Related Experiment Video
Updated: Jul 4, 2025
06:18
Pedicle Screw Placement Using an Augmented Reality Head-Mounted Display in a Porcine Model
Published on: May 24, 2024
2.2K
Assessing intraoperative pedicle screw placement accuracy using biplanar radiographs compared to three-dimensional
George Gorgy1, Fedan Avrumova1, Philip K Paschal1
1Department of Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Journal of Robotic Surgery
|February 8, 2024
Summary
Two-dimensional (2D) imaging may inaccurately confirm pedicle screw (PS) placement. Intraoperative three-dimensional (3D) imaging, validated by CT scans, offers superior accuracy for assessing PS positioning and breaches in spinal surgery.
Area of Science:
- Orthopedics
- Neurosurgery
- Radiology
Background:
- Biplanar (2D) imaging, utilizing anteroposterior views and the M-line method, has been the standard for pedicle screw (PS) placement verification.
- Intraoperative three-dimensional (3D) imaging systems, such as the Gertzbein-Robbins system (GRS), are increasingly available for assessing PS breach and positioning.
- Accurate PS placement is critical for the success of posterior thoracic and lumbar instrumented fusion procedures.
Purpose of the Study:
- To compare the accuracy of 2D imaging versus 3D imaging in assessing pedicle screw position.
- To determine if 2D imaging is sufficient for verifying pedicle screw placement compared to advanced 3D imaging modalities.
Main Methods:
- Retrospective review of prospectively collected data from 204 adult patients undergoing posterior thoracic and lumbar instrumented fusion.
- Analysis of intraoperative images (2D and 3D) and postoperative CT scans for 103 patients with 362 pedicle screws.
- Verification of intraoperative 3D imaging (GRS) findings against postoperative CT scans and comparison with 2D imaging (M-line) assessments.
Main Results:
- Postoperative CT findings were consistent with intraoperative 3D GRS findings, validating the accuracy of 3D imaging.
- One percent of pedicle screws were falsely verified as accurate by the 2D M-line method, with 3D imaging revealing false negatives or positives.
- Intraoperative 3D scans demonstrated accuracy comparable to postoperative CT scans in detecting pedicle screw breaches.
Conclusions:
- Intraoperative 3D imaging is highly accurate for assessing pedicle screw breaches, comparable to postoperative CT scans.
- A significant number of pedicle screws may be inaccurately deemed accurate by 2D imaging when assessed with 3D imaging.
- Intraoperative post-instrumentation 3D scans may be preferable to prevent postoperative identification of inaccurately placed pedicle screws.
