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Evaluation of intraoperative coronal alignment using a computer-assisted rod bending system (CARBS) without intraoperative radiation exposure in adult spinal deformity surgery: a technical note and preliminary results

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Abstract

Purpose

Intraoperative radiographs and fluoroscopy are used in adult spinal deformity (ASD) surgery to prevent postoperative coronal malalignment but with limited accuracy. Therefore, we applied a computer-assisted rod bending system (CARBS: Bendini®) for an intraoperative coronal alignment evaluation. The purpose of this study is to introduce this novel technique and validate its accuracy.

Methods

Fifteen ASD patients were included in the study. The heads of the bilateral S1 pedicle screws (S1), the S1 spinous process, and the bilateral greater trochanter (GT) and the C7 spinous process were recorded with CARBS for an intraoperative coronal alignment evaluation. The lines which connect the bilateral S1 and GT were used as references. The C7-center sacral vertical line (C7-CSVL) on the CARBS monitor was checked, and the C7-CSVL from the intraoperative CARBS recording and postoperative standing whole spine radiograph were compared.

Results

Intraoperative C7-CSVL with CARBS was 35.1 ± 31.6 mm when the S1 pedicle screws were used as the reference line and was 16.6 ± 17.8 mm when the GTs were used. Postoperative C7-CSVL by radiograph was 15.1 ± 16.5 mm. In addition, the intraoperative C7-CSVL with CARBS and the postoperative C7-CSVL showed a strong positive correlation in both GT (R = 0.86, p < 0.01) and in S1(R = 0.79, p < 0.01), with a better correlation found in GT than in S1.

Conclusion

Intraoperative C7-CSVL with CARBS was found to be highly accurate in ASD surgery. Our results suggest that this novel technique can be useful as an alternative to intraoperative radiography and fluoroscopy and may reduce radiation exposure.

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Funding

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan

    Takumi Takeuchi, Yuhei Takamizawa, Kazumasa Konishi, Hideto Sano, Masahito Takahashi & Naobumi Hosogane

  2. Keiyu Orthopaedic Hospital, 2267-1, Akouda-Cho, Tatebayashi, Gunma-Ken, 374-0013, Japan

    Kiyohiro Nakamichi & Hitoshi Kono

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  1. Takumi Takeuchi
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Contributions

All the authors whose names appear on the submission made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; drafted the work or revised it critically for important intellectual content; approved the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Naobumi Hosogane.

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TT, YT, KK, HS, MT, KN, HK, and NH declare that have no conflict of interest.

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This study was approved by the Institutional Review Board of Kyorin University School of Medicine (IRB No. R04-183).

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Takeuchi, T., Takamizawa, Y., Konishi, K. et al. Evaluation of intraoperative coronal alignment using a computer-assisted rod bending system (CARBS) without intraoperative radiation exposure in adult spinal deformity surgery: a technical note and preliminary results. Spine Deform 11, 1199–1208 (2023). https://doi.org/10.1007/s43390-023-00698-7

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