Intraoperative three-dimensional fluoroscopy-based computerized tomography guidance for percutaneous kyphoplasty

Area of Science:

• Minimally Invasive Surgery
• Medical Imaging Technology
• Orthopedic Surgery

Background:

• Percutaneous kyphoplasty is a standard treatment for pathological vertebral compression fractures (VCFs).
• Current procedures typically rely on biplanar fluoroscopic guidance.
• The efficacy of three-dimensional (3D) image guidance for kyphoplasty has not been previously evaluated in clinical studies.

Purpose of the Study:

• To assess the effectiveness of isocentric fluoroscopy-based navigation for percutaneous kyphoplasty.
• To compare operating times between 3D isocentric fluoroscopy and traditional biplanar fluoroscopy.
• To evaluate the impact on intraoperative radiation exposure.

Main Methods:

• A prospective study involving 11 patients undergoing kyphoplasty with isocentric 3D fluoroscopy.
• Comparison with a historical cohort of 9 patients who had the procedure using only biplanar fluoroscopy.
• Evaluation of operating time, fluoroscopy time, and complications like cement extravasation.

Main Results:

• Isocentric 3D fluoroscopy group: mean operating time 60 minutes (one-level) and 68.5 minutes (two-level).
• Biplanar fluoroscopy group: mean operating time 69.2 minutes (one-level).
• Mean fluoroscopy time was significantly lower with isocentric 3D fluoroscopy (41.3s + 40s spin) compared to biplanar (293.2s) (p=0.02).

Conclusions:

• Isocentric fluoroscopy significantly reduces radiation exposure for patients and staff.
• This technique does not increase the mean operating time compared to biplanar fluoroscopy.
• Isocentric fluoroscopy represents a significant advancement for percutaneous kyphoplasty procedures.