Intra-operative computer navigation guided cervical pedicle screw insertion in thirty-three complex cervical spine deformities

Abstract

Background:Cervical pedicle screw fixation is challenging due to the small osseous morphometrics and the close proximity of neurovascular elements. Computer navigation has been reported to improve the accuracy of pedicle screw placement. There are very few studies assessing its efficacy in the presence of deformity. Also cervical pedicle screw insertion in children has not been described before. We evaluated the safety and accuracy of Iso-C 3D-navigated pedicle screws in the deformed cervical spine.Materials and Methods:Thirty-three patients including 15 children formed the study group. One hundred and forty-five cervical pedicle screws were inserted using Iso-C 3D-based computer navigation in patients undergoing cervical spine stabilization for craniovertebral junction anomalies, cervico-thoracic deformities and cervical instabilities due to trauma, post-surgery and degenerative disorders. The accuracy and containment of screw placement was assessed from postoperative computerized tomography scans.Results:One hundred and thirty (89.7%) screws were well contained inside the pedicles. Nine (6.1%) Type A and six (4.2%) Type B pedicle breaches were observed. In 136 levels, the screws were inserted in the classical description of pedicle screw application and in nine deformed vertebra, the screws were inserted in a non-classical fashion, taking purchase of the best bone stock. None of them had a critical breach. No patient had any neurovascular complications.Conclusion:Iso-C navigation improves the safety and accuracy of pedicle screw insertion and is not only successful in achieving secure pedicle fixation but also in identifying the best available bone stock for three-column bone fixation in altered anatomy. The advantages conferred by cervical pedicle screws can be extended to the pediatric population also.

Reconstruction of the Subaxial Cervical Spine Using Pedicle Screw Instrumentation

“…18 , 19 However, recently developed computer navigation systems facilitate obtaining real-time 3-dimensional instrument/screw tip information in each step of screw placement. 20 Subsequently, further developments in technology have enhanced safety and contributed to refi nement of surgical techniques. 21 , 22 Besides computer navigation systems, several aiming tools including CT cutout techniques and specifi c navigation templates have been introduced to obtain accurate placement of pedicle screws in the cervical spine.…”

Spinal Navigation for Cervical Pedicle Screws: Surgical Pearls and Pitfalls

“…In the recent past, 3-dimensional (3D) navigation has evolved to be an excellent tool and has shown promising results in overcoming the challenges associated with pedicle screw insertion. 9 - 17 However, the existing literature on the use of intraoperative O-arm-based 3D navigation, specifically for CPS insertion, is still sparse with small sample sizes.…”

A Review of the Historical Evolution, Biomechanical Advantage, Clinical Applications, and Safe Insertion Techniques of Cervical Pedicle Screw Fixation

“…Krammer et al instrumented 12 human anatomic specimens with 3.5-mm screws from C3-C7 and found a lower complication rate with CAS than with topographic landmarks and lamino-foramitomy 52) . Comparative studies have shown consistently better accuracy results with CAS [65][66][67][68] . The downside with the use of CAS is that it is expensive and that intraoperative tracer loosening and position change cause a drift of the navigation map, leading to the malpositioning of the screws.…”