Accuracy of pedicle screw insertion in posterior scoliosis surgery: a comparison between intraoperative navigation and preoperative navigation techniques

PurposeThis study was conducted to compare the efficacy and accuracy of intraoperative navigation (O-arm or Arcadis navigation) and preoperative CT-based navigation in adolescent idiopathic scoliosis (AIS) surgery.MethodsSixty-seven patients with scoliosis were grouped according to the method of navigation used in their fixation surgeries. A total of 492 pedicle screws were implanted in 27 patients using intraoperative navigation, and 626 screws were implanted in 40 patients using preoperative navigation. We analyzed the postoperative CT images for pedicle violations using the Gertzbein classification.ResultsThere was no statistical difference in the accuracy of pedicle screw placement between two groups. However, in the apical region (the apex ± 2 vertebrae), the accuracy of safe pedicle screw placement (grades 0, 1) was significantly higher in the intraoperative navigation group than in the preoperative navigation group (94.8 vs 89.2%, respectively; P = 0.035). Intraoperative navigation significantly diminished medial perforation compared to preoperative navigation (P = 0.027), and the number of screws per vertebra that could be placed in the apical region was significantly higher in intraoperative navigation group (P < 0.001). In addition, the time required for the registration procedure and insertion of one pedicle screw was 11.3 ± 2.1 min in the preoperative group, but significantly decreased to 5.1 ± 1.1 min in the intraoperative group (P < 0.001).ConclusionsBoth preoperative CT-based and intraoperative navigation systems provide sufficient accuracy and safety in pedicle screw insertion for AIS surgery. Intraoperative navigation systems facilitate pedicle screw insertion in the apical region and reduce registration time during AIS surgery which improves the efficacy and accuracy of pedicle screw insertion.

[1]  L. Lenke,et al.  Pedicle Morphology In Thoracic Adolescent Idiopathic Scoliosis: Is Pedicle Fixation an Anatomically Viable Technique? , 2000, Spine.

[2]  S R Garfin,et al.  Placement of pedicle screws in the thoracic spine. Part II: An anatomical and radiographic assessment. , 1995, The Journal of bone and joint surgery. American volume.

[3]  Ping Zhou,et al.  Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies , 2011, European Spine Journal.

[4]  U. Liljenqvist,et al.  Comparative analysis of pedicle screw and hook instrumentation in posterior correction and fusion of idiopathic thoracic scoliosis , 2002, European Spine Journal.

[5]  Lothar Kinzl,et al.  Does Computer-Assisted Spine Surgery Reduce Intraoperative Radiation Doses? , 2006, Spine.

[6]  Charles Kuntz,et al.  Accuracy of Thoracic Vertebral Body Screw Placement Using Standard Fluoroscopy, Fluoroscopic Image Guidance, and Computed Tomographic Image Guidance: A Cadaver Study , 2003, Spine.

[7]  Manabu Ito,et al.  Accuracy Analysis of Pedicle Screw Placement in Posterior Scoliosis Surgery: Comparison Between Conventional Fluoroscopic and Computer-Assisted Technique , 2007, Spine.

[8]  Toshiaki Kotani,et al.  Accuracy of Pedicle Screw Placement in Scoliosis Surgery: A Comparison between Conventional Computed Tomography-Based and O-Arm-Based Navigation Techniques , 2014, Asian spine journal.

[9]  L. Nolte,et al.  Navigation an der Brust- und Lendenwirbelsäule mit dem 3D-Bildwandler , 2004, Der Chirurg.

[10]  Munish C. Gupta,et al.  Apical Sublaminar Wires Versus Pedicle Screws—Which Provides Better Results for Surgical Correction of Adolescent Idiopathic Scoliosis? , 2005, Spine.

[11]  V. P. Kumar,et al.  A CADAVER STUDY , 2008 .

[12]  Naoki Ishiguro,et al.  Segmental Pedicle Screwing for Idiopathic Scoliosis Using Computer-assisted Surgery , 2008, Journal of spinal disorders & techniques.

[13]  L. Lenke,et al.  A Novel Pedicle Channel Classification Describing Osseous Anatomy: How Many Thoracic Scoliotic Pedicles Have Cancellous Channels? , 2010, Spine.

[14]  H. Hashidate,et al.  Accuracy of Multilevel Registration in Image-Guided Pedicle Screw Insertion for Adolescent Idiopathic Scoliosis , 2010, Spine.

[15]  Manuel Moser,et al.  Accuracy of patient-specific template-guided vs. free-hand fluoroscopically controlled pedicle screw placement in the thoracic and lumbar spine: a randomized cadaveric study , 2017 .

[16]  Y. Qiu,et al.  Does intraoperative navigation improve the accuracy of pedicle screw placement in the apical region of dystrophic scoliosis secondary to neurofibromatosis type I: comparison between O-arm navigation and free-hand technique , 2016, European Spine Journal.

[17]  F. Costa,et al.  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 , 2012, Spine.

[18]  U. Liljenqvist,et al.  Segmental pedicle screw instrumentation in idiopathic thoracolumbar and lumbar scoliosis , 2000, European Spine Journal.

[19]  Ho-Joong Kim,et al.  A prospective, randomized, controlled trial of robot‐assisted vs freehand pedicle screw fixation in spine surgery , 2017, The international journal of medical robotics + computer assisted surgery : MRCAS.

[20]  Jie Zhang,et al.  Dosimetric characterization of a cone-beam O-arm imaging system. , 2009, Journal of X-ray science and technology.

[21]  S. Gertzbein,et al.  Accuracy of Pedicular Screw Placement In Vivo , 1990, Spine.

[22]  K. Cheung,et al.  Predictability of the fulcrum bending radiograph in scoliosis correction with alternate-level pedicle screw fixation. , 2010, The Journal of bone and joint surgery. American volume.

[23]  C. K. Lee,et al.  Segmental Pedicle Screw Fixation in the Treatment of Thoracic Idiopathic Scoliosis , 1995, Spine.

[24]  K. Uchida,et al.  :—More than 5 year follow-up— , 1999 .

[25]  H. Halm,et al.  Morphometric analysis of thoracic and lumbar vertebrae in idiopathic scoliosis. , 2000, Spine.

[26]  L. Nolte,et al.  Improved Accuracy of Pedicle Screw Insertion With Computer-Assisted Surgery: A Prospective Clinical Trial of 30 Patients , 1997, Spine.

[27]  L. Nolte,et al.  [Intraoperative three-dimensional navigation for pedicle screw placement]. , 2004, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[28]  Y. Qiu,et al.  The Superiority of Intraoperative O-arm Navigation-assisted Surgery in Instrumenting Extremely Small Thoracic Pedicles of Adolescent Idiopathic Scoliosis , 2016, Medicine.

[29]  M. Tezer,et al.  Comparative analysis of pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery , 2008, International Orthopaedics.

[30]  J. D. De Guise,et al.  Thoracic Pedicle Morphometry in Vertebrae from Scoliotic Spines , 2004, Spine.

[31]  Sang-Min Lee,et al.  Selective Thoracic Fusion With Segmental Pedicle Screw Fixation in the Treatment of Thoracic Idiopathic Scoliosis: More than 5-Year Follow-Up , 2005, Spine.

[32]  Jörn Steinbeck,et al.  Analysis of Vertebral Morphology in Idiopathic Scoliosis with Use of Magnetic Resonance Imaging and Multiplanar Reconstruction , 2002, The Journal of bone and joint surgery. American volume.

[33]  T. Akazawa,et al.  Evaluation of pedicle screw placement by pedicle channel grade in adolescent idiopathic scoliosis: should we challenge narrow pedicles? , 2015, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.