Accuracy of pedicle screw placement in the thoracic and lumbosacral spines using O-arm-based navigation versus conventional freehand technique

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Abstract

Background

The accuracy and safety of pedicle screw insertion was markedly improved with the introduction of intraoperative three-dimensional navigation system during the last decade. This study aimed to evaluate the accuracy of pedicle screw placement using O-arm-based navigation system versus conventional freehand technique.

Methods

We reviewed the accuracy of 341 thoracic ( n = 173) and lumbosacral ( n = 168) pedicle screws placed in 60 consecutive patients using either O-arm-based navigation or freehand technique in the Department of Neurosurgery of Beijing Tsinghua Changgung Hospital between January 2015 and June 2018. Patient-specific characteristics, treatment-related characteristics, and screw-specific accuracy were analyzed. The accuracy of pedicle screw placement was measured by Gertzbein-Robbins scale and screw grades A and B were clinically acceptable.

Results

One hundred ninety-one screws were inserted in the O-arm-based navigation group and 150 in the freehand group. One hundred eighty-three (95.81%) clinically acceptable screws were placed in the navigation group and 135 (90.00%) in the freehand group ( p = 0.034). Twenty-three (6.74%) screw revisions were performed in the two groups (8 screws in the navigation group and 15 screws in the freehand group) and significant difference was observed in thoracic spine ( p = 0.018), while no statistical significance was presented in lumbosacral spine ( p > 0.05). Twenty-four (12.57%) screws in the navigation group and 24 (16.00%) in the freehand group violated the cortex ( p > 0.05). Medial screw deviation was the most common problem in the two groups.

Conclusion

The O-arm-based navigation exhibits higher accuracy for pedicle screw insertion than the freehand insertion technique.

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Most cited references 18

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Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques.

Ioannis Gelalis, Nikolaos K Paschos, Emilios E Pakos … (2012)

With the advances and improvement of computer-assisted surgery devices, computer-guided pedicle screws insertion has been applied to the lumbar, thoracic and cervical spine. The purpose of the present study was to perform a systematic review of all available prospective evidence regarding pedicle screw insertion techniques in the thoracic and lumbar human spine. We considered all prospective in vivo clinical studies in the English literature that assessed the results of different pedicle screw placement techniques (free-hand technique, fluoroscopy guided, computed tomography (CT)-based navigation, fluoro-based navigation). MEDLINE, OVID, and Springer databases were used for the literature search covering the period from January 1950 until May 2010. 26 prospective clinical studies were eventually included in the analysis. These studies included in total 1,105 patients in which 6,617 screws were inserted. In the studies using free-hand technique, the percentage of the screws fully contained in the pedicle ranged from 69 to 94%, with the aid of fluoroscopy from 28 to 85%, using CT navigation from 89 to 100% and using fluoroscopy-based navigation from 81 to 92%. The screws positioned with free-hand technique tended to perforate the cortex medially, whereas the screws placed with CT navigation guidance seemed to perforate more often laterally. In conclusion, navigation does indeed exhibit higher accuracy and increased safety in pedicle screw placement than free-hand technique and use of fluoroscopy.

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A prospective multicenter registry on the accuracy of pedicle screw placement in the thoracic, lumbar, and sacral levels with the use of the O-arm imaging system and StealthStation Navigation.

Tamara G. F. Costa, Robrecht van der Wel, Erik De Clercq … (2012)

An international, multicenter, prospective, postmarketing clinical registry to record the accuracy of pedicle screw placement, using the O-arm Complete Multidimensional Surgical Imaging System with StealthStation Navigation. To evaluate the accuracy of pedicle screw placement in common neurosurgical practice and assess the patient's radiation exposure. Several imaging techniques have been used to increase accurate pedicle screw placement. The O-arm 3-dimensional (3D) imaging (Medtronic Navigation, Louisville, CO), an intraoperative computed tomographic (CT) scan, combined with an existing navigation system was reported to further increase accuracy of screw placement, especially because an intraoperative 3D scan provides information for screw adjustment before wound closure. Patients already planned for instrumented spinal surgery were operated while using the O-arm as imaging device and the StealthStation Navigation (Medtronic Navigation, Louisville, CO) as navigation tool. At the end of all pedicle screw insertions, the placement was classified according to a validated method. The accuracy of pedicle screw placement based on the intraoperative 3D scan and the surgeon's perception of correct screw placement were assessed as well as the radiation doses the patient received during the entire procedure. During a 16-month period, a total of 1922 screws in 353 patients were evaluated. In 97.5%, the screws were correctly placed. Only 2.5% of the screws were considered as misplaced, and 1.8% of the screws were revised during the same procedure. When the surgeon perceived the screws to be correctly placed, the CT scan verified his assessment in 98.5% of the cases. The mean radiation dose was comparable with half the dose of a 64 multislice CT scan. The use of the O-arm in combination with a navigation system increases the accuracy of pedicle screw placement. The accuracy of the surgeon's perception and the need to limit the radiation dose for the patient justify an additional CT scan only after careful assessment of the potential additional value.

