[Variability of the screw position after 3D-navigated sacroiliac screw fixation. Influence of the surgeon's experience with the navigation technique].

BACKGROUND The precision of sacroiliac screw placement can be improved with the use of navigation techniques. The purpose of this study was to evaluate the accuracy of 3D-navigated sacroiliac screw positioning in relation to the surgeon's experience with the navigation technique. PATIENTS AND METHODS A consecutive series of 3D-navigated sacroiliac screw placements were prospectively evaluated between December 2005 and February 2008. Postoperatively the precision of screw placement was analyzed in relation to the surgeon's navigation experience with a CT-scan using the criteria of Smith. RESULTS A total of 37 screws were implanted by 7 surgeons in 33 patients. In the group of surgeons with less experience in navigation techniques two cases of malpositioning led to revision of the screws. No screws which were implanted or assisted by surgeons experienced in navigation needed to be revised. There was no significant difference in the malposition rate. CONCLUSION In the clinical setup a malpositioning of sacroiliac screws is possible even with the use of 3D navigation. One reason may be a low level of navigation experience of the surgeon in combination with low experience in the conventional technique. Therefore even in navigation-based placement of sacroiliac screws the malpositioning rate is dependent on the surgeon's experience with the navigation technique. The correct placement of the screws should be controlled intraoperatively using the 3D image intensifier.

[1]  Rick Sasso,et al.  An Evaluation of Image-Guided Technologies in the Placement of Percutaneous Iliosacral Screws , 2006, Spine.

[2]  F. Gebhard,et al.  Navigationsgestützte Arthrodese des Iliosakralgelenks , 2005, Der Unfallchirurg.

[3]  L. Nolte,et al.  A-Mode-Ultraschall-Pointer für die navigierte Beckenchirurgie , 2008, Der Unfallchirurg.

[4]  J. Windolf,et al.  Perkutane, 2D-fluoroskopisch navigierte Sakrumverschraubung in Rückenlage , 2007, Der Unfallchirurg.

[5]  H. Eckhardt,et al.  Nachuntersuchung unserer Schlittenendoprothesen nach 8–11 Jahren , 2000, Der Orthopäde.

[6]  J. Windolf,et al.  Computerassistierte Verschraubung des hinteren Beckenrings , 2006, Der Unfallchirurg.

[7]  L. P. Nolte,et al.  Bildwandler-gestützte Navigation Eine experimentelle Studie zu Beckenverschraubungen , 2001, Der Unfallchirurg.

[8]  C Krettek,et al.  Navigated percutaneous pelvic sacroiliac screw fixation: Experimental comparison of accuracy between fluoroscopy and Iso-C3D navigation , 2006, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[9]  A. M. Blake-Toker,et al.  CT guided percutaneous fixation of sacroiliac fractures in trauma patients. , 2001, The Journal of trauma.

[10]  J. Windolf,et al.  Computer-assisted screw insertion into the first sacral vertebra using a three-dimensional image intensifier: results of a controlled experimental investigation , 2006, European Spine Journal.

[11]  T. Pohlemann,et al.  Die perkutane transiliosakrale Zugschraubenosteosynthese des hinteren Beckenrings , 2007, Der Unfallchirurg.