Search Results (82)

Background: Traumatic fractures of the cervical spine pose significant challenges in management, particularly in young patients, where preserving mobility is crucial. Patient Characteristics: A 30-year-old woman presented with a C3 lateral mass and pedicle fracture following a motor vehicle collision. Initial conservative management with a rigid cervical collar for three months failed to reduce the diastasis, and the debilitating neck pain worsened. Preoperative imaging confirmed fracture instability without spinal cord compression. Intervention and Outcome: Preoperative screw trajectory planning was conducted with the My Spine MC system (Medacta), and fine-tuning was achieved on a 3D-printed model of the vertebra. A posterior midline approach was employed to expose the C3 vertebra, and a Herbert screw was inserted under fluoroscopic guidance. Imaging at three months demonstrated significant fracture reduction and early bone fusion. The patient achieved substantial improvement in functional mobility without complications. Conclusion: Herbert screw fixation holds potential as a less-invasive alternative to conventional posterior stabilization for selected cervical fractures. This technical note provides the reader with the required information to support surgical planning and execution. Full article

Chronic kidney disease (CKD) is prevalent throughout the world, and peritoneal dialysis (PD) has been a growing mode of renal replacement therapy (RRT) for over four decades. Peritoneal dialysis has several advantages in cost, patient satisfaction, and quality of life, despite accounting for only one in ten patients on dialysis in the United States. In spite of some contraindications and barriers to effective PD, the vast majority of renal failure patients are candidates, especially when in a high-volume program with surgical expertise readily available. Reliable access via an intraabdominal PD catheter is paramount for managing end-stage renal disease patients. Surgical approaches for PD catheter insertion have evolved substantially alongside innovations in catheter design. Recent data suggests that the advanced laparoscopic catheter placement offers the best results and long-term survival. However, image-guided fluoroscopic insertion can be performed without general anesthesia, is highly effective, and is growing in usage. Being able to start PD urgently is vital in avoiding hemodialysis (HD) and its complications, and this is a growing theme worldwide, despite slightly higher morbidity. Infectious and mechanical complications are relatively common and are frustrating to PD patients and the physicians who care for them. Peritonitis and exit site infections require antibiotic coverage and sometimes, surgical intervention. Catheter dysfunction is a frequent mechanical issue requiring a multidisciplinary approach: medical treatment, nurse-administered flushing and clot dissolvers, interventional radiology evaluation and wire manipulation, and surgical laparoscopy for catheter salvage. Full article

Pelvic floor dysfunction (PFD) is one of the most significant postoperative consequences in gynecological surgery, leading to impaired bowel function, structural alteration, and reduced quality of life. The conventional technique using fluoroscopic defecography and perineal ultrasonography provides an incomplete assessment of multi-compartment defects and post-surgical changes. Magnetic resonance defecography (MRD) represents a valuable alternative imaging method in the assessment of PFD following gynecological surgery, increasing diagnostic accuracy and enabling personalized treatment planning. MRD achieves high-resolution multi-compartmental assessment of the pelvic floor in dynamic states. Particularly, it is able to detect postoperative complications such as mesh retraction, organ prolapse, and fistula formation, not visible to other modalities. This narrative review discusses the role of MRD in diagnosing PFD and its advantages in detecting functional and anatomical changes following gynecological surgery. This review also examined the ability of MRD to demonstrate surgical changes and its contribution to possible standardization in clinical practice. Full article

