Abstract
ABSTRACT Objective To compare the use of a dynamic surgical guide (PediGuard®) and pilot hole preparation, with the use of a probe and the aid of fluoroscopy in osteoporotic or osteopenic patients undergoing pedicular fixation of the thoracic or lumbar spine. Methods One hundred and eight patients were randomized. A pilot hole was prepared with the dynamic surgical guide (PediGuard®), or with a probe with the aid of fluoroscopy. A total of 657 vertebral pedicles (120 thoracic and 180 lumbar) were included in the study. The parameters used for the comparison were: accuracy of the pedicular screw, number of fluoroscopic shots, and change in intraoperative trajectory of the perforation after detecting pedicle wall rupture. Results In the group with use of the dynamic surgical guide, malpositioning of the pedicle screws was observed in 8 (2.6%) patients and intraoperative change of perforation trajectory in 12 (4%) patients, and there were 52 fluoroscopic shots. In the group without use of the dynamic surgical guide (PediGuard®), misplacement of the pedicle screws was observed in 33 (11%) patients and intraoperative change of perforation trajectory in 47 (13.2%) patients, and there were 136 fluoroscopic shots. Conclusion The use of the dynamic surgical guide (PediGuard®) in patients with osteoporosis or osteopenia enabled more accurate placement of pedicular screws, with less change in the intraoperative course of the perforation and less intraoperative radiation. Level of Evidence II; Randomized clinical trial of lesser quality.
Highlights
Pedicle screw fixation is widely used in the thoracic and lumbar spine to enhance arthrodesis and to correct deformities
The use of the DSD device to prepare pedicle pilot holes in osteoporotic and osteopenic patients undergoing pedicle screw fixation in the thoracic and lumbar spine improved the accuracy of pedicle screw placement, decreased the change of intra-operative pilot hole trajectory, and decreased the use of intra-operative radiation
There are several technologies that assist with pedicle navigation, the Dynamic Surgical Guidance (DSG) device is the only hand-held device that can detect possible vertebral cortex perforation during pedicle preparation for screw placement
Summary
Pedicle screw fixation is widely used in the thoracic and lumbar spine to enhance arthrodesis and to correct deformities. The clinical usefulness of pedicle screw fixation is supported by the high rate of fusion, deformity correction, and clinical outcomes.[1,2]. Some drawbacks of pedicle screw fixation are the potential for inaccurate screw placement and the exposure of the surgeon, patient, and operating room personnel to radiation.[3,4]. Fluoroscopy is the most common technique used to assist pedicle screw insertion due to its capacity to present real time images and produce a higher rate of accurate screw placement than with the freehand technique.[5,6] the surgeon’s exposure to radiation during a fluoroscopic assisted thoracolumbar pedicle screw surgery is 10-12 times greater compared to other non-spinal procedures assisted by the fluoroscopic technique.[6,7] The average accuracy for pedicle screws inserted freehand or with fluoroscopy is 85.1% and for pedicle screws using navigation, 95.5%.5 Fluoroscopy is the most common technique used to assist pedicle screw insertion due to its capacity to present real time images and produce a higher rate of accurate screw placement than with the freehand technique.[5,6] the surgeon’s exposure to radiation during a fluoroscopic assisted thoracolumbar pedicle screw surgery is 10-12 times greater compared to other non-spinal procedures assisted by the fluoroscopic technique.[6,7]
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