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Does intraoperative navigation improve the accuracy of pedicle screw placement in the apical region of dystrophic scoliosis secondary to neurofibromatosis type I: comparison between O-arm navigation and free-hand technique

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Abstract

Purpose

To assess the accuracy of O-arm-navigation-based pedicle screw insertion in dystrophic scoliosis secondary to NF-1 and compare it with free-hand pedicle screw insertion technique.

Methods

32 patients with dystrophic NF-1-associated scoliosis were divided into two groups. A total of 92 pedicle screws were implanted in apical region (two vertebrae above and below the apex each) in 13 patients using O-arm-based navigation (O-arm group), and 121 screws were implanted in 19 patients using free-hand technique (free-hand group). The postoperative CT images were reviewed and analyzed for pedicle violation. The screw penetration was divided into four grades: grade 0 (ideal placement), grade 1 (penetration <2 mm), grade 2 (penetration between 2 and 4 mm), and grade 3 (penetration >4 mm).

Results

The accuracy rate of pedicle screw placement (grade 0, 1) was significantly higher in the O-arm group (79 %, 73/92) compared to 67 % (81/121) of the free-hand group (P = 0.045). Meanwhile, a significantly lower prevalence of grade 2–3 perforation was observed in the O-arm group (21 vs. 33 %, P < 0.05), and the incidence of medial perforation was significantly minimized by using O-arm navigation compared to free-hand technique (2 vs. 15 %, P < 0.01). Moreover, the implant density in apical region was significantly elevated by using O-arm navigation (58 vs. 42 %, P < 0.001).

Conclusion

We reported 79 % accuracy of O-arm-based pedicle screw placement in dystrophic NF-1-associated scoliosis. O-arm navigation system does facilitate pedicle screw insertion in dystrophic NF-1-associated scoliosis, demonstrating superiorities in the safety and accuracy of pedicle screw placement in comparison with free-hand technique.

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Acknowledgments

This work was supported by the National Natural Science Foundation of China (Grant No. 81371912). 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.

Conflict of interest

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of the manuscript.

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Authors and Affiliations

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

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

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  1. Mengran Jin
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  2. Zhen Liu
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  3. Xingyong Liu
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  4. Huang Yan
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  7. Zezhang Zhu
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Correspondence to Zezhang Zhu.

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Jin, M., Liu, Z., Liu, X. et al. Does intraoperative navigation improve the accuracy of pedicle screw placement in the apical region of dystrophic scoliosis secondary to neurofibromatosis type I: comparison between O-arm navigation and free-hand technique. Eur Spine J 25, 1729–1737 (2016). https://doi.org/10.1007/s00586-015-4012-0

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