Abstract
Cervical pedicle screw (CPS) may be the biomechanically best system for posterior cervical segmental fixation, but may carry a surgery-related risk. The purpose of this study was to evaluate the safety of CPS placement using computer navigation system for posterior cervical instrumented fixation and discuss its complication avoidance and management. Posterior cervical instrumented fixation using CPS was performed in a total of 128 patients during the period between 2007 and 2015. Intraoperative image guidance was achieved using a preoperative 3D CT-based or an intraoperative 3D CT-based navigation system. A total of 762 CPSs were placed in the spine level of C2 to Th3. The radiological accuracy of CPS placement was evaluated using postoperative CT. Accuracy of CPS placement using a preoperative 3D CT-based navigation system was 93.6 % (423 of 452 screws) in grade 0; the screw was completely contained in the pedicle, and accuracy of CPS placement using an intraoperative 3D CT-based navigation system was a little bit improved to 97.1 % (301 of 310 screws) in grade 0. CPS misplacement (more than half of screw) was 3.3 % (15 of 452 screws) using a preoperative 3D CT-based navigation system, and CPS misplacement (more than half of screw) was 0.6 % (2 of 310 screws) using an intraoperative 3D CT-based navigation system. In total, 38 screws (5.0 %) were found to perforate the cortex of pedicle, although any neural or vascular complications closely associated with CPS placement were not encountered. Twenty nine of 38 screws (76.3 %) were found to perforate laterally, and seven screws (18.4 %) were found to perforate medially. Image-guided CPS placement has been an important advancement to secure the safe surgery, although the use of CPS placement needs to be carefully determined based on the individual pathology.
Highlights
Posterior cervical instrumented fixation has undergone revolutionary changes over the last several decades, since posterior cervical stabilization using lateral mass screw (LMS) was first described by Roy-Camille et al in 1979 [1]
The radiological accuracy of cervical pedicle screw (CPS) placement was evaluated using postoperative CT scans and was defined retrospectively by a grading scale originally proposed by Neo et al [20]. (Fig. 3)
A total of 452 CPSs were placed using a preoperative 3D CT-based navigation system, and a total of 310 CPSs using an intraoperative 3D CTbased navigation system, so that 762 CPSs were placed in the spine level of C2 to Th3
Summary
Posterior cervical instrumented fixation has undergone revolutionary changes over the last several decades, since posterior cervical stabilization using lateral mass screw (LMS) was first described by Roy-Camille et al in 1979 [1]. Successful clinical application of CPS for traumatic cervical injury was first reported by Abumi et al [1], and posterior cervical instrumented fixation using CPS is gaining popularity and can be applied for cervical spine injury and for several cervical pathological conditions, such as cervical spondylotic myelopathy (CSM) with instability, kyphotic deformity, congenital anomaly, or neoplastic destruction. The popularization of posterior cervical instrumented fixation has raised an important issue of safe surgical management. The purpose of this study was to evaluate the accuracy of CPS placement using computer navigation system for posterior cervical instrumented fixation and discuss its complication avoidance and management
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