Artikel
Accuracy of image guided dorsal cervical screw placement using image guided navigation system – early results of retrospective multicentric study
Genauigkeit der navigierten Implantation von dorsalen zervikalen Schraubensysteme – Vergleich von zwei Bildgebungssystemen
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Veröffentlicht: | 25. Mai 2022 |
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Objective: Posterior cervical instrumentation can be challenging. The goal of this retrospective study was to assess the accuracy of posterior cervical screw placement, with pedicle screw insertion or lateral mass screw instrumentation technique, using three-dimensional rotation of C-arm vs. O-arm based neuro-navigation.
Methods: 100 patients (50 patients each from 2 different hospitals), who underwent between January 2013 and December 2020, posterior cervical screw fixation using Siemens-Arcadis Orbic 3D C-arm with a navigation system (Brainlab, AG, Munich, Germany) in hospital 1 or dorsal cervical instrumentation using O-arm (Medtronic, Minneapolis, Minnesota, USA) with a navigation system (S7 StealthStation) in hospital 2, were included in our study. The accuracy of screw placement was determined using postoperative CT scans and categorized according to Neo el al. once pedicle screw was used and according to Bransford el al. when lateral mass screw was implanted.
Results: 598 screws: 375 screws in the C-arm group (hospital 1) and 223 screws in the O-arm group (hospital 2), were studied. 22 screws (5,9%) from C-arm group, as well 12 screws (5,3%) from O-arm group, needed to be revised intraoperatively due to misplacement. From C-arm group: from a total of 250 pedicle screws, 220 screws (88%) were categorized as grade 0, 26 screws (10,4%) were categorized as grade 1, 2 screws (0,8%) were categorized as grade 2 and 2 screws (0,8%) were categorized as grade 3. From a total of 125 screws inserted in cervical lateral mass, 120 screws (96%) were categorized as grade A and 4 (3,2%) screws were categorized as grade B and 1 screw (0,8%) were categorized as grade C. From O-arm group: from a total of 102 pedicle screws, 91 pedicle screws (89,2%) were categorized as grade 0, 9 screws (8,8) were categorized as grade 1 and 2 screws (2%) were categorized as grade 3. From a total of 109 screws inserted in cervical lateral mass, 106 screws (97, 2%) were categorized as grade A and 3 (2,8%) screws were categorized as grade B.
Conclusion: dorsal cervical instrumentation using 3D-arm or O-arm neuro-navigation system provides an assisting tool, which can assure a safe and accurate dorsal cervical screw implantation. Although O-arm dorsal cervical screw implantation may show higher level of accuracy, no statistical significance between both assisting tools was recognized.