Intraoperative Three-Dimensional Fluoroscopy-Based Computerized
Object: Percutaneous kyphoplasty is an established method for the treatment of pathological vertebral compression fractures (VCFs). This procedure is usually performed with the aid of biplanar fluoroscopic image guidance. There are currently no published clinical studies in which the use of three-dimensional (3D) image guidance to facilitate this technique has been evaluated. The purpose of this study was to evaluate the efficacy of isocentric fluoroscopy-based navigation for the kyphoplasty procedure, with special reference to operating time and the amount of radiation exposure.
Methods: A prospective clinical study was performed in which 11 consecutive patients with painful pathological VCFs that did not respond to conservative treatment underwent the kyphoplasty procedure. During this procedure, cannulation of the pedicle and vertebral body was performed with the aid of isocentric 3D fluoroscopy visualization. Total operating time and intraoperative fluoroscopy time for this group was compared with a cohort of nine patients who underwent the procedure prior to the availability of isocentric fluoroscopy (only biplanar fluoroscopy was used). Possible complications such as cement extravasations were evaluated during the procedure and on postoperative computerized tomography scans.
The mean duration of surgery for the 3D isocentric fluoroscopic guidance group was 60 minutes (range 36–89 minutes) for one-level and 68.5 minutes (range 65–75 minutes) for two-level cases. Because of a learning curve with the equipment, the operating time for the initial cases was significantly longer than with the later ones. Even with the initial cases included, the mean operating time was shorter compared with the biplanar fluoroscopy-assisted procedures, which averaged 69.2 minutes (range 44–113 minutes) for one-level procedures. This difference was not statistically significant. The mean fluoroscopy exposure time was 41.3 seconds (range 25–62 seconds) in the isocentric fluo-roscopy-assisted procedures, with an additional 40 seconds of fluoroscopy time used for the 3D fluoroscopy "spin," compared with 293.2 seconds (range 180–400 seconds) in the biplanar fluoroscopy-assisted procedures. The difference was statistically significant (p = 0.02). All pedicles were accessed without difficulty and no complications were encountered in either group of patients.
Conclusions: The main advantage of isocentric fluoroscopy is the significant reduction in radiation exposure for the patient and surgical staff without an increase in the mean operating time. This technique is a significant advancement over biplanar fluoroscopy in this setting.
An estimated 700,000 VCFs occur every year in the US. Osteoporotic fractures of the spine are a common cause of morbidity, and lead to a 23% increase in mortality rates in elderly patients. Not all fractures can be treated conservatively.
The kyphoplasty and vertebroplasty procedures have recently been developed for their potential to provide immediate pain relief and stability with minimally invasive surgical intervention. A 95 to 100% success rate in terms of pain relief after kyphoplasty has been reported, in comparison with 42% in a conservatively treated patient group.
1990s, kyphoplasty has become the preferred method for treating osteoporotic VCFs for many spine surgeons, compared with the vertebroplasty procedure for most interventional radiologists. The potential advantages of kyphoplasty over vertebroplasty include the avoidance of high-pressure injections, uncontrolled fills, and the ability to restore vertebral height or reduce the associated spinal Other potential surgical risks, such as cement leaks, have also reportedly been reduced in comparison with vertebroplasty.
Complication rates reported in the literature on kyphoplasty vary from 0 to 9.8%. These events are commonly related to the initial cannulation of the pedicle and VB and include spinal cord injury, pulmonary cement embolus, epidural hematoma, epidural cement extravasation, cerebrospinal fluid leakage, and transient adult respiratory distress syndrome. Lieberman, et al., reported a 20% balloon rupture rate and an 8.6% cement extravasation rate.
Significantly more advanced intraoperative image guidance techniques have recently become more widespread and available, but have not been reported in association with the kyphoplasty procedure. We describe the first series of patients who underwent this minimally invasive procedure with the aid of isocentric fluoroscopy-based image guidance in an effort to decrease the risk of complications, the operating time, and the amount of radiation exposure for both the patient and the OR personnel.
