TY - JOUR
T1 - Electromagnetic navigation for percutaneous guide-wire insertion
T2 - Accuracy and efficiency compared to conventional fluoroscopic guidance
AU - von Jako, R. A.
AU - Carrino, J. A.
AU - Yonemura, K. S.
AU - Noda, G. A.
AU - Zhue, W.
AU - Blaskiewicz, D.
AU - Rajue, M.
AU - Groszmann, D. E.
AU - Weber, G.
PY - 2009/8
Y1 - 2009/8
N2 - The combination of electromagnetic (EM) navigation with intraoperative fluoroscopic images has the potential to create the ideal environment for spinal surgical applications. This technology enhances standard intraoperative fluoroscopic information for localization of the pedicle entry point and trajectory and may be an effective alternative to other image-guided surgery (IGS) systems. This study was performed to assess the accuracy and time efficiency (placement and fluoroscopy) using EM navigation versus conventional fluoroscopy in the placement of pedicle guide-wires. Kirschner wire (K-wire) placement was performed in cadavers from T8 to S1 using EM navigation versus conventional fluoroscopy. Time for set-up, placement, and fluoroscopy was recorded. After insertion, the accuracy for each level was assessed for the presence and location of facet joint, pedicle, or vertebral cortical perforation using computed tomography imaging with multiplanar reconstructions. K-wire placements were 100% successful for both methods. Comparing EM-based IGS-assisted placement with the conventional fluoroscopy method showed a longer set-up time of 9.6 min versus 3.6 min, respectively. However, mean placement times of 6.3 min versus 9.7 min (P = 0.005) and mean fluoroscopy times of 11 s versus 48 s (P < 0.0001) were both shorter for the EM group. There were no significant differences in the proportion of pedicle, vertebral body, or facet joint breaches. A higher proportion of ideal trajectories was achieved in the EM group. Therefore, we have shown that an EM IGS system can assist the spine surgeon in minimally invasive pedicle screw insertion by providing high-accuracy K-wire placement with a significant reduction in fluoroscopy time.
AB - The combination of electromagnetic (EM) navigation with intraoperative fluoroscopic images has the potential to create the ideal environment for spinal surgical applications. This technology enhances standard intraoperative fluoroscopic information for localization of the pedicle entry point and trajectory and may be an effective alternative to other image-guided surgery (IGS) systems. This study was performed to assess the accuracy and time efficiency (placement and fluoroscopy) using EM navigation versus conventional fluoroscopy in the placement of pedicle guide-wires. Kirschner wire (K-wire) placement was performed in cadavers from T8 to S1 using EM navigation versus conventional fluoroscopy. Time for set-up, placement, and fluoroscopy was recorded. After insertion, the accuracy for each level was assessed for the presence and location of facet joint, pedicle, or vertebral cortical perforation using computed tomography imaging with multiplanar reconstructions. K-wire placements were 100% successful for both methods. Comparing EM-based IGS-assisted placement with the conventional fluoroscopy method showed a longer set-up time of 9.6 min versus 3.6 min, respectively. However, mean placement times of 6.3 min versus 9.7 min (P = 0.005) and mean fluoroscopy times of 11 s versus 48 s (P < 0.0001) were both shorter for the EM group. There were no significant differences in the proportion of pedicle, vertebral body, or facet joint breaches. A higher proportion of ideal trajectories was achieved in the EM group. Therefore, we have shown that an EM IGS system can assist the spine surgeon in minimally invasive pedicle screw insertion by providing high-accuracy K-wire placement with a significant reduction in fluoroscopy time.
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U2 - 10.1016/j.neuroimage.2009.05.002
DO - 10.1016/j.neuroimage.2009.05.002
M3 - Article
C2 - 19427905
AN - SCOPUS:67651163423
SN - 1053-8119
VL - 47
SP - T127-T132
JO - NeuroImage
JF - NeuroImage
IS - SUPPL. 2
ER -