Horst Balling1, Thomas R Blattert2. 1. Department for Spine Surgery and Traumatology, Orthopaedische Fachklinik Schwarzach, Dekan-Graf-Str. 2-6, 94374, Schwarzach, Germany. horst.balling@ofks.de. 2. Department for Spine Surgery and Traumatology, Orthopaedische Fachklinik Schwarzach, Dekan-Graf-Str. 2-6, 94374, Schwarzach, Germany.
Abstract
PURPOSE: In the field of spinal surgery, 3D-fluoroscopy navigation-assisted pedicle screw (PS) insertion with intra-operative 3D-image control represents a modern application of contemporary navigation technology. In literature, sectional or vertebral accuracy limitations of this image-guidance approach are not profoundly specified. This observational study explicitly differentiates accuracy rates and misplacement mode between spinal sections and single vertebrae from T10 to S1 using a navigation-assisted approach. METHODS: From February 2011 through July 2015, all 3D-fluoroscopy navigation-assisted, 3D-image controlled PS insertions from T10 to S1 were prospectively recorded and evaluated for PS insertion depth, angulation, and entering-point modifications after intraoperative O-arm control scanning. Major complications requiring revision surgery for neurological damage/major bleedings, and procedure-related unintended violations of anatomical structures were recorded. RESULTS: In 1547 navigation-assisted PS insertions, thoracolumbar accuracy (96.4%) was significantly higher than sacral accuracy (92.6%, p ≈ 0.007) due to special requirements to exact PS (insertion depth) in S1 (p < 0.001). Vertebrae with modification rates above average were identified (T10, L5-S1) (p < 0.001). Major complications did not occur, anatomical structures were violated in 1.2% (19/1547 PS insertions). CONCLUSIONS: In navigation-assisted O-arm-controlled PS placements, correct PS insertion depths are less easily to achieve than correct trajectory or entering-points, which is important for bicortical PS anchorage in S1. Therefore, post-instrumentation PS control by 3D-imaging or at least intraoperative fluoroscopy is recommended for levels with special requirements to exact PS insertion depths (e.g. S1).
PURPOSE: In the field of spinal surgery, 3D-fluoroscopy navigation-assisted pedicle screw (PS) insertion with intra-operative 3D-image control represents a modern application of contemporary navigation technology. In literature, sectional or vertebral accuracy limitations of this image-guidance approach are not profoundly specified. This observational study explicitly differentiates accuracy rates and misplacement mode between spinal sections and single vertebrae from T10 to S1 using a navigation-assisted approach. METHODS: From February 2011 through July 2015, all 3D-fluoroscopy navigation-assisted, 3D-image controlled PS insertions from T10 to S1 were prospectively recorded and evaluated for PS insertion depth, angulation, and entering-point modifications after intraoperative O-arm control scanning. Major complications requiring revision surgery for neurological damage/major bleedings, and procedure-related unintended violations of anatomical structures were recorded. RESULTS: In 1547 navigation-assisted PS insertions, thoracolumbar accuracy (96.4%) was significantly higher than sacral accuracy (92.6%, p ≈ 0.007) due to special requirements to exact PS (insertion depth) in S1 (p < 0.001). Vertebrae with modification rates above average were identified (T10, L5-S1) (p < 0.001). Major complications did not occur, anatomical structures were violated in 1.2% (19/1547 PS insertions). CONCLUSIONS: In navigation-assisted O-arm-controlled PS placements, correct PS insertion depths are less easily to achieve than correct trajectory or entering-points, which is important for bicortical PS anchorage in S1. Therefore, post-instrumentation PS control by 3D-imaging or at least intraoperative fluoroscopy is recommended for levels with special requirements to exact PS insertion depths (e.g. S1).
Authors: Ganesh Rao; Darrel S Brodke; Matthew Rondina; Kent Bacchus; Andrew T Dailey Journal: Spine (Phila Pa 1976) Date: 2003-11-15 Impact factor: 3.468
Authors: K J Schnake; B König; U Berth; R J Schroeder; F Kandziora; U Stöckle; M Raschke; N P Haas Journal: Unfallchirurg Date: 2004-02 Impact factor: 1.000
Authors: Ioannis D Gelalis; Nikolaos K Paschos; Emilios E Pakos; Angelos N Politis; Christina M Arnaoutoglou; Athanasios C Karageorgos; Avraam Ploumis; Theodoros A Xenakis Journal: Eur Spine J Date: 2011-09-07 Impact factor: 3.134