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Navigated percutaneous versus open pedicle screw implantation using intraoperative CT and robotic cone-beam CT imaging

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Abstract

Purpose

Percutaneous paraspinal pedicle screw implantation (PPSI) reduces soft tissue trauma, blood loss, and postoperative pain but remains technically challenging and associated with radiation exposure and implant-related artefacts. Here, we determined the feasibility, screw accessibility, and the accuracy of navigated PPSI in the thoraco-lumbar sacral spine using intraoperative computed tomography (iCT) and robotic cone-beam CT (CBCT) imaging.

Methods

Between 2015 and 2018, 465 percutaneous paraspinal pedicle screws were implanted in 75 patients using iCT- or CBCT-based spinal navigation with 230 screws connected to rod reducers during screw assessment imaging (iCT 198; CBCT 32). Clinical and demographic data, intraoperative screw accessibility, and screw accuracy were analyzed and compared to a case-matched cohort of 75 patients undergoing navigated implantation of 481 pedicle screws through an open midline approach.

Results

Both iCT and CBCT permitted reliable assessment of each implanted screw, regardless of artifacts caused by rod reducers. Although overall accuracy for correct placement was comparable between PPSI and open surgery (PPSI 96.6%; Open 94.2%), PPSI compared favorably to open surgery regarding complete placement within the pedicle (PPSI 90.1%; Open 75.1%; p  <  0.0001), regional placement accuracy in the lumbar (PPSI 97.8%; Open 91.5%; p  <  0.001), and lumbar-sacral spine (PPSI 100%; Open 81.2%; p  <  0.05), next to the duration of surgery and length of hospitalization.

Conclusions

PPSI with iCT- and CBCT-based spinal navigation improves the accuracy, safety, and workflow of navigated spinal instrumentation. Next, a cost-effectiveness and outcome analysis should determine whether iCT and CBCT imaging are truly economically justified.

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Authors and Affiliations

  1. Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Dimitri Tkatschenko, Paul Kendlbacher, Marcus Czabanka, Peter Vajkoczy & Nils Hecht

  2. Department of Neuroradiology, Charité – Universitätsmedizin Berlin, Berlin, Germany

    Georg Bohner

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  1. Dimitri Tkatschenko
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  2. Paul Kendlbacher
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Correspondence to Peter Vajkoczy.

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Peter Vajkoczy has served as a consultant for Aesculap and Ulrich Medical. The other authors declare that they have no conflict of interest.

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Tkatschenko, D., Kendlbacher, P., Czabanka, M. et al. Navigated percutaneous versus open pedicle screw implantation using intraoperative CT and robotic cone-beam CT imaging. Eur Spine J 29, 803–812 (2020). https://doi.org/10.1007/s00586-019-06242-4

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  • DOI: https://doi.org/10.1007/s00586-019-06242-4

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