Computer tomography assessment of pedicle screw placement in thoracic spine: comparison between free hand and a generic 3D-based navigation techniques

Abstract

Introduction Although pedicle screw fixation is a wellestablished technique for the lumbar spine, screw placement in the thoracic spine is more challenging because of the smaller pedicle size and more complex 3D anatomy. The intraoperative use of image guidance devices may allow surgeons a safer, more accurate method for placing thoracic pedicle screws while limiting radiation exposure. This generic 3D imaging technique is a new generation intraoperative CT imaging system designed without compromise to address the needs of a modern OR. Aim The aim of our study was to check the accuracy of this generic 3D navigated pedicle screw implants in comparison to free hand technique described by Roy-Camille at the thoracic spine using CT scans. Material and methods The material of this study was divided into two groups: free hand group (group I) (18 patients; 108 screws) and 3D group (27 patients; 100 screws). The patients were operated upon from January 2009 to March 2010. Screw implantation was performed during internal fixation for fractures, tumors, and spondylodiscitis of the thoracic spine as well as for degenerative lumbar scoliosis. Results The accuracy rate in our work was 89.8 % in the free hand group compared to 98 % in the generic 3D navigated group. Conclusion In conclusion, 3D navigation-assisted pedicle screw placement is superior to free hand technique in the thoracic spine.

Computer navigation versus fluoroscopy-guided navigation for thoracic pedicle screw placement: a meta-analysis

“…By following the inclusion and exclusion criterias, we finally obtained 14 satisfactory articles published from 2008 to 2013 [1,3,11,13,18,20,23,27,28,33,37,38,40,41]. Ten of these studies were RCTs and the other four were prospective studies.…”

Comparison of intraoperative O-arm- and conventional fluoroscopy (C-arm)-assisted insertion of pedicle screws in the treatment of fracture of thoracic vertebrae

“…Thoracic screw perforates the cortical margins of the pedicle at a rate ranging from 16% to 54%, leading to the potential for hemorrhage, nerve root injury, or spinal cord injury. 18 Experienced surgeons can insert the thoracic pedicle screws with intraoperative fluoroscopy. However, freehand placement of pedicle screw may be safe in very experienced hands.…”

Reliability of the Planned Pedicle Screw Trajectory versus the Actual Pedicle Screw Trajectory using Intra-operative 3D CT and Image Guidance

“…[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Extensive literature has been published describing the technique, benefits, and drawbacks of each method, as well as comparisons between different approaches. [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] With its increasing use has come a multitude of studies regarding the safety of this technique. Proper screw placement is imperative in order to avoid complications such as CSF leak, and pedicle fractures.…”