a single surgeon between 3/12/2020 and 8/13/2021 were reviewed. All screws that were secondarily navigated after identified as misdirected on intraoperative CT scan were included. Neuromonitoring reports were culled for mA threshold to triggered EMG response for all redirected screws. Intraoperative, post-de novo screw placement images (fluoroscopy scout and intraoperative CT) and post-redirection intraoperative scoliosis films and post-operative scoliosis films were independently reviewed by a senior neuroradiologist. Fifty redirected screws in the thoracic, lumbar, sacral, and ilium were identified as misdirected and redirected via navigation. The new trajectory of all screws was confirmed satisfactory by independent review between a senior neuroradiologist and neurosurgeon. Four screws could not be verified by post-operative imaging (4/50, 8%). All triggered EMG stimulated > 15 mA. No screws required return to the operating room for revision. No patients experienced a post-operative deficit. Redirection of misdirected thoracolumbar and sacroiliac screws can be performed using intraoperative CT and navigation as a means to detect and directly visualize appropriate placement.

PMID:37665478 | DOI:10.1007/s11701-023-01686-9

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Integrating navigation assistance for redirecting freehanded spinal instrumentation: experience and technique

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J Robot Surg. 2023 Sep 4. doi: 10.1007/s11701-023-01686-9. Online ahead of print.ABSTRACTRetrospective review of all spinal fusions > 3 levels involving the thoracolumbar and/or sacroiliac at a single institution, by a single surgeon between 3/12/2020 and 8/13/2021 were reviewed. All screws that were secondarily navigated after identified as misdirected on intraoperative CT scan were included.

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