Comparison of AIRO intraoperative CT with C-arm fluoroscopy during posterior lumbar interbody fusion: safety and clinical efficacy

Abstract

Navigation systems have evolved from uniplanar, two-dimensional C-arm fluoroscopy to multiplanar, 3D intraoperative computed tomography (iCT). The purpose of this study is to compare the use of a newly developed navigation system, the AIRO iCT, with the golden standard intraoperative navigation system, C-arm fluoroscopy, in terms of safety and clinical efficacy. Patients, eligible for a full posterior lumbar interbody fusion, were asked to participate in the study. During surgery, radiation exposure of the patient, the surgeon, the operating nurse and the anesthesiologist was calculated or measured by personal dosimeters. Moreover, the lateral and anteroposterior peak skin dose of the patient was measured by GafchromicTM films. To evaluate the clinical efficacy of the surgeries, differences in clinical questionnaires before and after surgery were analyzed. Using AIRO iCT, the radiation dose of the operating room staff was significantly reduced. In contrast, the effective dose of the patient increased fourfold with iCT. However, the lateral peak skin dose of the patient was significantly lower with iCT. A difference in the pain score, disability score and health state of the patients after surgery performed with iCT or fluoroscopy was not found. Future research must focus on elucidating the long-term benefits of iCT-assisted surgeries by investigating clinical outcome, complications and number of revisions. Furthermore, a cost-benefit analysis of AIRO iCT must point out if AIRO iCT is the best 3D navigation technology.