Improved accuracy of pedicle screw insertion with computer-assisted surgery. A prospective clinical trial of 30 patients.

Abstract

A prospective clinical trial was done to study the accuracy of pedicle screw placement in 30 consecutive computer-assisted orthopedic surgeries. To determine the accuracy and clinical applicability of this new method for pedicle screw insertion. Conventional screw insertion techniques have been associated with high pedicle screw malplacement rates in cadaver studies and clinical studies with postoperative computed tomography evaluation. Thirty transpedicular, low-back, titanium instrumentations were performed with computer-assisted orthopedic surgery. The accuracy of screw placement was evaluated using a sophisticated computed tomography protocol. The total number of pedicle screws was 174. Of these, 139 (79.9%) could be inserted with computer-assisted orthopedic surgery. The malplacement rate of computer-assisted orthopedic surgery screws was 4.3%. In screws that were not inserted by computer-assisted orthopedic surgery, the malplacement rate was 14.3%. One malplaced screw that had not been inserted with computer-assisted orthopedic surgery caused L4 root paresis. The accuracy of pedicle screw placement using computer-assisted surgery proved to be superior to the accuracy obtained when using conventional techniques.