Timing of Vertebral Registration in Three-dimensional, Fluoroscopy-based, Image-guided Spinal Surgery

Study Design: The timing of vertebral registration using isocentric fluoroscopy was recorded in 20 consecutive patients undergoing image-guided spinal surgery. Objective: To determine if vertebral registration in three-dimensional, fluoroscopy-based, image-guided spinal surgery can be performed in an efficient manner. Summary of Background Data: Many spine surgeons are reluctant to incorporate spinal image guidance into their surgical practice due to the perception that it is time consuming and tedious, especially the task of vertebral registration. The authors evaluated the time required for vertebral level registration using the Arcadis Orbic isocentric C-arm (Siemens Medical Solutions, Erlangen, Germany) in conjunction with the BrainLAB (BrainLAB, Westchester, IL) image-guided system for spinal surgery cases. Methods: The time required to register vertebral segments using the isocentric C-arm was assessed in 20 consecutive patients undergoing spinal fusions by the senior author (E.W.N.). Overall, 80 vertebral segments spanning from C1 to S1 were registered with 23 spins of the isocentric C-arm. Timing was started when the surgeon began to place the image-guided reference arc on the spine and commenced when the spine could be navigated using the image-guided system. Results: The average time required for this process was 8 minutes and 34 seconds per patient. No complications occurred in this study as a result of instrumentation placement or the use image guidance. Excellent navigation accuracy was obtained in all cases and no malfunction of the isocentric C-arm or image-guided system occurred. Postoperative radiographic studies were performed on all patients and revealed adequate placement of instrumentation. Conclusions: The use of the isocentric C-arm for vertebral registration in image-guided spinal surgery can be performed in an efficient manner. In this study, multiple vertebral levels of registration could be accomplished in less than 9 minutes with minimal to no radiation exposure to the surgeon and operating room personnel.