Comparative Results Between Conventional and Computer-Assisted Pedicle Screw Installation in the Thoracic, Lumbar, and Sacral Spine

Amiot, Louis-Philippe; Lang, K.; Putzier, Michael; Zippel, H; Labelle, Hubert

doi:10.1097/00007632-200003010-00012

Cited by 421 publications

(280 citation statements)

References 27 publications

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“…At review, 48 papers were excluded as they did not meet the inclusion criteria (Table 1). Thus, 23 publications [5,6,8,9,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] were analysed in this paper (Table 2; 2 randomised controlled trials, 12 case-control studies and 9 case series). Three studies were in German language and remaining 20 studies were in English.…”

Section: Resultsmentioning

confidence: 99%

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Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws

et al. 2010

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A number of studies have shown increased accuracy of pedicle screw placement in spine with the help of computer-assisted navigation. The literature is lacking in regard to functional benefit derived from this technique. The aim of this systematic review was to look at the functional outcomes following computer-assisted pedicle screw placement in spine. A 'Dialog Datastar' search was used using optimized search strategy covering the period from 1950 to July 2009; 23 papers were finally included which met our inclusion criteria. We report on a total of 1,288 patients with 5,992 pedicle screws. The comparison of neurological complications in two groups demonstrated an odds ratio of 0.25 (95% CI 0.06, 1.14) in favour of using navigation for pedicle screw insertion (p = 0.07). Comparative trials demonstrated a significant advantage in terms of accuracy of navigation over conventional pedicle screw insertion with a relative risk of 1.12 (95% CI 1.09, 1.15) (p \ 0.00001). Navigation does not show statistically significant benefit in reducing neurological complications and there was insufficient data in the literature to infer a conclusion in terms of fusion rate, pain relief and health outcome scores.

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Section: Resultsmentioning

confidence: 99%

“…Six studies [12,13,19,24,26,30] reported follow-up period ranging from 15 to 34 months, while one study followed the patients to clinical and radiological bony fusion [16], but none reported on rate of fusion achieved.…”

Section: Fusion Ratementioning

confidence: 99%

Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws

et al. 2010

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“…Considering the narrow margin of error [2,26] in pedicular screw placement, we considered those screws within the safe zone which were displaced by \2 mm on medial side and by \4 mm on lateral side. In previous studies, rate of pedicle-wall perforation varied between 1.5 and 43% [2,8,11,18,20,22,29,30,36,37]. Most studies have shown usually rates of misplacement between 28 and 43% and only a few studies have shown rates less than 5% [2].…”

Section: Discussionmentioning

confidence: 98%

“…So, accurate and safe placement of screw within the pedicle is a crucial step during the surgery. Various methods such as free hand technique, Penfield outside-in technique, under C-arm control, computer assisted navigational surgery and stereotectic surgery, etc., to put the pedicle screw have been described in the literature [20,22,29]. The use of intra-operative fluoroscopy for placement of pedicle screws has resulted in prolonged fluro time and radiation exposure to the surgical personnel and patient [32].…”

Section: Introductionmentioning

confidence: 99%

“…However, we have found that free-hand technique is relatively easy to learn and is as accurate [22] as the other methods, which were implemented in our study. There are also various intraoperative methods, such as SSEP, MEP or computer assisted surgery [11,29], described to detect pedicle violation or neural injury. The literature also showed that accuracy and safety of pedicle screws was around 90-95% in various pathologies on postoperative CT scan, MRI or radiogram [2,8,18,30,36,37].…”

Section: Introductionmentioning

confidence: 99%

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Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

et al. 2008

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It is a retrospective analytic study of 1,009 transpedicular screws (689 thoracic and 320 lumbosacral), inserted with free-hand technique in neuromuscular scoliosis using postoperative CT scan. The aim of paper was to determine the accuracy and safety of transpedicular screw placement with free-hand technique in neuromuscular scoliosis and to compare the accuracy at different levels in such population. All studies regarding accuracy and safety of pedicle screw in scoliosis represent idiopathic scoliosis using various techniques such as free-hand, navigation, image intensifier, etc., for screw insertion. Anatomies of vertebrae and pedicle are distorted in scoliosis, hence accurate and safe placement of pedicle screw is prerequisite for surgery. Between 2004 and 2006, 37 consecutive patients, average age 20 years (9-44 years), of neuromuscular scoliosis were operated with posterior pedicle screw fixation using free-hand technique. Accuracy of pedicle screws was studied on postoperative CT scan. Placement up to 2 mm medial side and 4 mm lateral side was considered within-safe zone. Of the 1,009 screws, 273 screws were displaced medially, laterally or on the anterior side showing that 73% screws (68% in thoracic and 82.5% in lumbar spine) were accurately placed within pedicle. Considering the safe zone, 93.3% (942/1009, 92.4% in thoracic and 95.3% in lumbar spine) of the screws were within the safe zone. Comparing accuracy according to severity of curve, accuracy was 75% in group 1 (curve \90°) and 69% in group 2 (curve [90°) with a safety of 94.8 and 91.2%, respectively (P = 0.35). Comparing the accuracy at different thoracic levels, it showed 67, 64 and 72% accuracy in upper, middle and lower thoracic levels with safety of 96.6, 89.2 and 93.1%, respectively, exhibiting no statistical significant difference (P = 0.17). Pedicle screw placement in neuromuscular scoliosis with free-hand technique is accurate and safe as other conditions.

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Intra-operative tracking of the trunk during surgical correction of scoliosis: A feasibility study

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Comparative Results Between Conventional and Computer-Assisted Pedicle Screw Installation in the Thoracic, Lumbar, and Sacral Spine

Abstract: Computer assistance can decrease the incidence of incorrectly positioned pedicle screws.

Cited by 421 publications

References 27 publications

Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws

Functional outcome of computer-assisted spinal pedicle screw placement: a systematic review and meta-analysis of 23 studies including 5,992 pedicle screws

Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique

Intra-operative tracking of the trunk during surgical correction of scoliosis: A feasibility study

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