Computer navigation technique-assisted posterior spinal pedicle screw placement fixation: accuracy and safety

doi:10.3969/j.issn.2095-4344.2015.13.028

Abstract

Abstract:

BACKGROUND: Posterior pedicle screw fixation is an important method to treat various diseases of the spine and to stabilize the spine. Computer navigation system can completely, intuitively and truly reveal the morphology of various tissues and their positions so that the performer can obtain three-dimensional images in time and avoid the risk area of the operation to the utmost, and can directly introduce accurate placement of the screw in the vertebral body.
OBJECTIVE: To evaluate the accuracy and safety of computer navigation technique-assisted posterior spinal pedicle screw placement.
METHODS: 307 patients with spine diseases, who were treated in the First Affiliated Hospital of Guangxi Medical
University from July 2008 to January 2014, were enrolled in this study. They received computer navigation technique-assisted posterior spinal pedicle screw placement and laminectomy for decompression. C-arm fluoroscopy was applied to assess the precision of pedicle screw position during the operation. The mean implantation time per screw and the exposure time to radiation were recorded. 3-day postoperative radiographs and CT examination, which allowed measurements of screw position relative to pedicle position according to Andrew classification, were performed routinely.
RESULTS AND CONCLUSION: Of the 1 820 screws inserted by computer-assisted navigation, 1 778 were grade I (accuracy 97.69 %). A total of 92 screws were implanted in the cervical vertebrae, including 90 grade-I screws (accuracy 97.82%). 502 screws were implanted in the thoracic vertebrae, including 492 grade-I screws (accuracy 98%). 1 226 screws were implanted in the lumbar vertebrae, including 1 196 grade-I screws (accuracy 97.2%). The mean implantation time per screw was (7.0±1.5) minutes. 215 patients were followed up for (12±6) months. No complications such as fixator displacement or breakage or neurovascular injury occurred. Above findings suggested that computer navigation system-assisted spinal pedicle screw implantation provides real-time, multi-perspective, three-dimensional visualization of spinal anatomy, ensures the accuracy and safety of spinal pedicle screw implantation, and apparently reduces exposure time to radiation.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Bone Nails, Therapy, Computer-Assisted, Internal Fixators, Spine

CLC Number:

R318

Chen Xiao-ming, Xiao Zeng-ming, Zong Shao-hui, Chen Qian-fen. Computer navigation technique-assisted posterior spinal pedicle screw placement fixation: accuracy and safety[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(13): 2119-2124.

