Reducing Implant-Associated Complications in Scoliosis Surgery by Using O-Arm Navigation and Additive Technologies

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Abstract

Background. Posterior spinal fusion with multisegmental fixation with pedicle screws is the method of choice in the treatment of patients with severe scoliosis. Malposition of pedicle screws, as a cause of implant-associated complications when using the free-hand technique of their implantation, occurs with a frequency of 1.5 to 50.0%. High risks of implant-associated complications require the widespread implementation of technologies for their prevention, including O-arm navigation and additive technologies. Aims — to compare the accuracy and safety of surgical correction of scoliosis using the free-hand technique, O-arm navigation and additive technologies to reduce the risk of implant-associated complications. Methods. A total of 72 patients operated on for scoliotic deformity were included in the study. Group I included 25 patients (447 screws) operated on using the free-hand technique of transpedicular screw implantation, group II included 25 patients (528 screws) operated on using O-arm navigation, and group III included 22 patients (430 screws) operated on using additive technologies based on 3D printing. A comparative analysis of the frequency and distribution of malpositions was carried out in the groups, as well as a search for relationships between various radiographic parameters. Results. In the free-hand group, the average angle of deformation before surgery was 78.48 ± 18.28, the total frequency of malpositions was 16.6%, including: grade 1 — 2.01%, grade 2 — 6.94%, grade 3 — 7.6%. In the O-arm group, the angle of deformation was 90.84 ± 30.16, a total of malpositions was 4.92%, including: grade 1 — 1.52%, grade 2 — 2.84%, grade 3 — 0.57%. In the 3D printing group, the average angle was 95.36 ± 20.93, a total of malpositions was 6.28%, including: grade 1 — 3.72%, grade 2 — 2.33%, grade 3 — 0.23%. When assessing the relationship between the rotation of the apical vertebra and the Cobb angle of deformation on the frequency of malpositions in the free-hand group, a high degree of direct relationship was found (p < 0.05). No correlation was found between the frequency of malpositions and rotations of the apical vertebra and the Cobb angle of deformation in the O-arm group. In the 3D group, a moderate correlation was observed (p < 0.05). In the free-hand group, 1 neurological complication was noted, in the O-arm and 3D groups, no complications were noted. Conclusions. The use of free-hand — the technique of installing pedicle screws in surgical correction of spinal deformities is relatively safe. However, an increase in the severity of spinal deformity is associated with a high risk of implant-associated complications in severe spinal deformities. The use of O-arm navigation and additive technologies significantly reduces the risk of implant-associated complications, which increases the effectiveness and safety of surgical correction of severe forms of scoliosis.

About the authors

Ivan P. Pimbursky

National Medical Research Center for Children’s Health

Email: bdfyltvbljd@yandex.ru
ORCID iD: 0009-0002-5274-3941
SPIN-code: 6085-7940

MD

Russian Federation, 2 Lomonosovsky Prospekt, 119296, Moscow

Ivan E. Domrachev

National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov

Email: VaniaD97@mail.ru
ORCID iD: 0009-0005-9014-3068
SPIN-code: 1367-3096

MD

Russian Federation, Moscow

Oleg B. Chelpachenko

National Medical Research Center for Children’s Health; Research Institute of Emergency Children’s Surgery and Traumatology

Email: chelpachenko81@mail.ru
ORCID iD: 0000-0002-0333-3105
SPIN-code: 7738-5108

MD, PhD

Russian Federation, 2 Lomonosovsky Prospekt, 119296, Moscow; Moscow

Sergey V. Kolesov

National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov

Email: dr-kolesov@yandex.ru
ORCID iD: 0000-0002-4252-1854
SPIN-code: 1989-6994

MD, PhD

Russian Federation, Moscow

Konstantin V. Zherdev

National Medical Research Center for Children’s Health; I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)

Email: drzherdev@mail.ru
ORCID iD: 0000-0003-3698-6011
SPIN-code: 8712-1738

MD, PhD, Assistant Professor

Russian Federation, 2 Lomonosovsky Prospekt, 119296, Moscow; Moscow

Sergey P. Yatsyk

Russian Medical Academy of Continuous Professional Education

Email: macadamia@yandex.ru
ORCID iD: 0000-0001-6966-1040
SPIN-code: 4890-8742

MD, PhD, Professor, Corresponding Member of the RAS

Russian Federation, Moscow

Andrey S. Butenko

National Medical Research Center for Children’s Health

Email: butenko.as@nczd.ru
ORCID iD: 0000-0002-7542-8218
SPIN-code: 9703-4935

MD

Russian Federation, 2 Lomonosovsky Prospekt, 119296, Moscow

Arcady I. Kazmin

National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov

Author for correspondence.
Email: kazmin.cito@mail.ru
ORCID iD: 0000-0003-2330-0172
SPIN-code: 4944-4173

MD, PhD

Russian Federation, Moscow

References

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Supplementary files

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2. Fig. 1. Topography of the chest organs at the level of the thoracic spine. Example of medial malposition

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3. Fig. 2. Displacement of the structures of the spinal canal to the concave side of the deformation. A - spinal cord at the level of the Th11 vertebra (myelography)

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4. Fig. 3. Topography of the chest organs at the level of the thoracic spine. Example of lateral malposition

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5. Fig. 4. Topography of the vessels in front of the spinal column at the level of the thoracic spine. Example of anterior malposition: A - aorta; B - v. Hemiazygos; C - v. Azygos

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6. Fig. 5. 3D model of the deformation with guides for transpedicular screws

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7. Fig. 6. Graph of the dependence of the frequency of malpositions in group I (free-hand): A - on the rotation of the apical vertebra (r = 0.713; p < 0.001); B - on the angle of deformation according to Cobb (r = 0.657; p < 0.05)

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8. Fig. 7. Graph of the dependence of the frequency of malpositions in group II (O-arm): A - on the rotation of the apical vertebra (r = 0.072; p = 0.734); B - on the angle of deformation according to Cobb (r = 0.298; p = 0.147)

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9. Fig. 8. Graph of the dependence of the frequency of malpositions in group III (3D): A - on the rotation of the apical vertebra (r = 0.491, p < 0.05); B - on the angle of deformation according to Cobb (r = 0.423; p < 0.05)

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10. Fig. 9. Clinical example. Patient A., 15 years old: A — radiograph before surgery; B — result of the second stage of surgery; C — critical malpositions at the Th11 and L levels.

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