J Korean Neurosurg Soc.  2014 Jul;56(1):16-20. 10.3340/jkns.2014.56.1.16.

Accuracy of Pedicle Screw Insertion Using Fluoroscopy-Based Navigation-Assisted Surgery : Computed Tomography Postoperative Assessment in 96 Consecutive Patients

• Lee KD
• Lyo IU
• Kang BS
• Sim HB
• Kwon SC
• Park ES

• KMID: 2067071
• DOI: http://doi.org/10.3340/jkns.2014.56.1.16

Abstract

OBJECTIVE
Two-dimensional fluoroscopy-based computerized navigation for the placement of pedicle screws offers the advantage of using stored patient-specific imaging data in providing real-time guidance during screw placement. The study aimed to describe the accuracy and reliability of a fluoroscopy-based navigation system for pedicle screw insertion.
METHODS
A total of 477 pedicle screws were inserted in the lower back of 96 consecutive patients between October 2007 and June 2012 using fluoroscopy-based computer-assisted surgery. The accuracy of screw placement was evaluated using a sophisticated computed tomography protocol.
RESULTS
Of the 477 pedicle screws, 461 (96.7%) were judged to be inserted correctly. Frank screw misplacement [16 screws (3.3%)] was observed in 15 patients. Of these, 8 were classified as minimally misplaced (< or =2 mm); 3, as moderately misplaced (2.1-4 mm); and 5, as severely misplaced (>4 mm). No complications, including nerve root injury, cerebrospinal fluid leakage, or internal organ injury, were observed in any of the patients.
CONCLUSION
The accuracy of pedicle screw placement using a fluoroscopy-based computer navigation system was observed to be superior to that obtained with conventional techniques.

Keyword

Accuracy; Pedicle screw; Fluoroscopy-based navigator

MeSH Terms

Cerebrospinal Fluid
Humans
Surgery, Computer-Assisted

Figure

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  Fig. 1 A : Stealth Station Treon Plus® (Medtronic Surgical Navigation Technologies). B : Navigated tools and markers. Each tool is equipped with passive markers (blue arrow). The reference frame (red arrow) is also visible. C : The calibration grid is fixed to the image intensifier and contains radioopaque elements arranged on 2 parallel plates.

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  Fig. 2 Two single radiographic views. The anterior-posterior and lateral views are acquired within the intended operative area.

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