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Updated: Jun 20, 2026
Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
Conventional versus digital radiographs for intraoperative cervical spine-level localization: a prospective time and
Michael P Steinmetz1, Thomas E Mroz, Ajit Krishnaney
1Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA. steinmm@ccf.org
Background:
In today's health-care environment, operational efficiency is intrinsic to balancing the need for increased productivity driven by rising costs and potentially decreasing reimbursement. Other operational factors kept constant, decreasing the time for a procedure can be viewed as one marker for increased efficiency.
Purpose:
To prospectively evaluate the time and operating room efficiency differences between the two methods for intraoperative level localization. STYDY DESIGN: Prospective nonrandomized study.
Patient Sample:
Prospective consecutive patients undergoing a single-level anterior cervical discectomy and fusion (ACDF) with plate and allograft.
Outcomes Measures:
Time for performance and interpretation of intraoperative localization radiograph.
Methods:
This is a prospective nonrandomized study of patients treated consecutively with a single-level ACDF with allograft and plating. All the patients underwent a conventional approach to the cervical spine. After exposure, a spinal needle was placed in the exposed intervertebral disc and a radiography was performed. Either a conventional or a digital radiography was used in each case.
Results:
Eighteen patients were enrolled in this study. Ten patients underwent localization with conventional radiography, whereas eight patients underwent localization with digital imaging. The mean time for conventional radiography was 823 seconds (standard deviation [SD], 159), and for digital, it was 100 seconds (SD, 34; p<.001).
Conclusions:
Current technology provides options for level localization. Digital imaging provides equally accurate information as conventional radiography in a significantly reduced amount of time. Image quality, ease or archival, and manipulation provided by digital radiography are superior to those by provided fluoroscopy. Keeping operational factors constant, decreasing the time for a procedure, and increasing the efficiency of the environment may be viewed as a surrogate for improving the cost basis for a procedure.
