Computer-assisted versus free-hand pedicle screw implantation

doi:10.3969/j.issn.2095-4344.2013.09.009

Abstract

Abstract:

BACKGROUND: Traditional pedicle screw placement technique relies on the anatomical landmark recognition and experience of the surgeons, even experienced spine surgeons may make the poor position of pedicle screw implantation. Computer navigation system can provide real-time multi-planar image and improve the placement accuracy for pedicle screw implantation. Lumbar vertebrae is the common position of pedicle screw implantation, and no literatures have reported the comparison of computer-assisted and free-hand lumber vertebral pedicle screw implantation at home and abroad.
OBJECTIVE: To explore the accuracy and application of computer navigation in lumbar pedicle screw implantation in comparison with free-hand pedicle screw implantation.
METHODS: 190 patients with lumbar disc herniation and lumbar spinal stenosis were selected, and all the patients were treated with posterior decompression pedicle screw implantation and intervertebral fusion or intertransverse fusion. The patients were randomly divided into two group, 90 patients in computer-assisted group and 100 patients in free-hand group. The implantation time, accuracy, piercing rate and incidence of neurovascular damage were compared between two groups.
RESULTS AND CONCLUSION: A total of 480 pedicle screws were implanted into the computer-assisted group, the average implantation time was (8.0±2.5) minutes and the accuracy was 80.4% (386/480); a total of 514 pedicle screws were implanted into the free-hand group, the average implantation time was (3.0±1.0) minutes and the accuracy was 84.4% (430/514). Statistical analysis showed that the implantation time in the computer-assisted group was significantly longer than that in the free-hand group (P < 0.01). There were no significant differences in accuracy, piercing rate and incidence of neurovascular injury between two groups. The results suggest that during the lumber pedicle screw implantation, computer-assisted pedicle screw implantation has no significant advantages compared with free-hand pedicle screw implantation, and the implantation time of computer-assisted implantation is longer than that of free-hand implantation. Therefore, the computer-assistance has little help to the lumbar pedicle screw implantation.

Key words: bone and joint implants, spinal implants, computer-assistance, free-hand, lumbar vertebrae, pedicle, screws, internal fixation, accuracy, piercing rate, neurovascular injury, randomized controlled study

CLC Number:

R318

Zhang Qi-wei, Zhang Yao-nan, Sun Chang-tai, Xu Hong-bing. Computer-assisted versus free-hand pedicle screw implantation[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(9): 1579-1585.

Figures/Tables 3

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