Skip to main content

Advertisement

SpringerLink
Log in

Navigated pedicle screw placement using computed tomographic data in dorsolumbar fractures

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Computed tomographic (CT) based navigation is a technique to improve the accuracy of pedicle screw placement. It is believed to enhance accuracy of pedicle screw placement, potentially avoiding complications arising due to pedicle wall breach. This study aims to assess the results of dorsolumbar fractures operated by this technique.

Materials and Methods

Thirty consecutive skeletally mature patients of fractures of dorsolumbar spine (T9–L5) were subjected to an optoelectronic navigation system. All patients were thoroughly examined for neurological deficit. The criterion for instability were either a tricolumnar injury or presence of neurological deficit or both. Patients with multilevel fractures and distorted spine were excluded from study. Time taken for insertion of each pedicle screw was recorded and placement assessed with a postoperative CT scan using Laine’s grading system.

Results

Only one screw out of a total of 118 screws was misplaced with a Laine’s Grade 5 placement, showing a misplacement rate of 0.847%. Average time for matching was 7.8 min (range 5–12 min). Average time taken for insertion of a single screw was 4.19 min (range 2–8 min) and total time for all screws after exposure was 34.23 min (range 24–45 min) for a four screw construct. No neurovascular complications were seen in any of the patients postoperatively and in subsequent followup of 1‑year duration.

Conclusion

CT‑based navigation is effective in improving accuracy of pedicle screw placement in traumatic injuries of dorsolumbar spine (T9–L5), however additional cost of procuring CT scan to the patient and cost of equipment is of significant concern in developing countries. Reduced radiation exposure and lowered ergonomic constraints around the operation table are its additional benefits.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gaines RW Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg Am 2000;82-A:1458–76.

    Article  Google Scholar 

  2. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 1983;8:817–31.

    Article  CAS  Google Scholar 

  3. Yahiro MA. Comprehensive literature review. Pedicle screw fixation devices. Spine (Phila Pa 1976) 1994;19:2274–8S.

    Article  Google Scholar 

  4. Mirkovic S, Abitbol JJ, Steinmann J, Edwards CC, Garfin SR. Anatomic considerations for sacral screw placement. Orthop Trans 1991;15:235–6.

    Google Scholar 

  5. Amiot LP, Lang K, Putzier M, Zippel H, Labelle H. Comparative results between conventional and computer-assisted pedicle screw installation in the thoracic, lumbar, and sacral spine. Spine (Phila Pa 1976) 2000;25:606–14.

    Article  CAS  Google Scholar 

  6. Castro WH, Halm H, Jerosch J, Malms J, Steinbeck J, Blasius S. Accuracy of pedicle screw placement in lumbar vertebrae. Spine 1996;21:1320–4.

    Article  CAS  Google Scholar 

  7. Laine T, Schlenzka D, Mäkitalo K, Tallroth K, Nolte LP, Visarius H. Improved accuracy of pedicle screw insertion with computer-assisted surgery. A prospective clinical trial of 30 patients. Spine (Phila Pa 1976) 1997;22:1254–8.

    Article  CAS  Google Scholar 

  8. Merloz P, Tonetti J, Pittet L, Coulomb M, Lavalleé S, Sautot P. Pedicle screw placement using image-guided techniques. Clin Orthop Relat Res 1998;(354):39–48.

    Google Scholar 

  9. Schulze CJ, Munzinger E, Weber U. Clinical relevance of accuracy of pedicle screw placement. A computed tomographic-supported analysis. Spine (Phila Pa 1976) 1998;23:2215–20.

    Article  CAS  Google Scholar 

  10. Vaccaro AR, Rizzolo SJ, Allardyce TJ, Ramsey M, Salvo J, Balderston RA, et al. Placement of pedicle screws in the thoracic spine. Part I: Morphometric analysis of the thoracic vertebrae. J Bone Joint Surg Am 1995;77:1193–9.

    Article  CAS  Google Scholar 

  11. Datir SP, Mitra SR. Morphometric study of the thoracic vertebral pedicle in an Indian population. Spine (Phila Pa 1976) 2004;29:1174–81.

    Article  Google Scholar 

  12. Merloz P, Tonetti J, Eid A, Faure C, Lavallee S, Troccaz J, et al. Computer-assisted spine surgery. Clin Orthop Relat Res 1997;(337):86–96.

    Google Scholar 

  13. Schlenzka D, Laine T, Lund T. Computer-assisted spine surgery. Eur Spine J 2000;9 Suppl 1:S57–64.

    Article  Google Scholar 

  14. Nolte LP, Slomczykowski MA, Berlemann U, Strauss MJ, Hofstetter R, Schlenzka D, et al. A new approach to computer-aided spine surgery: Fluoroscopy-based surgical navigation. Eur Spine J 2000;9 Suppl 1:S78–88.

    Article  Google Scholar 

  15. Kalfas IH, Kormos DW, Murphy MA, McKenzie RL, Barnett GH, Bell GR, et al. Application of frameless stereotaxy to pedicle screw fixation of the spine. J Neurosurg 1995;83:641–7.

    Article  CAS  Google Scholar 

  16. Fu TS, Chen LH, Wong CB, Lai PL, Tsai TT, Niu CC, et al. Computer-assisted fluoroscopic navigation of pedicle screw insertion: An in vivo feasibility study. Acta Orthop Scand 2004;75:730–5.

