TY - CHAP
T1 - Does navigation improve pedicle screw placement accuracy? Comparison between navigated and non-navigated percutaneous and open fixations
AU - Innocenzi, Gualtiero
AU - Bistazzoni, Simona
AU - D’Ercole, Manuela
AU - Cardarelli, Giovanni
AU - Ricciardi, Francesco
PY - 2017/1/1
Y1 - 2017/1/1
N2 - 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.
AB - 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.
KW - Fluoroscopy-guided pedicle screw fixation
KW - Free-hand pedicular screw fixation
KW - Pedicle screw accuracy
KW - Percutaneous pedicular screw fixation
KW - Spinal CT-based navigation system
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U2 - 10.1007/978-3-319-39546-3_42
DO - 10.1007/978-3-319-39546-3_42
M3 - Chapter
C2 - 28120086
AN - SCOPUS:85011000184
VL - 124
T3 - Acta Neurochirurgica, Supplementum
SP - 289
EP - 295
BT - Acta Neurochirurgica, Supplementum
PB - Springer-Verlag Wien
ER -