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

Ashwaq Alqurashi,Mohamad Bakhaidar,Mohammed Alfiky,Soha A Alomar,Saleh S Baeesa

doi:10.7759/cureus.17431

Abstract

BackgroundTranspedicular 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.MethodsWe 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.ResultsFifteen 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.ConclusionIn 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.

Highlights

Since King's introduction of pedicle screws in 1944, transpedicular screws (TPS) have emerged as an essential tool for spinal fusion for various clinical indications [1]
Based on more than 2mm breach increments measured on CT images, lumbar pedicular screw placement accuracy was 100% in the intraoperative CT-guided navigation (iCT-Nav) group and 86.9% in the FS group
We present our experience by comparing the outcome and accuracy of screw placement in patients who underwent a lumbar fusion for degenerative lumbar disk disease using the conventional fluoroscopy method to intraoperative CT-guided navigation

Summary

Introduction

Since King's introduction of pedicle screws in 1944, transpedicular screws (TPS) have emerged as an essential tool for spinal fusion for various clinical indications [1]. Degenerative disc disease, spondylolysis and spondylolisthesis, fractured vertebrae, spondylitis, and vertebral tumors are common indications of spinal fusion. This procedure may carry a risk of screw misplacement, with a possibility of neural damage, if the medial cortex of the pedicle were penetrated [2]. Advancements in imaging have led to the use of intraoperative fluoroscopy to promote accuracy in screw placement. This method is associated with increased radiation exposure to the patient and surgeon and increased operative time [3]. Transpedicular screws are a common adjunct for lumbar spine fusion. We aim to evaluate the accuracy of pedicle screw insertion using intraoperative CT-guided navigation in lumbar spondylosis

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