    Article  Google Scholar 

  17. Rajasekaran S, Vidyadhara S, Ramesh P, Shetty AP. Randomized clinical study to compare the accuracy of navigated and nonnavigated thoracic pedicle screws in deformity correction surgeries. Spine (Phila Pa 1976) 2007;32:E56–64.

    Article  CAS  Google Scholar 

  18. Jaiswal A, Shetty AP, Rajasekaran S. Role of intraoperative Iso-C based navigation in challenging spine trauma. Indian J Orthop 2007;41:312–7.

    Article  Google Scholar 

  19. Laine T, Lund Y, Likoski M, Schlenzka D, Lohikoski J. Accuracy of pedicle screw insertion with and without computer assistance: A prospective randomized controlled clinical trial of 46 patients. International Society for the Study of Lumbar Spine, 26th Meeting, Kona Hawaii June, 1999. p. 21–5.

    Google Scholar 

  20. Amiot L.P, Lang K, Putzier M, Lang K, Zippel H. Comparative results between conventional and computer-assisted pedicle screw insertion in the thoracic, lumbar, and sacral spine. Spine 2000;25:606–614.

    Article  CAS  Google Scholar 

  21. Ebmeier K, Haberland N, Kalff RL. Spinal navigation in combination with intraoperative computed tomography. Computer AssistedOrthopaedic Surgery, Fourth International Symposium, Davos, 17–19 March 1999.

    Google Scholar 

  22. McAfee PC, Yuan HA, Fredrickson BE, Lubicky JP. The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification. J Bone Joint Surg Am 1983;65:461–73.

    Article  CAS  Google Scholar 

  23. Foley KT, Simon DA, Rampersaud YR. Virtual fluoroscopy: Computer-assisted fluoroscopic navigation. Spine (Phila Pa 1976) 2001;26:347–51.

    Article  CAS  Google Scholar 

  24. Weidner A, Wähler M, Chiu ST, Ullrich CG. Modification of C1-C2 transarticular screw fixation by image-guided surgery. Spine (Phila Pa 1976) 2000;25:2668–73.

    Article  CAS  Google Scholar 

  25. Wang HC, Yang YL, Lin WC, Chen WF, Yang TM, Lin YJ, et al. Computer-assisted pedicle screw placement for thoracolumbar spine fracture with separate spinal reference clamp placement and registration. Surg Neurol 2008;69:597–601.

    Article  Google Scholar 

  26. Girardi FP, Cammisa FP Jr, Sandhu HS, Alvarez L. The placement of lumbar pedicle screws using computerised stereotactic guidance. J Bone Joint Surg Br 1999;81:825–9.

    Article  CAS  Google Scholar 

  27. Han W, Gao ZL, Wang JC, Li YP, Peng X, Rui J, et al. Pedicle screw placement in the thoracic spine: A comparison study of computer-assisted navigation and conventional techniques. Orthopedics 2010;33:8

    Article  Google Scholar 

  28. Laine T, Lund T, Ylikoski M, Lohikoski J, Schlenzka D. Accuracy of pedicle screw insertion with and without computer assistance: A randomised controlled clinical study in 100 consecutive patients. Eur Spine J 2000;9:235–40.

    Article  CAS  Google Scholar 

  29. Rampersaud YR, Foley KT, Shen AC, Williams S, Solomito M. Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine (Phila Pa 1976) 2000;25:2637–45.

    Article  CAS  Google Scholar 

  30. Smith HE, Welsch MD, Sasso RC, Vaccaro AR. Comparison of radiation exposure in lumbar pedicle screw placement with fluoroscopy vs computer-assisted image guidance with intraoperative three-dimensional imaging. J Spinal Cord Med 2008;31:532–7.

    Article  Google Scholar 

  31. Slomczykowski M, Roberto M, Schneeberger P, Ozdoba C, Vock P. Radiation dose for pedicle screw insertion. Fluoroscopic method versus computer-assisted surgery. Spine (Phila Pa 1976) 1999;24:975–82.

    Article  CAS  Google Scholar 

  32. Allam Y, Silbermann J, Riese F, Greiner-Perth R. Computer tomography assessment of pedicle screw placement in thoracic spine: Comparison between free hand and a generic 3D-based navigation techniques. Eur Spine J 2013;22:648–53.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Postgraduate Institute, India

    Rajbahadur Sharma

  2. Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India

    Sudhir Garg, Rohit Jindal & Ravi Gupta

  3. Department of Orthopaedics, Maulana Azad Medical College and LNJP Hospital, New Delhi, India

    Anshul Goe

  4. Department of Orthopaedic Surgery, Government Medical College and Hospital, India

    Saurabh Kapoor

Authors
  1. Saurabh Kapoor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rajbahadur Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sudhir Garg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rohit Jindal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ravi Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anshul Goe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Saurabh Kapoor.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kapoor, S., Sharma, R., Garg, S. et al. Navigated pedicle screw placement using computed tomographic data in dorsolumbar fractures. IJOO 48, 555–561 (2014). https://doi.org/10.4103/0019-5413.144216

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/0019-5413.144216

Key words

MeSH terms

Search

Navigation