Navigated Cementoplasty With O-Arm and Surgivisio: An Ambispective Comparison With Radiation Exposure

Vertebral compression fractures (VCF) are usually treated by cementoplasty. Computerized navigation allows more accurate surgery without additional imaging acquisition for guidance and related radiation exposure. New technologies trend to optimize the irradiation for patients and surgeons. The objective was to investigate the radiological results and radiation exposure of O-arm navigation compared with the all-in-one 2-dimensional/3-dimensional (2D/3D) Surgivisio device in navigated cementoplasty procedures.

Patients in the O-arm group comprised an O-arm prospective cohort as well as previous patients. Operations for VCF by navigated cementoplasty took place over 18 months. Patients in the Surgivisio group were the first patients operated on using Surgivisio and were prospectively recruited. Demographic, operative, and irradiation data were collected, as well as the image quality subjectively evaluated by the surgeon. The vertebal filling was evaluated using the Garnier classification and quoted as satisfactory, acceptable, or poor. The effective dose in millisievert (mSv) was calculated for radiation exposure estimation, and the absolute risk of cancer (AR) in percent equivalent to a whole-body irradiation was also calculated.

A total of 123 patients were included: 62 in the O-arm group and 61 in the Surgivisio group. A total of 166 vertebrae were analyzed. Compared with the Surgivisio group, the effective dose was significantly higher in the O-arm group, with a mean of 11.47 vs 1.14 mSv, respectively (P < 0.001). The 2D part of the effective dose received by the surgeon was significantly higher in the O-arm group, with an average of 2.25 vs 0.47 mSv, respectively (P < 0.001). Overall AR followed the same trend, with a mean of 4.9 × 10^-4% in the O-arm group and 5.7 × 10^-5% in the Surgivisio group (P < 0.001). Operative time was significantly higher in the O-arm group (34.52 vs 30.12 minutes respectively, P = 0.03). Image quality was similarly sufficient in 3D, but in 2D, image quality was significantly better in the O-arm group (P = 0.01). Vertebral filling was significantly better in the O-arm group, with 100% of results reported as satisfactory and acceptable versus 85% in the Surgivisio group (P < 0.001).

The O-arm delivered a 10-times higher effective dose during navigated cementoplasty in comparison with the Surgivisio device. The O-arm also had a longer operative time, but it had better image quality and radiological results.