Analysis of CT-based Navigation System for Pedicle Screw Placement

Abstract

The incidence of pedicle screw breech varies based on anatomic location, body habitus, surgeon experience, spinal deformity, and surgical technique. Pedicle breeches have been reported to occur in up to 40% of screws. The purpose of this retrospective study was to compare the rates of revision of pedicle screw placement when using intraoperative C-arm vs O-arm (Medtronic, Memphis, Tennessee) assessment of pedicle screws. An economic analysis was also performed based on the estimated cost of pedicle screw revision. Four (1%) of 386 control patients required pedicle screw revision for a breeched pedicle screw not identified with intraoperative C-arm fluoroscopy. In the study group, none of the 331 patients returned to the operating room when O-arm was used to assess pedicle screw placement. Based on the 1% rate of returning to the operating room in the control group, the annual rate of cases nationwide requiring pedicle screw revision would be approximately 2300, with a cost of approximately $40,595,000.These results suggest that the use of intraoperative O-arm can reduce the need for revision of a breeched pedicle screw. This can potentially lead to a major cost savings.

A new 3-dimensional method for measuring precision in surgical navigation and methods to optimize navigation accuracy

“…Also, with the added confidence of the navigation, screw placement was attempted in all pedicles, even if they may have otherwise been deemed too small or difficult without the navigation. In the end, the accuracy of O-arm images for evaluation of instrumentation placement has been found to be comparable to a postoperative CT scan [41][42][43], and the number of screws felt to be in an appropriate position was comparable to previously reported data. All grade III/IV breaches were noted to be lateral, which is likely due to the ability for direct visualization of more difficult pedicles and placement of instrumentation toward the safer lateral cortex.…”

Burden of disease of reoperations in instrumental spinal surgeries in Germany

“…Coding might be incomplete if the hospital receives no incentive to record every OPS code related to the hospitalization, although there are strong coding regulations in place [31]. More frequent assistance with intraoperative navigation and imaging techniques in ISS might reduce the frequency of reoperations and the subsequent patient burden [1,16,32,33].…”

“…Reoperations might be necessary to correct pedicle screw malplacements and are associated with significant additional resource utilization and cost from the payer's perspective. Imaging techniques to assist the surgeon have the potential to reduce complications due to misplaced pedicle screws and may, therefore, have a positive impact on patients' well-being and payer budgets [13][14][15][16][17].…”

The accuracy of pedicle screw placement using intraoperative image guidance systems

“…14,54 Only a few studies stated whether inaccuracies in screw placement were clinically significant, caused any complications, or required an operation for repositioning. However, there is no clear evidence that any degree of pedicle breach is acceptable, especially if medial screw misplacements are considered.…”