Comparison of intraoperative cone-beam CT versus preoperative fan-beam CT for navigated spine surgery: a prospective randomized study

Tsung-Hsi Tu Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;
School of Medicine, National Yang Ming Chiao Tung University, Taipei;

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Yi-Hsuan Kuo Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;
Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei;

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Chih-Chang Chang Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;
School of Medicine, National Yang Ming Chiao Tung University, Taipei;
Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei;

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Chao-Hung Kuo Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;
School of Medicine, National Yang Ming Chiao Tung University, Taipei;
Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei;

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Hsuan-Kan Chang Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;
School of Medicine, National Yang Ming Chiao Tung University, Taipei;
Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei; and

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Li-Yu Fay Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;
School of Medicine, National Yang Ming Chiao Tung University, Taipei;

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Mei-Yin Yeh Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;
School of Medicine, National Yang Ming Chiao Tung University, Taipei;
Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan

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Chin-Chu Ko Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;
School of Medicine, National Yang Ming Chiao Tung University, Taipei;

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Wen-Cheng Huang Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;
School of Medicine, National Yang Ming Chiao Tung University, Taipei;

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Jau-Ching Wu Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei;
School of Medicine, National Yang Ming Chiao Tung University, Taipei;

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OBJECTIVE

This prospective randomized study aimed to investigate the accuracy, radiation exposure, and surgical workflow optimization of a novel intraoperative spinal navigation system using preoperative fan-beam (FB) CT versus the classic intraoperative cone-beam (CB) CT in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).

METHODS

In this two-arm, single-center, randomized study, the authors evaluated the safety and clinical outcomes of a novel navigation system for pedicle screw placement in spine surgery.

RESULTS

The accuracy of pedicle screw placement in the experimental group (FB group) was 94.38%, while it was 94.55% in the control group (CB group). Notably, the intraoperative radiation exposure to patients in the FB CT group (mean 0.361 ± 0.261 mSv) was significantly lower than that in the CB CT group (mean 6.526 ± 13.591 mSv) (p < 0.0001). Furthermore, the intraoperative preparation time for screw placement in the FB group (mean 10.6 ± 5.62 minutes) was significantly lower than that in the CB group (mean 17.6 ± 5.59 minutes) (p = 0.0004). No significant differences were observed for blood loss during surgery, total radiation exposure to surgeons, mean time for inserting a single pedicle screw, revision surgery rate, patients’ reported outcomes, and length of postoperative hospital stay between the two groups. Significant differences were observed for intraoperative radiation exposure to patients and the preparation time for pedicle screw placement.

CONCLUSIONS

The preoperative FB CT-based intraoperative spinal navigation system demonstrated comparable accuracy and safety when compared with the intraoperative CB CT-based system. Moreover, the FB CT-based system had a shorter time for screw placement and reduced intraoperative radiation exposure to patients. These findings support the potential benefits of adopting this novel navigation system to enhance surgical precision and reduce radiation-related risks in MIS-TLIF procedures.

ABBREVIATIONS

CB = cone beam; FB = fan beam; IGS = image guidance system; MIS-TLIF = minimally invasive transforaminal lumbar interbody fusion; ODI = Oswestry Disability Index; VAS = visual analog scale.
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Illustration from Lee et al. (pp 132–142). © Jae-Koo Lee, published with permission.

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