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European Spine Journal

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01-03-2013 | Original Article

Computer tomography assessment of pedicle screw placement in thoracic spine: comparison between free hand and a generic 3D-based navigation techniques

Authors: Yasser Allam, J. Silbermann, F. Riese, R. Greiner-Perth

Published in: European Spine Journal | Issue 3/2013

Abstract

Introduction

Although pedicle screw fixation is a well-established technique for the lumbar spine, screw placement in the thoracic spine is more challenging because of the smaller pedicle size and more complex 3D anatomy. The intraoperative use of image guidance devices may allow surgeons a safer, more accurate method for placing thoracic pedicle screws while limiting radiation exposure. This generic 3D imaging technique is a new generation intraoperative CT imaging system designed without compromise to address the needs of a modern OR.

Aim

The aim of our study was to check the accuracy of this generic 3D navigated pedicle screw implants in comparison to free hand technique described by Roy-Camille at the thoracic spine using CT scans.

Material and methods

The material of this study was divided into two groups: free hand group (group I) (18 patients; 108 screws) and 3D group (27 patients; 100 screws). The patients were operated upon from January 2009 to March 2010. Screw implantation was performed during internal fixation for fractures, tumors, and spondylodiscitis of the thoracic spine as well as for degenerative lumbar scoliosis.

Results

The accuracy rate in our work was 89.8 % in the free hand group compared to 98 % in the generic 3D navigated group.

Conclusion

In conclusion, 3D navigation-assisted pedicle screw placement is superior to free hand technique in the thoracic spine.

Choi WW, Green BA, Levi AD (2000) Computer assisted fluoroscopic targeting system for pedicle screw insertion. Neurosurgery 47:872–878PubMedCrossRef

Cinotti G, Gumina S, Ripani M, Postacchini F (1999) Pedicle instrumentation in the thoracic spine. A morphometric and cadaveric study for placement of screws. Spine 24:114–119PubMedCrossRef

Foley KT, Simon DA, Rampersaud YR (2001) Virtual fluoroscopy: computer-assisted fluoroscopic navigation. Spine 26:347–351PubMedCrossRef

Fu TS, Wong CB, Tsai TT, Liang YC, Chen LH, Chen WJ (2008) Pedicle screw insertion: computed tomography versus fluoroscopic image guidance. Int Orthop 32:517–521PubMedCrossRef

Holly LT, Foley KT (2003) Intraoperative spinal navigation. Spine 28:S54–S61PubMed

Kim YJ, Lenke LG (2005) Thoracic pedicle screw placement: free-hand technique. Neurol India 53:512–519PubMedCrossRef

Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD (2004) Free hand pedicle screw placement in the thoracic spine: is it safe? Spine 29:333–342PubMedCrossRef

Kosmopoulos V, Schizas C (2007) Pedicle screw placement accuracy: a metaanalysis. Spine 32:E111–E120PubMedCrossRef

Krag MH, Weaver DL, Beynnon BD, Haugh LD (1998) Morphometry of the thoracic and lumbar spine related to transpedicular screw placement for surgical spinal fixation. Spine 13:27–32CrossRef

10.

Laine T, Lund T, Ylikoski M, Lohikoski J, Schlenzka D (2000) Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients. Eur Spine J 9:235–240PubMedCrossRef

11.

Laine T, Makitalo K, Schlenzka D, Tallroth K, Poussa M, Alho A (1997) Accuracy of pedicle screw insertion: a prospective CT study in 30 low back patients. Eur Spine J 6:402–405PubMedCrossRef

12.

Laine T, Schlenzka D, Makitalo K, Tallroth K, Nolte LP, Visarius H (1997) Improved accuracy of pedicle screw insertion with computer assisted surgery. A prospective clinical trial of 30 patients. Spine 22:1254–1258PubMedCrossRef

13.

Learch TJ, Massie JB, Pathria MN, Ahlgren BA, Garfin SR (2004) Assessment of pedicle screw placement utilizing conventional radiography and computed tomography: a proposed systematic approach to improve accuracy of interpretation. Spine 29:767–773PubMedCrossRef

14.

