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Placement of thoracolumbar pedicle screws using O-arm-based navigation: technical note on controlling the operational accuracy of the navigation system

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Abstract

Suboptimal placements of pedicle screws may lead to neurological and vascular complications. Computer-assisted image guidance has been shown to improve accuracy in spinal instrumentation. Checking the accuracy of the navigation system during pedicle screw placement is fundamental. We describe a novel technique of using continuous accuracy check of the navigation system during O-arm-based neuronavigation to instrument the thoracolumbar region. Forty thoracic and 42 lumbar screws were inserted in 12 patients. The Mirza evaluation system was used to evaluate the accuracy of the inserted screws. There was no neurological injury and no need to reposition any screw. The accuracy of the screws placement was excellent. Our technique of continuous at will operational accuracy check of the neuronavigation system is associated with extreme accuracy of screw placement, no need to bring a patient back to the operating room to reposition a pedicle screw, and with excellent outcome.

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References

  1. Amato V, Giannachi L, Irace C, Corona C (2010) Accuracy of pedicle screw placement in the lumbosacral spine using conventional technique: computed tomography postoperative assessment in 102 consecutive patients. J Neurosurg Spine 12(3):306–313. doi:10.3171/2009.9.SPINE09261

    Article  PubMed  Google Scholar 

  2. Beck M, Mittlmeier T, Gierer P, Harms C, Gradl G (2009) Benefit and accuracy of intraoperative 3D-imaging after pedicle screw placement: a prospective study in stabilizing thoracolumbar fractures. Eur Spine J 18(10):1469–1477. doi:10.1007/s00586-009-1050-5

    Article  PubMed  Google Scholar 

  3. Benzel EC, Rupp FW, McCormack BM, Baldwin NG, Anson JA, Adams MS (1995) A comparison of fluoroscopy and computed tomography-derived volumetric multiple exposure transmission holography for the guidance of lumbar pedicle screw insertion. Neurosurgery 37(4):711–716

    Article  PubMed  CAS  Google Scholar 

  4. Berry E, Cuppone M, Porada S, Millner PA, Rao A, Chiverton N, Seedhom BB (2005) Personalised image-based templates for intra-operative guidance. Proc Inst Mech Eng H 219(2):111–118

    PubMed  CAS  Google Scholar 

  5. Bjarke Christensen F, Stender Hansen E, Laursen M, Thomsen K, Bunger CE (2002) Long-term functional outcome of pedicle screw instrumentation as a support for posterolateral spinal fusion: randomized clinical study with a 5-year follow-up. Spine (Phila Pa 1976) 27(12):1269–1277

    Article  Google Scholar 

  6. Bledsoe JM, Fenton D, Fogelson JL, Nottmeier EW (2009) Accuracy of upper thoracic pedicle screw placement using three-dimensional image guidance. Spine J 9(10):817–821

    Article  PubMed  Google Scholar 

  7. Glossop ND, Hu RW, Randle JA (1996) Computer-aided pedicle screw placement using frameless stereotaxis. Spine (Phila Pa 1976) 21(17):2026–2034

    Article  CAS  Google Scholar 

  8. Hart RA, Hansen BL, Shea M, Hsu F, Anderson GJ (2005) Pedicle screw placement in the thoracic spine: a comparison of image-guided and manual techniques in cadavers. Spine (Phila Pa 1976) 30(12):E326–E331

    Article  Google Scholar 

  9. Kosmopoulos V, Schizas C (2007) Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976) 32(3):E111–E120. doi:10.1097/01.brs.0000254048.79024.8b

    Article  Google Scholar 

  10. Mirza SK, Wiggins GC, Kuntz C, York JE, Bellabarba C, Knonodi MA, Chapman JR, Shaffrey CI (2003) Accuracy of thoracic vertebral body screw placement using standard fluoroscopy, fluoroscopic image guidance, and computed tomographic image guidance: a cadaver study. Spine (Phila Pa 1976) 28(4):402–413

    Google Scholar 

  11. Nottmeier EW, Seemer W, Young PM (2009) Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. J Neurosurg Spine 10(1):33–39. doi:10.3171/2008

    Article  PubMed  Google Scholar 

  12. Park P, Foley KT, Cowan JA, Marca FL (2010) Minimally invasive pedicle screw fixation utilizing O-arm fluoroscopy with computer-assisted navigation: feasibility, technique, and preliminary results. Surg Neurol Int 1:44. doi:10.4103/2152-7806.68705

    Article  PubMed  Google Scholar 

  13. Rajasekaran S, Vidyadhara S, Ramesh P, Shetty AP (2007) Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine (Phila Pa 1976) 32(2):E56–E64

    Article  CAS  Google Scholar 

  14. Rampersaud YR, Lee KS (2007) Fluoroscopic computer-assisted pedicle screw placement through a mature fusion mass: an assessment of 24 consecutive cases with independent analysis of computed tomography and clinical data. Spine (Phila Pa 1976) 32(2):217–222

    Article  Google Scholar 

  15. Schizas C, Michel J, Kosmopoulos V, Theumann N (2007) Computer tomography assessment of pedicle screw insertion in percutaneous posterior transpedicular stabilization. Eur Spine J 16(5):613–617

    Article  PubMed  Google Scholar 

  16. Schwender JD, Holly LT, Rouben DP, Foley KT (2005) Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech 18(Suppl):S1–S6

    Article  PubMed  Google Scholar 

  17. Sugimoto Y, Ito Y, Tomioka M, Shimokawa T, Shiozaki Y, Mazaki T, Tanaka M (2010) Clinical accuracy of three-dimensional fluoroscopy (IsoC-3D)-assisted upper thoracic pedicle screw insertion. Acta Med Okayama 64(3):209–212

    PubMed  Google Scholar 

  18. Tian NF, Xu HZ (2009) Image-guided pedicle screw insertion accuracy: a meta-analysis. Int Orthop 33(4):895–903. doi:10.1007/s00264-009-0792-3

    Article  PubMed  Google Scholar 

  19. Tormenti MJ, Kostov DB, Gardner PA, Kanter AS, Spiro RM, Okonkwo DO (2010) Intraoperative computed tomography image-guided navigation for posterior thoracolumbar spinal instrumentation in spinal deformity surgery. Neurosurg Focus 28(3):E11

    Article  PubMed  Google Scholar 

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Conflict of interest

None of the authors has any conflict of interest concerning the financial, materials, or methods used in this study or the findings specified in this paper.

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Authors and Affiliations

  1. Department of Neurological Surgery, Ohio State University Medical Center, N1025 Doan Hall, 410 W. 10th Avenue, Columbus, OH, 43210, USA

    Mario Ammirati

  2. Department of Neurological Surgery, University of Illinois College of Medicine, Illinois Neurological Institute, Peoria, IL, USA

    Asem Salma

Authors
  1. Mario Ammirati
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  2. Asem Salma
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Correspondence to Mario Ammirati.

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Comments

Alexander Brawanski, Regensburg, Germany

The authors propose an interesting method to increase the accuracy of the placemant of pedicle screws. There are several other methods to increase accuracy, their’s is an interesting alternative.

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Ammirati, M., Salma, A. Placement of thoracolumbar pedicle screws using O-arm-based navigation: technical note on controlling the operational accuracy of the navigation system. Neurosurg Rev 36, 157–162 (2013). https://doi.org/10.1007/s10143-012-0421-2

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  • DOI: https://doi.org/10.1007/s10143-012-0421-2

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