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Incidence and risk factors for the misplacement of pedicle screws in scoliosis surgery assisted by O-arm navigation—analysis of a large series of one thousand, one hundred and forty five screws

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Abstract

Purpose

To assess the accuracy of O-arm-navigation-based pedicle screw placement in scoliosis surgery and identify the potential risk factors for the misplacement of pedicle screws.

Methods

One hundred forty four scoliosis patients treated with O-arm-navigation-based pedicle screw instrumentation were enrolled, and 1145 pedicle screws implanted in the apical region of the curves were retrospectively reviewed for accuracy according to post-operative CT images. The potential risk factors and independent predictive factor(s) for the misplaced screws were identified statistically.

Results

The overall malpositioning rate of pedicle screw was 9.8%; 54.5% of which were misplaced laterally. Univariate and multivariate logistic regression analysis of clinical and surgical treatment variables indicated that patients with congenital scoliosis (CS) [OR: 1.489 (95% CI: 1.002–2.213; P = 0.035)] and neurofibromatosis type I (NF-1) [OR: 1.785 (95% CI: 1267–2.045; P = 0.026)], middle-thoracic spine [OR: 1.661 (95% CI: 1.107–2.481; P = 0.021)], the concave pedicles [OR: 1.527 (95% CI: 1.020–2.285; P = 0.019)], and the segments three levels away from the tracker [OR: 3.522 (95% CI: 2.357–5.263; P = 0.001)] were independently associated with pedicle screw misplacement.

Conclusion

O-arm-assisted navigation does improve the accuracy and safety of pedicle screw placement in scoliosis surgery. However, unavoidable screw malpositioning remained, which occurred significantly more often in patients with CS and NF-1, in middle-thoracic spine, in the concave pedicles, and in the segments three levels away from the tracker.

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    Authors and Affiliations

    1. Department of Orthopaedics, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang Province, China

      Mengran Jin

    2. Department of Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road, No. 321, Nanjing, Jiangsu Province, 210008, China

      Mengran Jin, Zhen Liu, Yong Qiu, Huang Yan, Xiao Han & Zezhang Zhu

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    1. Mengran Jin
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    2. Zhen Liu
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    Correspondence to Zezhang Zhu.

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    The authors declare that they have no competing interests.

    Funding

    This study was supported by grants from the National Natural Science Foundation of China (Grant No. 81301521), Natural Science Foundation of Zhejiang Provincial (CN) (LY14H060006) and Chinese Medicine Research Program of Zhejiang Province (CN) (2015114820). No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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    This article does not contain any studies with human participants or animals performed by any of the authors.

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    Informed consent was obtained from all individual participants included in the study.

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    Mengran Jin and Zhen Liu contributed equally to this work.

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    Jin, M., Liu, Z., Qiu, Y. et al. Incidence and risk factors for the misplacement of pedicle screws in scoliosis surgery assisted by O-arm navigation—analysis of a large series of one thousand, one hundred and forty five screws. International Orthopaedics (SICOT) 41, 773–780 (2017). https://doi.org/10.1007/s00264-016-3353-6

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    • DOI: https://doi.org/10.1007/s00264-016-3353-6

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