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Impact of Computer-Assisted Navigation on C-
arm Radiation and Time during Spinal
Procedures: A Clinical Evaluation
Timothy Wang, MD1; Vikram Mehta, MD MPH1; Farah Hamouda, BS2; Eric Sankey, MD1;
Chester Yarbrough, MD1; Robert Lark, MD1; and Muhammad Abd-El-Barr, MD PhD1
Duke University Medical Center, Durham, NC1 and TrackX Technology, LLC, Chapel Hill, NC2
Poster #: 91
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Disclosures
• Timothy Y. Wang: None
• Vikram A. Mehta: None
• Farah Hamouda: Employee of TrackX
• Eric W. Sankey: None
• Chester Yarbrough: None
• Robert Lark: None
• Muhammad M. Abd-El-Barr: None
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Introduction
• Minimally invasive spine surgery is dependent
on imaging and thus radiation exposure
• Novel technologies are required to reduce
exposure to as low as possible and create
accurate images
• TrackX is a novel computer-assisted navigation
technology that utilizes standard intraoperative
c-arm fluoroscopy
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Introduction
• Computer-assisted navigation works by placing navigational spheres on a low profile frame attached to the radiation source and camera of the c-arm (figure 1)
• Additional navigational clips are placed on the instrument (figure 2)
• After a fluoroscopic image is taken, any movement in the instrument will be continuously updated and displayed in real time on the monitor (figure 3)
• Objective: Determine if computer-assisted navigation (TrackX) reduces radiation production, operative time, and number of x-rays in minimally invasive spine surgery
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Figures
Figure 2: An instrument with navigational spheres attached
Figure 1: C-arm with navigation attachments on the radiation source and camera
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Figures
Figure 3: Screenshot of the navigational monitor with the instrument finding the pedicle
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Methods
• Study Design: Single institution, multi-surgeon, non-blinded, internally randomized controlled clinical trial in live subjects
• Population: 13 patients undergoing minimally invasive spine surgery
• Intervention: Computer-assisted intraoperative c-arm fluoroscopy navigation
• Time, number of x-rays, and radiation produced was tracked for the tasks of skin marking, first-dilator placement, hardware placement, and hardware removal
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Results
• 10 study patients and 3 control patients, 3 surgeons
• Computer-assisted navigation significantly reduced
operative time for all tasks.
• 81% reduced operative time overall
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Results
• Computer-assisted navigation significantly reduced x-
rays for all tasks except hardware removal
• 78% reduction in overall x-rays
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Results
• Computer-assisted navigation significantly reduced
radiation for all tasks except hardware removal
• 83% reduced radiation overall
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Discussion and Summary
• Computer-assisted navigation resulted in 83% less radiation in the operating room
• Computer-assisted navigation resulted in 81% less time in task completion
• Computer-assisted navigation is simple to setup and requires no preoperative imaging
• Computer-assisted navigation thus allows increased surgical efficiency while increasing operative efficiency and improving intraoperative safety