Clinical application of percutaneous pedicle screw placement guided by ultrasound volume navigation combined with X-ray fluoroscopy: a prospective randomized controlled study_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIN Xuxin ^1,2 , SHANG Lijie ² , SHEN Suhong ² , WANG Qingfeng ² , FU Xiaoyan 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;

Corresponding author：

ZHAO Gang, Email: 13663889866@163.com

Keywords：

Ultrasound volume navigation; percutaneous pedicle screw; internal fixation; spinal fracture

DOI：

10.7507/1002-1892.202306071

Video：

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Objective To explore the feasibility and accuracy of ultrasound volume navigation (UVN) combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation through a prospective randomized controlled study. Methods Patients with thoracic and lumbar vertebral fractures scheduled for percutaneous pedicle screw fixation between January 2022 and January 2023 were enrolled. Among them, 60 patients met the selection criteria and were included in the study. There were 28 males and 32 females, with an average age of 49.5 years (range, 29-60 years). The cause of injury included 20 cases of traffic accidents, 21 cases of falls, 17 cases of slips, and 2 cases of heavy object impact. The interval from injury to hospital admission ranged from 1 to 5 days (mean, 1.57 days). The fracture located at T₁₂ in 15 cases, L₁ in 20 cases, L₂ in 19 cases, and L₃ in 6 cases. The study used each patient as their own control, randomly guiding pedicle screw implantation using UVN combined with X-ray fluoroscopy on one side of the vertebral body and the adjacent segment (trial group), while the other side was implanted under X-ray fluoroscopy (control group). A total of 4 screws and 2 rods were implanted in each patient. The implantation time and fluoroscopy frequency during implantation of each screw, angle deviation and distance deviation between actual and preoperative planned trajectory by imaging examination, and the occurrence of zygapophysial joint invasion were recorded. Results In terms of screw implantation time, fluoroscopy frequency, angle deviation, distance deviation, and incidence of zygapophysial joint invasion, the trial group showed superior results compared to the control group, and the differences were significant (P<0.05). Conclusion UVN combined with X-ray fluoroscopy-guided percutaneous pedicle screw implantation can yreduce screw implantation time, adjust dynamically, reduce operational difficulty, and reduce radiation damage.

Citation： LIN Xuxin, SHANG Lijie, SHEN Suhong, WANG Qingfeng, FU Xiaoyan, ZHAO Gang. Clinical application of percutaneous pedicle screw placement guided by ultrasound volume navigation combined with X-ray fluoroscopy: a prospective randomized controlled study. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(10): 1253-1258. doi: 10.7507/1002-1892.202306071 Copy

1.	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.
2.	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.
3.	Alander DH, Cui S. Percutaneous pedicle screw stabilization: surgical technique, fracture reduction, and review of current spine trauma applications. J Am Acad Orthop Surg, 2018, 26(7): 231-240.
4.	Ishii K, Funao H, Isogai N, et al. The history and development of the percutaneous pedicle screw (PPS) system. Medicina (Kaunas), 2022, 58(8): 1064.
5.	Dunn C, Faloon M, Milman E, et al. Accuracy and safety of percutaneous lumbosacral pedicle screw placement using dual-planar intraoperative fluoroscopy. Asian Spine J, 2018, 12(2): 238-245.
6.	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.
7.	Yahanda AT, Moore E, Ray WZ, et al. First in-human report of the clinical accuracy of thoracolumbar percutaneous pedicle screw placement using augmented reality guidance. Neurosurg Focus, 2021, 51(2): E10.
8.	杨俊松, 郝定均, 刘团江, 等. 脊柱机器人与透视辅助下经皮植钉治疗腰椎滑脱症中植钉精度的对比研究. 中国修复重建外科杂志, 2018, 32(11): 1371-1376.
9.	Richter PH, Gebhard F. Application of navigation in the fractured spine. Oper Orthop Traumatol, 2023, 35(1): 29-36.
10.	Otomo N, Funao H, Yamanouchi K, et al. Computed tomography-based navigation system in current spine surgery: a narrative review. Medicina (Kaunas), 2022, 58(2): 241.
11.	尹稳, 焦伟, 于海洋. 经皮椎弓根螺钉置钉辅助技术及应用进展. 中国脊柱脊髓杂志, 2022, 32(8): 743-747.
12.	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.
13.	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.
14.	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.
15.	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.
16.	Aibar-Almazán A, Voltes-Martínez A, Castellote-Caballero Y, et al. Current status of the diagnosis and management of osteoporosis. Int J Mol Sci, 2022, 23(16): 9465.
17.	杜心如, 叶启彬, 赵玲秀, 等. 腰椎人字嵴顶点椎弓根螺钉进钉方法的解剖学研究. 中国临床解剖学杂志, 2002, 20(2): 86-88.
18.	郭楚, 刘达, 吴文波, 等. 基于电磁定位的超声图像与CT图像的融合方法. 中国生物医学工程学报, 2018, 37(5): 529-536.
19.	巫明钢, 万绍平, 卢漫. 超声容积导航在临床中的应用进展. 实用医院临床杂志, 2019, 16(6): 245-247.
20.	周雁, 种皓, 冯磊, 等. 超声容积导航技术在腰部椎间孔及神经根定位的应用研究. 中国临床医生杂志, 2022, 50(11): 1329-1334.
21.	Jiang F, Li XX, Liu L, et al. The mini-open wiltse approach with pedicle screw fixation versus percutaneous pedicle screw fixation for treatment of neurologically intact thoracolumbar fractures: a systematic review and meta-analysis. World Neurosurg, 2022, 164: 310-322.
22.	Zou P, Yang JS, Wang XF, et al. Comparison of clinical and radiologic outcome between mini-open wiltse approach and fluoroscopic-guided percutaneous pedicle screw placement: a randomized controlled trial. World Neurosurg, 2020, 144: e368-e375.
23.	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.
24.	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.

