Our Summary

This research paper looks at how well using a special 3D navigation system in surgery for children with scoliosis works. This system, called intraoperative computed tomography navigation (iCT-Navi), helps surgeons insert screws into the spine more accurately. However, it also exposes the patient to more radiation, which is a concern. The researchers wanted to find out if any new techniques or studies had been done to try and reduce this radiation exposure while still making the surgery more accurate.

To do this, they looked at a lot of different research papers on the topic, and focused on ones that looked at how often the screws pierced the spine (which is bad) and how much radiation the patient was exposed to during surgery. They also compared iCT-Navi to other methods, like using a CT scan before surgery to guide the operation.

They found 20 papers that met their criteria, and these papers covered over 500 patients and over 6,000 screw insertions. They found that only a small fraction of the screws pierced the spine, and there were no reports of injuries caused by the screws. They also found that certain factors, like how far the screw was from the reference frame, how many screws were inserted, the location of the screw, the thickness of the vertebra, the height of the patient, and the patient’s gender, could increase the risk of the screw piercing the spine.

Interestingly, they found that reducing the dose of radiation by 1/5 or 1/10 didn’t seem to make the operation less accurate. However, they also found that the ways that different studies measured things like piercing and radiation dose weren’t consistent, which made it hard to compare results. They recommend standardizing these measurements to make future research more useful.

FAQs

  1. What is the purpose of the 3D navigation system used in pediatric scoliosis surgery?
  2. What factors can increase the risk of the screw piercing the spine during the surgery?
  3. Has research found any methods to reduce radiation exposure during pediatric scoliosis surgery using the iCT-Navi system?

Doctor’s Tip

A doctor may tell a patient that pediatric scoliosis surgery, specifically using a 3D navigation system like iCT-Navi, can help improve the accuracy of screw insertion into the spine. However, it is important to discuss the potential risks and benefits of increased radiation exposure with the patient and their family. It is also important to follow up with regular check-ups and monitoring after surgery to ensure proper healing and alignment of the spine.

Suitable For

Overall, pediatric scoliosis surgery using iCT-Navi is typically recommended for patients who have significant spinal deformities that are causing pain, difficulty breathing, or other serious complications. These patients may have curves in their spine that are severe enough to require surgical intervention to prevent further progression and improve quality of life. Additionally, patients who have not responded well to conservative treatments such as bracing or physical therapy may also be recommended for surgery.

It is important to note that each case is unique, and the decision to undergo surgery should be made in consultation with a pediatric orthopedic surgeon who specializes in scoliosis treatment. The risks and benefits of surgery, as well as alternative treatment options, should be carefully considered before making a decision.

Timeline

Before pediatric scoliosis surgery:

  • Patient is diagnosed with scoliosis and treatment options are discussed with their healthcare team
  • Patient undergoes pre-operative evaluations and tests
  • Patient and their family receive education on the surgery, including potential risks and benefits
  • Surgery date is scheduled and preparations are made
  • Patient undergoes surgery, with the use of iCT-Navi to guide the placement of screws in the spine

After pediatric scoliosis surgery:

  • Patient is monitored closely in the hospital for any complications
  • Patient begins physical therapy and rehabilitation to aid in recovery
  • Patient may experience pain and discomfort, which is managed with medication
  • Patient is discharged from the hospital once they are stable and able to continue recovery at home
  • Patient continues follow-up appointments with their healthcare team to monitor progress and address any concerns
  • Over time, patient gradually resumes normal activities and experiences improved spinal alignment and function.

What to Ask Your Doctor

  1. What are the potential risks and benefits of pediatric scoliosis surgery using iCT-Navi compared to other methods?
  2. How many surgeries have you performed using iCT-Navi for pediatric scoliosis, and what is your success rate?
  3. How will the use of iCT-Navi affect the length of the surgery and the recovery time for my child?
  4. Are there any alternative treatment options for pediatric scoliosis that do not involve surgery?
  5. What measures will be taken to minimize radiation exposure during the surgery?
  6. What is the likelihood of the screws piercing the spine during the surgery, and how can this risk be minimized?
  7. How will my child’s age, height, and gender affect the success of the surgery using iCT-Navi?
  8. What is the expected outcome of the surgery in terms of correcting the curvature of the spine and improving my child’s quality of life?
  9. Are there any long-term effects or complications associated with pediatric scoliosis surgery using iCT-Navi?
  10. What post-operative care and follow-up appointments will be necessary for my child after the surgery?

Reference

Authors: Oba H, Uehara M, Ikegami S, Hatakenaka T, Kamanaka T, Miyaoka Y, Kurogouchi D, Fukuzawa T, Mimura T, Tanikawa Y, Koseki M, Ohba T, Takahashi J. Journal: Spine J. 2023 Feb;23(2):183-196. doi: 10.1016/j.spinee.2022.09.004. Epub 2022 Sep 27. PMID: 36174926