Comparison of screw placement guided by O-arm navigation and ultrasound volume navigation in minimally invasive transforaminal lumbar interbody fusion_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIN Xuxin ^1,2 , CHANG Qing ² , SHANG Lijie ² , SHEN Suhong ³ , FU Zhuo ³ , WANG Yifan ² , ZHOU Lufan ² , FU Hao ² ,  ZHAO Gang ²

1. Graduate School, Hunan University of Chinese Medicine, Changsha Hunan, 410208, P. R. China;
2. First Department of Minimally Invasive Spine, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471000, P. R. China;
3. Department of Functional Examination, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471000, P. R. China;

Corresponding?author：

ZHAO Gang, Email: 13663889866@163.com

Keywords：

Minimally invasive transforaminal lumbar interbody fusion; O-arm navigation; ultrasound volume navigation; screw placement

DOI：

10.7507/1002-1892.202308067

Video：

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Objective To compare the effectiveness of O-arm navigation and ultrasound volume navigation (UVN) in guiding screw placement during minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery. Methods Sixty patients who underwent MIS-TLIF surgery for lumbar disc herniation between June 2022 and June 2023 and met the selection criteria were included in the study. They were randomly assigned to group A (screw placement guided by UVN during MIS-TLIF) or group B (screw placement guided by O-arm navigation during MIS-TLIF), with 30 cases in each group. There was no significant difference in baseline data, including gender, age, body mass index, and surgical segment, between the two groups (P>0.05). Intraoperative data, including average single screw placement time, total radiation dose, and average single screw effective radiation dose, were recorded and calculated. Postoperatively, X-ray film and CT scans were performed at 10 days to evaluate screw placement accuracy and assess facet joint violation. Pearson correlation and Spearman correlation analyses were used to observe the relationship between the studied parameters (average single screw placement time and screw placement accuracy grading) and BMI. Results The average single screw placement time in group B was significantly shorter than that in group A, and the total radiation dose of single segment and multi-segment and the average single screw effective radiation dose in group B were significantly higher than those in group A (P<0.05). There was no significant difference in the total radiation dose between single segment and multiple segments in group B (P>0.05), while the total radiation dose of multiple segments was significantly higher than that of single segment in group A (P<0.05). No significant difference was found in the accuracy of screw implantation between the two groups (P>0.05). In both groups, the grade 1 and grade 2 screws broke through the outer wall of the pedicle, and no screw broke through the inner wall of the pedicle. There was no significant difference in the rate of facet joint violation between the two groups (P>0.05). In group A, both the average single screw placement time and screw placement accuracy grading were positively correlated with BMI (r=0.677, P<0.001; r=0.222, P=0.012), while in group B, neither of them was correlated with BMI (r=0.224, P=0.233; r=0.034, P=0.697). Conclusion UVN-guided screw placement in MIS-TLIF surgery demonstrates comparable efficiency, visualization, and accuracy to O-arm navigation, while significantly reducing radiation exposure. However, it may be influenced by factors such as obesity, which poses certain limitations.

Citation： LIN Xuxin, CHANG Qing, SHANG Lijie, SHEN Suhong, FU Zhuo, WANG Yifan, ZHOU Lufan, FU Hao, ZHAO Gang. Comparison of screw placement guided by O-arm navigation and ultrasound volume navigation in minimally invasive transforaminal lumbar interbody fusion. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(11): 1403-1409. doi: 10.7507/1002-1892.202308067 Copy

