Accuracy of pedicle screw placement in the thoracic and lumbosacral spines using O-arm-based navigation versus conventional freehand technique

Linkai Jing,James Wang,Huifang Zhang,Zhenze Wang,Zhenxing Sun,Guihuai Wang

doi:10.1186/s41016-019-0154-y

Linkai Jing, James Wang + Show 4 more

Open Access

https://doi.org/10.1186/s41016-019-0154-y

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Abstract

BackgroundThe accuracy and safety of pedicle screw insertion was markedly improved with the introduction of intraoperative three-dimensional navigation system during the last decade. This study aimed to evaluate the accuracy of pedicle screw placement using O-arm-based navigation system versus conventional freehand technique.MethodsWe reviewed the accuracy of 341 thoracic (n = 173) and lumbosacral (n = 168) pedicle screws placed in 60 consecutive patients using either O-arm-based navigation or freehand technique in the Department of Neurosurgery of Beijing Tsinghua Changgung Hospital between January 2015 and June 2018. Patient-specific characteristics, treatment-related characteristics, and screw-specific accuracy were analyzed. The accuracy of pedicle screw placement was measured by Gertzbein-Robbins scale and screw grades A and B were clinically acceptable.ResultsOne hundred ninety-one screws were inserted in the O-arm-based navigation group and 150 in the freehand group. One hundred eighty-three (95.81%) clinically acceptable screws were placed in the navigation group and 135 (90.00%) in the freehand group (p = 0.034). Twenty-three (6.74%) screw revisions were performed in the two groups (8 screws in the navigation group and 15 screws in the freehand group) and significant difference was observed in thoracic spine (p = 0.018), while no statistical significance was presented in lumbosacral spine (p > 0.05). Twenty-four (12.57%) screws in the navigation group and 24 (16.00%) in the freehand group violated the cortex (p > 0.05). Medial screw deviation was the most common problem in the two groups.ConclusionThe O-arm-based navigation exhibits higher accuracy for pedicle screw insertion than the freehand insertion technique.

Highlights

The accuracy and safety of pedicle screw insertion was markedly improved with the introduction of intraoperative three-dimensional navigation system during the last decade
Following the introduction of the O-arm® and StealthStation system (Medtronic, Minneapolis, MN, USA), we retrospectively reviewed and evaluated the accuracy of pedicle screw insertion using this O-arm-based navigation and compared with conventional freehand technique
We retrospectively reviewed the accuracy of 341 pedicle screws in 60 consecutive patients who had undergone thoracic and lumbosacral instrumented procedures at our hospital between January 2015 and June 2018

Summary

Introduction

The accuracy and safety of pedicle screw insertion was markedly improved with the introduction of intraoperative three-dimensional navigation system during the last decade. With advances in frame fixation, camera technology, automatic registration, and image manipulation software, computer-assisted navigation surgery is proving extremely useful and reliable during procedures performed on the spine [2, 6, 7]. Such advances allow surgeons to track and monitor the instruments used relative to the patient’s anatomy in real time using markers and appropriate. Following the introduction of the O-arm® and StealthStation system (Medtronic, Minneapolis, MN, USA), we retrospectively reviewed and evaluated the accuracy of pedicle screw insertion using this O-arm-based navigation and compared with conventional freehand technique

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