Download PDF
Vet Comp Orthop Traumatol 2022; 35(06): 370-380
DOI: 10.1055/s-0042-1750056
Original Research

Accuracy and Safety of Neuronavigation for Minimally Invasive Stabilization in the Thoracolumbar Spine Using Polyaxial Screws-Rod: A Canine Cadaveric Proof of Concept

Julien Guevar 
1   Division of Surgery, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
,
Eva S. Samer 
1   Division of Surgery, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
,
Christina Precht
2   Division of Clinical Radiology, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
,
Justus M.K. Rathmann
3   Institute of Sociology, University of Zurich, Zurich, Switzerland
,
Franck Forterre 
1   Division of Surgery, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Objectives The main aim of this study was to evaluate the feasibility of minimally invasive stabilization with polyaxial screws-rod using neuronavigation and to assess accuracy and safety of percutaneous drilling of screw corridors using neuronavigation in thoracolumbar spine and compare it between an experienced and a novice surgeon.

Study Design Feasibility of minimally invasive polyaxial screws-rod fixation using neuronavigation was first performed in the thoracolumbar spine of two dogs. Accuracy and safety of drilling screw corridors percutaneously by two surgeons from T8 to L7 in a large breed dog using neuronavigation were established by comparing entry and exit points coordinates deviations on multiplanar reconstructions between preoperative and postoperative datasets and using a vertebral cortical breach grading scheme.

Results Feasibility of minimally invasive stabilization was demonstrated. For the experienced surgeon, safety was 100% and mean (standard deviation) entry point deviations were 0.3 mm (0.8 mm) lateral, 1.3 mm (0.8 mm) ventral and 0.7 mm (1.8 mm) caudal. The exit points deviations were 0.8 mm (1.9 mm) lateral, 0.02 mm (0.9 mm) dorsal and 0.7 mm (2.0 mm) caudal. Significant difference in accuracy between surgeons was found in the thoracic region but not in the lumbar region. Accuracy and safety improvement are noted for the thoracic region when procedures were repeated by the novice.

Conclusion This proof of concept demonstrates that using neuronavigation, minimally invasive stabilization with polyaxial screws-rod is feasible and safe in a large breed dog model.

Keywords

minimally invasive spine surgery - neuronavigation - accuracy - safety - polyaxial screw

Authors' Contributions

J.G. and E.S. executed the experiments and registered the data. J.R. did statistical analysis. J.G., E.S., F.F., C.P., and J.R. interpreted and critically revised the manuscript for important intellectual contribution. All the authors approved the final version.




