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

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

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

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

Figures

Figure 2: An instrument with navigational spheres attached

Figure 1: C-arm with navigation attachments on the radiation source and camera

Figures

Figure 3: Screenshot of the navigational monitor with the instrument finding the pedicle

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

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

Results

• Computer-assisted navigation significantly reduced x-

rays for all tasks except hardware removal

• 78% reduction in overall x-rays

Results

• Computer-assisted navigation significantly reduced

radiation for all tasks except hardware removal

• 83% reduced radiation overall

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