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Significantly improved lumbar arthroplasty placement using image guidance: technical note.

Laurence A G Marshman¹, Tai Friesem, Y Raja Rampersaud

¹Department of Spinal Surgery, University Hospital of North Tees, Hardwick, Stockton, North Tees, UK. l.a.g.marshman@btinternet.com

|August 19, 2007

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Image-guidance systems (IGS) significantly improve lumbar total disc arthroplasty accuracy compared to conventional fluoroscopy. This technology should be considered for routine use in spinal surgery for better implant placement.

Area of Science:

Spinal Surgery
Medical Device Technology
Orthopedic Surgery

Background:

Conventional fluoroscopy is widely used for lumbar total disc arthroplasty (TDA) placement.
Previous studies suggested potential benefits of image-guidance systems (IGS) but lacked statistical significance.
Accurate implant placement is crucial for successful TDA outcomes.

Purpose of the Study:

To compare the accuracy of lumbar total disc arthroplasty placement using an image-guidance system (IGS) versus conventional fluoroscopy.
To evaluate the impact of IGS on implant positioning in patients with chronic discogenic low back pain.

Main Methods:

A comparative study involving 6 patients undergoing lumbar TDA with IGS and 14 patients without IGS.
Implant placement was assessed post-operatively using high-resolution CT scans and specialized software.

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Key parameters evaluated included off-center mal-placement, axial rotational mal-placement, and coronal tilt.

Main Results:

Lumbar TDAs performed with IGS demonstrated significantly greater accuracy in all measured parameters compared to those without IGS.
Specifically, IGS group showed reduced off-center placement (1.1 vs. 2.3 mm), improved axial rotation (88.8 vs. 87.1 degrees), and less coronal tilt (1.0 vs. 2.6 degrees).
No significant difference in operative time was observed between the IGS and non-IGS groups.

Conclusions:

This clinical study provides the first evidence of significantly improved accuracy for lumbar TDA placement using IGS compared to conventional fluoroscopy.
IGS offers a valuable tool for enhancing precision in lumbar total disc arthroplasty.
Routine consideration of IGS for lumbar TDA insertion is recommended to improve surgical outcomes.