Objective: The aim of this study is to present the initiation of robotic-guided (RG) spine surgery into routine clinical care at a single center with the use of intraoperative CT (iCT) automatic registration-based navigation. The workflow included iCT with automatic registration, fusion with preoperative imaging, verification of preplanned screw trajectories, RG introduction of K-wires, and the insertion of pedicle screws (PSs), followed by a control iCT scan. Methods: All patients who underwent RG implantation of pedicle screws using the Cirq^® robotic arm (BrainLab, Munich, Germany) in the thoracolumbar spine at our department were included in the study. The accuracy of the pedicles screws was assessed using the Gertzbein–Robbins scale (GRS). Results: In total, 108 patients (60 female, mean age 68.7 ± 11.4 years) in 109 surgeries underwent RG PS placement. Indications included degenerative spinal disorders (n = 30 patients), spondylodiscitis (n = 24), tumor (n = 33), and fracture (n = 22), with a mean follow-up period of 7.7 ± 9 months. Thirty-seven cases (33.9%) were performed percutaneously, and all others were performed openly. Thirty-three operations were performed on the thoracic spine, forty-four on the lumbar and lumbosacral spine, thirty on the thoracolumbar, one on the cervicothoracic spine, and one on the thoracolumbosacral spine. The screws were inserted using a fluoroscopic (first 12 operations) or navigated technique (latter operations). The mean operation time was 228.8 ± 106 min, and the mean robotic time was 31.5 ± 18.4 min. The mean time per K-wire was 5.35 ± 3.98 min. The operation time was lower in the percutaneous group, while the robot time did not differ between the two groups. Robot time and the time per K-wire improved over time. Out of 688 screws, 592 were GRS A screws (86.1%), 54 B (7.8%), 22 C (3.2%), 12 D (1.7%), and 8 E (1.2%). Seven screws were revised intraoperatively, and after revision, all were GRS A. E screws were either revised or removed. In the case of D screws, screws located at the end of the construct were revised, while so-called in-out-in screws in the middle of the construct were not revised. Conclusions: Brainlab’s Cirq^® Robotic Alignment Module feature enables placement of pedicle screws in the thoracolumbar spine with high accuracy. A learning curve is shown through improvements in robotic time and time per K-wire. Full article

Intramedullary nailing (IMN) is the gold standard for fixing mid-shaft fractures of long bones, but distal locking remains a challenging procedure. This study aims to develop and evaluate a novel mixed reality (MR)-based surgical navigation system for distal locking of IMN through phantom experiments. Twelve bone models closely replicating the mechanical properties, anatomy, and density of human tibial bone were utilized. Six orthopedic surgeons participated in the phantom experiments using both MR and traditional electromagnetic (EM) navigation systems. Effectiveness was evaluated using postoperative fluoroscopic imaging and the time taken for distal locking. Compared to the EM navigation system, the MR system significantly reduced distal locking time (81.54 ± 6.06 vs. 132.67 ± 6.45 s per screw) and achieved a higher success rate (23/24 vs. 21/24 screws accurately placed), but the difference in terms of success rate is not statistically significant. The MR-based navigation system for distal locking of IMN is time-efficient, accurate, and shows high potential for enhancing surgical precision in orthopedic procedures. Full article

This study presents a bilateral control architecture that links fluoroscopic image feedback directly to the kinematics of a tendon-driven, three-joint robotic catheter and a 3-DoF motorised C-arm, intending to preserve optimal imaging geometry during autonomous catheter insertion and thereby mitigating radiation exposure. Forward and inverse kinematics for both manipulators were derived via screw theory and geometric analysis, while a calibrated projection model generated synthetic X-ray images whose catheter bending angles were extracted through intensity thresholding, segmentation, skeletonisation, and least-squares circle fitting. The estimated angle fed a one-dimensional extremum-seeking routine that rotated the C-arm about its third axis until the apparent bending angle peaked, signalling an orthogonal view of the catheter’s bending plane. Implemented in a physics-based simulator, the framework achieved inverse-kinematic errors below 0.20% for target angles between ${20}^{°}$ and ${90}^{°}$, with accuracy decreasing to 3.00% at ${10}^{°}$. The image-based angle estimator maintained a root-mean-square error $\le 3$% across most of the same range, rising to 6.4% at ${10}^{°}$. The C-arm search consistently located the optimal perspective, and the combined controller steered the catheter tip along a predefined aortic path without collision. These results demonstrate sub-degree angular accuracy under idealised, noise-free conditions and validate real-time coupling of image guidance to dual-manipulator motion; forthcoming work will introduce realistic image noise, refined catheter mechanics, and hardware-in-the-loop testing to confirm radiation-dose and workflow benefits. Full article