Mirza SK, Wiggins GC, Kuntz C 4th, York JE, Bellabarba C, Knonodi MA, Chapman JR, Shaffrey CI (2003) Accuracy of thoracic vertebral body screw placement using standard fluoroscopy, fluoroscopic image guidance, and computed tomographic image guidance: a cadaver study. Spine 28:402–413PubMed

15.

Nottmeier EW, Seemer W, Young PM (2009) Placement of thoracolumbar pedicle screwsusing three-dimensional image guidance: experience in a large patient cohort. J Neurosurg Spine 10:33–39PubMedCrossRef

16.

Panjabi MM, Takata K, Goel V, Federico D, Oxland T, Duranceau J, Krag M (1991) Thoracic human vertebrae. Quantitative three-dimensional anatomy. Spine 16:888–901

17.

Roy-Camille R (1970) Osteosynthesis du rachis dorsal, lombaire et lombo-sacre par plaques metalliques vissees dans les pedicules vertebraux et les apophyses articulaires. Presse Med 578:1447

18.

Roy-Camille R, Saillant G, Berteaux D, Salgado V (1976) Osteosynthesis of thorako-lumbar spine fractures with metal plates screwed through the vertebral pedicles. Reconstr Surg Traumatol 15:2–16PubMed

19.

Roy-Camille R, Saillant G, Mazel C (1986) Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res 203:7–17PubMed

20.

Silbermann J, Riese F, Allam Y, Reichert T, Koeppert H, Gutberlet M (2011) Computer tomography assessment of pedicle screw placement in lumbar and sacral spine: comparison between free-hand and O-arm based navigation techniques. Eur Spine J 20:875–881PubMedCrossRef

21.

Steinmann JC, Herkowitz HN, el-Kommos H, Wesolowski DP (1993) Spinal pedicle fixation. Confirmation of an image-based technique for screw placement. Spine 18:1856–1861PubMedCrossRef

22.

Vaccaro AR, Rizzolo SJ, Allardyce TJ, Ramsey M, Salvo J, Balderston RA, Cotler JM (1995) Placement of pedicle screws in the thoracic spine. Part I: morphometric analysis of the thoracic vertebrae. J Bone Joint Surg [Am] 77:1193–1199

23.

Vaccaro AR, Rizzolo SJ, Balderston RA, Allardyce TJ, Garfin SR, Dolinskas C, An HS (1995) Placement of pedicle screws in the thoracic spine. Part II: an anatomical and radiographic assessment. J Bone Joint Surg [Am] 77:1200–1206

24.

Weinstein JN, Spratt KF, Spengler D, Brick C, Reid S (1988) Spinal pedicle fixation: reliability and validity of roentgenogram-based assessment and surgical factors on successful screw placement. Spine 13:1012–1018PubMedCrossRef

25.

Wendl K, von recum J, Wentzensen A, Gruetzner PA (2003) Iso-C (3 D-assisted) navigated implantation of pedicle screws in thoracic and lumbar vertebrae. Unfallchirug 106:907–913

26.

Wiesner L, Kothe R, Ruther W (1999) Anatomic evaluation of two different techniques for the percutaneous insertion of pedicle screws in the lumbar spine. Spine 24:1599–1603PubMedCrossRef

27.

Zausinger S, Scheder B, Uhl E, Heigl T, Morhard D, Tonn JC (2009) Intraoperative computed tomography with integrated navigation system in spinal stabilizations. Spine 34:2919–2926PubMedCrossRef

Title: Computer tomography assessment of pedicle screw placement in thoracic spine: comparison between free hand and a generic 3D-based navigation techniques
Authors: Yasser Allam
J. Silbermann
F. Riese
R. Greiner-Perth
Publication date: 01-03-2013
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 3/2013
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-012-2505-7

At a glance: The STEP trials

Springer Medicine

Computer tomography assessment of pedicle screw placement in thoracic spine: comparison between free hand and a generic 3D-based navigation techniques

Abstract

Introduction

Aim

Material and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Aim

Material and methods

Results

Conclusion

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