Figures/Tables 3

References

[1] Botolin S, Merritt C, Erickson M. Aseptic loosening of pedicle screw as a result of metal wear debris in a pediatric patient. Spine (Phila Pa 1976).2013;38(1):E38-42.
[2] Gelalis ID, Paschos NK, Pakos EE, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J. 2012;21(2):247-255.
[3] Suk SI, Kim JH, Kim SS, et al. Pedicle screw instrumentation in adolescent idiopathic scoliosis (AIS). Eur Spine J. 2012; 21(1):13-22.
[4] Verlaan JJ, Dhert WJ, Oner FC. Intervertebral disc viability after burst fractures of the thoracic and lumbar spine treated with pedicle screw fixation and direct end-plate restoration. Spine J. 2013;13(3):217-221.
[5] Min K, Sdzuy C, Farshad M. Posterior correction of thoracic adolescent idiopathic scoliosis with pedicle screw instrumentation: results of 48 patients with minimal 10-year follow-up. Eur Spine J. 2013;22(2):345-354.
[6] Yoshihara H, Passias PG, Errico TJ. Screw-related complications in the subaxial cervical spine with the use of lateral mass versus cervical pedicle screws: a systematic review. J Neurosurg Spine. 2013;19(5):614-623.
[7] Nakashima H, Yukawa Y, Imagama S, et al. Complications of cervical pedicle screw fixation for nontraumatic lesions: a multicenter study of 84 patients. J Neurosurg Spine. 2012; 16(3):238-247.
[8] 杨明坤,刘川,张旭,等.上胸椎椎弓根螺钉固定并发症的探讨[J].实用骨科杂志,2014,20(6):500-503.
[9] Larson AN, Polly DW Jr, Guidera KJ, et al. The accuracy of navigation and 3D image-guided placement for the placement of pedicle screws in congenital spine deformity. J Pediatr Orthop. 2012;32(6):e23-29.
[10] Zwingmann J, Hauschild O, Bode G, et al. Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2013;133(9):1257-1265.
[11] Nolte LP, Zamorano LJ, Jiang Z, et al. Image-guided insertion of transpedicular screws. A laboratory set-up. Spine (Phila Pa 1976). 1995;20(4):497-500.
[12] Lehman RA Jr, Kang DG, Lenke LG, et al. Return to sports after surgery to correct adolescent idiopathic scoliosis: a survey of the Spinal Deformity Study Group. Spine J. 2013. in press.
[13] Luo TD, Polly DW Jr, Ledonio C, et al. Accuracy of Pedicle Screw Placement in Children≤10 Years Using Navigation and Intraoperative CT. J Spinal Disord Tech. 2014. in press.
[14] Youkilis AS, Quint DJ, McGillicuddy JE, et al. Stereotactic navigation for placement of pedicle screws in the thoracic spine. Neurosurgery. 2001;48(4):771-778; discussion 778-779.
[15] Foley KT, Simon DA, Rampersaud YR. Virtual fluoroscopy: computer-assisted fluoroscopic navigation. Spine (Phila Pa 1976). 2001;26(4):347-351.
[16] Smith HE, Welsch MD, Sasso RC, et al. Comparison of radiation exposure in lumbar pedicle screw placement with fluoroscopy vs computer-assisted image guidance with intraoperative three-dimensional imaging. J Spinal Cord Med. 2008;31(5):532-537.
[17] 叶斌,孟祥龙,刘玉增,等.徒手置钉技术在脊柱畸形矫正中的准确性与安全性研究[J].脊柱外科杂志,2014,12(1):25-34.
[18] Kim YJ, Lenke LG, Bridwell KH, et al. Free hand pedicle screw placement in the thoracic spine: is it safe? Spine (Phila Pa 1976). 2004;29(3):333-342; discussion 342.
[19] Hicks JM, Singla A, Shen FH, et al. Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine (Phila Pa 1976). 2010;35(11):E465-470.
[20] 张余,尹庆水,徐国洲,等.胸腰椎椎弓根钉内固定术并发症的分析[J].中国矫形外科杂志,2001,8(4):334-336.
[21] Luther N, Iorgulescu JB, Geannette C, et al. Comparison of Navigated Versus Non-Navigated Pedicle Screw Placement in 260 Patients and 1434 Screws: Screw Accuracy, Screw Size, and the Complexity of Surgery. J Spinal Disord Tech. 2013. in press.
[22] Uehara M, Takahashi J, Hirabayashi H, et al. Perforation rates of cervical pedicle screw insertion by disease and vertebral level. Open Orthop J. 2010;4:142-146.
[23] Hyun SJ, Kim YJ, Cheh G, et al. Free Hand Pedicle Screw Placement in the Thoracic Spine without Any Radiographic Guidance : Technical Note, a Cadaveric Study. J Korean Neurosurg Soc. 2012;51(1):66-70.
[24] Faizan A, Kiapour A, Kiapour AM, et al. Biomechanical analysis of various footprints of transforaminal lumbar interbody fusion devices. J Spinal Disord Tech. 2014;27(4): E118-127.
[25] Zang L, DU P, Hai Y, et al. Device related complications of the Coflex interspinous process implant for the lumbar spine. Chin Med J (Engl). 2013;126(13):2517-2522.
[26] Paik H, Kang DG, Lehman RA Jr, et al. The biomechanical consequences of rod reduction on pedicle screws: should it be avoided? Spine J. 2013;13(11):1617-1626.
[27] Joglekar SB, Mehbod AA. Surgeon's view of pedicle screw implantation for the monitoring neurophysiologist. J Clin Neurophysiol. 2012;29(6):482-488.
[28] 池永龙,徐华梓,林焱,等.微创经皮椎弓根螺钉内固定治疗胸腰椎骨折的初步探讨[J].中华外科杂志,2004,42(21):1307-1311.
[29] Zhang QS, Lü GH, Wang XB, et al. The significance of removing ruptured intervertebral discs for interbody fusion in treating thoracic or lumbar type B and C spinal injuries through a one-stage posterior approach. PLoS One. 2014; 9(5):e97275.
[30] 吴静,茅金宝,孔祥云,等.导航与普通透视对手术室医务人员放射量的对比分析[J].医学影像学杂志,2013,23(10):1631-1634.
[31] Van de Kelft E, Costa F, Van der Planken D, et al. A prospective multicenter registry on the accuracy of pedicle screw placement in the thoracic, lumbar, and sacral levels with the use of the O-arm imaging system and StealthStation Navigation. Spine (Phila Pa 1976). 2012;37(25):E1580-1587.
[32] Lee MH, Lin MH, Weng HH, et al. Feasibility of Intra-operative Computed Tomography Navigation System for Pedicle Screw Insertion of the Thoraco-lumbar Spine. J Spinal Disord Tech. 2012. in press.
[33] 田伟,刘亚军,刘波,等.计算机导航在脊柱外科手术应用实验和临床研究[J].中华骨科杂志,2006,26(10):671-675.