Advertisement

Cervical pedicle screw instrumentation is more reliable with O-arm-based 3D navigation: analysis of cervical pedicle screw placement accuracy with O-arm-based 3D navigation

  • Sourabh Chachan
  • Hamid Rahmatullah Bin Abd Razak
  • Wee Lim Loo
  • John Carson Allen
  • Dinesh Shree Kumar
Original Article

Abstract

Purpose

Despite proven biomechanical superiority and resultant superior clinical outcomes, pedicle instrumentation in cervical spine is not widely practiced due to technical difficulties, steep learning curve, and possible potential catastrophic complications due to screw misplacement. This study was undertaken with the purpose to evaluate the feasibility, accuracy, and complications of cervical pedicle screw instrumentation solely using O-arm-based 3D navigation technology.

Methods

Prospectively maintained data from a single-surgeon case series were retrospectively analyzed. All the patients had undergone cervical pedicle instrumentation under O-arm 3D navigation. Screw placement accuracy was analyzed and compared among different vertebral levels and also between different patient groups.

Results

A total of 241 cervical pedicle screws were inserted in 44 patients. Out of the 241 screws, 197 (81.74%) were inserted at the level of C3–C6 vertebrae with nearly equal distribution among the 4 vertebrae, followed by 32 (13.28%) and 12 (4.98%) screws at C2 and C7 vertebrae, respectively. After the analysis of screw placement as per Gertzbein classification, the overall breach rates were found to be 7.05% (17 screws) with 52.94% (10 screws) Grade I, 47.06% (7 screws) Grade II, and nil Grade III screw breaches.

Conclusion

The use of O-arm-based intra-operative 3D scans for navigation can make cervical pedicle screw placement reliable. High accuracy and better intra-operative control can increase surgeon’s confidence in using cervical pedicle instrumentation on more regular basis.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Cervical pedicle screw insertion O-arm 3D navigation Accuracy of cervical pedicle screw insertion Complications of cervical pedicle screw insertion 

Notes

Compliance with ethical standards

Conflict of interest

None of the authors has any potential conflict of interest.

Supplementary material

586_2018_5585_MOESM1_ESM.pptx (130 kb)
Supplementary material 1 (PPTX 130 kb)
586_2018_5585_MOESM2_ESM.xlsx (15 kb)
Supplementary material 2 (XLSX 14 kb)

