Accuracy of pedicle screw insertion in posterior scoliosis surgery: a comparison between intraoperative navigation and preoperative navigation techniques

Zhang, Wei; Takigawa, Tomoyuki; Wu, Yong; Sugimoto, Yukihiko; Tanaka, Masato; Ozaki, Toshifumi

doi:10.1007/s00586-016-4930-5

Cited by 49 publications

(38 citation statements)

References 31 publications

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“…Moreover, pedicle screw misplacement can result in a loss of fixation, and therefore, the accuracy of pedicle screw placement is an important aspect of vertebral instrumentation, with two types of techniques established in clinical practice: the free‐hand and the image‐guided . Both approaches require a steep learning curve for less‐experienced spine surgeons, nevertheless, image‐guided techniques offer additional information because surgical instruments can be intraoperatively tracked and visualized, and therefore assist spine surgeons toward a more accurate screw placement . However, if an image‐guided insertion technique is used or, for example, in the case of a low bone density that reduces screw fixation, pedicle screw placement plans should be determined preoperatively .…”

Section: Introductionmentioning

confidence: 99%

“…2,3,10,11 Both approaches require a steep learning curve for less-experienced spine surgeons, 3,12 nevertheless, image-guided techniques offer additional information because surgical instruments can be intraoperatively tracked and visualized, 13 and therefore assist spine surgeons toward a more accurate screw placement. 4,10 However, if an imageguided insertion technique is used or, for example, in the case of a low bone density that reduces screw fixation, 14,15 pedicle screw placement plans should be determined preoperatively. 16 While manual planning is a time-consuming and often impractical procedure, computer-assisted planning methods represent a viable alternative.…”

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confidence: 99%

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Computer‐assisted pedicle screw trajectory planning using CT‐inferred bone density: A demonstration against surgical outcomes

et al. 2019

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Purpose Image‐guided spine surgery and preoperative computer‐assisted planning provide spine surgeons with tools to improve the safety, accuracy, and reliability of pedicle screw placement. The purpose of this study is to demonstrate a computer‐assisted pedicle screw placement planning tool in comparison to screws as delivered by a spine surgeon. Methods We describe a novel computer‐assisted tool for preoperative pedicle screw placement planning in computed tomography (CT) images, designed with respect to the vertebral shape and structure, and augmented with respect to the considerations of surgical practice. The approach is based on three‐dimensional (3D) modeling of the vertebral body and pedicles, and planning of the pedicle screw size and insertion trajectory by maximizing the screw fastening strength, evaluated through CT‐inferred bone density maps. The approach is augmented by yielding screw plans consistent with the straight‐forward surgical technique of aligning screws parallel to vertebral endplates, and the screw entry points following the spinal curvature to facilitate rod attachment. For a cohort of 25 patients, placement plans were retrospectively obtained for 204 pedicle screws with the computer‐assisted tool from preoperative CT images, while reference trajectories of inserted pedicle screws were reconstructed in 3D from postoperative biplanar radiographs. Results The best performing version of the computer‐assisted tool achieved clinically acceptable preoperative pedicle screw placement plans in 96.6% of the cases, while the comparison to the postoperative reconstructions resulted in 3.4 ± 2.5 mm for the screw entry point location, 2.7 ± 1.6 mm for the screw crossing point location, and 7.4 ± 5.3∘ for the screw sagittal inclination (mean absolute difference ± standard deviation). Conclusion Quantitative comparison revealed that the preoperative placement plans are consistent with the postoperative results, and that the computer‐assisted tool integrating bone density and surgical constraints can successfully incorporate important aspects of pedicle screw placement. The results therefore confirm the accuracy of the tool prior to being integrated in an image‐guidance system.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Computer‐assisted pedicle screw trajectory planning using CT‐inferred bone density: A demonstration against surgical outcomes

et al. 2019

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“…Pedicle screw perforation rates reported in the literature vary widely from 1.2% to 65.0% ( Tables 1 , 2 ) [ 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 ]. This wide variation in pedicle perforation rates was influenced by the method of assessment, which was performed using plain radiography or CT. Studies that used plain radiographic assessment had very low total perforation rates ranging from 1.2% to 3.0% [ 28 , 33 , 35 , 38 , 42 ].…”

Section: Pedicle Screw Malpositioning and Neurological Injury In Scolmentioning

confidence: 99%

“…Studies that used only CT to evaluate the position of all pedicle screws had higher perforation rates ranging from 6.4% to 65% [ 29 30 31 32 34 36 37 39 40 41 43 44 45 46 47 48 49 ]. However, reported perforation rates based on CT varied widely as well.…”