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Computer tomography assessment of pedicle screw placement in lumbar and sacral spine: comparison between free-hand and O-arm based navigation techniques.

H Koeppert, T Reichert, Y Allam … (2011)

Transpedicular screw fixation has been accepted worldwide since Harrington et al. first placed pedicle screws through the isthmus. In vivo and in vitro studies indicated that pedicle screw insertion accuracy could be significantly improved with image-assisted systems compared with conventional approaches. The O-arm is a new generation intraoperative imaging system designed without compromise to address the needs of a modern OR like no other system currently available. The aim of our study was to check the accuracy of O-arm based and S7-navigated pedicle screw implants in comparison to free-hand technique described by Roy-Camille at the lumbar and sacral spine using CT scans. The material of this study was divided into two groups, free-hand group (group I) (30 patients; 152 screws) and O-arm group (37 patients; 187 screws). The patients were operated upon from January to September 2009. Screw implantation was performed during PLIF or TLIF mainly for spondylolisthesis, osteochondritis and post-laminectomy syndrome. The accuracy rate in our work was 94.1% in the free-hand group compared to 99% in the O-arm navigated group. Thus it was concluded that free-hand technique will only be safe and accurate when it is in the hands of an experienced surgeon and the accuracy of screw placement with O-arm can reach 100%.

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Author and article information

Contributors

Linkai Jing: linkai_jing@163.com

Zhenze Wang: 26406455@qq.com

Zhenxing Sun: sunzhenxing0035@sina.com

Huifang Zhang: zhfa01219@btch.edn.cn

James Wang: jjwang@btch.edu.cn

Guihuai Wang: + 86-01056118887 , guihuai_wang@163.com

Journal

Journal ID (nlm-ta): Chin Neurosurg J

Journal ID (iso-abbrev): Chin Neurosurg J

Title: Chinese Neurosurgical Journal

Publisher: BioMed Central (London )

ISSN (Print): 2095-9370

ISSN (Electronic): 2057-4967

Publication date (Electronic): 4 March 2019

Publication date PMC-release: 4 March 2019

Publication date Collection: 2019

Volume: 5

Electronic Location Identifier: 6

Affiliations

[1 ]ISNI 0000 0001 0662 3178, GRID grid.12527.33, School of Clinical Medicine, , Tsinghua University, ; Beijing, 100084 China

[2 ]ISNI 0000 0001 0662 3178, GRID grid.12527.33, Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, , Tsinghua University, ; Beijing, 102218 China

[3 ]Department of Neurosurgery, Haicheng Zhenggu Hospital, Anshan City, 114200 Liaoning China

Article

Publisher ID: 154

DOI: 10.1186/s41016-019-0154-y

PMC ID: 7398394

PubMed ID: 32922906

SO-VID: 948e6e1d-8ec3-4e58-a042-b5fe09846efe

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 16 October 2018

Date accepted : 30 January 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;

Award ID: 81472817

Award Recipient : Guihuai Wang

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Keywords: accuracy,freehand,navigation,o-arm,pedicle screw

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Keywords: accuracy, freehand, navigation, o-arm, pedicle screw

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Accuracy of pedicle screw placement in the thoracic and lumbosacral spines using O-arm-based navigation versus conventional freehand technique

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Most cited references 18

Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques.

A prospective multicenter registry on the accuracy of pedicle screw placement in the thoracic, lumbar, and sacral levels with the use of the O-arm imaging system and StealthStation Navigation.

Computer tomography assessment of pedicle screw placement in lumbar and sacral spine: comparison between free-hand and O-arm based navigation techniques.

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