Introduction With the advances and improvement of computer-assisted surgery devices, computer-guided pedicle screws insertion has been applied to the lumbar, thoracic and cervical spine. The purpose of the present study was to perform a systematic review of all available prospective evidence regarding pedicle screw insertion techniques in the thoracic and lumbar human spine. Materials and methodsWe considered all prospective in vivo clinical studies in the English literature that assessed the results of different pedicle screw placement techniques (free-hand technique, fluoroscopy guided, computed tomography (CT)-based navigation, fluoro-based navigation). MEDLINE, OVID, and Springer databases were used for the literature search covering the period from January 1950 until May 2010. Results 26 prospective clinical studies were eventually included in the analysis. These studies included in total 1,105 patients in which 6,617 screws were inserted. In the studies using free-hand technique, the percentage of the screws fully contained in the pedicle ranged from 69 to 94%, with the aid of fluoroscopy from 28 to 85%, using CT navigation from 89 to 100% and using fluoroscopy-based navigation from 81 to 92%. The screws positioned with free-hand technique tended to perforate the cortex medially, whereas the screws placed with CT navigation guidance seemed to perforate more often laterally. ConclusionsIn conclusion, navigation does indeed exhibit higher accuracy and increased safety in pedicle screw placement than free-hand technique and use of fluoroscopy.

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We report the outcome of 50 patients with degenerative lumbar spinal stenosis who were treated surgically by spinal decompression between 1984 and 1995. Their mean age at the time of surgery was 59.9 (45-77) years and the mean follow-up was 11.6 (6.1-17.2) years. Five patients had a concomitant spinal fusion. The preoperative data were collected retrospectively from the patients' charts. The follow-up data were obtained from a clinical examination and questionnaire including overall pain, ability to work, walking ability, use of analgesics and satisfaction with surgery. The outcome was rated as excellent in 23 patients, good in 13 patients, fair in 9 patients and poor in 5 patients. Patients with concomitant fusion had good to excellent results and were more satisfied, whereas patients with long-standing preoperative symptoms had poor to fair result and were less satisfied.Résumé Nous rapportons le résultat de 50 malades avec une sténose lombaire dégénérative qui a été traité chirurgicalement par décompression vertébrale entre 1984 et 1995. L'âge moyen à la chirurgie était 59,9 (45-77) ans et le suivi moyen était 11,6 (6.1-17.2) années. Cinq malades avaient une fusion vertébrale concomitante. Les données préopératoires ont été rassemblées rétrospectivement. Les données du suivi ont été obtenues par un examen clinique et un questionnaire qui inclut les douleurs , la capacité de travailler, la capacité de marcher, l'usage d'analgésiques et la satisfaction de la chirurgie. Le résultat a été estimé comme excellent pour 23 malades, bon pour 13 malades, juste pour 9 et mauvais pour 5 malades. Les patients avec une fusion concomitante avaient des résultats bons ou excellents et étaient plus satisfaits alors que ceux avec symptômes préopératoires anciens avaient des résultats moyens ou mauvais et étaient moins satisfaits.