1.	Knezevic NN, Candido KD, Vlaeyen JWS, et al. Low back pain. Lancet, 2021, 398(10294): 78-92.
2.	Katz JN, Zimmerman ZE, Mass H, et al. Diagnosis and management of lumbar spinal stenosis: A review. JAMA, 2022, 327(17): 1688-1699.
3.	Zhao Y, Bo X, Wang C, et al. Guided punctures with ultrasound volume navigation in percutaneous transforaminal endoscopic discectomy: A technical note. World Neurosurg, 2018, 119: 77-84.
4.	Coric D, Rossi VJ, Peloza J, et al. Percutaneous, navigated minimally invasive posterior cervical pedicle screw fixation. Int J Spine Surg, 2020, 14(s3): S14-S21.
5.	Liu H, Wu J, Tang Y, et al. Percutaneous placement of lumbar pedicle screws via intraoperative CT image-based augmented reality-guided technology. J Neurosurg Spine, 2019, 20: 1-6.
6.	McCloskey K, Turlip R, Ahmad HS, et al. Virtual and augmented reality in spine surgery: A systematic review. World Neurosurg, 2023, 173: 96-107.
7.	Zhang M, Li J, Fang T, et al. Application of 3-dimensional printing guide template and pointed lotus-style regulator in percutaneous pedicle screw fixation for thoracolumbar fractures. Sci Rep, 2022, 12(1): 2930.
8.	曾柏方, 吳超, 李濤, 等. 3D打印皮外導板輔助微創椎弓根螺釘植入治療多節段胸腰椎骨折. 中國修復重建外科雜志, 2021, 35(6): 742-749.
9.	Lin S, Wang F, Hu J, et al. Comparison of the accuracy and safety of TiRobot-assisted and fluoroscopy-assisted percutaneous pedicle screw placement for the treatment of thoracolumbar fractures. Orthop Surg, 2022, 14(11): 2955-2963.
10.	Yang JS, He B, Tian F, et al. Accuracy of robot-assisted percutaneous pedicle screw placement for treatment of lumbar spondylolisthesis: A comparative cohort study. Med Sci Monit, 2019, 25: 2479-2487.
11.	Panchmatia JR, Vaccaro AR, Wang W, et al. Lumbar percutaneous pedicle screw breach rates: A comparison of robotic navigation platform versus conventional techniques. Clin Spine Surg, 2020, 33(4): E162-E167.
12.	Chang CC, Chang HK, Wu JC, et al. Comparison of radiation exposure between O-arm navigated and C-arm guided screw placement in minimally invasive transforaminal lumbar interbody fusion. World Neurosurg, 2020, 139: e489-e495.
13.	Kim HC, Jeong YH, Oh SH, et al. Single-position oblique lumbar interbody fusion and percutaneous pedicle screw fixation under O-arm navigation: A retrospective comparative study. J Clin Med, 2022, 12(1): 312.
14.	Li C, Li H, Su J, et al. Comparison of the accuracy of pedicle screw placement using a fluoroscopy-assisted free-hand technique with Robotic-assisted navigation using an O-arm or 3D C-arm in scoliosis surgery. Global Spine J, 2022.
15.	Feng W, Wang W, Chen S, et al. O-arm navigation versus C-arm guidance for pedicle screw placement in spine surgery: a systematic review and meta-analysis. Int Orthop, 2020, 44(5): 919-926.
16.	Ouchida J, Kanemura T, Satake K, et al. Simultaneous single-position lateral interbody fusion and percutaneous pedicle screw fixation using O-arm-based navigation reduces the occupancy time of the operating room. Eur Spine J, 2020, 29(6): 1277-1286.
17.	Liu YB, Wang Y, Chen ZQ, et al. Volume navigation with fusion of real-time ultrasound and CT images to guide posterolateral transforaminal puncture in percutaneous endoscopic lumbar discectomy. Pain Physician, 2018, 21(3): E265-E278.
18.	Shapey J, Dowrick T, Delaunay R, et al. Integrated multi-modality image-guided navigation for neurosurgery: open-source software platform using state-of-the-art clinical hardware. Int J Comput Assist Radiol Surg, 2021, 16(8): 1347-1356.
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21.	Zielinski AH, Bredahl KK, Ghulam QM, et al. Full-volume assessment of abdominal aortic aneurysm by improved-field-of-view 3-D ultrasound performs comparably to computed tomographic angiography. Ultrasound Med Biol, 2022, 48(2): 283-292.
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23.	Zhao Y, Yan N, Yu S, et al. Reduced radiation exposure and puncture time of percutaneous transpedicular puncture with real-time ultrasound volume navigation. World Neurosurg, 2018, 119: e997-e1005.
24.	Chan A, Parent E, Mahood J, et al. 3D ultrasound navigation system for screw insertion in posterior spine surgery: a phantom study. Int J Comput Assist Radiol Surg, 2022, 17(2): 271-281.
25.	Gueziri HE, Georgiopoulos M, Santaguida C, et al. Ultrasound-based navigated pedicle screw insertion without intraoperative radiation: feasibility study on porcine cadavers. Spine J, 2022, 22(8): 1408-1417.
26.	郭楚, 劉達, 吳文波, 等. 基于電磁定位的超聲圖像與CT圖像的融合方法. 中國生物醫學工程學報, 2018, 37(5): 529-536.
27.	杜心如, 葉啟彬, 趙玲秀, 等. 腰椎人字嵴頂點椎弓根螺釘進釘方法的解剖學研究. 中國臨床解剖學雜志, 2002, 20(2): 86-88.
28.	王天藝, 袁碩, 范寧, 等. 超聲與CT圖像融合技術及其在脊柱外科中的應用進展. 中國脊柱脊髓雜志, 2021, 31(1): 86-90.
29.	De Silva T, Uneri A, Zhang X, et al. Real-time, image-based slice-to-volume registration for ultrasound-guided spinal intervention. Phys Med Biol, 2018, 63(21): 215016.

