The purpose of the study is to evaluate the benefit of having 3D information intra operatively for precise placement of pedicle screws. The objectives are 1)To address the clinical challenges faced by surgeons during spinal surgeries in absence of 3D navigation. 2) To observe the success rate of 3D information. 3) To understand the rate of change of path of screws with the help of 3D information.
Pedicle screws are commonly used to assist in fusion of the thoracic and lumbar spine. Most surgeons have confidence in their ability to accurately place pedicle screws via various techniques. However, misplaced screws can cause nerve damage, failure of fixation, and need for revision surgery. Neurologic deficits after pedicle screw surgery have been reported to occur up to 5% of the time. Intraoperative x-ray radiography/fluoroscopy is widely used to guide and evaluate the delivery of surgical devices, but the assessment of device placement is often limited to qualitative interpretation of radiographic views in relation to the 3D patient anatomy. The qualitative interpretation can fail to reliably detect suboptimal delivery and/or breach of adjacent critical structures. One such example is in spine surgery procedures in which screws are placed through the spinal pedicle near critical anatomical structures such as nerves (e.g., spinal cord) and major vessels (e.g., aorta).
Despite reports of improved accuracy, use of image guidance for spine surgery is not the perfect standard of care. Limitations on the use of image guidance include the cost of purchase of the systems, time required for usage in the operating room, and questionable accuracy of the systems. In fact, (hypothetically) image guidance for the placement of pedicle screws will decrease the cost of healthcare as it will reduce the side effects and medical expenditure on the disability caused by the inadequate surgeries.
Anonymised CT from PACS of the hospital will be analysed with the help of Faculty from Manipal Institute of Technology. Pre Operative CT with be correlated with Intra Operative C Arm fluoroscopy and postoperative CT. A 3D to 2D correlation will be made using a segmental based technique being delvelped by Manipal Institute Of Technology.
Success rate of the procedure while using 3D information during surgeries and rate of change of path of screws during the surgery are analysed.
Bhat, Shyamasunder N Dr., "Clinical relevance of 3D information in spine surgery for accurate placement of pedicle screws by registering preoperative CT, intraoperative images and verification with postoperative CT" (2022). Health collection. 11.