Presentation (CTI)

OBJECTIVES: This study evaluates the safety and effectiveness of the Intraoperative CT Imaging System for Navigational Spine Surgery. The technique aims to enhance pedicle screw insertion accuracy by using intraoperative CT images for navigation in spinal fusion surgeries.
METHODS: A systematic review assessed safety (radiation exposure) and effectiveness (positional accuracy and readjustment rates). Five databases, including KoreaMed, Ovid-MEDLINE, and Cochrane Library, were searched. Two independent assessors applied inclusion criteria, extracted data, and evaluated study quality using the Scottish Intercollegiate Guidelines Network checklist.
RESULTS: From 700 initial articles, five studies met the inclusion criteria: one non-randomized controlled trial and four retrospective cohort studies. These studies included patients undergoing spinal screw fixation for degenerative, infectious, or traumatic spinal disorders or tumors. The intervention was compared to the O-arm® imaging system. Study quality ratings were 1+ (one study), 2+ (one study), and 2- (three studies).(Safety) Radiation exposure was reported in three studies. One study found significantly higher patient exposure in the intervention group (8.7 mSv vs. 2.58 mSv, p < 0.05), while another reported lower exposure. Medical personnel exposure was significantly lower in the intervention group. The subcommittee concluded that the technique's safety is acceptable, as CT imaging provides critical accuracy benefits. (Effectiveness) Three studies found significantly higher positional accuracy in the intervention group, while one showed no difference, and another reported lower accuracy without statistical significance. Two studies reported lower readjustment rates, while two showed higher but insignificant differences. Given the higher resolution and similar or better accuracy compared to O-arm®, the subcommittee deemed the technique effective.
CONCLUSIONS: The subcommittee concluded that Intraoperative CT Imaging for Navigational Spine Surgery is a safe and effective technique for improving pedicle screw insertion accuracy (Level C evidence)