Article
Clinical efficiency and quality of operating room-based sliding gantry CT as compared to mobile cone-beam CT-based navigated pedicle screw placement – an observational cohort study on 853 patients and 6733 screws
Klinische Effizienz und Qualität des OP-basierten sliding gantry CTs im Vergleich zum mobilen cone-beam CT für die navigierte Anlage von Pedikel-Schrauben – eine Observations-Kohorten-Studie an 853 Patienten und 6733 Schrauben
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Published: | June 4, 2021 |
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Objective: Today, multiple solutions for navigation-guided pedicle screw placement are available. For the present study, we analyzed the efficiency of an operating room (OR)-based sliding-gantry CT (ORCT) and a mobile cone-beam CT (CBCT)-based approach for spinal instrumentation.
Methods: We analyzed all patients who underwent ORCT-based or CBCT-based pedicle screw placement for spinal instrumentation at our department between 11/2015 and 01/2020.
Results: Intra- and postoperative complications as well as number of navigated screws and levels per case did not differ between the two groups. Although the accuracy of screw placement according to Gertzbein-Robbins classification did not differ between the two groups, more screws had to be revised intraoperatively in the CBCT group (ORCT: 98, 2.8% vs. CBCT: 128, 4.0%; p=0.0081).
The median time of patients inside the OR (Entry – Exit) was significantly shorter for the ORCT group (ORCT: median, [95% CI] 237.5, [247.8, 264.3] min, CBCT: 267, [274.4, 291.5] min; p<0.0001) based on shorter times for Positioning - Incision (ORCT: 17, [18.1, 19.9] min, CBCT: 32, [32.2, 35.5] min; p<0.0001) and Suture - Exit (ORCT: 22, [23.6, 26.1] min, CBCT: 25.5, [27.5, 30.7] min; p<0.0001).
Conclusion: The present results show that the choice of assistive technology for navigated pedicle screw placement has significant impact on standard spine procedures even in a high-volume spine center. Particularly with regard to cost-effectiveness and the duration of surgeries, the shorter time needed for preparation and de-positioning in the ORCT group made the main difference, while the quality of accuracy was even higher.