1. Knezevic NN, Candido KD, Vlaeyen JWS, et al. Low back pain. Lancet, 2021, 398(10294): 78-92.
2. Katz JN, Zimmerman ZE, Mass H, et al. Diagnosis and management of lumbar spinal stenosis: A review. JAMA, 2022, 327(17): 1688-1699.
3. Zhao Y, Bo X, Wang C, et al. Guided punctures with ultrasound volume navigation in percutaneous transforaminal endoscopic discectomy: A technical note. World Neurosurg, 2018, 119: 77-84.
4. Coric D, Rossi VJ, Peloza J, et al. Percutaneous, navigated minimally invasive posterior cervical pedicle screw fixation. Int J Spine Surg, 2020, 14(s3): S14-S21.
5. Liu H, Wu J, Tang Y, et al. Percutaneous placement of lumbar pedicle screws via intraoperative CT image-based augmented reality-guided technology. J Neurosurg Spine, 2019, 20: 1-6.
6. McCloskey K, Turlip R, Ahmad HS, et al. Virtual and augmented reality in spine surgery: A systematic review. World Neurosurg, 2023, 173: 96-107.
7. Zhang M, Li J, Fang T, et al. Application of 3-dimensional printing guide template and pointed lotus-style regulator in percutaneous pedicle screw fixation for thoracolumbar fractures. Sci Rep, 2022, 12(1): 2930.
8. 曾柏方, 吳超, 李濤, 等. 3D打印皮外導板輔助微創椎弓根螺釘植入治療多節段胸腰椎骨折. 中國修復重建外科雜志, 2021, 35(6): 742-749.
9. Lin S, Wang F, Hu J, et al. Comparison of the accuracy and safety of TiRobot-assisted and fluoroscopy-assisted percutaneous pedicle screw placement for the treatment of thoracolumbar fractures. Orthop Surg, 2022, 14(11): 2955-2963.
10. Yang JS, He B, Tian F, et al. Accuracy of robot-assisted percutaneous pedicle screw placement for treatment of lumbar spondylolisthesis: A comparative cohort study. Med Sci Monit, 2019, 25: 2479-2487.
11. Panchmatia JR, Vaccaro AR, Wang W, et al. Lumbar percutaneous pedicle screw breach rates: A comparison of robotic navigation platform versus conventional techniques. Clin Spine Surg, 2020, 33(4): E162-E167.
12. Chang CC, Chang HK, Wu JC, et al. Comparison of radiation exposure between O-arm navigated and C-arm guided screw placement in minimally invasive transforaminal lumbar interbody fusion. World Neurosurg, 2020, 139: e489-e495.
13. Kim HC, Jeong YH, Oh SH, et al. Single-position oblique lumbar interbody fusion and percutaneous pedicle screw fixation under O-arm navigation: A retrospective comparative study. J Clin Med, 2022, 12(1): 312.
14. Li C, Li H, Su J, et al. Comparison of the accuracy of pedicle screw placement using a fluoroscopy-assisted free-hand technique with Robotic-assisted navigation using an O-arm or 3D C-arm in scoliosis surgery. Global Spine J, 2022.
15. Feng W, Wang W, Chen S, et al. O-arm navigation versus C-arm guidance for pedicle screw placement in spine surgery: a systematic review and meta-analysis. Int Orthop, 2020, 44(5): 919-926.
