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Rate and mode of screw misplacements after 3D-fluoroscopy navigation-assisted insertion and 3D-imaging control of 1547 pedicle screws in spinal levels T10-S1 related to vertebrae and spinal sections

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Abstract

Purpose

In the field of spinal surgery, 3D-fluoroscopy navigation-assisted pedicle screw (PS) insertion with intra-operative 3D-image control represents a modern application of contemporary navigation technology. In literature, sectional or vertebral accuracy limitations of this image-guidance approach are not profoundly specified. This observational study explicitly differentiates accuracy rates and misplacement mode between spinal sections and single vertebrae from T10 to S1 using a navigation-assisted approach.

Methods

From February 2011 through July 2015, all 3D-fluoroscopy navigation-assisted, 3D-image controlled PS insertions from T10 to S1 were prospectively recorded and evaluated for PS insertion depth, angulation, and entering-point modifications after intraoperative O-arm control scanning. Major complications requiring revision surgery for neurological damage/major bleedings, and procedure-related unintended violations of anatomical structures were recorded.

Results

In 1547 navigation-assisted PS insertions, thoracolumbar accuracy (96.4%) was significantly higher than sacral accuracy (92.6%, p ≈ 0.007) due to special requirements to exact PS (insertion depth) in S1 (p < 0.001). Vertebrae with modification rates above average were identified (T10, L5-S1) (p < 0.001). Major complications did not occur, anatomical structures were violated in 1.2% (19/1547 PS insertions).

Conclusions

In navigation-assisted O-arm-controlled PS placements, correct PS insertion depths are less easily to achieve than correct trajectory or entering-points, which is important for bicortical PS anchorage in S1. Therefore, post-instrumentation PS control by 3D-imaging or at least intraoperative fluoroscopy is recommended for levels with special requirements to exact PS insertion depths (e.g. S1).

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Authors and Affiliations

  1. Department for Spine Surgery and Traumatology, Orthopaedische Fachklinik Schwarzach, Dekan-Graf-Str. 2-6, 94374, Schwarzach, Germany

    Horst Balling & Thomas R. Blattert

Authors
  1. Horst Balling
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  2. Thomas R. Blattert
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Correspondence to Horst Balling.

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Conflict of interest

The author declares that there is no competing interest.

Funding

None were declared.

Disclosures

The device (O-arm) is FDA-approved or approved by corresponding national agency for this indication. This research was not sponsored by an organization. The authors declare that they have full control of all primary data and that they allow the journal to review their data if requested. Thomas R. Blattert has received honoraria from AOSpine, Aesculap, Medtronic, SponTech, and Magnifi. For the remaining author none were declared.

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Balling, H., Blattert, T.R. Rate and mode of screw misplacements after 3D-fluoroscopy navigation-assisted insertion and 3D-imaging control of 1547 pedicle screws in spinal levels T10-S1 related to vertebrae and spinal sections. Eur Spine J 26, 2898–2905 (2017). https://doi.org/10.1007/s00586-017-5108-5

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  • DOI: https://doi.org/10.1007/s00586-017-5108-5

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