Purpose

There is an increasing need for pedicle screw positioning while decreasing radiation exposure. This study compares intra-operative radiation dose using posterior internal fixation using impedancemetry-guided pedicle positioning by the Pediguard system versus standard free-hand sighting when surgery was performed with a trainee or expert surgeon.

Material and methods

Using the electrical properties of bone, the Pediguard detects iatrogenic penetration of the pedicle wall and gives auditory feedback to the surgeon. A single centre, two surgeons (one experienced and the other novice) conducted a continuous prospective randomized study for one year. Twenty patients were randomized into one group (free-hand control group) receiving pedicle instrumentation without the use of the Pediguard and the second group receiving pedicle instrumentation with the use of the Pediguard. The total screw placement times and fluoroscopic times for each screw was recorded and pedicle screw position was analyzed on post-operative CT scan.

Results

Among the 104 screwed pedicles, 22 unrecognized perforations were detected by CT scan, while no perforation signal was observed intra-operatively. Only one perforation was greater than 2 mm. The overall screwing time was 4.33 ± 1.2 minutes per screw for experienced surgeon and 5.84 ± 2.5 minutes per screw for the novice. Pediguard did not increased significantly the time (0.3 mn per screw) for the experienced surgeon, but the time with Pediguard was longer (2 mn more per screw) for the novice surgeon, particularly at the thoracic level. The overall fluoroscopic average time per screw for the experienced surgeon is 5.8 ± 2.3 s and 10.4 ± 4.5 s for the novice surgeon. For the novice surgeon, radiation time reduced from 12 (without Pediguard) to 6 s (with Pediguard). There was no significant difference for the experienced surgeon in terms of improvement in radiation time with the use of Pediguard.

Conclusion

The overall time was longer for the novice surgeon with the Pediguard system, but allowed to decrease by 50% the fluoroscopy time.

中文翻译：

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骨传导和脊柱透视，手眼耳对话，椎弓根螺钉定位：一种新的人类认知系统，用于精确和减少辐射；比人工智能和机器学习系统更好？

目的

在减少辐射暴露的同时，越来越需要椎弓根螺钉定位。本研究比较了由 Pediguard 系统使用阻抗测量引导的椎弓根定位后路内固定术与由实习医生或专家外科医生进行手术时的标准徒手瞄准的术中辐射剂量。

材料与方法

Pediguard 利用骨骼的电特性，检测椎弓根壁的医源性穿透，并向外科医生提供听觉反馈。一个中心，两名外科医生（一名经验丰富，另一名新手）进行了为期一年的连续前瞻性随机研究。将 20 名患者随机分为一组（徒手对照组），在不使用 Pediguard 的情况下接受椎弓根内固定，而第二组在使用 Pediguard 的情况下接受椎弓根内固定。记录每个螺钉的总置钉次数和透视次数，并在术后 CT 扫描中分析椎弓根螺钉位置。

结果

104个螺钉椎弓根中有22个CT扫描未发现穿孔，术中未见穿孔信号。只有一个穿孔大于 2 毫米。经验丰富的外科医生的总拧紧时间为每颗螺钉 4.33 ± 1.2 分钟，新手每颗螺钉的总拧紧时间为 5.84 ± 2.5 分钟。Pediguard 没有显着增加经验丰富的外科医生的时间（每个螺钉 0.3 百万），但新手外科医生使用 Pediguard 的时间更长（每个螺钉增加 2 百万），尤其是在胸椎水平。经验丰富的外科医生每颗螺钉的总体透视平均时间为 5.8 ± 2.3 秒，新手外科医生为 10.4 ± 4.5 秒。对于新手外科医生，辐射时间从 12 秒（没有 Pediguard）减少到 6 秒（有 Pediguard）。

结论

使用 Pediguard 系统的新手外科医生的总体时间更长，但可以减少 50% 的透视时间。