Section: Pedicle Screw Malpositioning and Neurological Injury In Scolmentioning

confidence: 99%

“…Computer navigation-assisted pedicle screw fixation during AIS surgery has been shown to increase accuracy and reduce surgical time and radiation [ 34 44 56 ]. Zhang et al [ 49 ] also showed that intraoperative navigation systems facilitate pedicle screw insertion in patients with AIS, which resulted in better efficiency and accuracy of pedicle screw placement in the apical region of the scoliotic spine than preoperative navigation. Table 2 summarizes published reports on the accuracy of pedicle screw insertion using navigation systems according to the etiology of scoliosis, navigation technique, screw assessment method, and the rate of perforation relative to the severity thereof.…”

Section: Pedicle Screw Malpositioning and Neurological Injury In Scolmentioning

confidence: 99%

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Safety of Pedicle Screws in Adolescent Idiopathic Scoliosis Surgery

Chan

Kwan

2017

Asian Spine J

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To review existing publications on the safety of pedicle screw insertions in adolescent idiopathic scoliosis (AIS). Despite having increased risk for neurological and visceral injuries, the use of pedicle screws have led to increased correction rates in scoliosis surgery. A review was performed on topics pertinent to pedicle screw insertion in AIS, which included pedicle morphometry in AIS, structures at risk during pedicle screw insertion, and accuracy and safety of various pedicle screw insertion techniques. The importance of computer navigation and future research regarding pedicle screw placement in AIS were also briefly reviewed. Many authors have reported abnormal pedicle anatomy in AIS. Injury to the neural structures was highest over the apical region, whereas aortic injury was the highest at T5 and T10. In the proximal thoracic spine, the esophagus could be injured even with screws as short as 25 mm. Overall pedicle perforation rates for perforations >0 and >2 mm (assessed by computed tomography) ranged from 6.4% to 65.0% and 3.7% to 29.9%, respectively. The critical pedicle perforation (>2 mm excluding lateral thoracic) and anterior perforation (>0 mm) rates was reported to range from 1.5% to 14.5% and 0.0% to 16.1%, respectively. Pedicle perforation rates were lower with the use of computer navigation. The incidence of neurological adverse events after scoliosis surgery was 0.06%–1.9%. Aortic injury has only been observed in case reports. According to the available literature, pedicle screw insertion in AIS is considered safe with low rates of clinical adverse events. Moreover, the use of navigation technology has been shown to reduce pedicle perforation rates.

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Pedicle screw path planning for multi‐level vertebral fixation

Zhao,

Zhang,

Zhan

et al. 2024

Medical Physics

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BackgroundFor the spinal internal fixation procedures, connecting rods to the pedicle screws are commonly used in all spinal segments from the cervical to sacral spine. So far, we have only seen single vertebral screw trajectory planning methods in literatures. Joint screw placements in multi‐level vertebrae with the constraint of an ipsilateral connecting rod are not considered.PurposeIn this paper, a screw trajectory planning method that considers screw‐rod joint system with both multi‐level vertebral constraints and individual vertebral safety tolerance are proposed.MethodsThe proposed method addresses three challenging constraints jointly for multi‐level vertebral fixation with pedicle screws. First, a cylindrical screw safe passage model is suggested instead of a unique mathematical optimal trajectory for a single pedicle. Second, the flexible screw cap accessibility model is also included. Third, the connecting rod is modeled to accommodate the spine contour and support the needed gripping capacity. The retrospective clinical data of relative normal shape spines from Beijing Jishuitan hospital were used in the testing. The screw trajectories from the existing methods based on single vertebra and the proposed method based on multi‐level vertebrae optimization are calculated and compared.ResultsThe results showed that the calculated screw placements by the proposed method can achieve 88% success rate without breaking the pedicle cortex and 100% in clinical class A quality (allow less than 2 mm out of the pedicle cortex) compared to 86.1% and 99.1%, respectively, with the existing methods. Expert evaluation showed that the screw path trajectories and the connecting rod calculated by the new method satisfied the clinical implantation requirements.ConclusionsThe new screw planning approach that seeks an overall optimization for multi‐level vertebral fixation is feasible and more advantageous for clinical use than the single vertebral approaches.

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Accuracy of pedicle screw insertion in posterior scoliosis surgery: a comparison between intraoperative navigation and preoperative navigation techniques

Cited by 49 publications

References 31 publications

Computer‐assisted pedicle screw trajectory planning using CT‐inferred bone density: A demonstration against surgical outcomes

Computer‐assisted pedicle screw trajectory planning using CT‐inferred bone density: A demonstration against surgical outcomes

Safety of Pedicle Screws in Adolescent Idiopathic Scoliosis Surgery

Pedicle screw path planning for multi‐level vertebral fixation

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