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European Spine Journal

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01-06-2016 | Original Article

Cervical pedicle screw placement using intraoperative computed tomography imaging with a mobile scanner gantry

Authors: Toshitaka Yoshii, Takashi Hirai, Kenichiro Sakai, Hiroyuki Inose, Tsuyoshi Kato, Atsushi Okawa

Published in: European Spine Journal | Issue 6/2016

Abstract

Purpose

A multi-detector computed tomography (CT) imaging system with a mobile scanner gantry in the operating room can provide intraoperative reconstructed images with a high resolution. We devised a technique for cervical pedicle screw (CPS) placement using the mobile CT system and evaluated the accuracy of this technique.

Methods

Forty-eight patients who underwent cervical fixation using CPSs were prospectively enrolled in this study. Initial pedicle probing was performed approximately to the depth of the posterior aspect of the vertebral body using fluoroscopic lateral view, and a marking pin was put in place. Intraoperative CT images were obtained to confirm whether the position of the marking pin was accurate. After adequate modification of the trajectory was performed, an appropriately sized CPS was inserted. The accuracy of the CPS was evaluated using postoperative reconstructed CT images, and compared with a historical control group of 22 patients (CPS insertion using only fluoroscopy).

Results

A total of 193 CPSs were inserted. Intraoperative CT images demonstrated that 12.4 % of the initial probings were not accurate, and modification of the trajectory was required. On postoperative CT, 92.7 % of the CPSs were found to be placed accurately: the accuracy was significantly higher than the control group (80.9 %). In the cases using intraoperative CT images, only 1.0 % of the screws were judged to show grade 2 screw misplacement; no neurovascular complications associated with screw placement were observed.

Conclusions

The technique of CPS placement using mobile CT was shown to be safe and effective in preventing catastrophic complications associated with CPS insertion.

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Title: Cervical pedicle screw placement using intraoperative computed tomography imaging with a mobile scanner gantry
Authors: Toshitaka Yoshii
Takashi Hirai
Kenichiro Sakai
Hiroyuki Inose
Tsuyoshi Kato
Atsushi Okawa
Publication date: 01-06-2016
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 6/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-016-4508-2

At a glance: The STEP trials

Springer Medicine

Cervical pedicle screw placement using intraoperative computed tomography imaging with a mobile scanner gantry

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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