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The accuracy of pedicle screw placement using computer-assisted surgery proved to be superior to the accuracy obtained when using conventional techniques.

A prospective study of the accuracy of titanium pedicle screw placement in 30 low back operations was performed. The postoperative plain radiographs and CT reformation images were evaluated by two independent radiologists. Thirty-two out of 152 screws (21%) perforated the pedicle cortex. One-tenth of the perforations was detected with conventional radiography. In ten patients (33%) all the screws were located within the pedicle. The clinical significance of this study lies in the finding that pedicle perforations are more frequent than is generally believed and that, in spite of the many malplacements, no screw that perforated by less than 4.0 m m caused neurological problems. Only one nerve root lesion was detected.

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Computer assistance has been shown to improve significantly the accuracy and safety of pedicle screw insertion under clinical conditions. The technique of image-guided navigation is described in this article, based on the authors' clinical experience of over 4 years. The value of navigation systems for preoperative planning is discussed. Clinical results of the application of this new method in the cervical, thoracic, and lumbosacral spine as well as the iliosacral joints are presented by means of the authors' own studies and reports from the literature. Pros and cons of computer guidance are discussed. The authors predict computer navigation will be used in percutaneous and minimally invasive procedures in the near future.