Application of 3D O-arm-navigated pedicle screw insertion in spinal stability reconstruction in patients with spinal cord and spinal column tumors

Abstract

Objective To explore the advantages of O-arm-navigated pedicle screw insertion in patients with spinal column and spinal cord tumors. Methods We retrospectively enrolled 29 patients with spinal tumors who underwent pedicle placement using O-arm-based navigation (Group A, 21 cases) or freehand technique (Group B, 8 cases) at Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University from October 2015 to December 2017. Screw position was judged on the 3D O-arm images and the accuracy of screws placement was evaluated according to the Gertzbein-Robbins scale. The clinical data and neuroimaging data were collected during the follow-up. Results Age, sex, body mass index, mean blood loss, length of stay and radiation dose showed no significant difference (all P>0.05) between the 2 groups. The operation time in group A was longer than that in group B (109.7±59.9 min vs. 74.5±19.4 min, P=0.025). A total of 134 screws were inserted in Group A and 117 screws was classified as grade A, 11 as grade B and 6 as grade C. There were 45 screws inserted in group B and 34 screws were classified as grade A, 4 as grade B, 6 as grade C and 1 as grade D. The accuracy of screw inserting was significantly different between the 2 groups (group A: 95.5% and group B: 84.4%, χ2=4.604, P=0.032). No screw-related neurovascular complications occurred. Conclusion O-arm-based navigation system could markedly improve the accuracy of screw insertion and thus help reconstruct spinal stability. Key words: Spinal cord neoplasms; Spinal neoplasms; Neuronavigation; O-arm; Spinal fixation