In vivo pedicle screw placement: image-guided virtual vision.

Near-real-time frameless stereotaxy registering intraoperative anatomy to a preoperative three-dimensional computer model has been developed for use with in vivo pedicle screw placement. Eight patients underwent thoracolumbar and lumbar spine stabilization surgery using this new technology, and 32 pedicle screws were placed. Three additional patients had 12 pedicle screws removed during revision surgery, and they allowed the authors to estimate the accuracy of this navigational system. Accuracy was determined by comparing pedicle screw position on postoperative computed tomographs for the first eight patients and on preoperative computed tomographs for the latter three patients, with the intraoperative computer trajectory data gathered during operation. In the group of eight patients, all screws were intrapedicular. In evaluating all 11 patients, the overall accuracy was +/- 2 mm, but the greatest error of 5.4 mm was noted in the sagittal plane measurement. During the development phase of this technology, time constraints prolong surgery, but this may be addressed once the tool's accuracy has been confirmed and intraoperative radiographic confirmation becomes unnecessary. In vivo real-time frameless stereotaxy for pedicle screw placement offers promise for the future. Refinements are needed to improve accuracy and address time constraints.