Does intraoperative 3D navigation improve SpineJack vertebral augmentation in thoracic and lumbar compression fracture? - 06/08/21

Doi : 10.1016/j.otsr.2021.103028

Mehdi Boudissa ^a,^b,⁎ , Pierre Girard ^a, Gaël Kerschbaumer ^a, Sébastien Ruatti ^a, Jérôme Tonetti ^a,^b
^a Service de chirurgie orthopédique et traumatologique, université Grenoble Alpes, centre hospitalier universitaire de Grenoble, 38700 La Tronche, France
^b CNRS UMR 5525, TIMC-IMAG Lab, university Grenoble Alpes, 38700 La Tronche, France

^⁎Corresponding author. Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU Grenoble, boulevard de la Chantourne, 38700 La Tronche, France.Service de chirurgie orthopédique et traumatologique, hôpital Nord, université Grenoble Alpes, CHU Grenobleboulevard de la ChantourneLa Tronche38700France

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Abstract

Introduction

The aim of this retrospective study was to evaluate the effect of navigation on the positioning of the SpineJack implant in the treatment of thoracic and lumbar compression fractures.

Methods

Between January 2018 and December 2019, all patients operated on for thoracic or lumbar fracture using the SpineJack device in stand-alone were included in this single-center study. The positioning of the SpineJack implant was analyzed on axial CT views by measuring the angle between the axis of the pedicle and the axis of the final implant. The relationships between implant positioning and the use of navigation or fluoroscopy, pedicle dimensions and levels of injury were analyzed. Surgical time, radiation exposure, radiological findings and complications were assessed.

Results

One hundred patients were included, for 103 fractured vertebrae and a total of 205 implants, 148 placed under standard fluoroscopy and 57 with the Surgivisio navigation system. For pedicle diameters≥5mm (165 implants), the positioning of the implant relative to the axis of the pedicle was significantly better in the navigation group: 2°±1.4° (range, 0–7°) in the fluoroscopy group versus 1.2°±1.1° (range, 0–5°) in the navigation group (p=0.04). There were no significant differences in reduction of vertebral kyphosis angle or mean operating time. Dose area product (DAP) was significantly higher with navigation: 4.43Gy.cm² versus 0.47Gy.cm² (p<0.001) and dose to the surgeon significantly lower: 0.5 versus 1.6μSv (p<0.001). No difference was found regarding complications. Subgroup analysis showed significantly greater operative time and patient irradiation in the fluoroscopy group when pedicle diameter was less than 5mm.

Conclusion

This study demonstrates the interest of navigation for positioning the SpineJack implant with respect to the pedicle axis in vertebrae with pedicle diameter≥5mm. This study also confirmed the reliability of navigation and lower radiation dose to the surgeon, regardless of the fracture level. Navigation reduced operating time and patient irradiation for vertebrae with pedicle diameter<5mm.