Safety and accuracy of spinal instrumentation surgery in a hybrid operating room with an intraoperative cone-beam computed tomography

  • Christian A. Bohoun
  • Kentaro Naito
  • Toru Yamagata
  • Samantha Tamrakar
  • Kenji Ohata
  • Toshihiro Takami
Original Article


Although spinal instrumentation technique has undergone revolutionary progress over the past few decades, it may still carry significant surgery-related risks. The purpose of the present study was to assess the radiological accuracy of spinal screw instrumentation using a hybrid operating room (OR) and quantify the related radiation exposure. This retrospective study included 33 cases of complex spine fusion surgeries that were conducted using a hybrid OR with a flat panel detector (FPD) angiography system. Twelve cases (36.4%) were cervical, and 21 (63.6%) were thoracolumbar. The average number of spine fusion levels was 3 and 4.8, respectively, at the cervical and thoracolumbar spine levels. A FPD angiography system was used for intraoperative cone-beam computed tomography (CBCT) to obtain multi-slice spine images. All operations were conducted under optimized radiation shielding. Entrance surface doses (ESDs) and exposure times were recorded in all cases. A total of 313 screws were placed. Satisfactory screw insertion could be achieved in all cases with safe screw placement in 97.4% and acceptable placement in 2.6%. None of the cases showed any significant anatomical violation by the screws. The radiation exposure to the patients was absolutely consistent with the desired ESD value, and that to the surgeons, under the annual dose limit. These results suggest that the hybrid OR with a FPD angiography system is helpful to achieve safe and precise spinal fusion surgery, especially in complex cases.


Cone-beam CT Hybrid operating room Radiation exposure Spinal instrumentation Surgical safety 



All of the authors are sincerely grateful to Mr. Koji Yokoyama, Mr. Shohei Sasaki, Mr. Akihiko Kakimi, Mr. Toshiyo Norimasa, and Mr. Yoshinori Takao for their technical contribution to intraoperative image guidance.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval and informed consent

The authors certify that all applicable institutional and governmental regulations concerning the ethical use of clinical data were adhered to for the present study. This retrospective outcome analysis of spine surgery was approved by the ethics committee of Osaka City University Graduate School of Medicine.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryOsaka City University Graduate School of MedicineOsakaJapan
  2. 2.Department of NeurosurgeryOsaka City General HospitalOsakaJapan

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