Abstract
BackgroundCorrect positioning of pedicle screws can be challenging. Intraoperative imaging may be helpful. The purpose of this study was to evaluate the use of intraoperative 3D imaging with a cone-beam CT. The hypotheses were that intraoperative 3D imaging (1) will lead to an intraoperative revision of pedicle screws and (2) may diminish the rate of perforated screws on postoperative imaging.MethodsTotally, 351 patients (age 60.9 ± 20.3 a (15–96); m/f 203/148) underwent dorsal instrumentation with intraoperative 3D imaging with 2215 pedicle screws at a trauma center level one. This study first evaluates intraoperative imaging. After this, 501 screws in 73 patients (age 62.5 ± 19.7 a; m/f 47/26) of this collective were included in the study group (SG) and their postoperative computed tomography was evaluated with regard to screw position. Then, 500 screws in 82 patients (age 64.8 ± 14.4 a; m/f 51/31) as control group (CG), who received the screws with conventional 2D fluoroscopy but without 3D imaging, were evaluated with regard to screw position.ResultsDuring the placement of the 2215 pedicle screws, 158 (7.0%) intraoperative revisions occurred as a result of 3D imaging. Postoperative computed tomography of the SG showed 445 (88.8%) screws without relevant perforation (type A + B), of which 410 (81.8%) could be classified as type A and 35 (7.0%) could be classified as type B. Fifty-six (11.2%) screws in SG showed relevant perforation (type C–E). In contrast, 384 (76.8%) screws in the CG were without relevant perforation (type A + B), of which 282 (56.4%) could be classified as type A and 102 (20.4%) as type B. One hundred and sixteen (23.2%) screws in the CG showed relevant perforation (type C–E).ConclusionThis study shows that correct placement of pedicle screws in spine surgery with conventional 2D fluoroscopy is challenging. Misplacement of screws cannot always be prevented. Intraoperative 3D imaging with a CBCT can be helpful to detect and revise misplaced pedicle screws intraoperatively. The use of intraoperative 3D imaging will probably minimize the number of revision procedures due to perforating pedicle screws.
Highlights
Correct positioning of pedicle screws can be challenging
The intraoperative 3D imaging was performed for diagnostic reasons and not due to complications
A total of 158 (7.0%) intraoperative revisions were made intraoperatively based on the intraoperative 3D imaging (Table 1)
Summary
Correct positioning of pedicle screws can be challenging. Intraoperative imaging may be helpful. Misplaced pedicle screws after dorsal instrumentation are observed in between 1.5 and 40% of cases in the current literature [3,4,5] This is of particular importance due to the adjacent structures. While lateral malpositioning of the pedicle screw may affect the stability, medial perforation of the pedicle screw may be associated with severe neurologic impairment Despite this anatomic proximity, injuries of these important nervous structures are rarely observed. The screw tip should lie in the vertebral body, but without penetrating the ventral cortex This is very important if adjacent organs (e.g., aorta, vena cava, lung, trachea, esophagus, etc.) and blood vessels are present, which can be injured intraoperatively. This rarely happens [3, 6,7,8]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
