title: Feasibility of laser-guided percutaneous pedicle screw placement in the lumbar spine using a hybrid-OR.
abstract: OBJECTIVE
  Innovations in intraoperative imaging lead to major changes in orthopaedic surgery. In our setting, a 3D flat-panel c-arm (Artis zeego) is mounted on a robotic arm offering an integrated aiming tool (Syngo iGuide). Our aim was to investigate the feasibility of Syngo iGuide for pedicle screw placement in comparison with fluoroscopic screw implantation.
  
  
  METHODS
  In 10 lumbar models, 100 screws were implanted. In 5 models, a standard fluoroscopic technique was used. Syngo iGuide was used in all other models. Afterwards, CT-scans were performed and screw accuracy was investigated.
  
  
  RESULTS
  The procedure time for the new technique was significantly longer in comparison with the standard technique. The post-operative CT showed the same accuracy in both groups.
  
  
  CONCLUSIONS
  Syngo iGuide proofed feasible for percutaneous implantation of pedicle screws in anatomic models. Syngo iGuide can be a help for screw implantation in difficult anatomic regions without the need of an additional navigation system.
authors.affiliation: Department of Trauma-, Hand- and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany. peter.richter@uniklinik-ulm.de.
authors.forename: P H
authors.initials: PH
authors.lastname: Richter
authors.affiliation: Department of Trauma-, Hand- and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Gebhard
authors.affiliation: Department of Trauma-, Hand- and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Salameh
authors.affiliation: Department of Trauma-, Hand- and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Schuetze
authors.affiliation: Centre for Orthopaedic, Trauma and Spine Surgery, Donau-Ries Hospital Donauwoerth, Neudegger Allee 6, 86609, Donauwoerth, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Kraus
mesh_terms: D001863:Bone Screws; D004867:Equipment Design; D005240:Feasibility Studies; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007834:Lasers; D008159:Lumbar Vertebrae / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods*; D065289:Pedicle Screws; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed
keywords: Accuracy; Hybrid-OR; Minimally invasive; Pedicle screw; Syngo iGuide