Articles: 3d-fluoroscopy.
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Intraoperative 3D fluoroscopy (3DRX) is increasingly used in fracture management instead of conventional fluoroscopy (RX), but its effect on the treatment and outcome of tibial plateau fractures (TFs) is not well known. This study aims to evaluate whether the use of 3DRX in the treatment of tibial plateau fractures reduces the number of revision surgeries. ⋯ Implementing 3DRX in treating TFs improves the assessment of fracture alignment and implant position perioperatively, resulting in more intraoperative corrections and no revision surgeries within 6 weeks postoperatively. However, using 3DRX significantly increases perioperative radiation exposure and surgery duration without a significant rise in postoperative infections and a shorter hospital length of stay.
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The cervical pedicle screw (CPS) requires careful and accurate placement because of the critical risk for neurovascular injury. This study aimed to introduce and evaluate the safety and efficacy of a new CPS placement technique using intraoperative C-arm cone-beam CT (CBCT) and a pilot screw without navigation system. ⋯ The novel technique enables intraoperative adjustment of the trajectory of the CPS as well as confirmation of the CPS path before penetrating the isthmus of the pedicle, resulting in accurate and safe CPS placement, which outweighs the demerits of radiation exposure. These slides can be retrieved under Electronic Supplementary Material.
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Observational Study
Spinal navigation for minimally invasive thoracic and lumbosacral spine fixation: implications for radiation exposure, operative time, and accuracy of pedicle screw placement.
Navigation is emerging as a useful adjunct in percutaneous, minimally invasive spinal surgery (MIS). The aim of this study was to compare C-Arm navigated, O-Arm navigated and conventional 2D-fluoroscopy assisted MIS thoracic and lumbosacral spine fixation techniques in terms of operating time, radiation exposure and accuracy of pedicle screw (PS) placement. ⋯ O-Arm navigation provides greater accuracy of percutaneous instrumentation placement with an acceptable procedural radiation dose delivered to the patients and comparable operative times. These slides can be retrieved under Electronic Supplementary material.
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Minimally invasive spine surgery is associated with obstructed visibility of anatomic landmarks and increased radiation exposure, leading to higher incidence of pedicle screw mispositioning. To address these drawbacks, intraoperative 3-dimensional fluoroscopy (io3DF) and navigation are being increasingly used. We aimed to present our dedicated multifunctional hybrid operating room (HyOR) setup and evaluate the accuracy and safety of io3DF image-guided spinal navigation in transforaminal lumbar interbody fusion with percutaneous pedicle screw (PPS) placement. ⋯ Spine navigation based on io3DF images enabled us to avoid radiation exposure to the operating room team while delivering minimal but sufficient radiation doses to our patients. This approach achieved an accuracy rate of 99.6% for PPS placement in the safe zone, without significant complications.
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Percutaneous iliosacral screw insertion requires substantial experience and detailed anatomical knowledge to find the proper entry point and trajectory even with the use of a navigation system. Our hypothesis was that three-dimensional (3D) fluoroscopic navigation combined with a preoperative computed tomography (CT)-based plan could enable surgeons to perform safe and reliable iliosacral screw insertion. The purpose of the current study is two-fold: (1) to demonstrate the navigation accuracy for sacral fractures and sacroiliac dislocations on widely displaced cadaveric pelves; and (2) to report the technical and clinical aspects of percutaneous iliosacral screw insertion using the CT-3D-fluoroscopy matching navigation system. ⋯ The CT-3D-fluoroscopy matching navigation system was accurate and robust regardless of pelvic ring fracture type and fragment displacement. Percutaneous iliosacral screw insertion with the navigation system is clinically feasible.