1. 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.
2. 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.
3. Alander DH, Cui S. Percutaneous pedicle screw stabilization: surgical technique, fracture reduction, and review of current spine trauma applications. J Am Acad Orthop Surg, 2018, 26(7): 231-240.
4. Ishii K, Funao H, Isogai N, et al. The history and development of the percutaneous pedicle screw (PPS) system. Medicina (Kaunas), 2022, 58(8): 1064.
5. Dunn C, Faloon M, Milman E, et al. Accuracy and safety of percutaneous lumbosacral pedicle screw placement using dual-planar intraoperative fluoroscopy. Asian Spine J, 2018, 12(2): 238-245.
6. 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.
7. Yahanda AT, Moore E, Ray WZ, et al. First in-human report of the clinical accuracy of thoracolumbar percutaneous pedicle screw placement using augmented reality guidance. Neurosurg Focus, 2021, 51(2): E10.
8. 杨俊松, 郝定均, 刘团江, 等. 脊柱机器人与透视辅助下经皮植钉治疗腰椎滑脱症中植钉精度的对比研究. 中国修复重建外科杂志, 2018, 32(11): 1371-1376.
9. Richter PH, Gebhard F. Application of navigation in the fractured spine. Oper Orthop Traumatol, 2023, 35(1): 29-36.
10. Otomo N, Funao H, Yamanouchi K, et al. Computed tomography-based navigation system in current spine surgery: a narrative review. Medicina (Kaunas), 2022, 58(2): 241.
11. 尹稳, 焦伟, 于海洋. 经皮椎弓根螺钉置钉辅助技术及应用进展. 中国脊柱脊髓杂志, 2022, 32(8): 743-747.
12. 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.
13. 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.
14. 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.
15. 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.
16. Aibar-Almazán A, Voltes-Martínez A, Castellote-Caballero Y, et al. Current status of the diagnosis and management of osteoporosis. Int J Mol Sci, 2022, 23(16): 9465.
17. 杜心如, 叶启彬, 赵玲秀, 等. 腰椎人字嵴顶点椎弓根螺钉进钉方法的解剖学研究. 中国临床解剖学杂志, 2002, 20(2): 86-88.
18. 郭楚, 刘达, 吴文波, 等. 基于电磁定位的超声图像与CT图像的融合方法. 中国生物医学工程学报, 2018, 37(5): 529-536.
19. 巫明钢, 万绍平, 卢漫. 超声容积导航在临床中的应用进展. 实用医院临床杂志, 2019, 16(6): 245-247.
20. 周雁, 种皓, 冯磊, 等. 超声容积导航技术在腰部椎间孔及神经根定位的应用研究. 中国临床医生杂志, 2022, 50(11): 1329-1334.
21. Jiang F, Li XX, Liu L, et al. The mini-open wiltse approach with pedicle screw fixation versus percutaneous pedicle screw fixation for treatment of neurologically intact thoracolumbar fractures: a systematic review and meta-analysis. World Neurosurg, 2022, 164: 310-322.
22. Zou P, Yang JS, Wang XF, et al. Comparison of clinical and radiologic outcome between mini-open wiltse approach and fluoroscopic-guided percutaneous pedicle screw placement: a randomized controlled trial. World Neurosurg, 2020, 144: e368-e375.
23. 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.
24. 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.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of percutaneous pedicle screw placement guided by ultrasound volume navigation combined with X-ray fluoroscopy: a prospective randomized controlled study

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