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69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

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Accuracy and revision rate of intraoperative computed tomography point-to-point navigation for lateral mass and pedicle screw placement – 11 year single-center experience in 1054 patients

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  • Basem Ishak - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
  • Martin Volz - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
  • Till Schneider - Universitätsklinikum Heidelberg, Neuroradiologie, Heidelberg, Deutschland
  • Grutza Marin - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
  • Andreas W. Unterberg - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
  • Karl Kiening - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocV032

doi: 10.3205/18dgnc033, urn:nbn:de:0183-18dgnc0338

Published: June 18, 2018

© 2018 Ishak 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: A high accuracy in intraoperative computed tomography (ioCT) navigation utilizing an intraoperative acquired dataset for pedicle screw placement has been reported. To improve the accuracy and counteract against intraoperative movement of predefined registration points, we introduce an ioCT point-to-point navigation, where marker screws were inserted intraoperative to increase patient safety.

Methods: 1054 patients who underwent ioCT point-to-point navigation for lateral mass and pedicle screw placement were retrospectively analysed between 09/2005 and 09/2016. Implant-related complications, such as screw misplacement, screw loosening and revision rate were determined. Furthermore, we investigated the rate of adjacent level degeneration (ALD) and correlated that to risk factors, such as gender, ASA-score, smoking, diabetes mellitus, hypertonia and BMI. All patients have had an x-ray control of minimum 6 months and a postoperative CT-scan was available in 401 patients.

Results: In total 6059 screws were inserted in 1054 patients. There were 553 (52.5%) female and 501 (47.5%) male patients. Average age was 63.5y, mean BMI 27.6 (SD 13.9). 1427 (23.5%) screws were inserted in the cervical, 995 (16.4%) in the thoracic, 3167 (52.3%) in the lumbar and 470 (7.8%) in the sacral spine. Eight patients needed revision for screw misplacement (0.76%). Total screw misplacement rate was 0.26% (16/6059). Seven patients required revision surgery due to screw loosening (0.66%) with a total screw loosening rate of 0.21% (13/6059). Two patients (0.19%) needed revision due to cage migration. Revision surgery for ALD was required in 35 patients (3.32%). Significant risk factors for ALD could not be found.

Conclusion: With the use of ioCT based spinal point-to-point navigation by inserting reference markers we demonstrated a high accuracy in screw placement with a low revision rate (0.76%) and a total screw revision rate of 0.21%. In case of insecurity regarding screw placement or intraoperative movement, re-registration can be repeated quickly by touching clearly defined landmarks.