title: Interest of intra-operative 3D imaging in spine surgery: a prospective randomized study.
abstract: We report a single-center, prospective, randomized study for pedicle screw insertion in opened and percutaneous spine surgeries, using a computer-assisted surgery (CAS) technique with three-dimensional (3D) intra-operative images intensifier (without planification on pre-operative CT scan) vs conventional surgical procedure.
  
  
  
  We included 143 patients: Group C (conventional, 72 patients) and Group N (3D Fluoronavigation, 71 patients). We measured the pedicle screw running time, and surgeon's radiation exposure. All pedicle runs were assessed according to Heary by two independent radiologists on a post-operative CT scan.
  
  
  
  3D Fluoronavigation appeared less accurate in percutaneous procedures (24 % of misplaced pedicle screws vs 5 % in Group C) (p = 0.007), but more accurate in opened surgeries (5 % of misplaced pedicle screws vs 17 % in Group C) (p = 0.025). For one vertebra, the average surgical running time reached 8 min in Group C vs 21 min in Group N for percutaneous surgeries (p = 3.42 × 10(-9)), 7.33 min in Group C vs 16.33 min in Group N (p = 2.88 × 10(-7)) for opened surgeries. The 3D navigation device delivered less radiation in percutaneous procedures [0.6 vs 1.62 mSv in Group C (p = 2.45 × 10(-9))]. For opened surgeries, it was twice higher in Group N with 0.21 vs 0.1 mSv in Group C (p = 0.022).
  
  
  
  The rate of misplaced pedicle screws with conventional techniques was nearly the same as most papers and a little bit higher with CAS. Surgical running time and radiation exposure were consistent with many studies. Our work hypothesis is partially confirmed, depending on the type of surgery (opened or closed procedure).
authors.affiliation: University Department of Orthopaedic Surgery and Traumatology, CHU A. Michallon, 38043, Grenoble Cedex, France. sruatti@chu-grenoble.fr.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Ruatti
authors.affiliation: University Department of Medical Imaging, CHU A. Michallon, 38043, Grenoble Cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Dubois
authors.affiliation: Clinical Investigation and Technological Innovation Center (CIC-IT), Joseph Fourier University, 38043, Grenoble Cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Chipon
authors.affiliation: University Department of Orthopaedic Surgery and Traumatology, CHU A. Michallon, 38043, Grenoble Cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Kerschbaumer
authors.affiliation: University Department of Orthopaedic Surgery and Traumatology, CHU A. Michallon, 38043, Grenoble Cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Milaire
authors.affiliation: Clinical Investigation and Technological Innovation Center (CIC-IT), Joseph Fourier University, 38043, Grenoble Cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Moreau-Gaudry
authors.affiliation: University Department of Orthopaedic Surgery and Traumatology, CHU A. Michallon, 38043, Grenoble Cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Tonetti
authors.affiliation: University Department of Orthopaedic Surgery and Traumatology, CHU A. Michallon, 38043, Grenoble Cedex, France.
authors.forename: Ph
authors.initials: P
authors.lastname: Merloz
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D065289:Pedicle Screws; D011446:Prospective Studies; D013131:Spine / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: 3D fluoroscope; 3D imaging; Computer-aided surgery; Navigation and spine surgery; Spine surgery