gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Comparison of Revision Rates in 3D C-Arm Fluoroscopy Navigated and Freehand Placed Pedicle Screws in the Thoracolumbar Spine – A Systematic Analysis of 8 Years of Pedicle Screw Placement

Meeting Abstract

  • Jens Fichtner - Klinikum rechts der Isar der TU München, Klinik für Neurochirurgie, München, Deutschland
  • Nicole Hofmann - Klinikum rechts der Isar TU München, Klinik für Neurochirurgie, München, Deutschland
  • Jan S. Kirschke - Klinikum rechts der Isar TU München, Klinik für Neuroradiologie, München, Deutschland
  • Niels Buchmann - Klinik für Neurochirurgie, Klinikum rechts der Isar, TU München, München, Deutschland
  • Jens Gempt - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • Bernhard Meyer - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • Yu-MI Ryang - Klinikum rechts der Isar TU München, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.21.03

doi: 10.3205/17dgnc294, urn:nbn:de:0183-17dgnc2941

Published: June 9, 2017

© 2017 Fichtner 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

Text

Objective: Higher accuracy rates of image-guided pedicle screw placement compared to freehand placement in the thoracolumbar spine has been proven in the literature. Image-guidance in spine surgery has increased significantly during the past decade; however, there is a lack of data concerning the impact of spinal navigation on revision surgeries due to misplaced pedicle screws (PS). This analysis is aimed at identifying the rate of revision surgeries for misplaced PS in 3D C Arm fluoroscopic navigation (3DFL) compared to freehand (FH) PS placement.

Methods: A systematic analysis of a total of 2150 patients (mean age 64 ± 14 years; range 14-97) with 12320 PS who underwent dorsal instrumentation of the thoracolumbar spine between January 2008 and December 2015 was conducted. To assess revision rates for misplaced PS, patients were divided into 2 groups. Group 1 comprised all patients undergoing surgery with use of 3DFL (January 2011-Dec 2015), group 2 all patients receiving surgery in the FH technique (January 2008-Dec 2015), respectively. The use of 3DFL was initiated in January 2011 in our department. The examined time period of the 3DFL group is therefore shorter. Postoperative CT-scans and or intraoperative 3D scans for verification and assessment of PS was routinely performed in all patients.

Results: There was an overall rate of revision surgeries for malpositioned PS of 2.9% (n=63 patients; n=15 thoracic, n=46 lumbosacral and n=2 thoracolumbar). The revision rate of all pedicle screws was 0.8% (n=96 PS). In the 3DFL group the rate of secondary revision surgeries was significantly lower with 1.3% (n=14 patients; n=6 thoracic, n=7 lumbosacral, n=1 thoraco-lumbar) compared to 4.8% (n=49 patients; n=9 thoracic, n=39 lumbar, n=1 thoracolumbar) in the FH group, respectively (p<0.001). There were 28 PS (0.4%) in the 3DFL (n=28 PS; n=12 thoracic, n=14 lumbosacral and n=2 thoracolumbar), compared to 68 PS (1.3%) in the FH group (n=68 PS; n=11 thoracic PS, n=54 lumbosacral PS and n=3 thoracolumbar PS) that needed revision surgery, respectively (p< 0.001).

Conclusion: The use of 3D C-Arm fluoroscopy navigated PS placement is able to significantly reduce the rate of revision surgeries for misplaced PS after dorsal instrumentation of the thoracolumbar spine compared to conventional FH technique.