Ludovic Kaminski

Accuracy of a new intraoperative cone beam CT imaging technique (Artis zeego II) compared to postoperative CT scan for assessment of pedicle screws placement and breaches detection

PurposeThe goal of this study was to compare the accuracy of a novel intraoperative cone beam computed tomography (CBCT) imaging technique with that of conventional computed tomography (CT) scans for assessment of pedicle screw placement and breach detection.MethodsThree hundred and forty-eight pedicle screws were inserted in 58 patients between October 2013 and March 2016. All patients had an intraoperative CBCT scan and a conventional CT scan to verify the placement of the screws. The CBCT and CT images were reviewed by two surgeons to assess the accuracy of screw placement and detect pedicle breaches using two established classification systems. Agreement on screw placement between intraoperative CBCT and postoperative CT was assessed using Kappa and Gwet’s coefficients. Using CT scanning as the gold standard, the sensitivity, specificity, positive predictive value, and negative predictive value were calculated to determine the ability of CBCT imaging to accurately evaluate screw placement.ResultsThe Kappa coefficient was 0.78 using the Gertzbein classification and 0.80 using the Heary classification, indicating a substantial agreement between the intraoperative CBCT and postoperative CT images. Gwet’s coefficient was 0.94 for both classifications, indicating almost perfect agreement. The sensitivity, specificity, positive predictive value and negative predictive value of the CBCT images were 77, 98, 86, and 96%, respectively, for the Gertzbein classification and 79, 98, 88, and 96%, respectively, for the Heary classification.ConclusionsIntraoperative CBCT provides accurate assessment of pedicle screw placement and enables intraoperative repositioning of misplaced screws. This technique may make postoperative CT imaging unnecessary.

Radiation dose reduction in thoracic and lumbar spine instrumentation using navigation based on an intraoperative cone beam CT imaging system: a prospective randomized clinical trial

PurposeSpine surgery still remains a challenge for every spine surgeon, aware of the potential serious outcomes of misplaced instrumentation. Though many studies have highlighted that using intraoperative cone beam CT imaging and navigation systems provides higher accuracy than conventional freehand methods for placement of pedicle screws in spine surgery, few studies are concerned about how to reduce radiation exposure for patients with the use of such technology. One of the main focuses of this study is based on the ALARA principle (as low as reasonably achievable).MethodA prospective randomized trial was conducted in the hybrid operating room between December 2015 and December 2016, including 50 patients operated on for posterior instrumented thoracic and/or lumbar spinal fusion. Patients were randomized to intraoperative 3D acquisition high-dose (standard dose) or low-dose protocol, and a total of 216 pedicle screws were analyzed in terms of screw position. Two different methods were used to measure ionizing radiation: the total skin dose (derived from the dose–area product) and the radiation dose evaluated by thermoluminescent dosimeters on the surgical field.ResultsAccording to Gertzbein and Heary classifications, low-dose protocol provided a significant higher accuracy of pedicle screw placement than the high-dose protocol (96.1 versus 92%, respectively). Seven screws (3.2%), all implanted with the high-dose protocol, needed to be revised intraoperatively. The use of low-dose acquisition protocols reduced patient exposure by a factor of five.ConclusionThis study emphasizes the paramount importance of using low-dose protocols for intraoperative cone beam CT imaging coupled with the navigation system, as it at least does not affect the accuracy of pedicle screw placement and irradiates drastically less.

The effect of storage delay and storage temperature on orthopaedic surgical samples contaminated by Staphylococcus Epidermidis.

Background Prosthetic Joint Infection (PJI) is a rare but devastating complications with high morbitity and mortality. The identification of the causal microorganism remains crucial and determines therapeutic strategies and success. Microbiology cultures remain the common method to diagnose PJI. Unfortunately, 14% of intra-articular punctures remain negative after culture. The microorganisms are best detected by inoculation of microbiology samples in blood culture bottles (Bactec), or after sonication of the implant and polymerase chain reaction (PCR). The identification of the causal microorganism remains crucial and determines therapeutic success. Objectives This study was conducted to assess the effect of culture lead time and sample storage temperature on the detection of the pathogen. Methods We obtained bone fragments from femoral heads during primary arthroplasty. Bone fragments were contaminated with a strain of Staphylococcus epidermidis. Four set-ups with different combinations of storage delay and storage temperature were tested. Results Our study shows the need to cultivate as soon as possible and optimally within 2h after the completion of sampling. Temporary storage in a refrigerator at 4°C also appears to have a positive influence on bacterial viability. At present, these conclusions concern only the Staphylococcus Epidermidis. Others studies are requested to generalize this conclusion to other bacteria.

Pedicle screw insertion accuracy in terms of breach and reposition using a new intraoperative cone beam computed tomography imaging technique and evaluation of the factors associated with these parameters of accuracy: a series of 695 screws

PurposeThe goals of this study were to assess the accuracy of pedicle screw insertion using an intraoperative cone beam computed tomography (CBCT) system, and to analyze the factors potentially influencing this accuracy.MethodsSix hundred and ninety-five pedicle screws were inserted in 118 patients between October 2013 and March 2016. Screw insertion was performed using 2D-fluoroscopy or CBCT-based navigation. Accuracy was assessed in terms of breach and reposition. All the intraoperative CBCT scans, done after screw insertion, were reviewed to assess the accuracy of screw placement using two established classification systems: Gertzbein and Heary. Generalized linear mixed models were used to model the odds (95% CI) for a screw to lead to a breach according to the independent variables.ResultsThe breach rate was 11.7% using the Gertzbein classification and 15.4% using the Heary classification. Seventeen screws (2.4%) were repositioned intraoperatively. The only factor affecting statistically the odds to have a breach was the indication of surgery. The patients with non-degenerative disease had a significantly higher risk of breach than those with degenerative disease.ConclusionUse of intraoperative CBCT as 2D-fluoroscopy or coupled with a navigation system for pedicle screw insertion is accurate in terms of breach occurrence and reposition. However, these rates depend on the classification or grading system used. Use of a navigation system does not decrease the risk of breach significantly. And the risk of breach is higher in non-degenerative conditions (trauma, scoliosis, infection, and malignancy disease) than in degenerative diseases.