Background/Objectives: Virtual reality (VR), a component of extended reality (XR), has shown promise in pre-procedural planning by providing immersive, patient-specific simulations. In pain management, where precise anatomical understanding is critical for interventions such as peripheral nerve stimulation (PNS), nerve blocks, and intrathecal pump placement, the application of VR remains underexplored. This case series examines the role of VR in enhancing pre-procedural planning for complex chronic pain interventions. Methods: From August 2022 to December 2024, six patients with anatomically challenging conditions underwent VR-assisted pre-procedural planning at Weill Cornell Medical Center. Patient-specific 3D models were created using the manual or automatic segmentation of imaging data and reviewed in VR to optimize procedural strategies by the surgeons performing the case. Procedures were then performed using conventional fluoroscopic or ultrasound guidance. Results: In all cases, VR facilitated the improved visualization of complex anatomies and informed optimal procedural trajectories. In patients with a complex cancer anatomy, previous surgical changes, or hardware, VR enabled precise PNS lead or needle placement, resulting in significant pain reductions postoperatively. In certain cases where previous interventional pain procedures had failed, VR allowed for a “second opinion” to develop an alternative approach with improved outcomes. Finally, in one case, VR served to potentially prevent patient harm by providing insight to the proceduralists regarding an alternative approach. Across the series, VR enhanced the spatial awareness, procedural accuracy, and confidence in navigating challenging anatomical scenarios. Conclusions: This case series demonstrates the utility of VR in pre-procedural planning for chronic pain interventions. By enabling detailed anatomical visualization and trajectory optimization, VR has the potential to improve outcomes in complex cases. Further studies are needed to evaluate its broader clinical applications and cost-effectiveness in pain management. Full article

(1) Background: Flexible flatfoot is characterized by medial arch collapse, leading to musculoskeletal impairments. We examined the effects of single-arch foot orthosis (SFO) and dual-arch foot orthosis (DFO) on arch height, kinematics, and kinetics in young females during walking and jogging. (2) Methods: Healthy females (n = 19) with flexible flatfoot were tested under three conditions: regular shoes, SFO, and DFO. Motion capture and a 3D force plate gathered biomechanical data. We also used a high-speed dual fluoroscopic imaging system (DFIS) to assess dynamic foot morphology. Outcomes included normalized truncated navicular height, medial arch angle, angles and moments at the metatarsophalangeal, subtalar, ankle, knee, and hip joints. (3) Results: Both types of orthoses improved the normalized navicular height and reduced the medial arch angle, with DFO vs. SFO showing greater effects (p < 0.001). DFO vs. SFO was also more effective in limiting the range of motion (ROM) of the metatarsophalangeal joint and dorsiflexion (p < 0.001). Additionally, DFO reduced the ankle range of motion and the maximum knee flexion during walking. Both orthoses reduced subtalar plantarflexion moments during stance (p < 0.001) and modulated ankle plantarflexion moments throughout different phases of gait. DFO uniquely enhanced metatarsophalangeal plantarflexion moments during jogging (p < 0.001). (4) Conclusions: Dual vs. single transverse arch foot orthosis is more effective in improving gait biomechanics in females with flexible flatfoot. Longitudinal studies are needed to confirm these benefits. Full article

