Accuracy of Pedicle Screw Placement Comparing an Electronic Conductivity Device and a Multi-axis Angiography Unit with C-arm Fluoroscopy in Lumbar Fixation Surgery for Safety

Abstract

The aim of this study was to compare the accuracy, safety, and usefulness of percutaneous pedicle screw (PPS) placement for lumbar fixation using a multi-axis angiography unit (MAU) and an electronic conductivity device (ECD) with a cannulated Jamshidi needle with that using a conventional C-arm. Of 65 cases that underwent lumbar fixation (region between L1-S1) during April 2013 to March 2019, 57 cases that could be followed-up for more than 12 months after the procedure were included. Among them, 31 patients (150 screws) received treatment with MAU and ECD (MAU+ECD group) and 26 (117 screws) were treated with the conventional C-arm. We performed a retrospective study of the surgical techniques used in each group at our institute by assessing the accuracy of PPS using Gertzbin–Robbins classification and the Japanese Orthopedic Association (JOA) score for recovery. There was no significant difference in surgery outcome based on the JOA recovery rate. There was a significant difference between the two groups in terms of Accuracy-1 (Group A indicating accuracy and Groups B–E indicating inaccuracy), where the rates were 85.3% and 72.0% in the MAU+ECD group and C-arm group, respectively ( P = 0.008). There was also a significant difference between the two groups in terms of Accuracy-2 (Groups A–B indicating accuracy; Groups C–E indicate inaccuracy), where the rates were 98.0% and 92.4% in the MAU+ECD and C-arm groups, respectively ( P = 0.036). A combination of MAU and ECD is a safe and accurate method for inserting screws into the pedicle.

Spine Surgery with Electronic Conductivity Device: A Prospectively Multicenter Randomized Clinical Trial and Literature Review

“…In retrospective studies, Allaoui et al ., 31 Yurube et al ., 32 and Kudo et al ., 33 showed the accuracy between 87.7% and 93.6%. Kageyama et al 16 . showed a 98% accuracy in retrospective lumbar surgeries with ECD and multi‐axis angiography unit.…”

“…In retrospective studies, Allaoui et al, 31 Yurube et al, 32 and Kudo et al, 33 showed the accuracy between 87.7% and 93.6%. Kageyama et al 16 showed a 98% accuracy in retrospective lumbar surgeries with ECD and multi-axis angiography unit. For prospective randomized controlled trials, Bai et al, 34 Suess et al, 35 Defino et al, 36 Lebhar et al, 37 and Bhogal et al, 38 documented the accuracy from 85% to 97.4%, and shows that ECD increases pedicle screw accuracy, especially in scoliosis surgeries.…”

“…The initial report on detecting iatrogenic initial pedicle perforation in pigs using the ECD was made by Bolger et al 13 Since then, this technique has been tested in animal, cadaver, and clinical trials. [15][16][17][18] Although the results have been promising, one limitation of the ECD is that it only uses a single monochromatic signal light to determine the magnitude of resistance impedance. This lack of a visual signal similar to a traffic light may make it less user-friendly.…”