fluoroscopy

Fluoroscopy

Imaging technique that uses X rays to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed. However, modern fluoroscopes couple the screen to an X-ray image intensifier and CCD video camera allowing the images to be recorded and played on a monitor.

The use of X-rays, a form of ionizing radiation, requires the potential risks from a procedure to be carefully balanced with the benefits of the procedure to the patient. While physicians always try to use low dose rates during fluoroscopic procedures, the length of a typical procedure often results in a relatively high absorbed dose to the patient. Recent advances include the digitization of the images captured and flat panel detector systems; modern advances allow further reduction of the radiation dose to the patient.


In challenging-to-access anatomic regions, fluoroscopy and intraoperative neurophysiology can be employed to augment targeting of neuromodulation electrodes to the site of seizure onset zone or specific neurophysiological biomarkers of clinical interest while minimizing brain retraction 1).

C Arm

Digital subtraction angiography.

Fluoroscopy radiation exposure.


The aim of the present study was the verification of the accuracy of 2D fluoroscopy-based navigated pedicle screw placements at the thoracic and lumbar spine in a case series of traumatised patients. Within 36 months 111 pedicle screws were instrumented using C-arm based navigation in 29 patients, 60 at the thoracic and 51 at the lumbar spine. All screw positions were evaluated postoperatively by a routine thin-slice CT scan using multiplanar reconstruction. The position of a screw in relation of its pedicle was classified as: a) screw completely intraosseous, b) screw perforated less than thread level and c) screw perforated over thread level. In 34 thoracic (56.7%) and 32 lumbar (62.7%) screws complete intraosseous placement was observed, 14 thoracic screws (23.3%) and 14 lumbar screws (27.5%) perforated less than thread level. Perforations over thread level were found in 12 thoracic (20%) and 5 lumbar (9.8%) screws. Only medial and lateral perforations of the pedicle were documented (without neurological signs), cranial or caudal perforations did not occur. Segmentation of the C-arm navigation into two comparable treatment periods showed a learning curve with a reduction of perforations in the second sequence (after 57 pedicle instrumentations) of about 15%, this was not found to be statistically significant. The fluoroscopic navigation of pedicle screws is a safe procedure at the lumbar spine with equal accuracy compared to the non-navigated conventional instrumentation. Application of C-arm navigation at the thoracic spine showed more inaccuracies, so that 3D-based navigation seems to be more advantageous in this region 2).


QuiƱones-Hinojosa A, Robert Kolen E, Jun P, Rosenberg WS, Weinstein PR. Accuracy over space and time of computer-assisted fluoroscopic navigation in the lumbar spine in vivo. J Spinal Disord Tech. 2006 Apr;19(2):109-13. PubMed PMID: 16760784.


1)
Parker JJ, Jamiolkowski RM, Grant GA, Le S, Halpern CH. Hybrid Fluoroscopic and Neurophysiological Targeting of Responsive Neurostimulation of the Rolandic Cortex. Oper Neurosurg (Hagerstown). 2021 Jun 16:opab182. doi: 10.1093/ons/opab182. Epub ahead of print. PMID: 34133746.
2)
Arand M, Teller S, Gebhard F, Schultheiss M, Keppler P. [Clinical accuracy of fluoroscopic navigation at the thoracic and lumbar spine]. Zentralbl Chir. 2008 Dec;133(6):597-601. doi: 10.1055/s-0028-1098695. Epub 2008 Dec 17. German. PubMed PMID: 19090441.
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  • Last modified: 2021/06/17 09:06
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