Background/Objectives: Fluoroscopy has been widely adopted in interventional pulmonology, as it facilitates real-time visualization of the bronchoscope, endobronchial ultrasound, and biopsy tools during procedures. The purpose of this study was to evaluate the effectiveness of radiation shields in minimizing scattered X-ray dose to the bronchoscopist in a phantom study and to determine the dose of scattered X-ray dose to medical staff with radiation shields in clinical application. Methods: An anthropomorphic torso phantom was positioned on the fluoroscopic table between the C-arm X-ray tube and the image detector to mimic bronchoscopic operations. Upper and lower body lead shields were used to examine the effectiveness of radiation shielding. Scatter radiation rates were assessed at a first operator location using real-time dosimeters with and without protective devices. In clinical application, the scattered X-ray dose of the first operator and main assistant was measured using wearable radiation dosimeters during 20 procedures. Results: In the phantom study, scattered radiation without shielding was 266.34 ± 8.86 μSv/h (glabella), 483.90 ± 8.01 μSv/h (upper thorax), 143.97 ± 8.20 μSv/h (hypogastrium), and 7.22 ± 0.28 μSv/h (ankle). The combination of upper and lower body lead shields reduced the scattered X-ray dose by 98.7%, 98.3%, 66.2%, and 79.9% at these levels, respectively. In clinical application, mean scattered X-ray dose rates were 0.14 ± 0.05 μSv/procedure (eye), 0.46 ± 0.51 μSv/procedure (chest), 0.67 ± 0.50 μSv/procedure (hypogastrium), and 1.57 ± 2.84 μSv/procedure (assistant’s wrist). Conclusions: The combination of radiation shields significantly reduced the scattered X-ray dose at the operator site in the phantom study. The scattered X-ray dose to medical staff during bronchoscopy can be kept at a low level with the aid of a shielding system. Full article

The central conducting lymphatics (CCL) and mesenteric lymphatic systems are responsible for lipid absorption, fluid regulation, and protein delivery into the bloodstream. Disruptions in these systems can result in debilitating conditions such as chylothorax, plastic bronchitis, post-operative lymphocele, protein-losing enteropathy (PLE), and chylous ascites. Advances in imaging techniques, including magnetic resonance lymphangiography (MRL), computed tomography lymphangiography (CTL), and fluoroscopic lymphangiography, allow for detailed anatomic and functional evaluation of the lymphatic system, facilitating accurate diagnosis and intervention by interventional radiologists. This review explores the embryology, anatomy, and pathophysiology of the lymphatic system and discusses imaging modalities and interventional techniques employed to manage disorders of the conducting lymphatics in the chest and abdomen. Thoracic duct embolization (TDE), percutaneous transhepatic lymphatic embolization (PTLE), and sclerotherapy are highlighted as effective, minimally invasive approaches to treat lymphatic leaks and obstructions and have shown high success rates in reducing symptoms and improving patient outcomes, particularly when medical management fails. This review seeks to demonstrate how anatomical imaging can facilitate minimally invasive procedures to rectify disorders of lymphatic flow. Full article

Spinopelvic dissociation is a highly unstable orthopedic injury with a growing incidence worldwide. Operative treatment classically involves an open lumbopelvic fusion and sacroiliac stabilization, which carries high perioperative morbidity and mortality in a frail patient population. Advancements in spinal navigation, robotics, and minimally invasive surgery (MIS) techniques now allow these fracture patterns to be treated entirely percutaneously through small incisions. These incisions are just large enough to accommodate pedicle screw guides and enable the placement of lumbopelvic instrumentation, with rods being passed subfascially across pedicle screws and extending caudally to iliac fixation. This contrasts with the open midline approach, which requires more extensive soft tissue dissection and results in increased blood loss compared to percutaneous techniques. Modern imaging techniques, including CT navigation and robotics, facilitate the precise placement of sacral S2AI screw instrumentation in both open and percutaneous methods, all while safely avoiding previously placed trans-sacral fixation and other existing hardware, such as acetabular screws. Trans-sacral screws are typically percutaneously inserted first by the orthopedic trauma service, utilizing inlet, outlet, and lateral sacral fluoroscopic guidance to navigate the limited available corridor. With the advent of MIS techniques, trauma patients can now benefit from faster postoperative rehabilitation, minimal blood loss, decreased pain, and quicker mobilization. This article will review current concepts on spinopelvic anatomy, fracture patterns, indications for treatment, and current concepts for minimally invasive percutaneous lumbopelvic fixation, and it will present illustrative examples. Full article

