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An intraoperative fluoroscopic method to accurately measure the post-implantation position of pedicle screws

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Pedicle screw malplacement, leading to neurological symptoms, vascular injury, and premature implant loosening, is not uncommon and difficult to reliably detect intraoperatively with current techniques. We propose a new intraoperative post-placement pedicle screw position assessment system that can therefore allow surgeons to correct breaches during the procedure. Our objectives were to assess the accuracy and robustness of this proposed screw location system and to compare its performance to that of 2D planar radiography.

Methods

The proposed system uses two intraoperative X-ray shots acquired with a standard fluoroscopic C-arm and processed using 2D/3D registration methods to provide a 3D visualization of the vertebra and screw superimposed on one another. Point digitization and CT imaging of the residual screw tunnel were used to assess accuracy in five synthetic lumbar vertebral models (10 screws in total). Additionally, the accuracy was evaluated with and without correcting for image distortion and for various screw lengths, screw materials, breach directions, and vertebral levels.

Results

The proposed method is capable of localizing the implanted screws with less than 2 mm of translational error (RMSE: 0.7 and 0.8 mm for the screw head and tip, respectively) and less than \(2.3^{\circ }\) angular error (RMSE: \(1.3^{\circ }\)), with minimal change to the errors if image distortion is not corrected. Breaches and their anatomical locations were all correctly visualized and identified for a variety of screw lengths, screw materials, breach locations, and vertebral levels, demonstrating the robustness of this approach. In contrast, one breach, one non-breach, and the anatomical location of three screws were misclassified with 2D X-ray.

Conclusion

We have demonstrated an accurate and low-radiation technique for localizing pedicle screws post-implantation that requires only two X-rays. This intraoperative feedback of screw location and direction may allow the surgeon to correct malplaced screws intraoperatively, thereby reducing postoperative complications and reoperation rates.

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Funding

This project was supported by the Collaborative Health Research Projects (CHRP) program and the Engineers in Scrubs CREATE program, and funded by the Natural Sciences and Engineering Research Council of Canada (NSERC, Grant #CHRPJ 462233-2014) and the Canadian Institutes of Health Research (CIHR, Grant #MOP-134758).

Author information

Authors and Affiliations

  1. Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada

    Robyn Newell, Hooman Esfandiari & Antony J Hodgson

  2. Department of Mechanical Engineering, University of British Columbia, 2054-6250 Applied Science Lane, Vancouver, BC, V6T 1Z4, Canada

    Robyn Newell, Hooman Esfandiari, Renee Bernard & Antony J Hodgson

  3. McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada

    Carolyn Anglin

  4. Department of Civil Engineering, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada

    Carolyn Anglin

  5. Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, BC, Canada

    John Street

  6. International Collaboration on Repair Discoveries, University of British Columbia, Blusson Spinal Cord Center, Floor 6-818 10 Ave W, Vancouver, BC, V5Z 1M9, Canada

    John Street

  7. Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada

    John Street

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  1. Robyn Newell
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Correspondence to Robyn Newell.

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Newell, R., Esfandiari, H., Anglin, C. et al. An intraoperative fluoroscopic method to accurately measure the post-implantation position of pedicle screws. Int J CARS 13, 1257–1267 (2018). https://doi.org/10.1007/s11548-018-1732-8

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  • DOI: https://doi.org/10.1007/s11548-018-1732-8

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