Save
Diffuse reflectance spectroscopy reliably identifies the cortical bone three millimeters before breach in spinal fixation surgery
EANS Academy. Burström G. 09/26/19; 276079; EP02056
Dr. Gustav Burström
Dr. Gustav Burström

Access to this content is reserved for EANS members and attendees of this event. Click here to become an EANS member and gain your access to the full content of the EANS Academy


Abstract
Discussion Forum (0)
Rate & Comment (0)
Background: Accuracy in pedicle screw placement in published series varies greatly and severe misplacements have been reported in 1-6.5% of screws. Misplaced screws may result in complications ranging from inadequate fixation to serious vascular and neurological injury. Meanwhile, diffuse reflectance spectroscopy (DRS) has previously been shown to differentiate reliably between tissues in the human body. The aim of this study was to develop and provide a proof-of-concept for using diffuse reflectance spectroscopy as a warning system for impending pedicle breach during pedicle screw placement.
Method: DRS technology was incorporated at the tip of a combined pedicle screw and screwdriver and was used for tissue sampling during pedicle screw insertions on six cadavers. Each insertion was planned to result in a breach. DRS measurements were collected in the wavelength range of 400-1600. Measurements were labelled as cancellous, cortical or, if bordering the cortical bone within three millimeters, pre-cortical zone (PCZ), based on information from cone beam computed tomographies at corresponding positions. In addition, DR spectroscopy data was recorded after breach.
Results: Four typical pedicle breach types were performed, and a total of twelve pedicle breaches were recorded. For each breach direction, the technology was able to detect the transition of the screw tip from the cancellous bone to the PCZ (P < 0.001), to cortical bone (P < 0.001), and to a subsequent breach (P < 0.001). The mean fat fraction was 58.6±9.5% in cancellous bone, 8.7±13.0% in cortical bone, and 46.5±25.1% when breached. Impending breach could be reliably detected within 3 mm from the cortical border.
Conclusions: This study demonstrates that DRS technology reliably identifies the cortical bone three millimeters ahead of the screw in typical breach scenarios and that it has the potential to prevent breach in spinal fixation surgery.
Background: Accuracy in pedicle screw placement in published series varies greatly and severe misplacements have been reported in 1-6.5% of screws. Misplaced screws may result in complications ranging from inadequate fixation to serious vascular and neurological injury. Meanwhile, diffuse reflectance spectroscopy (DRS) has previously been shown to differentiate reliably between tissues in the human body. The aim of this study was to develop and provide a proof-of-concept for using diffuse reflectance spectroscopy as a warning system for impending pedicle breach during pedicle screw placement.
Method: DRS technology was incorporated at the tip of a combined pedicle screw and screwdriver and was used for tissue sampling during pedicle screw insertions on six cadavers. Each insertion was planned to result in a breach. DRS measurements were collected in the wavelength range of 400-1600. Measurements were labelled as cancellous, cortical or, if bordering the cortical bone within three millimeters, pre-cortical zone (PCZ), based on information from cone beam computed tomographies at corresponding positions. In addition, DR spectroscopy data was recorded after breach.
Results: Four typical pedicle breach types were performed, and a total of twelve pedicle breaches were recorded. For each breach direction, the technology was able to detect the transition of the screw tip from the cancellous bone to the PCZ (P < 0.001), to cortical bone (P < 0.001), and to a subsequent breach (P < 0.001). The mean fat fraction was 58.6±9.5% in cancellous bone, 8.7±13.0% in cortical bone, and 46.5±25.1% when breached. Impending breach could be reliably detected within 3 mm from the cortical border.
Conclusions: This study demonstrates that DRS technology reliably identifies the cortical bone three millimeters ahead of the screw in typical breach scenarios and that it has the potential to prevent breach in spinal fixation surgery.
Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.



Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.


Save Settings