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Computed tomography-guided vertebroplasty using a stereotactic guidance system (stereo-guide).

Patil AA - Surg Neurol Int (2010)

Bottom Line: The system was easy to use and proved to be accurate.No complication resulted from the procedure.The stereo-guide proved to be simple and easy to use.

View Article: PubMed Central - HTML - PubMed

Affiliation: Professor of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, USA.

ABSTRACT

Background: In order to make it easy to perform computed tomography (CT)-guided vertebroplasty a stereotactic guidance system called the "stereo-guide" was designed. A method to perform CT-guided vertebroplasty using this system is described.

Methods: The device is a rectangular flat plastic block. One of the flat surfaces of the block has deeply grooved protractor markings at 5-degree intervals; ranging from 0 to 30 degrees. The procedure is performed on the CT table. Based on distances and angle measurements obtained from CT images the device is placed on an appropriate location on the back of the patient and the needle is advanced to the target through the pedicle guided by the grooves on the device. Ten procedures were performed in nine patients with lumbar and thoracic pathology.

Results: The system was easy to use and proved to be accurate. No complication resulted from the procedure.

Conclusion: The stereo-guide proved to be simple and easy to use. Intraoperative scans helped to plan the trajectory and follow the injection of the cement.

No MeSH data available.


Related in: MedlinePlus

a: The needle tip at the target in axial viewb: Needle tip at the target in saggittal viewc: Needle tip at the target in coronal view
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Figure 0003: a: The needle tip at the target in axial viewb: Needle tip at the target in saggittal viewc: Needle tip at the target in coronal view

Mentions: The patient was placed prone on the CT table under general anesthesia. The table height was adjusted so as to place the patient approximately at the isocenter of the gantry. This was necessary in order to obtain scans with a tilt in the gantry. A lateral scout image was obtained. The angle of the pedicles with the vertical was measured. The gantry was tilted to this angle. Serial CT scans were obtained in the area of interest with a scan thickness and interval of 2 millimeters. The number of scans through the pedicle was counted and the middle one was chosen for distance measurements [Figure 2]. Entry to the target was through only one of the pedicles. There was no preference to the side of entry. Using the distance measurement mode of the CT computer, the length of line from the target through the middle of the pedicle to the skin surface was measured. The point made by this line on the skin surface was chosen as the entry point for the needle. The angle of this line with the vertical line and the distance of this line from the skin surface to the top of the pedicle were measured. Then the distance from the entry point to the midline was measured. A line was drawn on the patient's back to mark the midline. The CT table was then moved to bring the plane of the target in the plane of the horizontal laser light of the scanner. The needle entry point was marked with a small stab wound on the line created by the laser light on the patient's back at distance of CB [in Figure 2]. The device was then held in position, perfectly horizontal in the coronal plane (using the leveling bubble) with the lower end of the grooved surface along this line and the convergent point of the grooves at the stab wound [Figure 2]. The stereo-guide was then tilted in the sagittal plane parallel to the gantry. The distances AD and AB in Figure 2 were measured from the tip of the needle and marked. An 11-gauge Jamshidi bone biopsy needle was placed in the appropriate groove (at an angle approximately equal to the angle at point A in Figure 2) on the stereo-guide and advanced to the target. Bony resistance was encountered when the deeper marking on the needle reached the skin surface. If this did not occur, the trajectory of the needle was slightly altered to find the bony surface. A mallet was used to insert the needle in the bone. Intraoperative scans were obtained to follow the progression of needle insertion. If needed, necessary corrections were made in the trajectory of the needle. Once the target was reached [Figure 3] cement was injected. During injection, a series of scans were obtained [Figure 4] to make sure the cement was heading in the right direction.


Computed tomography-guided vertebroplasty using a stereotactic guidance system (stereo-guide).

Patil AA - Surg Neurol Int (2010)

a: The needle tip at the target in axial viewb: Needle tip at the target in saggittal viewc: Needle tip at the target in coronal view
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908353&req=5

Figure 0003: a: The needle tip at the target in axial viewb: Needle tip at the target in saggittal viewc: Needle tip at the target in coronal view
Mentions: The patient was placed prone on the CT table under general anesthesia. The table height was adjusted so as to place the patient approximately at the isocenter of the gantry. This was necessary in order to obtain scans with a tilt in the gantry. A lateral scout image was obtained. The angle of the pedicles with the vertical was measured. The gantry was tilted to this angle. Serial CT scans were obtained in the area of interest with a scan thickness and interval of 2 millimeters. The number of scans through the pedicle was counted and the middle one was chosen for distance measurements [Figure 2]. Entry to the target was through only one of the pedicles. There was no preference to the side of entry. Using the distance measurement mode of the CT computer, the length of line from the target through the middle of the pedicle to the skin surface was measured. The point made by this line on the skin surface was chosen as the entry point for the needle. The angle of this line with the vertical line and the distance of this line from the skin surface to the top of the pedicle were measured. Then the distance from the entry point to the midline was measured. A line was drawn on the patient's back to mark the midline. The CT table was then moved to bring the plane of the target in the plane of the horizontal laser light of the scanner. The needle entry point was marked with a small stab wound on the line created by the laser light on the patient's back at distance of CB [in Figure 2]. The device was then held in position, perfectly horizontal in the coronal plane (using the leveling bubble) with the lower end of the grooved surface along this line and the convergent point of the grooves at the stab wound [Figure 2]. The stereo-guide was then tilted in the sagittal plane parallel to the gantry. The distances AD and AB in Figure 2 were measured from the tip of the needle and marked. An 11-gauge Jamshidi bone biopsy needle was placed in the appropriate groove (at an angle approximately equal to the angle at point A in Figure 2) on the stereo-guide and advanced to the target. Bony resistance was encountered when the deeper marking on the needle reached the skin surface. If this did not occur, the trajectory of the needle was slightly altered to find the bony surface. A mallet was used to insert the needle in the bone. Intraoperative scans were obtained to follow the progression of needle insertion. If needed, necessary corrections were made in the trajectory of the needle. Once the target was reached [Figure 3] cement was injected. During injection, a series of scans were obtained [Figure 4] to make sure the cement was heading in the right direction.

Bottom Line: The system was easy to use and proved to be accurate.No complication resulted from the procedure.The stereo-guide proved to be simple and easy to use.

View Article: PubMed Central - HTML - PubMed

Affiliation: Professor of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, USA.

ABSTRACT

Background: In order to make it easy to perform computed tomography (CT)-guided vertebroplasty a stereotactic guidance system called the "stereo-guide" was designed. A method to perform CT-guided vertebroplasty using this system is described.

Methods: The device is a rectangular flat plastic block. One of the flat surfaces of the block has deeply grooved protractor markings at 5-degree intervals; ranging from 0 to 30 degrees. The procedure is performed on the CT table. Based on distances and angle measurements obtained from CT images the device is placed on an appropriate location on the back of the patient and the needle is advanced to the target through the pedicle guided by the grooves on the device. Ten procedures were performed in nine patients with lumbar and thoracic pathology.

Results: The system was easy to use and proved to be accurate. No complication resulted from the procedure.

Conclusion: The stereo-guide proved to be simple and easy to use. Intraoperative scans helped to plan the trajectory and follow the injection of the cement.

No MeSH data available.


Related in: MedlinePlus