Does navigation improve pedicle screw placement accuracy? Comparison between navigated and non-navigated percutaneous and open fixations

Gualtiero Innocenzi, Simona Bistazzoni, Manuela D’Ercole, Giovanni Cardarelli, Francesco Ricciardi

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Background: The aim of our study was to assess how a preoperative computed tomography (CT)-based navigation system affected the correctness and safety of transpedicular screw insertion, compared with standard techniques. Method: Between January 2012 and February 2014, 203 patients underwent thoracic and lumbar fixation, with open and percutaneous techniques; 218 screws were implanted through an open navigated technique (1.0 Spine & Trauma 3d ver. 2.0 BrainLab, Feldkirchen Germany) in 43 patients; 220 screws were inserted with an open free-hand technique in 45 patients; 230 screws were implanted in 56 patients using percutaneous CT-based navigation; and 236 screws were inserted in 59 patients using a percutaneous fluoroscopy-guided technique. To our knowledge, this is the first work comparing these four different techniques. The position of each screw was evaluated on CT scan reconstruction and classified according to a four-point grading scale (grade 0: no breach, grade 1: breach < 2 mm, grade 2: breach between 2 and 4 mm; grade 3: breach >4 mm). Statistical analysis was assessed by two-way analysis of variance (ANOVA) t test, while the Fisher least significant difference (LSD) method was employed to determine statistical significance. Results: Statistical analysis showed a significant difference in accuracy between the open CT-based navigation and the percutaneous CT-based navigation techniques (P= 0.0263) and between the open CT-based navigation and the percutaneous fluoroscopy-guided techniques (P=0.0258): a particular difference was observed in anterior misplacement between open CT-based navigation and the percutaneous fluoroscopy-guided technique (P= 0.0153). Conclusions: Our results confirm the advantages of the navigation technique, which ensures greater accuracy, in open as well as percutaneous procedures.

Original languageEnglish
Title of host publicationActa Neurochirurgica, Supplementum
PublisherSpringer-Verlag Wien
Pages289-295
Number of pages7
Volume124
DOIs
Publication statusPublished - Jan 1 2017

Publication series

NameActa Neurochirurgica, Supplementum
Volume124
ISSN (Print)0065-1419
ISSN (Electronic)2197-8395

Keywords

  • Fluoroscopy-guided pedicle screw fixation
  • Free-hand pedicular screw fixation
  • Pedicle screw accuracy
  • Percutaneous pedicular screw fixation
  • Spinal CT-based navigation system

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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