Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지
DOI QR코드

DOI QR Code

Evaluation of the accuracy of mobile cone-beam computed tomography after spinal instrumentation surgery

  • Eom, Ki Seong (Department of Neurosurgery, Wonkwang University School of Medicine) ;
  • Park, Eun Sung (Department of Neurosurgery, Wonkwang University School of Medicine) ;
  • Kim, Dae Won (Department of Neurosurgery, Wonkwang University School of Medicine) ;
  • Park, Jong Tae (Department of Neurosurgery, Wonkwang University School of Medicine) ;
  • Yoon, Kwon-Ha (Department of Radiology, Wonkwang University Hospital)
  • Received : 2021.01.16
  • Accepted : 2021.04.07
  • Published : 2022.03.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Pedicle screw fixation provides 3-column stabilization, multidimensional control, and a higher rate of interbody fusion. Although computed tomography (CT) is recommended for the postoperative assessment of pedicle screw fixation, its use is limited due to the radiation exposure dose. The purpose of this preliminary retrospective study was to assess the clinical usefulness of low-dose mobile cone-beam CT (CBCT) for the postoperative evaluation of pedicle screw fixation. Methods: The author retrospectively reviewed postoperative mobile CBCT images of 15 patients who underwent posterior pedicle screw fixation for spinal disease from November 2019 to April 2020. Pedicle screw placement was assessed for breaches of the bony structures. The breaches were graded based on the Heary classification. Results: The patients included 11 men and four women, and their mean age was 66±12 years. Of the 122 pedicle screws, 34 (27.9%) were inserted in the thoracic segment (from T7 to T12), 82 (67.2%) in the lumbar segment (from L1 to L5), and six (4.9%) in the first sacral segment. Although there were metal-related artifacts, the image of the screw position (according to Heary classification) after surgery could be assessed using mobile CBCT at all levels (T7-S1). Conclusions: Mobile CBCT was accurate in determining the location and integrity of the pedicle screw and identifying the surrounding bony structures. In the postoperative setting, mobile CBCT can be used as a primary modality for assessing the accuracy of pedicle screw fixation and detecting postoperative complications.

Keywords

References

  1. Fiani B, Quadri SA, Ramakrishnan V, Berman B, Khan Y, Siddiqi J. Retrospective review on accuracy: a pilot study of robotically guided thoracolumbar/sacral pedicle screws versus fluoroscopy-guided and computerized tomography stealth- guided screws. Cureus 2017;9:e1437.
  2. Cordemans V, Kaminski L, Banse X, Francq BG, Detrembleur C, Cartiaux O. Pedicle screw insertion accuracy in terms of breach and reposition using a new intraoperative cone beam computed tomography imaging technique and evaluation of the factors associated with these parameters of accuracy: a series of 695 screws. Eur Spine J 2017;26:2917-26. https://doi.org/10.1007/s00586-017-5195-3
  3. Carrino JA, Al Muhit A, Zbijewski W, et al. Dedicated conebeam CT system for extremity imaging. Radiology 2014; 270:816-24. https://doi.org/10.1148/radiol.13130225
  4. Posadzy M, Desimpel J, Vanhoenacker F. Cone beam CT of the musculoskeletal system: clinical applications. Insights Im- aging 2018;9:35-45. https://doi.org/10.1007/s13244-017-0582-1
  5. Pugmire BS, Shailam R, Sagar P, et al. Initial clinical experience with extremity cone-beam CT of the foot and ankle in pediatric patients. AJR Am J Roentgenol 2016;206:431-5. https://doi.org/10.2214/AJR.15.15099
  6. Heary RF, Bono CM, Black M. Thoracic pedicle screws: postoperative computerized tomography scanning assessment. J Neurosurg 2004;100:325-31.
  7. Boos N, Webb JK. Pedicle screw fixation in spinal disorders: a European view. Eur Spine J 1997;6:2-18. https://doi.org/10.1007/BF01676569
  8. Roy-Camille R, Saillant G, Berteaux D, Salgado V. Osteosyn-thesis of thoraco-lumbar spine fractures with metal plates screwed through the vertebral pedicles. Reconstr Surg Traumatol 1976;15:2-16.
  9. Ghodasara N, Yi PH, Clark K, Fishman EK, Farshad M, Fritz J. Postoperative spinal CT: what the radiologist needs to know. Radiographics 2019;39:1840-61. https://doi.org/10.1148/rg.2019190050
  10. Castro WH, Halm H, Jerosch J, Malms J, Steinbeck J, Blasius S. Accuracy of pedicle screw placement in lumbar vertebrae. Spine (Phila Pa 1976) 1996;21:1320-4. https://doi.org/10.1097/00007632-199606010-00008
  11. Laudato PA, Pierzchala K, Schizas C. Pedicle screw insertion accuracy using O-arm, robotic guidance, or freehand technique: a comparative study. Spine (Phila Pa 1976) 2018;43: E373-8. https://doi.org/10.1097/BRS.0000000000002449
  12. Fuster S, Vega A, Barrios G, et al. Accuracy of pedicle screw insertion in the thoracolumbar spine using image-guided navigation. Neurocirugia (Astur) 2010;21:306-11. https://doi.org/10.1016/S1130-1473(10)70123-8
  13. Petscavage-Thomas JM, Ha AS. Imaging current spine hardware: part 1, cervical spine and fracture fixation. AJR Am J Roentgenol 2014;203:394-405. https://doi.org/10.2214/AJR.13.12216
  14. Farber GL, Place HM, Mazur RA, Jones DE, Damiano TR. Accuracy of pedicle screw placement in lumbar fusions by plain radiographs and computed tomography. Spine (Phila Pa 1976) 1995;20:1494-9. https://doi.org/10.1097/00007632-199507000-00010
  15. Laine T, Makitalo K, Schlenzka D, Tallroth K, Poussa M, Alho A. Accuracy of pedicle screw insertion: a prospective CT study in 30 low back patients. Eur Spine J 1997;6:402-5. https://doi.org/10.1007/BF01834068
  16. Learch TJ, Massie JB, Pathria MN, Ahlgren BA, Garfin SR. Assessment of pedicle screw placement utilizing conventional radiography and computed tomography: a proposed systematic approach to improve accuracy of interpretation. Spine (Phila Pa 1976) 2004;29:767-73. https://doi.org/10.1097/01.BRS.0000112071.69448.A1
  17. McLellan AM, Daniel S, Corcuera-Solano I, Joshi V, Tanenbaum LN. Optimized imaging of the postoperative spine. Neuroimaging Clin N Am 2014;24:349-64. https://doi.org/10.1016/j.nic.2014.01.005
  18. Brenner DJ, Hall EJ. Computed tomography: an increasing source of radiation exposure. N Engl J Med 2007;357:2277-84. https://doi.org/10.1056/NEJMra072149