Publication History

Received: 21 September 2021

Accepted: 04 May 2022

Article published online:
27 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Weh M, Kraus KH. Chapter 34: Spinal fracture and luxations. In: Tobias KM, Johnston SA. eds. Veterinary Surgery: Small Animal. Missouri: Saunders; 2012: 487-503
    Google Scholar
  • 2 Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD. Free hand pedicle screw placement in the thoracic spine: is it safe?. Spine 2004; 29 (03) 333-342 , discussion 342
    CrossrefPubMedGoogle Scholar
  • 3 Watine S, Cabassu JP, Catheland S, Brochier L, Ivanoff S. Computed tomography study of implantation corridors in canine vertebrae. J Small Anim Pract 2006; 47 (11) 651-657
    CrossrefPubMedGoogle Scholar
  • 4 Wheeler JL, Cross AR, Rapoff AJ. A comparison of the accuracy and safety of vertebral body pin placement using a fluoroscopically guided versus an open surgical approach: an in vitro study. Vet Surg 2002; 31 (05) 468-474
    CrossrefPubMedGoogle Scholar
  • 5 Schmitt EM, Early P, Bergman R. et al. Computed tomography evaluation of proposed implant corridors in canine thoracic vertebrae. Vet Surg 2021; 50 (07) 1427-1433
    CrossrefPubMedGoogle Scholar
  • 6 Samer ES, Forterre F, Rathmann JMK, Stein VM, Precht CM, Guevar J. Accuracy and safety of image-guided freehand pin placement in canine cadaveric vertebrae. Vet Comp Orthop Traumatol 2021; 34 (05) 338-345
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Wallace N, Schaffer NE, Freedman BA. et al. Computer-assisted navigation in complex cervical spine surgery: tips and tricks. J Spine Surg 2020; 6 (01) 136-144
    CrossrefPubMedGoogle Scholar
  • 8 Austin MS, Vaccaro AR, Brislin B, Nachwalter R, Hilibrand AS, Albert TJ. Image-guided spine surgery: a cadaver study comparing conventional open laminoforaminotomy and two image-guided techniques for pedicle screw placement in posterolateral fusion and nonfusion models. Spine 2002; 27 (22) 2503-2508
    CrossrefPubMedGoogle Scholar
  • 9 Härtl R, Lam KS, Wang J, Korge A, Kandziora F, Audigé L. Worldwide survey on the use of navigation in spine surgery. World Neurosurg 2013; 79 (01) 162-172
    CrossrefPubMedGoogle Scholar
  • 10 Guevar J, Zidan N, Durand A, Olby NJ. Minimally invasive spine surgery in dogs: Evaluation of the safety and feasibility of a thoracolumbar approach to the spinal cord. Vet Surg 2020; 49 (Suppl. 01) O76-O85
    PubMedGoogle Scholar
  • 11 Guevar J, Olby N. Minimally invasive microsurgical decompression of an intervertebral disc protrusion in a dog. Vet Surg 2020; 49 (Suppl. 01) O86-O92
    PubMedGoogle Scholar
  • 12 Hwang YH, Lee HC, Lee JH. Operative techniques and preliminary outcomes following percutaneous endoscopic thoracolumbar pediculectomy in dogs. Vet Surg 2016; 45 (S1): O84-O94
    CrossrefPubMedGoogle Scholar
  • 13 Moon HS, Hwang YH, Lee HC, Lee JH. Operative techniques of percutaneous endoscopic mini-hemilaminectomy using a uniportal approach in dogs. J Vet Med Sci 2017; 79 (09) 1532-1539
    CrossrefPubMedGoogle Scholar
  • 14 Foley KT, Gupta SK. Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results. J Neurosurg 2002; 97 (1, Suppl): 7-12
    PubMedGoogle Scholar
  • 15 Kim TT, Drazin D, Shweikeh F, Pashman R, Johnson JP. Clinical and radiographic outcomes of minimally invasive percutaneous pedicle screw placement with intraoperative CT (O-arm) image guidance navigation. Neurosurg Focus 2014; 36 (03) E1
    CrossrefPubMedGoogle Scholar
  • 16 Mobbs RJ, Sivabalan P, Li J. Technique, challenges and indications for percutaneous pedicle screw fixation. J Clin Neurosci 2011; 18 (06) 741-749
    CrossrefPubMedGoogle Scholar
  • 17 Foley KT, Gupta SK, Justis JR, Sherman MC. Percutaneous pedicle screw fixation of the lumbar spine. Neurosurg Focus 2001; 10 (04) E10
    CrossrefPubMedGoogle Scholar
  • 18 Oertel MF, Hobart J, Stein M, Schreiber V, Scharbrodt W. Clinical and methodological precision of spinal navigation assisted by 3D intraoperative O-arm radiographic imaging. J Neurosurg Spine 2011; 14 (04) 532-536
    CrossrefPubMedGoogle Scholar
  • 19 Rivkin MA, Yocom SS. Thoracolumbar instrumentation with CT-guided navigation (O-arm) in 270 consecutive patients: accuracy rates and lessons learned. Neurosurg Focus 2014; 36 (03) E7
    CrossrefPubMedGoogle Scholar
  • 20 Tian W, Liu B, He D. et al; International Society for Computer Assisted Orthopaedic Surgery. Guidelines for navigation-assisted spine surgery. Front Med 2020; 14 (04) 518-527
    CrossrefPubMedGoogle Scholar