References

  1. 1.
    Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K (2000) Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine 25(8):962–969CrossRefPubMedGoogle Scholar
  2. 2.
    Barnes AH, Eguizabal JA, Acosta FL Jr, Lotz JC, Buckley JM, Ames CP (2009) Biomechanical pullout strength and stability of the cervical artificial pedicle screw. Spine 34(1):E16–E20CrossRefPubMedGoogle Scholar
  3. 3.
    Barsa P, Frohlich R, Sercl M et al (2016) The intraoperative portable CT scanner-based spinal navigation: a viable option for instrumentation in the region of cervico-thoracic junction. Eur Spine J 25(6):1643–1650CrossRefPubMedGoogle Scholar
  4. 4.
    Bredow J, Oppermann J, Kraus B, Schiller P, Schiffer G, Sobottke R, Eysel P, Koy T (2015) The accuracy of 3D fluoroscopy-navigated screw insertion in the upper and subaxial cervical spine. Eur Spine J 24:2967–2976CrossRefPubMedGoogle Scholar
  5. 5.
    Dunlap BJ, Karaikovic EE, Park HS, Sokolowski MJ, Zhang LQ (2010) Load sharing properties of cervical pedicle screw-rod constructs versus lateral mass screw-rod constructs. Eur Spine J 19(5):803–808CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Gelalis ID, Paschos NK, Pakos EE, Politis AN, Arnaoutoglou CM, Karageorgos AC, Ploumis A, Xenakis TA (2012) Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J 21(2):247–255CrossRefPubMedGoogle Scholar
  7. 7.
    Gertzbein SD, Robbins SE (1990) Accuracy of pedicular screw placement in vivo. Spine 15(1):11–14CrossRefPubMedGoogle Scholar
  8. 8.
    Holly LT, Foley KT (2003) Intraoperative spinal navigation. Spine 28:S54–S61PubMedGoogle Scholar
  9. 9.
    Ishikawa Y, Kanemura T, Yoshida G, Ito Z, Muramoto A, Ohno S (2010) Clinical accuracy of three-dimensional fluoroscopy-based computer-assisted cervical pedicle screw placement: a retrospective comparative study of conventional versus computer-assisted cervical pedicle screw placement. J Neurosurg Spine 13(5):606–611CrossRefPubMedGoogle Scholar
  10. 10.
    Ishikawa Y, Kanemura T, Yoshida G, Matsumoto A, Ito Z, Tauchi R, Muramoto A, Ohno S, Nishimura Y (2011) Intraoperative, full-rotation, three-dimensional image (O-arm)-based navigation system for cervical pedicle screw insertion. J Neurosurg Spine. 15(5):472–478CrossRefPubMedGoogle Scholar
  11. 11.
    Ito Y, Sugimoto Y, Tomioka M, Hasegawa Y, Nakago K, Yagata Y (2008) Clinical accuracy of 3D fluoroscopy-assisted cervical pedicle screw insertion. J Neurosurg Spine 9(5):450–453CrossRefPubMedGoogle Scholar
  12. 12.
    Larson AN, Polly DW Jr, Guidera KJ, Mielke CH, Santos ER, Ledonio CG, Sembrano JN (2012) The accuracy of navigation and 3D image-guided placement for the placement of pedicle screws in congenital spine deformity. J Pediatr Orthop 32(6):e23–e29CrossRefPubMedGoogle Scholar
  13. 13.
    Linh JM, Sk Dinesh, Pang BC et al (2014) Routine spinal navigation for thoraco–lumbar pedicle screw insertion using the O-arm three-dimensional imaging system improves placement accuracy. J Clin Neurosci 21:493–498CrossRefGoogle Scholar
  14. 14.
    Liu YJ, Tian W, Liu B, Li Q, Hu L, Li ZY, Yuan Q, Lu YW, Sun YZ (2010) Comparison of the clinical accuracy of cervical (C2–C7) pedicle screw insertion assisted by fluoroscopy, computed tomography-based navigation, and intraoperative three-dimensional C-arm navigation. Chin Med J 123(21):2995–2998PubMedGoogle Scholar
  15. 15.
    Ludwig SC, Kramer DL, Balderston RA, Vaccaro AR, Foley KF, Albert TJ (2000) Placement of pedicle screws in the human cadaveric cervical spine: comparative accuracy of three techniques. Spine 25(13):1655–1667CrossRefPubMedGoogle Scholar
  16. 16.
    Luther N, Iorgulescu JB, Geannette C, Gebhard H, Saleh T, Tsiouris AJ, Hartl R (2015) Comparison of navigated versus non-navigated pedicle screw placement in 260 patients and 1434 screws: screw accuracy, screw size, and the complexity of surgery. J Spinal Disord Tech 28(5):E298–E303CrossRefPubMedGoogle Scholar
  17. 17.
    Mason A, Paulsen R, Babuska JM, Rajpal S, Burneikiene S, Nelson EL, Villavicencio AT (2014) The accuracy of pedicle screw placement using intraoperative image guidance systems. J Neurosurg Spine 20(2):196–203CrossRefPubMedGoogle Scholar
  18. 18.
    Munusamy T, Thien A, Anthony MG et al (2015) Computed tomographic morphometric analysis of cervical pedicles in a multi-ethnic Asian population and relevance to subaxial cervical pedicle screw fixation. Eur Spine J 24:120–126CrossRefPubMedGoogle Scholar
  19. 19.
    Nakashima H, Yukawa Y, Imagama S, Kanemura T, Kamiya M, Yanase M, Ito K, Machino M, Yoshida G, Ishikawa Y, Mat-suyama Y, Ishiguro N, Kato F (2012) Complications of cervical pedicle screw fixation for nontraumatic lesions: a multicenter study of 84 patients. J Neurosurg Spine 16(3):238–247CrossRefPubMedGoogle Scholar
  20. 20.
    Owen BD, Christensen GE, Reinhardt JM et al (2007) Rapid prototype patient-specific drill template for cervical pedicle screw placement. Comput Aided Surg 12:303–308CrossRefPubMedGoogle Scholar
  21. 21.
    Panjabi MM, Shin EK, Chen NC, Wang JL (2000) Internal morphology of human cervical pedicles. Spine 25(10):1197–1205CrossRefPubMedGoogle Scholar
  22. 22.
    Rahmathulla G, Nottmeier EW, Pirris SM, Deen HG, Pichelmann MA (2014) Intraoperative image-guided spinal navigation: technical pitfalls and their avoidance. Neurosurg Focus 36:E3CrossRefPubMedGoogle Scholar
  23. 23.
    Rajasekaran S, Rishi SP, Shetty TAP (2010) Intra-operative computer navigation guided cervical pedicle screw insertion in thirty-three complex cervical spine deformities. J Craniovertebr Junction Spine 1(1):38–43CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Reinhold M, Magerl F, Riegr M, Blauth M (2007) Cervical pedicle screw placement: feasibility and accuracy of two new insertion techniques based on morphometric data. Eur Spine J 16(1):47–56CrossRefPubMedGoogle Scholar
  25. 25.
    Richter M, Cakir B, Schmidt R (2005) Cervical pedicle screws: conventional versus computer-assisted placement of cannulated screws. Spine 30:2280–2287CrossRefPubMedGoogle Scholar
  26. 26.
    Richter M, Mattes T, Cakir B (2004) Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine. Eur Spine J 13(1):50–59CrossRefPubMedGoogle Scholar
  27. 27.
    Shimokawa N, Takami T (2017) Surgical safety of cervical pedicle screw placement with computer navigation system. Neurosurg Rev (Germany) 40(2):251–258CrossRefGoogle Scholar
  28. 28.
    Tian W, Liu Y, Zheng S, Lv Y (2013) Accuracy of lower cervical pedicle screw placement with assistance of distinct navigation systems: a human cadaveric study. Eur Spine J 22(1):148–155CrossRefPubMedGoogle Scholar
  29. 29.
    Yukawa Y, Kato F, Ito K, Horie Y, Hida T, Nakashima H, Machino M (2009) Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope. Eur Spine J 18(9):1293–1299CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Zhang HL, Zhou DS, Jiang ZS (2011) Analysis of accuracy of computer-assisted navigation in cervical pedicle screw installation. Orthop Surg 3(1):52–56CrossRefPubMedGoogle Scholar
  31. 31.
    Ruofu Z, Huilin Y, Xiaoyun H et al (2008) CT evaluation of cervical pedicle in a Chinese population for surgical application of transpedicular screw placement. Surg Radiol Anat 30:389–396CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018
corrected publication May 2018

Authors and Affiliations

  • Sourabh Chachan
    • 1
  • Hamid Rahmatullah Bin Abd Razak
    • 1
  • Wee Lim Loo
    • 1
  • John Carson Allen
    • 2
  • Dinesh Shree Kumar
    • 1
  1. 1.Department of OrthopaedicsChangi General HospitalSingaporeSingapore
  2. 2.Centre for Quantitative Medicine, Duke-NUS Medical SchoolSingaporeSingapore

Personalised recommendations