Accuracy and Safety in Pedicle Screw Placement in the Thoracic and Lumbar Spines : Comparison Study between Conventional C-Arm Fluoroscopy and Navigation Coupled with O-Arm® Guided Methods

Abstract

ObjectiveThe authors performed a retrospective study to assess the accuracy and clinical benefits of a navigation coupled with O-arm® system guided method in the thoracic and lumbar spines by comparing with a C-arm fluoroscopy-guided method.MethodsUnder the navigation guidance, 106 pedicle screws inserted from T7 to S1 in 24 patients, and using the fluoroscopy guidance, 204 pedicle screws from T5 to S1 in 45 patients. The position of screws within the pedicle was classified into four groups, from grade 0 (no violation cortex) to 3 (more than 4 mm violation). The location of violated pedicle cortex was also assessed. Intra-operative parameters including time required for preparation of screwing procedure, times for screwing and the number of X-ray shot were assessed in each group.ResultsGrade 0 was observed in 186 (91.2%) screws of the fluoroscopy-guided group, and 99 (93.4%) of the navigation-guided group. Mean time required for inserting a screw was 3.8 minutes in the fluoroscopy-guided group, and 4.5 minutes in the navigation-guided group. Mean time required for preparation of screw placement was 4 minutes in the fluoroscopy-guided group, and 19 minutes in the navigation-guided group. The fluoroscopy-guided group required mean 8.9 times of X-ray shot for each screw placement.ConclusionThe screw placement under the navigation-guidance coupled with O-arm® system appears to be more accurate and safer than that under the fluoroscopy guidance, although the preparation and screwing time for the navigation-guided surgery is longer than that for the fluoroscopy-guided surgery.

Comparison of intraoperative O-arm- and conventional fluoroscopy (C-arm)-assisted insertion of pedicle screws in the treatment of fracture of thoracic vertebrae

“…Possibly for this reason, Shin et al found no statistically significant difference in operative time and estimated blood loss between navigated and nonnavigated cases. 27 To our knowledge, this is the first in the literature that compares the accuracy and safety of the intraoperative O-arm-assisted system without navigation procedure to conventional fluoroscopy. In our study, intraoperative three-axis view in the imaging screen of the O-arm machine offers better observation for the screw positions, which allows safe and accurate screw placement on the first attempt.…”

Reliability of the Planned Pedicle Screw Trajectory versus the Actual Pedicle Screw Trajectory using Intra-operative 3D CT and Image Guidance

“…[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Extensive literature has been published describing the technique, benefits, and drawbacks of each method, as well as comparisons between different approaches. [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] With its increasing use has come a multitude of studies regarding the safety of this technique. Proper screw placement is imperative in order to avoid complications such as CSF leak, and pedicle fractures.…”

Instrumenting the small thoracic pedicle: the role of intraoperative computed tomography image–guided surgery

“…Several retrospective studies have also demonstrated increased pedicle screw accuracy using intraoperative CT-based navigation versus conventional techniques. 16 …”

“…13 Intraoperative CT-based navigation systems have been increasingly used with high accuracy in the thoracolumbar spine. 8,16 Given the greater probability of error in placing pedicle screws in small thoracic pedicles, we retrospectively examined the accuracy of previous screw placements in patients with small thoracic pedicles that had been performed using intraoperative CT-guided navigation. In the present study, we analyze our experience with pedicle screw placements in thoracic pedicles with diameters ≤ 3 mm.…”