Object: Percutaneous kyphoplasty is an established method for the treatment of pathological vertebral compression fractures (VCFs). This procedure is usually performed with the aid of biplanar fluoroscopic image guidance. There are currently no published clinical studies in which the use of three-dimensional (3D) image guidance to facilitate this technique has been evaluated. The purpose of this study was to evaluate the efficacy of isocentric fluoroscopy-based navigation for the kyphoplasty procedure, with special reference to operating time and the amount of radiation exposure.
Methods: A prospective clinical study was performed in which 11 consecutive patients with painful pathological VCFs that did not respond to conservative treatment underwent the kyphoplasty procedure. During this procedure, cannulation of the pedicle and vertebral body was performed with the aid of isocentric 3D fluoroscopy visualization. Total operating time and intraoperative fluoroscopy time for this group was compared with a cohort of nine patients who underwent the procedure prior to the availability of isocentric fluoroscopy (only biplanar fluoroscopy was used). Possible complications such as cement extravasations were evaluated during the procedure and on postoperative computerized tomography scans.
The mean duration of surgery for the 3D isocentric fluoroscopic guidance group was 60 minutes (range 36–89 minutes) for one-level and 68.5 minutes (range 65–75 minutes) for two-level cases. Because of a learning curve with the equipment, the operating time for the initial cases was significantly longer than with the later ones. Even with the initial cases included, the mean operating time was shorter compared with the biplanar fluoroscopy-assisted procedures, which averaged 69.2 minutes (range 44–113 minutes) for one-level procedures. This difference was not statistically significant. The mean fluoroscopy exposure time was 41.3 seconds (range 25–62 seconds) in the isocentric fluo-roscopy-assisted procedures, with an additional 40 seconds of fluoroscopy time used for the 3D fluoroscopy "spin," compared with 293.2 seconds (range 180–400 seconds) in the biplanar fluoroscopy-assisted procedures. The difference was statistically significant (p = 0.02). All pedicles were accessed without difficulty and no complications were encountered in either group of patients.
Conclusions: The main advantage of isocentric fluoroscopy is the significant reduction in radiation exposure for the patient and surgical staff without an increase in the mean operating time. This technique is a significant advancement over biplanar fluoroscopy in this setting.
An estimated 700,000 VCFs occur every year in the US. Osteoporotic fractures of the spine are a common cause of morbidity, and lead to a 23% increase in mortality rates in elderly patients. Not all fractures can be treated conservatively.
The kyphoplasty and vertebroplasty procedures have recently been developed for their potential to provide immediate pain relief and stability with minimally invasive surgical intervention. A 95 to 100% success rate in terms of pain relief after kyphoplasty has been reported, in comparison with 42% in a conservatively treated patient group.
1990s, kyphoplasty has become the preferred method for treating osteoporotic VCFs for many spine surgeons, compared with the vertebroplasty procedure for most interventional radiologists. The potential advantages of kyphoplasty over vertebroplasty include the avoidance of high-pressure injections, uncontrolled fills, and the ability to restore vertebral height or reduce the associated spinal Other potential surgical risks, such as cement leaks, have also reportedly been reduced in comparison with vertebroplasty.
Complication rates reported in the literature on kyphoplasty vary from 0 to 9.8%. These events are commonly related to the initial cannulation of the pedicle and VB and include spinal cord injury, pulmonary cement embolus, epidural hematoma, epidural cement extravasation, cerebrospinal fluid leakage, and transient adult respiratory distress syndrome. Lieberman, et al., reported a 20% balloon rupture rate and an 8.6% cement extravasation rate.
Significantly more advanced intraoperative image guidance techniques have recently become more widespread and available, but have not been reported in association with the kyphoplasty procedure. We describe the first series of patients who underwent this minimally invasive procedure with the aid of isocentric fluoroscopy-based image guidance in an effort to decrease the risk of complications, the operating time, and the amount of radiation exposure for both the patient and the OR personnel.
SHARE
