gms | German Medical Science

66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Accuracy and safety of CT-navigated cervical and cervicothoracic pedicle screws

Meeting Abstract

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  • Yu-Mi Ryang - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • Jens Lehmberg - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • Niels Buchmann - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • Jens Gempt - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • Elisabeth Török - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München
  • Bernhard Meyer - Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocP 072

doi: 10.3205/15dgnc470, urn:nbn:de:0183-15dgnc4705

Published: June 2, 2015

© 2015 Ryang et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Pedicle screw (PS) placement in the cervical spine is technically demanding and poses a special challenge to the spine surgeon due to the small cervical pedicle diameter and the vicinity to the vertebral artery, nerve roots and spinal cord. In addition or because of the aforementioned reasons the use of pedicle screws in the cervical spine is relatively uncommon compared to the thoracolumbar spine. Therefore navigation can be a helpful tool to improve PS accuracy and reduce the risk for neurovascular complications. This prospective study assessed the accuracy and safety of CT-navigated (region matching) PS of the subaxial cervical spine (C3-7) and cervicothoracic junction (C6-TH3).

Method: A prospective cohort of twenty-four patients received PS instrumentation of the subaxial spine or cervicothoracic junction with aid of CT-navigated region matching (BrainLAB® Curve™ Image Guided Surgery). A total of 120 PS (54 cervical; 66 thoracic) were implanted. Indications were metastatic, infectious, traumatic and degenerative spine disease. Pedicle screw accuracy was assessed in routine postoperative CT-scans. Accuracy was graded using the Gertzbein and Robbins classification (grade A: no pedicle breach, grade B: 0.1-2 mm, grade C: 2.1-4 mm, grade D: 4.1-6 mm, grade E: >6 mm pedicle breach). Grades A and B were classified as correct pedicle screw placement.

Results: Overall accuracy (grades A and B) was 95%. Five percent of PS were graded as C (5 PS) and D (1 PS). Accuracy of cervical PS was higher (96.3%) than accuracy of thoracic PS (94.9%). There was no neurovascular complication and none of the patients needed revision surgery for misplaced pedicle screws.

Conclusions: CT-navigated pedicle screw instrumentation in the cervical and cervicothoracic spine is a safe procedure and yields high pedicle screw accuracy. No neurovascular lesion occurred in our series. No revision surgery was necessary due to misplaced pedicle screws. Since most spine surgeons do not routinely place PS in the cervical spine and cervicothoracic junction and the technique is more demanding compared to thoracolumbar PS implantation we propagate the routine use of navigation for these procedures.