Abstract
The surgical technique and the intraoperative technology that support spinal pedicle screw placement have consistently evolved over the past decades to decrease the misplacement rate of pedicle screws. We retrospectively evaluated our case series by analyzing the period 2016–2020. Patients undergoing pedicle screw fixation for cervical, thoracic, or lumbar spine degenerative diseases have been included. Surgery was carried out with the aid of intraoperative 3D C-arm fluoroscopy to assess and optimize screw placement and/or correct possible mispositioning. Each patient underwent a postoperative CT scan. Our aim was to evaluate the safety and accuracy of pedicle screw placement and estimate the variation in mispositioning rates. We carried out 329 surgical procedures, as follows: 70 cervical, 78 thoracic spine, and 181 lumbar spine surgeries. An excellent overall pedicle screw positioning was obtained, with slight differences between the cervical (98.6%), thoracic (100%), and lumbar (98.9%) tracts. Accordingly, only three patients required a revision surgery owing to mispositioning (0.91%). In particular, intraoperative C-arm fluoroscopy significatively improved the accuracy of thoracic screw positioning, as shown by postoperative CT scans. Our experience proves the crucial role of intraoperative C-arm fluoroscopy in pursuing optimal technical results and improving patient outcomes at follow-up.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Tian NF, Huang QS, Zhou P, Zhou Y, et al. Pedicle screw insertion accuracy with different assisted methods: a systematic review and meta-analysis of comparative studies. Eur Spine J. 2011;20(6):846–59.
Braga BP, De Morais JV, Vilela MD. Free-hand placement of high thoracic pedicle screws with the aid of fluoroscopy: evaluation of positioning by CT scans in a four-year consecutive series. Arq Neuropsiquiatr. 2010;68(3):390–5.
Rahmathulla G, Nottmeier EW, Pirris SM, Deen HG, et al. Intraoperative image-guided spinal navigation: technical pitfalls and their avoidance. Neurosurg Focus. 2014;36(3):E3.
Nottmeier EW, Seemer W, Young PM. Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. J Neurosurg Spine. 2009;10(1):33–9.
Ishikawa Y, Kanemura T, Yoshida G, Matsumoto A, et al. Intraoperative, full-rotation, three-dimensional image (O-arm)-based navigation system for cervical pedicle screw insertion. J Neurosurg Spine. 2011;15(5):472–8.
Feng W, Wang W, Chen S, Wu K, et al. O-arm navigation versus C-arm guidance for pedicle screw placement in spine surgery: a systematic review and meta-analysis. Int Orthop. 2020;44(5):919–26.
Holly LT, Foley KT. Three-dimensional fluoroscopy-guided percutaneous thoracolumbar pedicle screw placement. Technical note. J Neurosurg. 2003;99(3 Suppl):324–9.
Verma SK, Singh PK, Agrawal D, Sinha S, et al. O-arm with navigation versus C-arm: a review of screw placement over 3 years at a major trauma center. Br J Neurosurg. 2016;30(6):658–61.
Banat M, Wach J, Salemdawod A, Bahna M, et al. The role of intraoperative image guidance systems (three-dimensional C-arm versus O-arm) in spinal surgery: results of a single-center study. World Neurosurg. 2021;146:e817–21.
Rajasekaran S, Vidyadhara S, Ramesh P, Shetty AP. Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine (Phila Pa 1976). 2007;32(2):E56–64.
Mason A, Paulsen R, Babuska JM, Rajpal S, et al. The accuracy of pedicle screw placement using intraoperative image guidance systems. J Neurosurg Spine. 2014;20(2):196–203.
Gruetzner PA, Waelti H, Vock B, et al. Navigation using fluoro-CT technology. Eur J Trauma. 2004;30:161–70. https://doi.org/10.1007/s00068-004-1328-6.
Kosmopoulos V, Schizas C. Pedicle screw placement accuracy: a meta-analysis. Spine (Phila Pa 1976). 2007;32(3):E111–20.
Zeiller SC, Lee J, Lim M, Vaccaro AR. Posterior thoracic segmental pedicle screw instrumentation: evolving methods of safe and effective placement. Neurol India. 2005;53(4):458–65.
Chang CC, Chang HK, Wu JC, Tu TH, et al. Comparison of radiation exposure between O-arm navigated and C-arm guided screw placement in minimally invasive transforaminal lumbar interbody fusion. World Neurosurg. 2020;139:e489–95.
Nakashima H, Sato K, Ando T, Inoh H, et al. Comparison of the percutaneous screw placement precision of isocentric C-arm 3-dimensional fluoroscopy-navigated pedicle screw implantation and conventional fluoroscopy method with minimally invasive surgery. J Spinal Disord Tech. 2009;22(7):468–72.
Nottmeier EW, Bowman C, Nelson KL. Surgeon radiation exposure in cone beam computed tomography-based, image-guided spinal surgery. Int J Med Robot. 2012;8(2):196–200.
Annoni E, Joedicke H, et al. The 3D O-arm surgical imaging system with navigation effectively and economically addresses the challenges of spina stabilization procedures. Value Health. 2013;16:556.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Ethics declarations
The authors declare no conflicts of interest.
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Tumbiolo, S. et al. (2023). Pedicle Screw Placement Aided by C-Arm Fluoroscopy: A “Nevermore without” Technology to Pursue Optimal Spine Fixation. In: Visocchi, M. (eds) The Funnel: From the Skull Base to the Sacrum. Acta Neurochirurgica Supplement, vol 135. Springer, Cham. https://doi.org/10.1007/978-3-031-36084-8_33
Download citation
DOI: https://doi.org/10.1007/978-3-031-36084-8_33
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-36083-1
Online ISBN: 978-3-031-36084-8
eBook Packages: MedicineMedicine (R0)