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Usefulness of a navigation system in surgery for scoliosis: segmental pedicle screw fixation in the treatment

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Study design

Postoperative outcomes of segmental pedicle screw fixation were evaluated in posterior scoliosis surgery with the use of navigation system.

Objectives

We report the usefulness of a navigation system and a segmental pedicle screw fixation in surgery for scoliosis.

Summary of background data

Few reports on a segmental pedicle screw fixation method for scoliosis surgery using a navigation system have been published. This is the report on the usefulness of a navigation system in segmental pedicle screw fixation.

Methods

We targeted 16 cases in which segmental pedicle screw fixation had been performed using a navigation system at our hospital. We inserted 264 pedicle screws in total, and we did not perform registration for each corpus vertebrate in order to shorten the duration of the surgery. We reviewed screw deviation among the items for review using Neo classification with postoperative CT images (1.25 mm). For screw deviation in this case, grade 2 or higher in the Neo classification system was designated as total deviation. Furthermore, we evaluated the registration period per corpus vertebrae, the complications, duration of surgery, blood loss, Cobb angle, and the correction rate.

Results

In terms of screw deviation, 11 (4.2%) of the 264 inserted screws were classified as total deviation. However, there were no neurovascular complications during or after surgery in any cases, and all cases maintained strong internal fixation. In the relationship between the use or nonuse of registration and the deviation, four screws (3.2%) in the corpus vertebrae for which registration was performed and seven screws (5.0%) in the adjacent corpus vertebrae for which registration was not performed had deviated. The duration of registration per corpus vertebrate averaged 4 min and 24 s (58–791 s), but registration also requires a learning curve, so the duration of registration per corpus vertebrae averaged 1 min and 14 s in more recent cases, thus marking a significant shortening.

Conclusion

Segmental pedicle screw fixation are excellent in regard to their fixing and correction force and have been clinically applied even in surgery for scoliosis, but the potential risk of neurovascular complications is unavoidable. The adoption of a navigation system in surgery for scoliosis is useful to increase the safety and certainty of the insertion of pedicle screws.

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References

  1. Suk SI, Lee CK, Kim WJ et al (1995) Segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis. Spine 20:1399–1405. doi:10.1097/00007632-199506000-00012

    Article  PubMed  CAS  Google Scholar 

  2. Suk SI, Lee SM, Chung ER et al (2005) Selective thoracic fusion with segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis: more than 5-year follow-up. Spine 30:1602–1609. doi:10.1097/01.brs.0000169452.50705.61

    Article  PubMed  Google Scholar 

  3. Kotani Y, Abumi K, Ito M et al (2007) Accuracy analysis of pedicle screw placement in posterior scoliosis surgery: comparison between conventional fluoroscopic and computer-assisted technique. Spine 32:1543–1550. doi:10.1097/BRS.0b013e318068661e

    Article  PubMed  Google Scholar 

  4. Lonstein JE, Denis F, Perra JH et al (1999) Complications associated with pedicle screws. J Bone Joint Surg Am 81:1519–1528

    PubMed  CAS  Google Scholar 

  5. Minor ME, Morrissey NJ, Peress R et al (2004) Endovascular treatment of an iatrogenic thoracic aortic injury after spinal instrumentation: case report. J Vasc Surg 39:893–896. doi:10.1016/j.jvs.2003.10.056

    Article  PubMed  Google Scholar 

  6. Papin P, Arlet V, Marchesi D et al (1999) Unusual presentation of spinal cord compression related to misplaced pedicle screws in thoracic scoliosis. Eur Spine J 8:156–160. doi:10.1007/s005860050147

    Article  PubMed  CAS  Google Scholar 

  7. West JL, Ogilvie JW, Bradford DS (1991) Complications of the variable screw plate pedicle screw fixation. Spine 16:576–579. doi:10.1097/00007632-199105000-00016

    Article  PubMed  Google Scholar 

  8. Rajasekaran S, Vidyadhara S, Shetty AP (2007) Randomized clinical study to compare the accuracy of navigated and non-navigated thoracic pedicle screws in deformity correction surgeries. Spine 32:56–64. doi:10.1097/01.brs.0000252094.64857.ab

    Article  Google Scholar 

  9. Lenke LG, Betz RR, Harms J et al (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 83:1169–1181

    PubMed  Google Scholar 

  10. Liljenqvist UR, Link TM, Halm HF (2000) Morphometric analysis of thoracic and lumbar vertebrae in idiopathic scoliosis. Spine 25:1247–1253. doi:10.1097/00007632-200005150-00008

    Article  PubMed  CAS  Google Scholar 

  11. Sugimoto Y, Tanaka M, Nakanishi K et al (2007) Predicting intraoperative vertebral rotation in patients with scoliosis using posterior elements as anatomical landmarks. Spine 32:761–763

    Article  Google Scholar 

  12. Goto M, Kawakami N, Matsubara Y et al (1999) Vertebral rotation in scoliosis interobserver error and intraobserver error of the Aoro’s method. J Jpn Scoliosis Soc 14:1429–1432

    Google Scholar 

  13. Azuma S, Shimode M (2002) Scoliosis surgery using computer-assisted image guidance system. J Jpn Rheumatol 28:251–259

    Google Scholar 

  14. Kim YJ, Lenke LG, Kim J et al (2006) Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine 31:291–298. doi:10.1097/01.brs.0000197865.20803.d4

    Article  PubMed  Google Scholar 

  15. Zeiller SC, Lee J, Lim M et al (2005) Posterior thoracic segmental pedicle screw instrumentation: evolving methods of safe and effective placement. Neurol India 53:458–465

    Article  PubMed  CAS  Google Scholar 

  16. Liljenqvist UR, Halm HF, Link TM (1997) Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine 22:2239–2245. doi:10.1097/00007632-199710010-00008

    Article  PubMed  CAS  Google Scholar 

  17. Brown CA, Lenke LG, Bridwell KH et al (1998) Complications of pedicle thoracolumbar and lumbar pedicle screws. Spine 23:1566–1571. doi:10.1097/00007632-199807150-00012

    Article  PubMed  CAS  Google Scholar 

  18. Lehman RA, Lenke LG, Keeler KA et al (2007) Compted tomography evaluation of pedicle screws placed in the peadiatric deformed spine over an 8-year period. Spine 32:2679–2684. doi:10.1097/01.brs.0000259211.22036.2a

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Okayama University Hospital of Medicine and Dentistry, Okayama, Japan

    Kazuo Nakanishi, Masato Tanaka, Haruo Misawa, Yoshihisa Sugimoto & Toshifumi Ozaki

  2. Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan

    Tomoyuki Takigawa

Authors
  1. Kazuo Nakanishi
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  2. Masato Tanaka
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  3. Haruo Misawa
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  4. Yoshihisa Sugimoto
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  5. Tomoyuki Takigawa
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  6. Toshifumi Ozaki
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Corresponding author

Correspondence to Kazuo Nakanishi.

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Nakanishi, K., Tanaka, M., Misawa, H. et al. Usefulness of a navigation system in surgery for scoliosis: segmental pedicle screw fixation in the treatment. Arch Orthop Trauma Surg 129, 1211–1218 (2009). https://doi.org/10.1007/s00402-008-0807-3

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  • DOI: https://doi.org/10.1007/s00402-008-0807-3

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