Article
Navigated pedicle screw placement in the thoracic and lumbar spine using iCT – one year of experience in workflow, feasibility and accuracy
Navigierte Pedikelschrauben-Implantation in der thorakalen und lumbalen Wirbelsäule mittels intraoperativer Computer Tomographie. Erfahrungsbericht über ein Jahr – Arbeitsabläufe, Durchführbarkeit und Genauigkeit
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Published: | May 8, 2019 |
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Outline
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Objective: Spine surgery, due to its high socio-economical costs is one of the most critically viewed upon fields of medicine in our society. Regarding dorsal instrumentation of the spine fluoroscopic 3D C-arm guided pedicle screw placement is the most prevailing technique. Intra-operative CT (iCT) navigation for spine surgery is a modern technique with special regard to high accuracy and exposure reduction of patients and OR staff to radiation. In the following study we present our experience with iCT navigated pedicle screw placement in the thoraco-lumbar and sacral spine during the first 365 days.
Methods: Between September 2017 and September 2018 we treated 61 patients in a consecutive series with iCT AIRO©. Posterior instrumentations of the thoracic, or lumbo-sacral spine as well as combined interventions involving these regions were included. An independent observer assessed every pedicle screw implamted with regard to the Gertzbein & Robins classification.
Results: Altogether 317 screws were implanted. Initial accuracy of all screws was 91.79% (n=291 acceptably placed screws). Taking into account 15 (4.73%) intra-operatively detected and corrected screw misplacements, a total accuracy of 96.53% was achieved. After control CT subotpimal screws were left uncorrected because of limited possibility of repositioning. There was no significant fluctuation in accuracy during the observed period.
Conclusion: iCT navigated pedicle screw placement proved to be an easy and feasible procedure. High accuracy and intra-operative detection of screw misplacement reduced the need for reoperation, thus yielding a safer procedure for the patient.