Accuracy and safety of pedicle screws implantation using Zeego and Brainlab navigation system in hybrid operation room

Abstract

Background: Hybrid operating room (OR) allows a combination of three-dimensional (3D) robotic fluoroscopy with navigation to be performed intraoperatively for minimally invasive surgery (MIS) of the spine. We aimed to investigate the accuracy and radiation exposure of surgeons and OR staffs when the navigation system is engaged for percutaneous pedicle screws (PPSs) placement. Materials and Methods: This was a retrospective nonrandomized study involving patients who were all clinically and radiologically compatible with lumbar spondylolisthesis. The Gertzbein and Robbins (G and R) scale was used to define the screw placement accuracy in the navigated group, and the mean numbers of C-arm fluoroscopic images taken for screw positioning verification were recorded. Dichotomous and numerical variables were analyzed with the Chi-square test and t-test, respectively. Results: Between July 2015 and July 2016, a total of 103 patients were treated, which consisted of 38 patients or 164 PPSs under navigation and 65 patients or 282 PPSs under freehand technique. We found that all navigated PSSs were satisfactorily placed under G and R Grade A and Grade B. The mean fluoroscopic images taken were significantly lower in the navigated two-level and three-level surgeries group. The operation time was longer in navigated two-level surgeries, while there is an insignificant difference in three-level surgeries in both navigated and nonnavigated surgeries. Conclusion: Intraoperative 3D robotic fluoroscopy with a navigation system for MIS of the spine ensures safe PPS placement and can significantly reduce the radiation exposure of surgeons and medical staffs. The duration of surgeries performed under navigation will improve with a smooth workflow.

Keywords

• accuracy
• hybrid operating room
• navigation
• pedicle screws
• safety