16. Ouchida J, Kanemura T, Satake K, et al. Simultaneous single-position lateral interbody fusion and percutaneous pedicle screw fixation using O-arm-based navigation reduces the occupancy time of the operating room. Eur Spine J, 2020, 29(6): 1277-1286.
17. Liu YB, Wang Y, Chen ZQ, et al. Volume navigation with fusion of real-time ultrasound and CT images to guide posterolateral transforaminal puncture in percutaneous endoscopic lumbar discectomy. Pain Physician, 2018, 21(3): E265-E278.
18. Shapey J, Dowrick T, Delaunay R, et al. Integrated multi-modality image-guided navigation for neurosurgery: open-source software platform using state-of-the-art clinical hardware. Int J Comput Assist Radiol Surg, 2021, 16(8): 1347-1356.
19. Moritz AK, Winter K, K?hler C, et al. Evaluation of the accuracy of volume navigation of sonography and computed tomography using a phantom. Tierarztl Prax Ausg K Kleintiere Heimtiere, 2019, 47(5): 322-333.
20. Miyata A, Arita J, Kawaguchi Y, et al. Simulation and navigation liver surgery: an update after 2, 000 virtual hepatectomies. Glob Health Med, 2020, 2(5): 298-305.
21. Zielinski AH, Bredahl KK, Ghulam QM, et al. Full-volume assessment of abdominal aortic aneurysm by improved-field-of-view 3-D ultrasound performs comparably to computed tomographic angiography. Ultrasound Med Biol, 2022, 48(2): 283-292.
22. 王冰, 劉濤. 超聲容積導航與X線透視引導下椎間孔鏡技術治療腰椎間盤突出癥的臨床對比. 頸腰痛雜志, 2019, 40(3): 370-372.
23. Zhao Y, Yan N, Yu S, et al. Reduced radiation exposure and puncture time of percutaneous transpedicular puncture with real-time ultrasound volume navigation. World Neurosurg, 2018, 119: e997-e1005.
24. Chan A, Parent E, Mahood J, et al. 3D ultrasound navigation system for screw insertion in posterior spine surgery: a phantom study. Int J Comput Assist Radiol Surg, 2022, 17(2): 271-281.
25. Gueziri HE, Georgiopoulos M, Santaguida C, et al. Ultrasound-based navigated pedicle screw insertion without intraoperative radiation: feasibility study on porcine cadavers. Spine J, 2022, 22(8): 1408-1417.
26. 郭楚, 劉達, 吳文波, 等. 基于電磁定位的超聲圖像與CT圖像的融合方法. 中國生物醫學工程學報, 2018, 37(5): 529-536.
27. 杜心如, 葉啟彬, 趙玲秀, 等. 腰椎人字嵴頂點椎弓根螺釘進釘方法的解剖學研究. 中國臨床解剖學雜志, 2002, 20(2): 86-88.
28. 王天藝, 袁碩, 范寧, 等. 超聲與CT圖像融合技術及其在脊柱外科中的應用進展. 中國脊柱脊髓雜志, 2021, 31(1): 86-90.
29. De Silva T, Uneri A, Zhang X, et al. Real-time, image-based slice-to-volume registration for ultrasound-guided spinal intervention. Phys Med Biol, 2018, 63(21): 215016.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of screw placement guided by O-arm navigation and ultrasound volume navigation in minimally invasive transforaminal lumbar interbody fusion

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