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Accuracy of a new intraoperative cone beam CT imaging technique (Artis zeego II) compared to postoperative CT scan for assessment of pedicle screws placement and breaches detection

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Abstract

Purpose

The goal of this study was to compare the accuracy of a novel intraoperative cone beam computed tomography (CBCT) imaging technique with that of conventional computed tomography (CT) scans for assessment of pedicle screw placement and breach detection.

Methods

Three hundred and forty-eight pedicle screws were inserted in 58 patients between October 2013 and March 2016. All patients had an intraoperative CBCT scan and a conventional CT scan to verify the placement of the screws. The CBCT and CT images were reviewed by two surgeons to assess the accuracy of screw placement and detect pedicle breaches using two established classification systems. Agreement on screw placement between intraoperative CBCT and postoperative CT was assessed using Kappa and Gwet’s coefficients. Using CT scanning as the gold standard, the sensitivity, specificity, positive predictive value, and negative predictive value were calculated to determine the ability of CBCT imaging to accurately evaluate screw placement.

Results

The Kappa coefficient was 0.78 using the Gertzbein classification and 0.80 using the Heary classification, indicating a substantial agreement between the intraoperative CBCT and postoperative CT images. Gwet’s coefficient was 0.94 for both classifications, indicating almost perfect agreement. The sensitivity, specificity, positive predictive value and negative predictive value of the CBCT images were 77, 98, 86, and 96%, respectively, for the Gertzbein classification and 79, 98, 88, and 96%, respectively, for the Heary classification.

Conclusions

Intraoperative CBCT provides accurate assessment of pedicle screw placement and enables intraoperative repositioning of misplaced screws. This technique may make postoperative CT imaging unnecessary.

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Author information

Authors and Affiliations

  1. Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 53, Box B1.53.07, 1200, Brussels, Belgium

    Virginie Cordemans, Xavier Banse & Olivier Cartiaux

  2. Service D’orthopédie et de traumatologie de l’appareil Locomoteur, Cliniques Universitaires, Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium

    Ludovic Kaminski & Xavier Banse

  3. Instiute of Statistics, Biostatistics and Actuarial sciences (ISBA), Université Catholique de Louvain-la-Neuve, Voie du Roman Pays 34/ L1.03.01, Louvain-la-Neuve, 1348, Belgium

    Bernard G. Francq

Authors
  1. Virginie Cordemans
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  2. Ludovic Kaminski
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  3. Xavier Banse
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  4. Bernard G. Francq
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  5. Olivier Cartiaux
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Corresponding author

Correspondence to Virginie Cordemans.

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Conflict of interest

Dr. Cordemans has received funding from Siemens for this investigation regarding Artis zeego imaging system. Dr. Banse is consultant for Siemens. Dr. Cartiaux is funded by the Brussels Capital Region-Innoviris (Grant BB2B 2012-1-05). Drs. Kaminski and Francq declare that they have no conflict of interest.

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Cordemans, V., Kaminski, L., Banse, X. et al. Accuracy of a new intraoperative cone beam CT imaging technique (Artis zeego II) compared to postoperative CT scan for assessment of pedicle screws placement and breaches detection. Eur Spine J 26, 2906–2916 (2017). https://doi.org/10.1007/s00586-017-5139-y

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  • DOI: https://doi.org/10.1007/s00586-017-5139-y

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