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Comparison of radiation exposure and surgery time between an intraoperative CT with automatic surface registration and a preoperative CT with manual surface registration in navigated spinal surgeries

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Abstract

Purpose

This retrospective matched case–control study was conducted to compare two CT based surgery techniques for navigated screw placement in spinal surgery, whether a reduction of radiation exposure and surgery time could be achieved.

Methods

We matched cases treated with an intraoperative CT (iCT), regarding the type and number of implants, with cases treated with a preoperative CT (pCT) of one main surgeon. Outcome measures were radiation exposure due to intraoperative control x-rays, radiation exposure due to CT images, and the duration of surgery.

Results

The required radiation exposure could be significantly reduced in the iCT group. For the intraoperative control X-rays by 69% (median (MED) 88.50/standard deviation (SD) 107.84 and MED 286.00/SD 485.04 for iCT and pCT respectively—in Gycm2; p < 0.001) and for the CT examinations by 25% (MED 317.00/SD 158.62 and MED 424.50/SD 225.04 for iCT and pCT respectively—in mGycm; p < 0.001) with no significant change in surgery time. The correlation between the number of segments fused and the necessary surgery time decreased significantly for the iCT group (Pearson product-moment-correlation: r = 0.569 and r = 0.804 for iCT and pCT respectively; p < 0.05).

Conclusion

The results show that spinal navigation using an intraoperative CT with automatic registration compared to a preoperative CT and intraoperative manual surface registration, allows a significant reduction of radiation exposure, without prolonged surgery time. A significant benefit regarding cut-to-suture-time can be gained with surgeries of a larger scale.

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Availability of data and materials

All data used in this study are available.

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Authors and Affiliations

  1. Spine Center, St. Josefs-Hospital Wiesbaden, Beethovenstraße 20, 65189, Wiesbaden, Hesse, Germany

    Martin Mohammed Marzouk, Philipp Hartung & Marcus Richter

  2. Center for Orthopaedic and Trauma Surgery, St. Josefs-Hospital Wiesbaden, Beethovenstraße 20, 65189, Wiesbaden, Hesse, Germany

    Yama Afghanyar

  3. Justus-Liebig-Universität Gießen, Ludwigstraße 23, 35390, Gießen, Hesse, Germany

    Mark Mahmoud Marzouk

  4. Department of Internal Medicine, Hospital of Hofheim, Lindenstraße 10, 65719, Hofheim, Hesse, Germany

    Sarah Halima Boussouf

  5. Alt Oberliederbach 1, 65835, Liederbach, Hesse, Germany

    Martin Mohammed Marzouk

Authors
  1. Martin Mohammed Marzouk
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  2. Yama Afghanyar
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  3. Mark Mahmoud Marzouk
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  4. Sarah Halima Boussouf
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  5. Philipp Hartung
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  6. Marcus Richter
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Corresponding author

Correspondence to Martin Mohammed Marzouk.

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Conflict of interest

Marcus Richter holds company shares of Intrinsic Therapeutics and held lectures or has consultancy contracts with Brainlab, DePuy/Synthes, Intrinsic Therapeutics, Silony, Stryker, and Ulrich Medical. Philip Hartung held lectures for Brainlab and Ulrich medical. For the remaining authors none were declared.

Ethics approval

All protocols for this retrospective study were approved on the 8th of October 2019 by the ethics committee of the state chamber of physicians in Hesse, Germany. (Number: 2019–1400-evBO).

Consent to participate/Consent for publication

All participants in this study were older than 18 years of age at the time of their participation. After being informed in detail, all participants declared their willingness to participate in this study, and consented to the publication of the results, both verbally and in writing.

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Marzouk, M.M., Afghanyar, Y., Marzouk, M.M. et al. Comparison of radiation exposure and surgery time between an intraoperative CT with automatic surface registration and a preoperative CT with manual surface registration in navigated spinal surgeries. Eur Spine J 31, 685–692 (2022). https://doi.org/10.1007/s00586-021-07082-x

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  • DOI: https://doi.org/10.1007/s00586-021-07082-x

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