  • 21 Scarfe WC, Farman AG. What is cone-beam CT and how does it work?. Dent Clin North Am 2008; 52 (04) 707-730 , v
    Google Scholar
  • 22 Yazici B, Yolacan S. A comparison of various tests of normality. J Stat Comput Simul 2007; 77 (02) 175-183
    CrossrefPubMedGoogle Scholar
  • 23 Rasch D, Guiard V. The robustness of parametric statistical methods. Psychol Sci 2004; 46: 175-208
    PubMedGoogle Scholar
  • 24 Blanca MJ, Alarcón R, Arnau J, Bono R, Bendayan R. Non-normal data: is ANOVA still a valid option?. Psicothema 2017; 29 (04) 552-557
    PubMedGoogle Scholar
  • 25 Katisko JP, Kauppinen MT, Koivukangas JP, Heikkinen ER. Stereotactic operations using the o-arm. Stereotact Funct Neurosurg 2012; 90 (06) 401-409
    CrossrefPubMedGoogle Scholar
  • 26 Shahlaie K, Larson PS, Starr PA. Intraoperative computed tomography for deep brain stimulation surgery: technique and accuracy assessment. Neurosurg. 2011 Mar;68(1 Suppl Operative):114–24; discussion 124
    PubMedGoogle Scholar
  • 27 Smith AP, Bakay RA. Frameless deep brain stimulation using intraoperative O-arm technology. Clinical article. J Neurosurg 2011; 115 (02) 301-309
    CrossrefPubMedGoogle Scholar
  • 28 Guevar J, Bleedorn J, Cullum T, Hetzel S, Zlotnick J, Mariani CL. Accuracy and safety of three-dimensionally printed animal-specific drill guides for thoracolumbar vertebral column instrumentation in dogs: bilateral and unilateral designs. Vet Surg 2021; 50 (02) 336-344
    CrossrefPubMedGoogle Scholar
  • 29 Fujioka T, Nakata K, Nishida H. et al. A novel patient-specific drill guide template for stabilization of thoracolumbar vertebrae of dogs: cadaveric study and clinical cases. Vet Surg 2019; 48 (03) 336-342
    CrossrefPubMedGoogle Scholar
  • 30 Evans HE, Delahunta A. The skeleton. In: Millers Anatomy of the Dog. 4th edition.. Elsevier Saunders, Missouri; 2013. 4. 80-157
    Google Scholar
  • 31 Elford JH, Oxley B, Behr S. Accuracy of placement of pedicle screws in the thoracolumbar spine of dogs with spinal deformities with three-dimensionally printed patient-specific drill guides. Vet Surg 2020; 49 (02) 347-353
    CrossrefPubMedGoogle Scholar
  • 32 Mariani CL, Zlotnick JA, Harrysson O. et al. Accuracy of three-dimensionally printed animal-specific drill guides for implant placement in canine thoracic vertebrae: a cadaveric study. Vet Surg 2021; 50 (02) 294-302
    CrossrefPubMedGoogle Scholar
  • 33 Gang C, Haibo L, Fancai L, Weishan C, Qixin C. Learning curve of thoracic pedicle screw placement using the free-hand technique in scoliosis: how many screws needed for an apprentice?. Eur Spine J 2012; 21 (06) 1151-1156
    CrossrefPubMedGoogle Scholar
  • 34 Sturges BK, Kapatkin AS, Garcia TC. et al. Biomechanical comparison of locking compression plate versus positive profile pins and polymethylmethacrylate for stabilization of the canine lumbar vertebrae. Vet Surg 2016; 45 (03) 309-318
    CrossrefPubMedGoogle Scholar
  • 35 https://surgeryreference.aofoundation.org/spine/deformities/scheuermann-kyphosis/further-reading/pedicle-screw-insertion#lumbar-spine
    PubMed
  • 36 Wang H, Zhou Y, Li C, Liu J, Xiang L. Comparison of open versus percutaneous pedicle screw fixation using the sextant system in the treatment of traumatic thoracolumbar fractures. Clin Spine Surg 2017; 30 (03) E239-E246
    CrossrefPubMedGoogle Scholar
  • 37 Dahdaleh NS, Smith ZA, Hitchon PW. Percutaneous pedicle screw fixation for thoracolumbar fractures. Neurosurg Clin N Am 2014; 25 (02) 337-346
    CrossrefPubMedGoogle Scholar
  • 38 Lewchalermwong P, Suwanna N, Meij BP. Canine vertebral screw and rod fixation system: design and mechanical testing. Vet Comp Orthop Traumatol. 2018 Feb;31(02):095–101
    PubMedGoogle Scholar
  • 39 Tellegen AR, Willems N, Tryfonidou MA, Meij BP. Pedicle screw-rod fixation: a feasible treatment for dogs with severe degenerative lumbosacral stenosis. BMC Vet Res 2015; 11 (01) 299
    CrossrefPubMedGoogle Scholar
  • 40 Zindl C, Litsky AS, Fitzpatrick N, Allen MJ. Kinematic behavior of a novel pedicle screw-rod fixation system for the canine lumbosacral joint. Vet Surg 2018; 47 (01) 114-124
    CrossrefPubMedGoogle Scholar
  • 41 Teunissen M, van der Veen AJ, Smit TH, Tryfonidou MA, Meij BP. Effect of a titanium cage as a stand-alone device on biomechanical stability in the lumbosacral spine of canine cadavers. Vet J 2017; 220: 17-23
    CrossrefPubMedGoogle Scholar
  • 42 Ogrenci A, Yaman O. Surgeon handedness in transpedicular instrumentation-a short review. J Spine 2017; 6 (387) 479-482
    PubMedGoogle Scholar