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Accuracy and revision rate of intraoperative computed tomography point-to-point navigation for lateral mass and pedicle screw placement: 11-year single-center experience in 1054 patients

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Abstract

High accuracy in intraoperative computed tomography (iCT) navigation utilizing an intraoperatively acquired dataset for screw placement in the spine has been reported in the literature. To further improve the accuracy and counteract any intraoperative movement of predefined registration points, we introduce an iCT point-to-point navigation, where marker screws are inserted intraoperatively to increase patient safety. In all, 1054 patients who underwent iCT point-to-point navigation for lateral mass and pedicle screw placement were retrospectively analyzed between 09/2005 and 09/2016. Implant-related complications such as screw misplacement, screw loosening, and revision rate were determined. Furthermore, we investigated the rate of complications and the clinical outcome. In total, 6059 screws were inserted in 1054 patients. There were 553 (52.5%) female and 501 (47.5%) male patients. Average age was 63.5 years, mean BMI 27.5 (SD 13.9). Here, 1427 (23.5%) screws were inserted in the cervical, 995 (16.4%) in the thoracic, 3167 (52.3%) in the lumbar, and 470 (7.8%) in the sacral spine. Eight patients required a revision procedure for screw misplacement (0.8%). Total screw misplacement rate was 0.3% (16/6059). With the use of reference markers in iCT-based, spinal, point-to-point navigation, we achieved a high accuracy of screw placement with a low revision rate (0.8%) and a total screw misplacement rate of 0.3%.

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Acknowledgments

The authors of this study would like to thank Sherryl Sundell for language editing and proofreading the manuscript. Special thanks also go to Klaus Zweckberger, Jan Oliver Neumann, Daniel Hertle, Patrick Schiebel, Berk Orakcioglu, Oliver Sakowitz, Daniel Haux, and Martin Volz.

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Authors and Affiliations

  1. Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany

    Basem Ishak, Alexander Younsi, Carola Wieckhusen, Paula Slonczewski, Andreas W. Unterberg & Karl L. Kiening

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  1. Basem Ishak
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  2. Alexander Younsi
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  3. Carola Wieckhusen
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  4. Paula Slonczewski
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Correspondence to Basem Ishak.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the local ethical committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This retrospective study was approved by the Ethics Committee of the Heidelberg University Medical School (No. S-723/2017).

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Ishak, B., Younsi, A., Wieckhusen, C. et al. Accuracy and revision rate of intraoperative computed tomography point-to-point navigation for lateral mass and pedicle screw placement: 11-year single-center experience in 1054 patients. Neurosurg Rev 42, 895–905 (2019). https://doi.org/10.1007/s10143-018-01067-z

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