Feasibility of Computer-Assisted Fluoroscopic Navigation of Pedicle Screw Insertion

Although the clinical and biomechanical benefits of pedicle screw fixation have been well documented, accurate placement continues to be a source of difficulty and concern for the spinal surgeon. This study's objective was to evaluate the feasibility and application accuracy of a pedicle screw insertion assisted by a real-time 2-D image-guided system. Twelve patients underwent thoraco-lumbar and lumbar spine stabilization in which 66 pedicle screws were placed using this technology. The accuracy of the pedicle screws' positions was evaluated through post-operative images of plain radiographs and computed tomography scanning. The time for registration and pedicle screw insertion (1 segment including 4 screws) was 47.7 minutes (range: 24 to 90 minutes). Sixty-one (92.4%) screws were intra-pedicular without violation of the pedicle walls. The mean distances between the screw edge to the superior and inferior pedicle wall were 3.3±2.1 mm and 4.4±1.9 mm. The mean post-operative sagittal screw angle (SSA) was 5.6°±4.2°. The mean difference of SSA between planned virtual images and post-operative plain radiographs was 2.1°±1.8°. There were no intra- or postoperative complications, such as neurologic deficits and wound infections. Therefore, we concluded that by using computer-assisted 2D fluoscopic image navigation, it is possible to achieve a safe and reliable pedicle screw insertion in thoraco-lumbar spine surgery. The application accuracy is higher in the sagittal plane than in the axial plain in this 2-D image navigation technique. It is important for the surgeon to understand this limitation when using this technique [two clauses are not related. How does limitation of technique relate to promise of the method?].

並列關鍵字

pedicle screw ； fluoroscopic navigation ； computer-assistance ； thoraco-lumbar surgery

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