In recent years, pancreaticobiliary endoscopy (PBE) has evolved to include a wide range of endoscopic procedures used to treat various diseases. Several interventional endoscopic ultrasonography procedures have been developed for conditions that cannot be treated with conventional endoscopic methods. As PBE continues to advance, it is crucial to improve fluoroscopic systems to enhance image quality, ensure patient safety, reduce radiation exposure, and ensure the operation of video-recording systems. The difficult procedures require the precise imaging of thin pancreatic/biliary branch devices, including guidewires, catheters, and stents. It is crucial to reduce noise caused by patient breathing and movement, while retaining the necessary movement in the image on the screen. A stable table is effective for ensuring the safety of patients during the procedure. A reduction in radiation exposure is important, and the flame rate conversion technique is effective. Ensuring high-quality recording is useful for the video presentation of PBE procedures. In collaboration with Fujifilm (Tokyo, Japan), we researched and developed various functions in fluoroscopic systems for PBE. In this review, we outline the requirements for fluoroscopic procedures in PBE, the evolution of technology to date, and its prospects, while also presenting the commercial equipment currently available. Full article

The biomechanical mechanism of postoperative patellofemoral joint (PFJ) complications after open-wedge high tibial osteotomy (OWHTO) has not been investigated. This study was to determine the length changes in the patellar tendon (PT), medial patellotibial ligament (MPTL), medial patellofemoral ligament (MPFL), and quadriceps moment arm (QMA) during staircase motion before and after OWHTO. Computed tomography (CT) scans of 15 patients’ lower extremities were used to reconstruct three-dimensional models, and magnetic resonance imaging (MRI) of the knee and hip joints was used to mark the soft tissue footprints. Then, such soft tissue lengths were quantified by a dual fluoroscopic imaging system (DFIS). Additionally, function scores were used to assess patient outcome changes. The results showed that there was a contraction of the PT after OWHTO due to its adhesion to the osteotomy site, causing PT length to be negatively correlated to the open-wedge angle. In addition, the shortening of the MPTL and QMA caused patellar instability and an imbalance in the strength of the lower extremities. Additionally, most knee function scores improved after OWHTO, except the Feller scores. Multiple methods should be considered to optimize surgical procedures, postoperative rehabilitation, and physical therapy. Full article

Background: Knee-related injuries often result from poor movement patterns that destabilize the joint and increase stress on knee structures. Understanding the influence of foot positioning on knee biomechanics is critical for identifying high-risk movement patterns and preventing injuries. Methods: Twenty healthy male participants performed side-cutting movements at three different foot progression angles. One participant’s data were used to develop and validate a knee finite element model with high-speed dual fluoroscopic imaging (DFIS). Combined with a musculoskeletal analysis, the model simulated internal knee loads under various foot-positioning conditions. Results: The analysis revealed that, as the external foot progression angle increased, the ankle plantarflexion decreased, while the ankle internal rotation and knee valgus moments increased. Higher stress concentrations were observed on the ACL, lateral meniscus, lateral tibial cartilage, and medial collateral ligament, particularly at the femoral–tibial ACL attachments. Conclusion: The findings suggest that a toe-out foot position elevates the risk of knee injuries by increasing stress on key structures, whereas a toe-in position may enhance joint stability, reduce the ACL injury risk, and promote favorable muscle activation patterns. Full article

Lymphatic complications are becoming increasingly identified in cancer patients. Chylous ascites, chylothorax, lymphoceles, and lymphorrhea are common in cancer patients and can occur due to traumatic injury during surgeries or infiltrative effects of the tumors themselves. Recently, some anti-neoplastic medications are also thought to result in lymphatic complications. Management options range from conservative options to minimally invasive interventions, to surgical interventions with no standardized management strategy. Imaging techniques such as dynamic contrast-enhanced magnetic resonance lymphangiography and intranodal computed tomography or fluoroscopic lymphangiography are becoming more valuable in diagnosis and treatment planning. Minimally invasive interventions are rapidly evolving and have become the first-line intervention in most cases. Current research, however, faces limitations due to study design and variability. Standardized reporting and prospective studies are needed to advance the field. This review summarizes some of the latest literature on lymphatic interventions in cancer patients and provides reporting recommendations for future studies on lymphatic interventions. Full article