title: Significantly improved lumbar arthroplasty placement using image guidance: technical note.
abstract: METHODS
  Technical report.
  
  
  OBJECTIVE
  To compare the accuracy of lumbar total disc arthroplasty placement using an image-guidance system (IGS) with conventional fluoroscopy.
  
  
  BACKGROUND
  Most disc arthroplasties are inserted and analyzed using fluoroscopy. One previous cadaveric study demonstrated beneficial, but insignificant, effects of IGS on total disc arthroplasty placement compared with conventional fluoroscopy.
  
  
  METHODS
  Patients were considered for lumbar total disc arthroplasty who had chronic discogenic low back pain unresponsive to nonoperative management for at least 6 months. Total disc arthroplasty was performed in n = 6 with IGS and in n = 14 without IGS. Implant placement was analyzed after surgery using computer software on high-resolution CT with respect to 3 parameters: 1) off-center mal-placement, 2) axial rotational mal-placement, and 3) coronal tilt.
  
  
  RESULTS
  Arthroplasties inserted with IGS were positioned with significantly greater accuracy than non-IGS arthroplasties with respect to all 3 parameters measured (off-center: 1.1 +/- 0.3 vs. 2.3 +/- 0.3 mm, P = 0.031; rotation: 88.8 degrees +/- 0.2 degrees vs. 87.1 degrees +/- 0.4 degrees; P = 0.0084; and tilt: 1.0 degrees +/- 0.5 degrees vs. 2.6 degrees +/- 0.3 degrees, P = 0.01). There was no significant difference in operating time between non-IGS controls (123 +/- 5 minutes) and IGS (139 +/- 10 minutes) groups (P = 0.129).
  
  
  CONCLUSIONS
  This is the first clinical study to demonstrate significantly improved accuracy of lumbar total disc arthroplasty placement on CT using IGS compared with conventional fluoroscopy. IGS should be considered for routine use with lumbar total disc arthroplasty insertion.
authors: Department of Spinal Surgery, University Hospital of North Tees, Hardwick, Stockton, North Tees, UK. l.a.g.marshman@btinternet.com
authors: Laurence A G
authors: LA
authors: Marshman
authors: Tai
authors: T
authors: Friesem
authors: Y Raja
authors: YR
authors: Rampersaud
authors: Jean-Charles
authors: JC
authors: Le Huec
authors: Manoj
authors: M
authors: Krishna
authors: Guru R
authors: GR
authors: Reddy
mesh_terms: D000328:Adult; D019643:Arthroplasty, Replacement / Q000379:methods*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000601:surgery; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D025321:Surgery, Computer-Assisted / Q000379:methods*