Accuracy of percutaneous lumbar pedicle screw placement using the oblique or “owl's-eye” view and novel guidance technology

Idler, Cary; Rolfe, Kevin; Gorek, Josef E

doi:10.3171/2010.4.spine09580

Cited by 47 publications

(27 citation statements)

References 47 publications

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“…21 A portable reticle with integrated central laser beam is attached to the image-intensifi er surface of the C-arm and tracks the angular position of the fl uoroscope in real time. A microaccelerometer integrated into a clip-on attachment enables real-time calculation of the angular position of the pedicle cannulation needle.…”

Section: Methodsmentioning

confidence: 99%

Percutaneous Lumbar Pedicle Screw Placement Aided by Computer-Assisted Fluoroscopy-Based Navigation

Yang¹,

Wahl²,

Idler³

2012

Spine

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Section: Methodsmentioning

confidence: 99%

Percutaneous Lumbar Pedicle Screw Placement Aided by Computer-Assisted Fluoroscopy-Based Navigation

Yang¹,

Wahl²,

Idler³

2012

Spine

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“…Pedicles were cannulated using the ''owl's eye technique'' [7] with the a.p.-radiation beam centred on the pedicle coaxial with its sagittal and transverse angle. A lateral beam served for control after having inserted the screw.…”

Section: Surgery Under Fluoroscopymentioning

confidence: 99%

CT-navigation versus fluoroscopy-guided placement of pedicle screws at the thoracolumbar spine: single center experience of 4,500 screws

et al. 2012

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Purpose Single center evaluation of the placement accuracy of thoracolumbar pedicle screws implanted either with fluoroscopy or under CT-navigation using 3D-reconstruction and intraoperative computed tomography control of the screw position. There is in fact a huge variation in the reported placement accuracy of pedicle screws, especially concerning the screw placement under conventional fluoroscopy most notably due to the lack of the definition of screw misplacement, combined with a potpourri of postinstrumentation evaluation methods. Methods The operation data of 1,006 patients operated on in our clinic between 1995 and 2005 is analyzed retrospectively. There were 2,422 screws placed with the help of CT-navigation compared to 2,002 screws placed under fluoroscopy. The postoperative computed tomography images were reviewed by a radiologist and an independent spine surgeon. Results In the lumbar spine, the placement accuracy was 96.4 % for CT-navigated screws and 93.9 % for pedicle screws placed under fluoroscopy, respectively. This difference in accuracy was statistically significant (Fishers Exact Test, p = 0.001). The difference in accuracy became more impressing in the thoracic spine, with a placement accuracy of 95.5 % in the CT-navigation group, compared to 79.0 % accuracy in the fluoroscopy group (p \ 0.001). Conclusion This study underlines the relevance of CT-navigation-guided pedicle screw placement, especially when instrumentation of the middle and upper thoracic spine is carried out.

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“…Only a few studies have described the methods for accurate insertion percutaneous lumbar PSs using fluoroscopy, similar to conventional open procedures [1112]. Furthermore, no studies have compared the differences in mechanism and trends in resultant inaccuracies between open procedures and MIS, or the difference in radiation exposure in MIS among different fluoroscopic techniques.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Percutaneous Lumbosacral Pedicle Screw Placement Using the Oblique Fluoroscopic View Based on Computed Tomography Evaluations

et al. 2016

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Study DesignRetrospective.PurposeThis study aims to investigate the accuracy of the oblique fluoroscopic view, based on preoperative computed tomography (CT) images for accurate placement of lumbosacral percutaneous pedicle screws (PPS).Overview of LiteratureAlthough PPS misplacement has been reported as one of the main complications in minimally invasive spine surgery, there is no comparative data on the misplacement rate among different fluoroscopic techniques, or comparing such techniques with open procedures.MethodsWe retrospectively selected 230 consecutive patients who underwent posterior spinal fusion with a pedicle screw construct for degenerative lumbar disease, and divided them into 3 groups, those who had undergone: minimally invasive percutaneous procedure using biplane (lateral and anterior-posterior views using a single C-arm) fluoroscope views (group M-1), minimally invasive percutaneous procedure using the oblique fluoroscopic view based on preoperative CT (group M-2), and conventional open procedure using a lateral fluoroscopic view (group O: controls). The relative position of the screw to the pedicle was graded for the pedicle breach as no breach, <2 mm, 2–4 mm, or >4 mm. Inaccuracy was calculated and assessed according to the spinal level, direction and neurological deficit. Inter-group radiation exposure was estimated using fluoroscopy time.ResultsInaccuracy involved an incline toward L5, causing medial or lateral perforation of pedicles in group M-1, but it was distributed relatively equally throughout multiple levels in groups M-2 and controls. The mean fluoroscopy time/case ranged from 1.6 to 3.9 minutes.ConclusionsMinimally invasive lumbosacral PPS placement using the conventional fluoroscopic technique carries an increased risk of inaccurate screw placement and resultant neurological deficits, compared with that of the open procedure. Inaccuracy tended to be distributed between medial and lateral perforations of the L5 pedicle, as a result of pedicle morphology and the PPS pathway. Oblique fluoroscopic views, based on CT measurement, may allow accurate PPS insertion with a shorter fluoroscopy time.

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Accuracy of percutaneous lumbar pedicle screw placement using the oblique or “owl's-eye” view and novel guidance technology

Cited by 47 publications

References 47 publications

Percutaneous Lumbar Pedicle Screw Placement Aided by Computer-Assisted Fluoroscopy-Based Navigation

Percutaneous Lumbar Pedicle Screw Placement Aided by Computer-Assisted Fluoroscopy-Based Navigation

CT-navigation versus fluoroscopy-guided placement of pedicle screws at the thoracolumbar spine: single center experience of 4,500 screws

Accuracy of Percutaneous Lumbosacral Pedicle Screw Placement Using the Oblique Fluoroscopic View Based on Computed Tomography Evaluations

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