Prod'homme Marc, Saad Maxime, Tonetti Jérôme, Cavalié Guillaume, Kerschbaumer Gaël, Thangavelu Arun, Gassend Jean-Loup, Boudissa Mehdi
Clinic La Source, Spine Surgery Center, Lausanne, Switzerland
University Hospital of Grenoble, Orthopedic Surgery Department, La Tronche, France.
Int J Spine Surg. 2025 Sep 2;19(4):383-391. doi: 10.14444/8766.
Computerized navigation improves the accuracy of spine procedures. However, intraoperative imaging is plagued by ionizing irradiation and its cancer risk. Advanced technologies attempt to optimize the radiation dose. The goal of this study was to compare radiation exposure and screw accuracy of O-arm navigation and the Surgivisio device (SD) in pedicle screw insertion.
All patients operated on by navigated pedicle screw insertion during a 19-month period were prospectively included in 2 spine centers: the first with the O-arm and the second with the SD. Demographic, operative, and irradiation data were collected. The accuracy of the screw positioning was assessed using the Heary and Gertzbein classifications. The effective dose in millisievert (mSv) was calculated.
One hundred patients were included, 50 per group. Five hundred and twelve screws were inserted, among them 228 in 120 vertebrae with the O-am and 284 in 145 vertebrae with the SD. Screw accuracy was 99.1% with the O-arm vs 93.3% with the SD ( = 0.07). Operative times were similar, with 145 vs 139 minutes respectively, = 0.68. The effective dose was significantly higher in the O-arm group, with 5.43 vs 2.70 mSv with the SD ( < 0.01). The effective dose related to 2-dimensional imaging was significantly lower in the O-arm group than in the SD group, with 0.26 vs 1.16 mSv, respectively, < 0.01, related to a shorter imaging duration (4 vs 109 seconds respectively, < 0.01).
Accuracy of pedicle screws was higher with the O-arm than with the Surgivisio, but the latter showed less radiation exposure. Despite promising results, improvements in technology should be pursued for ergonomics and surgical safety.
计算机导航提高了脊柱手术的准确性。然而，术中成像受到电离辐射及其致癌风险的困扰。先进技术试图优化辐射剂量。本研究的目的是比较O型臂导航和Surgivisio设备（SD）在椎弓根螺钉植入术中的辐射暴露和螺钉准确性。
在19个月期间接受导航椎弓根螺钉植入手术的所有患者被前瞻性纳入2个脊柱中心：第一个中心使用O型臂，第二个中心使用SD。收集人口统计学、手术和辐射数据。使用Heary和Gertzbein分类评估螺钉定位的准确性。计算以毫希沃特（mSv）为单位的有效剂量。
共纳入100例患者，每组50例。共植入512枚螺钉，其中使用O型臂在120个椎体中植入228枚，使用SD在145个椎体中植入284枚。O型臂组的螺钉准确性为99.1%，而SD组为93.3%（P = 0.07）。手术时间相似，分别为145分钟和139分钟，P = 0.68。O型臂组的有效剂量显著更高，分别为5.43 mSv和2.70 mSv（P < 0.01）。与二维成像相关的有效剂量在O型臂组显著低于SD组，分别为0.26 mSv和1.16 mSv，P < 0.01，这与成像持续时间较短有关（分别为4秒和109秒，P < 0.01）。
O型臂的椎弓根螺钉准确性高于Surgivisio，但后者的辐射暴露较少。尽管结果令人鼓舞，但仍应在人体工程学和手术安全性方面追求技术改进。
