• Patients' satisfaction with provided care/information and expectations on clinical outcome after lumbar disc herniation surgery

      Rönnberg, Katarina; Lind, Bengt; Zoëga, Björn; Halldin, Klas; Gellerstedt, Martin; Brisby, Helena (Lippincott Williams & Wilkins, 2007-01-15)
      STUDY DESIGN: A prospective study of patients undergoing lumbar disc herniation surgery. OBJECTIVES: To assess patients' satisfaction with care/preoperative information, if expectations on surgical results and ability to return to work are related to baseline characteristics, and/or can predict self-reported outcome. Self-reported outcome was compared with objective outcome. SUMMARY OF BACKGROUND DATA: Patients' expectations on treatment results have been discussed as a predictive factor for postoperative outcome and satisfaction demonstrated to be directly related to patient expectations. METHODS: The study includes 148 patients, 46% women, mean age 40 (range 18-66). Before and 2 years after surgery, questionnaires about given information/care, expected/present work ability, and expectations on/obtained improvement of physical functions/symptoms (leg and back pain, sensibility, and muscle function) were filled in. The visual analog scale leg pain, Zung Depression Scale, and Oswestry Disability Index were used as baseline characteristics. At 2-year follow-up, self-reported and objective outcome was assessed. RESULTS: Satisfaction with given information/care were reported by 46% and 82%, respectively. Zung Depression Scale related to expectations on leg pain recovery (P = 0.022), work ability (P = 0.046), and satisfaction with given information (P = 0.031). Patients who expected to return (76%) and not return (24%) to work, returned in 78% and 26%, respectively (P = 0.021). A high agreement between self-reported outcome and objective outcome were found (P < 0.001). CONCLUSIONS: Patients undergoing lumbar disc herniation surgery are mostly satisfied with provided care before and after surgery, however, less satisfied with information provided. Further, patients with preoperative positive expectations on work return and realistic expectations on pain and physical recovery have a greater chance to be satisfied with the surgical results.
    • Pedicle Screw Placement Using Augmented Reality Surgical Navigation With Intraoperative 3D Imaging: A First In-Human Prospective Cohort Study.

      Elmi-Terander, Adrian; Burström, Gustav; Nachabe, Rami; Skulason, Halldor; Pedersen, Kyrre; Fagerlund, Michael; Ståhl, Fredrik; Charalampidis, Anastasios; Söderman, Michael; Holmin, Staffan; et al. (Lippincott Williams & Wilkins, 2019-04-01)
      STUDY DESIGN: Prospective observational study. OBJECTIVE: The aim of this study was to evaluate the accuracy of pedicle screw placement using augmented reality surgical navigation (ARSN) in a clinical trial. SUMMARY OF BACKGROUND DATA: Recent cadaveric studies have shown improved accuracy for pedicle screw placement in the thoracic spine using ARSN with intraoperative 3D imaging, without the need for periprocedural x-ray. In this clinical study, we used the same system to place pedicle screws in the thoracic and lumbosacral spine of 20 patients. METHODS: The study was performed in a hybrid operating room with an integrated ARSN system encompassing a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D capabilities, integrated optical cameras for augmented reality navigation, and noninvasive patient motion tracking. Three independent reviewers assessed screw placement accuracy using the Gertzbein grading on 3D scans obtained before wound closure. In addition, the navigation time per screw placement was measured. RESULTS: One orthopedic spinal surgeon placed 253 lumbosacral and thoracic pedicle screws on 20 consenting patients scheduled for spinal fixation surgery. An overall accuracy of 94.1% of primarily thoracic pedicle screws was achieved. No screws were deemed severely misplaced (Gertzbein grade 3). Fifteen (5.9%) screws had 2 to 4 mm breach (Gertzbein grade 2), occurring in scoliosis patients only. Thirteen of those 15 screws were larger than the pedicle in which they were placed. Two medial breaches were observed and 13 were lateral. Thirteen of the grade 2 breaches were in the thoracic spine. The average screw placement time was 5.2 ± 4.1 minutes. During the study, no device-related adverse event occurred. CONCLUSION: ARSN can be clinically used to place thoracic and lumbosacral pedicle screws with high accuracy and with acceptable navigation time. Consequently, the risk for revision surgery and complications could be minimized.
    • Surgical Navigation Technology Based on Augmented Reality and Integrated 3D Intraoperative Imaging: A Spine Cadaveric Feasibility and Accuracy Study.

      Elmi-Terander, Adrian; Skulason, Halldor; Söderman, Michael; Racadio, John; Homan, Robert; Babic, Drazenko; van der Vaart, Nijs; Nachabe, Rami; [ 1 ] Karolinska Univ Hosp, Dept Neurosurg, Stockholm, Sweden Show the Organization-Enhanced name(s) [ 2 ] Karolinska Univ Hosp, Dept Neuroradiol, Stockholm, Sweden Show the Organization-Enhanced name(s) [ 3 ] Cincinnati Childrens Hosp Med Ctr, Dept Pediat Intervent Radiol, Cincinnati, OH 45229 USA Show the Organization-Enhanced name(s) [ 4 ] Philips Healthcare, Dept Image Guided Therapy Syst, Veenpluis 6, NL-5684 PC Best, Netherlands (Lippincott Williams & Wilkins, 2016-11-01)
      A cadaveric laboratory study.