Pedicle screw placement in the thoracic spine: a comparison study of computer-assisted navigation and conventional techniques.

The technique of computer-assisted pedicle screw installation and its clinical benefit as compared with conventional pedicle screw installation was evaluated. Twenty-two patients had thoracic screw insertion under 3-dimentional computer-assisted navigation (92 screws) and 20 patients under conventional fluoroscopic control (84 screws). The 2 groups were compared for accuracy of screw placement, screw insertion time by postoperative thin-cut computed tomography scans, and statistical analysis. The cortical perforations were graded by 2-mm increments. In the computer group, 88 (95.65%) were grade I (good), 4 (4.35%) were grade II (<2 mm), and 0 were grade III (>2 mm) violations. There were 4 cortical violations (3.57%). In the conventional group, there were 14 cortical violations (16.67%), 70 (83.33%) were grade I (good), 11 (13.1%) were grade II (<2 mm), and 3 (3.57%) were grade III (>2 mm) violations (P<.001). The number (19.57%) of upper thoracic pedicle screws (T1-T4) inserted under 3-dimensional computer-assisted navigation was significantly higher than that (3.57%) by conventional fluoroscopic control (P<.001). Average screw insertion time in the conventional group was more than in the computer group (P<.001). Three-dimensional computer-assisted navigation pedicle screw placement can increase accuracy, reduce surgical time, and be performed safely and effectively at all levels of the thoracic spine, particularly the upper thoracic spine. Copyright 2010, SLACK Incorporated.

RCT Entities:   Population Interventions Outcomes