Accuracy of Pedicle Screw Placement Using Intraoperative CT-Guided Navigation and Conventional Fluoroscopy for Lumbar Spondylosis

Abstract

Background Transpedicular screws are a common adjunct for lumbar spine fusion. Accurate screw placement to prevent neurological injury has been the subject of many studies. The adoption of spine neuronavigation has shown a significant decrease in screw malposition morbidity. We aim to evaluate the accuracy of pedicle screw insertion using intraoperative CT-guided navigation in lumbar spondylosis. Methods We reviewed a prospective registry-based cohort study. This included patients who underwent transpedicular screws insertion for lumbar spondylosis under intraoperative CT-guided navigation (iCT-Nav) and compared it to another group operated using conventional fluoroscopy (FS) over one year. In addition, the correlation between clinical outcome using the visual analog scale (VAS) and short 12 physical component scores (SF-12 PCS) and hospital stay was reported. Results Fifteen patients were included in the iCT-Nav group compared to 42 patients in the FS group. The median age of the iCT-Nav group was 59.3 years old (27-76 years) versus 45 years old (20-60 years) in the FS group. The number of screws was 98 in the iCT-Nav group and 252 screws in the FS group. Based on more than 2-mm breach increments measured on CT images, lumbar pedicular screw placement accuracy was 100% in the iCT-Nav group and 86.9% in the FS group. None of the patients in the iCT-Nav group had to undergo any postoperative revisions. On the other hand, two patients of the FS group developed new postoperative symptoms related to displaced screws and required readmission and revision surgery. Conclusion In a commonly performed pedicular fixation in lumbar spondylosis, iCT-Nav has been shown to improve the accuracy of pedicle screw placement, hospital stay, and functional outcomes compared to FS.

A systematic comparison of the accuracy of monocular RGB tracking and LiDAR for neuronavigation

“…Our algorithm uses point correspondences (among C model and C LiDAR ) and returns a transformation matrix TM that describes a relationship between points in the model coordinate system and the LiDAR coordinate system (Figure 2). This can be expressed as a matrix multiplication, shown in Equation (1), where P ∈ R 3 . Our algorithm requires three non-collinear points to yield correct estimates of TM .…”

“…Both spine and cranial surgical procedures currently leverage guidance technologies to improve surgeon performance and achieve better patient outcomes. In spinal procedures, CT‐guided pedicle screw placement has gained popularity, which has resulted in greater screw placement accuracy and lower complication rates compared to freehand or fluoroscopic techniques [ 1 , 2 , 3 , 4 , 5 , 6 ]. In cranial procedures, image guidance has been frequently employed for tumour surgery, but the link to gross total resection rates and subsequently progression‐free survival and overall survival is still debated [ 7 , 8 , 9 , 10 ].…”